Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi

2015 ◽  
Vol 30 (6) ◽  
pp. 593-598 ◽  
Author(s):  
Rahul Choudhary ◽  
Ashish Goel ◽  
Sonal Pruthi ◽  
Sarathi Kalra ◽  
Sunil Agarwal ◽  
...  
Keyword(s):  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Mmse Score ◽  
Tertiary Care ◽  
Care Hospital ◽  
Short Term ◽  
Term Outcome ◽  
Arterial Blood ◽  
Short Term Outcome ◽  
Gcs Score

AbstractIntroductionWith an increasing number of sicker patients, limited hospital beds, and an emphasis on day care, the profile of patients hospitalized to medicine wards has undergone a radical re-definition. The increasing share of patients hospitalized through the emergency department for acute care to medicine wards has left little space for hospitalization through the outpatient department (OPD). There are some global data available on the profile of patients presenting to the emergency rooms (ERs) and their subsequent outcome. Data from developing countries, especially India, in this regard are lacking.MethodsThis cross-sectional study included all patients hospitalized to the medicine ward through the medical emergency services, provided by the Department of Medicine, each Wednesday and every sixth Sunday for the entire year (a total of 62 days), from November 2010 through October 2011, and followed their outcome up to seven days after hospitalization.ResultsOf the 3,618 cases presenting to medicine emergency on these days, 1,547 (42.3%) were advised admission. Nine hundred sixty-seven reported to the medicine wards. One hundred eleven (7.73%) expired within 24 hours; others absconded, were lost in transit, did not consent to participation, or were discharged. During the next seven days, 452 (46.7%) recovered sufficiently and were discharged to go home. Two hundred thirty (23.8%) left the hospital without informing the medical staff. Fourteen (1.4%) patients were transferred to other departments. One hundred thirty-seven (8.8%) patients died during the next six days of hospitalization. After Multivariate Logistic Regression analysis, abnormal Glasgow Coma Scale (GCS) score, high systolic blood pressure (BP), age, increased total leucocyte count, increased globulin, low bicarbonate in arterial blood, low Mini Mental Status Examination (MMSE) score, and a raised urea >40 mg/dL were found to be associated significantly with mortality.ConclusionOf the 1,547 patients who needed urgent hospitalization, 248 (16%) died within the first week, one-half of them within the first 24 hours. An advanced age, abnormal GCS score, low MMSE score, increased systolic BP, leukocytosis, acidosis, and uremia were found to be associated with a fatal outcome. Therefore, nearly one-half of the patients who would have a fatal short-term outcome were likely to do so within the first 24 hours, making the first day of presentation “the golden day” period.ChoudharyR, GoelA, PruthiS, KalraS, AgarwalS, KalraOP. Profile of patients hospitalized through the emergency room to the medicine ward and their short-term outcome at a tertiary care hospital in Delhi. Prehosp Disaster Med. 2015;30(6):593–598.

Clinical Profile and Short-Term Outcome of Neonatal Seizures in a Tertiary Care Hospital, Kuppam – A Retrospective Study

2021 ◽  
Vol 8 (27) ◽  
pp. 2381-2386
Author(s):  
Poojitha Kancherla ◽  
Harsha P.J. ◽  
Gowtham R. ◽  
Dowlath Anwar Basha ◽  
Chandran G.P ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Clinical Profile ◽  
Hypoxic Ischemic Encephalopathy ◽  
Care Hospital ◽  
Neonatal Seizures ◽  
Metabolic Disturbances ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Ischemic Encephalopathy

BACKGROUND Neonates presenting with seizures require long term stay in hospital and have higher chances of neuro-developmental delay later. Seizures in neonates are mostly subtle and difficult to diagnose. We wanted to study the clinical profile and short-term outcome on term and later pre-term neonates presenting with seizures. METHODS The study was a retrospective observational study done from November to December 2020 at PES Hospital, Kuppam. Retrospective data of neonatal seizures from May 2019 to April 2020 was considered for study. Details from the case records of neonates with seizures was collected. RESULTS Neonatal seizures (NS) were most common in females (53.8 %, 72/134). Subtle seizures were most common form of seizures in neonates which was seen in 64.2 % (86/134) babies followed by tonic seizures in 22.4 % (30/134). Neonatal seizures were most commonly seen in babies with hypoxic ischemic encephalopathy in 63.4 % (85/134) followed by metabolic disturbances in 15.6 % (21/134) and meningitis in 13.5 % (18/134). In babies with hypoxic ischemic encephalopathy, metabolic and meningitis subtle seizures were observed to be more common. Seizures were seen most commonly in first 72 hours of life (82.85 %, 111/134). Seizures in babies with hypoxic ischemic encephalopathy, metabolic causes most commonly occurred within first 24 hours of birth. Seizures in babies with meningitis most commonly occurred after 7 days of birth. Babies with neonatal seizures with sequelae was seen in 17.96 % (24/134) and 11.94 % babies died (16/134). CONCLUSIONS Subtle seizures were most common form and hypoxic ischemic encephalopathy was most common risk factor. Most neonatal seizures present within 72 hours of birth. Babies with meningitis presented with seizures most commonly after 72 hours of birth. KEYWORDS Hypoxic Ischemic Encephalopathy, Neonatal Seizures, Newborn, Aetiology, Outcome

scholarly journals Short-Term Outcome of Cardiac Surgeries in a Tertiary Care Hospital at the Eastern Part of Nepal

2021 ◽  
Vol 10 (1) ◽  
pp. 25-30
Author(s):  
Praman Sharma ◽  
Lokesh Yadav ◽  
Ahmad Shahbaz ◽  
Jyotindra Sharma ◽  
Rajesh Nepal ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Bypass Graft ◽  
Tertiary Care ◽  
Care Hospital ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Tertiary Center ◽  
The Mean

