Ortiz-Bernal, Laura. E-cigarette or vaping product use associated lung injury: an emergency medicine approach for early diagnosis and treatment. Retrieved from https://doi.org/doi:10.7282/t3-tb3g-hk11
DescriptionIntroduction. Electronic cigarettes (e-cigarettes) have gained popularity among the public leading to a catastrophic increase in use within recent years. An epidemic of E-cigarette or vaping product-use associated lung injury (EVALI) has killed 68 people and resulted in 2800 hospitalizations. EVALI presents with respiratory, gastrointestinal, and constitutional symptoms. A lack of provider knowledge exists regarding identification, screening, and management. No validated screening tools exist to screen for EVALI. A need for EVALI education among providers and standardized screening approaches is warranted.
Methodology. Design: Pre and post-test, retrospective, and prospective chart review approach. Setting: An Emergency Department of a hospital in New Jersey. Sample: (N=50); 39 Registered Nurses, 6 Physicians, 4 Physician Assistants, and 1 Nurse Practitioner. Interventions: Implementation of an EVALI screening tool, a pre and post-test before and after an educational vaping seminar, retrospective and prospective chart reviews to identify EVALI patients, and Likert Scale Survey for participant feedback of EVALI screening tool.
Results. A Wilcoxon Signed Rank Test showed a statistically significant increase in participant test scores. A 22% increase in vaping screening amongst all patients. There were 25 patients identified for possible EVALI via screening tool compared to 16 patients identified pre-intervention; 12.5% of patients received all recommended treatment pre-intervention and 24% post-intervention. There were 25% of patients that met CDC confirmed case EVALI pre-intervention and 12% post-intervention. However, 50% of patients identified prior received all of the CDC recommended treatment, and 100% of patients identified after received all treatment. Likert Survey results showed that the EVALI screening tool was effective, feasible, improved patient outcomes, improved provider competency, and recommended for sustained use.
Conclusion. EVALI results in severe lung injury and death if gone unidentified or treated. The adolescent population is at the highest risk for acquiring EVALI. This study addressed the lack of provider knowledge of EVALI and was the first to use a screening tool to identify EVALI in the emergency department. This study paves the way for new methods and standardized approaches to screening the vaping population to identify EVALI in emergency medicine.