Changes in COVID-19 in-hospital mortality in hospitalised adults in England over the first seven months of the pandemic: An observational study using administrative data

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

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In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study

The Lancet Regional Health - Europe ◽

10.1016/j.lanepe.2021.100055 ◽

2021 ◽

pp. 100055

Author(s):

Gianluca Campo ◽

Daniela Fortuna ◽

Elena Berti ◽

Rossana De Palma ◽

Giuseppe Di Pasquale ◽

...

Keyword(s):

Myocardial Infarction ◽

Observational Study ◽

Hospital Mortality ◽

Population Based

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Rotterdam and Marshall Scores for Prediction of in-hospital Mortality in Patients with Traumatic Brain Injury: An observational study

Brain Injury ◽

10.1080/02699052.2021.1927181 ◽

2021 ◽

pp. 1-9

Author(s):

Mohammad Asim ◽

Ayman El-Menyar ◽

Ashok Parchani ◽

Syed Nabir ◽

Mohamed Nadeem Ahmed ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Observational Study ◽

Hospital Mortality

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The prediction of in-hospital mortality by mid-upper arm circumference: a prospective observational study of the association between mid-upper arm circumference and the outcome of acutely ill medical patients admitted to a resource-poor hospital in sub-Saharan Africa

Clinical Medicine ◽

10.7861/clinmedicine.18-2-123 ◽

2018 ◽

Vol 18 (2) ◽

pp. 123-127 ◽

Cited By ~ 4

Author(s):

Martin Otyek Opio ◽

Teopista Namujwiga ◽

Imaculate Nakitende ◽

John Kellett ◽

Mikkel Brabrand

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Prospective Observational Study ◽

Sub Saharan Africa ◽

Medical Patients ◽

Upper Arm ◽

Arm Circumference ◽

Resource Poor ◽

Sub Saharan ◽

Mid Upper Arm Circumference

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Abstract 14868: Incidence and Outcomes of Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

Circulation ◽

10.1161/circ.132.suppl_3.14868 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Robert Berg ◽

Amy Clark ◽

Vinay M Nadkarni ◽

Frank Moler ◽

Robert M Sutton ◽

...

Keyword(s):

Intensive Care ◽

Observational Study ◽

Hospital Discharge ◽

Administrative Data ◽

Neurological Outcome ◽

Prospective Observational Study ◽

Pediatric Intensive Care ◽

Cardiac Patients ◽

Neurologic Outcomes ◽

Favorable Neurological Outcome

Introduction: Although registry and administrative data suggest that >6000 children have in-hospital cardiac arrests each year, most occur in pediatric intensive care units (PICUs), and 39% survive to hospital discharge, prospective research quality data on the incidence and outcomes of PICU CPR are not currently available. Objectives: To determine the incidence and outcomes CPR provided in PICUs. Methods: Multi-center prospective observational study of children <18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the NICHD-funded Collaborative Pediatric Critical Care Research Network from December 2011 to April 2013. Results: Among 10,078 children enrolled, 139 (1.4%) received CPR for ≥1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurological outcomes. The relative incidence of CPR events was higher for cardiac patients compared with non-cardiac patients (3.4% versus 0.8%, p<0.001), but survival rate to hospital discharge with favorable neurological outcome was not statistically different (41% versus 39%, respectively). Shorter duration of CPR was associated with higher survival rates: 66% [29/44] survived to hospital discharge after 1-3 minutes of CPR versus 28% [9/32] after >30 minutes, p<0.001. Among survivors, 26/29 (90%) had a favorable neurological outcome after 1-3 minutes versus 8/9 (89%) after >30 minutes of CPR. Conclusions: These data establish that contemporary PICU CPR, including long durations of CPR, results in high rates of survival to hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.

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Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01578-0 ◽

2020 ◽

Vol 32 (11) ◽

pp. 2367-2373 ◽

Cited By ~ 2

Author(s):

Arturo Vilches-Moraga ◽

Mollie Rowley ◽

Jenny Fox ◽

Haroon Khan ◽

Areej Paracha ◽

...

