Risk Factors and Independent Predictors of 30-Day Readmission for Altered Mental Status After Elective Spine Surgery for Spine Deformity: A Single Institutional Study of 1090 Patients

2017 ◽  
Vol 17 (10) ◽  
pp. S178-S179
Author(s):  
Aladine A. Elsamadicy ◽  
Owoicho Adogwa ◽  
Gireesh B. Reddy ◽  
Amanda Sergesketter ◽  
Hunter Warwick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Status ◽  
Spine Surgery ◽  
Altered Mental Status ◽  
Spine Deformity

Risk Factors and Independent Predictors of 30-Day Readmission for Altered Mental Status After Elective Spine Surgery for Spine Deformity: A Single-Institutional Study of 1090 Patients

2017 ◽  
Vol 101 ◽  
pp. 270-274 ◽  
Author(s):  
Aladine A. Elsamadicy ◽  
Owoicho Adogwa ◽  
Gireesh B. Reddy ◽  
Amanda Sergesketter ◽  
Hunter Warwick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Status ◽  
Spine Surgery ◽  
Altered Mental Status ◽  
Spine Deformity

scholarly journals Clinical characteristics, risk factors and antiviral treatments of influenza in immunosuppressed inpatients in Beijing during the 2015–2020 influenza seasons

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Yafen Liu ◽  
Yue Wang ◽  
Huan Mai ◽  
YuanYuan Chen ◽  
Baiyi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influenza Virus ◽  
Mental Status ◽  
Clinical Characteristics ◽  
Antiviral Treatment ◽  
Altered Mental Status ◽  
Haematopoietic Stem Cell ◽  
Severe Illness ◽  
Presenting Symptoms ◽  
Immunosuppressed Patients

Abstract Background Compared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance during influenza infections. However, few data on this population in China have been reported. We analysed the clinical characteristics, effects of antiviral therapy, and risk factors for admission to the intensive care unit (ICU) and death in this population after influenza infections and explored the influenza vaccination situation for this population. Methods We analysed 111 immunosuppressed inpatients who were infected with influenza virus during the 2015–2020 influenza seasons. Medical data were collected through the electronic medical record system and analysed. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results The most common cause of immunosuppression was malignancies being treated with chemotherapy (64.0%, 71/111), followed by haematopoietic stem cell transplantation (HSCT) (23.4%, 26/111). The most common presenting symptoms were fever and cough. Dyspnoea, gastrointestinal symptoms and altered mental status were more common in HSCT patients than in patients with immunosuppression due to other causes. Approximately 14.4% (16/111) of patients were admitted to the ICU, and 9.9% (11/111) of patients died. Combined and double doses of neuraminidase inhibitors did not significantly reduce the risk of admission to the ICU or death. Risk factors for admission to the ICU were dyspnoea, coinfection with other pathogens and no antiviral treatment within 48 h. The presence of dyspnoea and altered mental status were independently associated with death. Only 2.7% (3/111) of patients less than 12 months old had received a seasonal influenza vaccine. Conclusion Fever and other classic symptoms of influenza may be absent in immunosuppressed recipients, especially in HSCT patients. Conducting influenza virus detection at the first presentation seems to be a good choice for early diagnosis. Clinicians should pay extra attention to immunosuppressed patients with dyspnoea, altered mental status, coinfection with other pathogens and no antiviral treatment within 48 h because these patients have a high risk of severe illness. Inactivated influenza vaccines are recommended for immunosuppressed patients.

scholarly journals Risk Factors for In-hospital Mortality from Coronavirus Disease 2019 Infection Among Black Patients—An Urban Center Experience

2020 ◽  
Author(s):  
Ashish Bhargava ◽  
Mamta Sharma ◽  
Kathleen Riederer ◽  
Elisa Akagi Fukushima ◽  
Susanna M Szpunar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Mental Status ◽  
Multivariable Analysis ◽  
Case Fatality ◽  
Altered Mental Status ◽  
Adverse Outcomes ◽  
Urban Hospital ◽  
Duration Of Symptoms ◽  
Black Patients

Abstract Background Racial disparities are central in the national conversation about coronavirus disease 2019 (COVID-19) , with Black/African Americans being disproportionately affected. We assessed risk factors for death from COVID-19 among Black inpatients at an urban hospital in Detroit, Michigan. Methods This was a retrospective, single-center cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (the COVID-19 virus) on qualitative polymerase chain reaction assay who were admitted between 8 March 2020 and 6 May 2020. The primary outcome was in-hospital mortality. Results The case fatality rate was 29.1% (122/419). The mean duration of symptoms prior to hospitalization was 5.3 (3.9) days. The incidence of altered mental status on presentation was higher among patients who died than those who survived, 43% vs 20.0%, respectively (P < .0001). From multivariable analysis, the odds of death increased with age (≥60 years), admission from a nursing facility, Charlson score, altered mental status, higher C-reactive protein on admission, need for mechanical ventilation, presence of shock, and acute respiratory distress syndrome. Conclusions These demographic, clinical, and laboratory factors may help healthcare providers identify Black patients at highest risk for severe COVID-19–associated outcomes. Early and aggressive interventions among this at-risk population may help mitigate adverse outcomes.

