Risk Factors for Adverse Outcomes in Adult and Pediatric Patients With Hyperglycemia Presenting to the Emergency Department: A Systematic Review

Abstract Introduction Anastomotic leaks (AL) are a major complication after oesophagectomy. This meta-analysis aimed to determine identify risks factors for AL (pre-operative, intra-operative and post-operative factors) and assess the consequences to outcome on patients who developed an AL. Methods This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 31st December 2018. A meta-analysis was conducted with the use of random-effects modelling and prospectively registered with the PROSPERO database (Registration CRD42018130732). Results This review identified 174 studies reporting outcomes of 74,226 patients undergoing oesophagectomy. The overall pooled AL rates were 11%, ranging from 0 - 49% in individual studies. Majority of studies were from Asia (n=79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative). AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99 - 6.89, p<0.001) and cardiac complications (OR: 2.44, CI95%: 1.77 - 3.37, p<0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10 - 21 days, p<0.001 and in-hospital mortality (OR: 5.91, CI95%: 1.41 - 24.79, p=0.015). Conclusion AL are a major complication following oesophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL which can be a target for interventions to reduce anastomotic leak rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counselling and informed consent.

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Bidirectional brain–gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis

Gut ◽

10.1136/gutjnl-2021-325985 ◽

2021 ◽

pp. gutjnl-2021-325985

Author(s):

Keeley M Fairbrass ◽

Jessica Lovatt ◽

Brigida Barberio ◽

Yuhong Yuan ◽

David J Gracie ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Psychological Health ◽

Common Mental Disorders ◽

Meta Analysis ◽

Subsequent Development ◽

Adverse Outcomes ◽

Emergency Department Attendance ◽

Relative Risks ◽

The Brain

ObjectiveThe role of the brain–gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues.DesignWe searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline.ResultsWe included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively).ConclusionBidirectional effects of the brain–gut axis are present in IBD and may influence both the natural history of the disease and psychological health.

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Prevalence and Risk Factors of Emergency Department Presentations with Methamphetamine Intoxication or Dependence: A Systematic Review and Meta-analysis

Issues in Mental Health Nursing ◽

10.1080/01612840.2018.1553003 ◽

2019 ◽

Vol 40 (7) ◽

pp. 567-578 ◽

Cited By ~ 1

Author(s):

Njabulo Churchill Sibanda ◽

Rachel Kornhaber ◽

Glenn E. Hunt ◽

Kirsten Morley ◽

Michelle Cleary

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Emergency Department ◽

Meta Analysis

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LO58: Long-term outcomes among emergency department syncope patients: a systematic review

CJEM ◽

10.1017/cem.2018.120 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S27-S27

Author(s):

C. Leafloor ◽

P. Jiho Hong ◽

L. Sikora ◽

J. Elliot ◽

M. Mukarram ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Phase 1 ◽

Adverse Outcomes ◽

Cochrane Central Register ◽

Phase 2 ◽

Long Term Outcomes ◽

One Year

Introduction: Approximately 50% of patients discharged from the Emergency Department (ED) after syncope have no cause found. Long-term outcomes among syncope patients are not well studied, to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for long-term (one year) outcomes among ED patients with syncope. We aim to use the results of this review to guide us in prospective analysis of one year outcomes with our large database of syncope patients. Methods: We searched Cochrane Central Register of Controlled Trials, Medline and Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from the inception to June, 2017. We included studies that reported long-term outcomes among adult ED patients (16 years or older) with syncope. We excluded studies on pediatric patients, and studies that included syncope mimickers: pre-syncope, seizure, intoxication, loss of consciousness after head trauma. We also excluded case reports, letters to the editor and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. We selected articles based on title and abstract review during phase-1 and conducted full article review during phase-2. Meta-analysis was performed by pooling the outcomes using random effects model (RevMan v.5.3; Cochrane Collaboration). Results: Initial literature search generated 2094 articles after duplicate removal. 50 articles remained after phase-1 (=0.85) and 16 articles were included in the systematic review after phase-2 (=0.86). The 16 included studies enrolled a total of 44,755 patients. Pooled analysis at 1-year follow-up showed the following outcomes: 7% mortality; 14% recurrence of syncope requiring hospitalization; one study reported that 0.6% of patients had a pacemaker inserted; and two studies reported 0.8 11.5% of patients suffered new arrhythmias. Conclusion: An important proportion of ED patients with syncope suffer outcomes at 1-year. Appropriate follow-up is needed to prevent long-term adverse outcomes. Further prospective research to identify patients at risk for long-term important cardiac outcomes and death is needed.

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Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/doz089 ◽

2020 ◽

Vol 33 (3) ◽

Cited By ~ 3

Author(s):

Sivesh K Kamarajah ◽

Aaron Lin ◽

Thahesh Tharmaraja ◽

Yashvi Bharwada ◽

James R Bundred ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Major Complication ◽

Adverse Outcomes ◽

Cardiac Complications ◽

Modifiable Risk Factors ◽

Anastomotic Leaks ◽

Patient Counseling ◽

Prolonged Hospital

Summary Anastomotic leaks (AL) are a major complication after esophagectomy. This meta-analysis aimed to determine identify risks factors for AL (preoperative, intra-operative, and post-operative factors) and assess the consequences to outcome on patients who developed an AL. This systematic review was performed according to PRISMA guidelines, and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling and prospectively registered with the PROSPERO database (Registration CRD42018130732). This review identified 174 studies reporting outcomes of 74,226 patients undergoing esophagectomy. The overall pooled AL rates were 11%, ranging from 0 to 49% in individual studies. Majority of studies were from Asia (n = 79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative). AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99–6.89, P < 0.001) and cardiac complications (OR: 2.44, CI95%: 1.77–3.37, P < 0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10–21 days, P < 0.001), and in-hospital mortality (OR: 5.91, CI95%: 1.41–24.79, P = 0.015). AL are a major complication following esophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL, which can be a target for interventions to reduce AL rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counseling, and informed consent.

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Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/08919887211039016 ◽

2021 ◽

pp. 089198872110390

Author(s):

Syed Muhammad Ahsan Mehdi ◽

D. P. Devanand

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Blood Pressure ◽

Elderly Patients ◽

Electroconvulsive Therapy ◽

Cerebral Aneurysms ◽

Adverse Outcomes ◽

Safety Measures ◽

Effective Prevention ◽

Blood Pressure Elevation

Introduction: Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited. Methods: We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT. Results: A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary to ictal hypertensive surge during treatment with ECT. Discussion: Risk factors such as history of hypertension, age of the patient, extent of the ictal surge in blood pressure, efficacy of prophylactic treatment to control surge in blood pressure and characteristics of cerebral aneurysm each elevated the risk of complication in these cases. We reviewed safety measures based on the evidence from the current literature available. Conclusion: ECT is safe in elderly patients with cerebral aneurysms provided appropriate safety measures are employed. Screening for cerebral aneurysms in high risk patients, effective prevention and management of blood pressure elevation acutely during ECT is the best practice to avoid adverse outcomes.

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