Keyword(s):

Cognitive Impairment ◽

Observational Study ◽

Hospital Mortality ◽

Older Patients ◽

Care Home ◽

Emergency Laparotomy ◽

Older Patient ◽

Readmission Rates ◽

Clinical Frailty Scale ◽

Female Predominance

Abstract Introduction Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Methods Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. Results 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

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Predicted quality benefits of achievable performance benchmarks of chronic heart failure care in China: results from a nationwide observational study

BMJ Open ◽

10.1136/bmjopen-2020-036786 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036786

Author(s):

Chang Yin ◽

Xi Li ◽

Chao Wang ◽

Jingkun Li ◽

Xiaoqiang Bao ◽

...

Keyword(s):

Heart Failure ◽

Quality Improvement ◽

Chronic Heart Failure ◽

Observational Study ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

Patient Survey ◽

Primary Outcome Measure ◽

Adherence Rate ◽

Independent Variables

ObjectivesThis study aimed to set a data-driven achievable performance benchmark, explore the process–outcome association and speculate about the net gain in quality improvement with benchmarking.DesignObservational study.SettingPatient survey conducted at 466 secondary and tertiary hospitals across 31 provinces, autonomous regions and municipalities in China.Participants183 334 patients diagnosed with chronic heart failure (CHF) who were treated at 466 Chinese hospitals from January 2011 through May 2017.Primary independent variablesHospital process composite performance (HPCP).Secondary independent variablesPatient-level and hospital-level characteristics.Primary outcome measurePatients getting better or recovered after treatment, in-hospital mortality, length of hospital stay (LOS) and medical cost.MethodsHPCP was calculated using denominator-based weights. Mixed random-intercept models were used to evaluate the contributions of HPCP on patient outcomes and to speculate quality improvement after adjusting HPCP to benchmark level.ResultsWhen all hospitals were to operate at the benchmark level, the proportion of patients getting better or recovered after treatment would increase in most hospitals, particularly those with low baseline rates. However, there was no evidence for lowering in-hospital mortality, significant savings in cost or shortening LOS.ConclusionsIncreasing the adherence rate of CHF care and closing the gap in HPCP between hospitals have important implications for improving patient condition.

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Management of Patients With Sepsis in Canadian Community Emergency Departments: A Retrospective Multicenter Observational Study

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392820920082 ◽

2020 ◽

Vol 7 ◽

pp. 233339282092008

Author(s):

Victor C. K. Lo ◽

Haitong Su ◽

Yuet Ming Lam ◽

Kathleen Willis ◽

Virginia Pullar ◽

...

Keyword(s):

Quality Improvement ◽

Observational Study ◽

Hospital Mortality ◽

Emergency Departments ◽

Lactate Concentration ◽

Admission Rate ◽

Multicenter Observational Study ◽

Icu Admission ◽

Physician Assessment ◽

Assessment Time

Background: Sepsis is a life-threatening syndrome and a leading cause of morbidity and mortality representing significant financial burden on the health-care system. Early identification and intervention is crucial to maximizing positive outcomes. We studied a quality improvement initiative with the aim of reviewing the initial management of patients with sepsis in Canadian community emergency departments, to identify areas for improving the delivery of sepsis care. We present a retrospective, multicenter, observational study during 2011 to 2015 in the community setting. Methods: We collected data on baseline characteristics, clinical management metrics (triage-to-physician-assessment time, triage-to-lactate-drawn time, triage-to-antibiotic time, and volume of fluids administered within the first 6 hours of triage), and outcomes (intensive care unit [ICU] admission, in-hospital mortality) from a regional database. Results: A total of 2056 patients were analyzed. The median triage-to-physician-assessment time was 50 minutes (interquartile range [IQR]: 25-104), triage-to-lactate-drawn time was 50 minutes (IQR: 63-94), and triage-to-antibiotics time was 129 minutes (IQR: 70-221). The median total amount of fluid administered within 6 hours of triage was 2.0 L (IQR: 1.5-3.0). The ICU admission rate was 36% and in-hospital mortality was 25%. We also observed a higher ICU admission rate (51% vs 24%) and in-hospital mortality (44% vs 14%) in those with higher lactate concentration (≥4 vs ≤2 mmol/L), independent of other sepsis-related parameters. Conclusion: Time-to-physician-assessment, time-to-lactate-drawn, time-to-antibiotics, and fluid resuscitation in community emergency departments could be improved. Future quality improvement interventions are required to optimize management of patients with sepsis. Elevated lactate concentration was also independently associated with ICU admission rate and in-hospital mortality rate.

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