scholarly journals Clinical Characteristics, Risk Factors and Antiviral Treatments of Influenza in Immunosuppressed Inpatients in Beijing During the 2015-2020 Influenza Seasons

2021 ◽  
Author(s):  
Yafen Liu ◽  
Yue Wang ◽  
Huan Mai ◽  
YuanYuan Chen ◽  
Baiyi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influenza Virus ◽  
Influenza Vaccination ◽  
Mental Status ◽  
Clinical Characteristics ◽  
Antiviral Treatment ◽  
Univariate Analysis ◽  
Altered Mental Status ◽  
Hematopoietic Stem ◽  
Immunosuppressed Patients

Abstract Background Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors and effects of antiviral therapy in these populations. Methods We analyzed 111 immunosuppressed inpatients tested positive for influenza virus using RT-PCR during the 2015–2020 influenza seasons. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results The most common immunosuppression type was malignancies with chemotherapy 87.4% (97/111), then hematopoietic stem cell transplantation 23.4% (26/111). The most common presenting symptom was fever in 92.8% (103/111) patients, then cough 50.6% (44/87). 14.4% (16/111) patients were admitted to ICU and 9.9% (11/111) patients died. Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. Risk factors for admission to ICU were dyspnea, co-infection with other infections and no antiviral treatment within 48 hours, and presence of dyspnea and altered mental status were independently associated with death through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (3/111). Conclusion Fever and other classical symptoms of influenza may be absent in immunosuppressed recipients, and conducting influenza virus detection at the first time is a good choice for early diagnosis. Immunosuppressed patients with dyspnea, altered mental status, co-infection with other infections and no antiviral treatment within 48 hours are of note needed, because these people have high-risk to severe cases. Inactivated influenza vaccination should be taken into account in immunosuppressed patients.

scholarly journals Risk Factors Related to Falling in Patients after Stroke

2021 ◽  
Author(s):  
Olivera Djurovic ◽  
Olgica Mihaljevic ◽  
Snezana Radovanovic ◽  
Smiljana Kostic ◽  
Marjana Vukicevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Status ◽  
Altered Mental Status ◽  
Cerebrovascular Diseases ◽  
Stroke Patients ◽  
Retrospective Case ◽  
Factors Associated ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Significant Difference

Background: The aim of this study was to identify the risk factors associated with falling in post stroke patients. Methods: This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases "Sveti Sava" in Belgrade, Serbia, from 2018- 2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs. Results: A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P<0.001). We established statistically significant differences in mental status (P<0.001), sensibility (P=0.016), depressed mood (P<0.001), early (P=0.001) and medium insomnia (P=0.042), psychomotor slowness (P=0.030), somatic anxiety (P=0.044) and memory (P<0.001). Conclusion: Cerebrovascular disease distribution and the degree of neurological deficit primarily altered mental status, which could be recognized as one of the more important predictors for falling after stroke. The identification of risk factors may be a first step toward the design of intervention programs for preventing a future fall among hospitalized stroke patients.

Predicting medication-associated altered mental status in hospitalized patients: Development and validation of a risk model

2019 ◽  
Vol 76 (13) ◽  
pp. 953-963 ◽  
Author(s):  
Monica A Muñoz ◽  
Nakyung Jeon ◽  
Benjamin Staley ◽  
Carl Henriksen ◽  
Dandan Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Real Time ◽  
Mental Status ◽  
Risk Model ◽  
Predictive Ability ◽  
Altered Mental Status ◽  
Status Change ◽  
Early Management ◽  
History Of ◽  
Real Time Identification

Abstract Purpose This study presents a medication-associated altered mental status (AMS) risk model for real-time implementation in inpatient electronic health record (EHR) systems. Methods We utilized a retrospective cohort of patients admitted to 2 large hospitals between January 2012 and October 2013. The study population included admitted patients aged ≥18 years with exposure to an AMS risk–inducing medication within the first 5 hospitalization days. AMS events were identified by a measurable mental status change documented in the EHR in conjunction with the administration of an atypical antipsychotic or haloperidol. AMS risk factors and AMS risk–inducing medications were identified from the literature, drug information databases, and expert opinion. We used multivariate logistic regression with a full and backward eliminated set of risk factors to predict AMS. The final model was validated with 100 bootstrap samples. Results During 194,156 at-risk days for 66,875 admissions, 262 medication-associated AMS events occurred (an event rate of 0.13%). The strongest predictors included a history of AMS (odds ratio [OR], 9.55; 95% confidence interval [CI], 5.64–16.17), alcohol withdrawal (OR, 3.34; 95% CI, 2.18–5.13), history of delirium or psychosis (OR, 3.25; 95% CI, 2.39–4.40), presence in the intensive care unit (OR, 2.53; 95% CI, 1.89–3.39), and hypernatremia (OR, 2.40; 95% CI, 1.61–3.56). With a C statistic of 0.85, among patients scoring in the 90th percentile, our model captured 159 AMS events (60.7%). Conclusion The risk model was demonstrated to have good predictive ability, with all risk factors operationalized from discrete EHR fields. The real-time identification of higher-risk patients would allow pharmacists to prioritize surveillance, thus allowing early management of precipitating factors.

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