Background: Cardiac surgical procedures like coronary artery bypass graft surgery and aortic or mitral valve replacements are commonly performed worldwide. In the developing world, Cardio-Thoracic and Vascular Surgery are not adequately accessible except in a few major cities. We established the department to fill that gap at a tertiary center in the eastern part of Nepal. The main objective of the study was to evaluate the short-term outcome of all major cardiac surgeries. Materials and Methods: This is a retrospective study including all cardiac surgery cases operated over 18 months of the establishment. Demographics, various cardiac diseases, co-morbidities, pre-specified peri-operative, and postoperative outcomes were noted in pre-structured questionnaires. The ethical clearance was taken from the hospital ethical committee. Results: There were 67 major cardiac surgery cases performed. Among those 50.7% and 49.3% were males and females respectively with a median age of 50 years. The most common etiology was coronary artery disease (43.28%) followed by rheumatic heart disease (28.35%) and congenital heart diseases (23.88%). The mean cardiopulmonary bypass and aortic cross-clamp times were 93 min and 58 min respectively. The mean intensive care unit and hospital stays were 1.9 and 5.87 days respectively. One (1.5%) patient underwent reexploration and 6(8.9%) patients developed acute kidney injury. Peri-operative survival was 100% whereas the first and third-month survivals were 97% and 95% respectively. Conclusion: Major cardiac surgeries are feasible and safe in newly established cardiac surgery department with acceptable short-term morbidity and mortality.

scholarly journals Trends in Clinical Characteristics and Short-Term Outcome of HIV-Infected Patients at a Tertiary Care Hospital in South India

2018 ◽  
Vol 17 ◽  
pp. 232595821879588 ◽  
Author(s):  
Suryanarayana Bettadpura Shamanna ◽  
Kiran Kumar Matta ◽  
Abdoul Hamide
Keyword(s):  
Clinical Characteristics ◽  
Tertiary Care ◽  
Attrition Rate ◽  
Hiv Positive ◽  
Care Hospital ◽  
Limited Information ◽  
First Line ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

Background: Limited information is available on changing trends in HIV positive patients treated with first-line antiretroviral therapy from India. Methods: The clinical characteristics and short-term outcome were compared between a retrospective group enrolled between January 2006 and March 2007 (06-07 group—100 patients) and a prospective group enrolled between February 2011 and March 2012 (10-12 group—85 patients). Results: Median age was 36 and 38 years in 06-07 and 10-12 groups, respectively. Median baseline CD4 count was 146 cells/mL3 in the 10-12 group, and it was not significantly different from that of 06-07 group. Tuberculosis was diagnosed 3 times more commonly in the 10-12 group. The retention proportion at the end of 10 months was 68% in the 10-12 group when compared to that of 59% in the 06-07 group. Conclusion: There was a trend toward improved outcome over the period of time, but the attrition rate remained high.

scholarly journals Surgical Repair of VSD and their Short Term Outcome in a Tertiary Care Hospital

2019 ◽  
pp. 34-37
Author(s):  
Kazi Zahidul Hoque ◽  
Masumul Gani Chowdhury ◽  
Ashraful Islam ◽  
Makbul Hossain ◽  
Mostafizur Rahman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tertiary Care ◽  
Patch Repair ◽  
Cardiac Anomaly ◽  
Care Hospital ◽  
Short Term ◽  
Term Outcome ◽  
Congenital Cardiac Anomaly ◽  
Short Term Outcome ◽  
The Mean

Background: Ventricular Septal Defect (VSD) is the commonest congenital cardiac anomaly in Bangladesh. For this reason, patch repair of VSD is commonly performed cardiac surgery here. Aim: To observe the short term outcome of patch repair of VSD. Methods: 50 consecutive patients were enrolled in the study by purposive sampling who received treatment for isolated VSD in Department of Paediatric Cardiac Surgery of Dhaka Shishu Hospital, Dhaka, Bangladesh. They underwent ventricular patch repair from January, 2017 to December, 2017. A prospective observational cross-sectional study was conducted for this 12 months period. A pre-structured, interview and observation based, peer reviewed data collection sheet was prepared. Data regarding Sociodemographic, clinical, surgical and outcome profile were recorded. Data were compiled, edited and analyzed with SPSS version 23. Data were presented as mean and standard deviation, frequency percentage and median with range. Results: The mean birth weight of 50 patients was 2.8 kg (range: 2.1-3.5 kg) whereas the median of gestational age was 38 weeks. Among these 50 patients, 22 (44%) and 28 (56%) were boys and girls respectively. The indication of surgery was volume load, failure to thrive and repeated respiratory tract infection. Out of 50 patients, 46 (92%) had perimembranous variety. On the contrary, 4 (8%) experienced Double committed type of VSD. The mean Bypass time and Aortic cross-clamp time were recorded as 70 ± 13.7 minutes and 35 ± 6.85 minutes respectively. Out of 50 patients who underwent ventricular patch repair, 2 (4%) experienced pneumothorax, 1 (2%) got chylothorax and 1 (2%) had transient heart block. Total 45 (90%) patients showed uneventful outcome. Conclusion: Contemporary results of ventricular patch repair in case of VSD showed unparallel outcome with extremely low morbidity in our perspective.

Short term outcome for colorectal cancer patients undergoing surgery in Tertiary care center in Eastern India

2021 ◽  
Vol 47 (2) ◽  
pp. e50-e51
Author(s):  
Abhitesh Singh ◽  
Anshul Jain ◽  
Dillip Muduly ◽  
Mahesh Sultania ◽  
Jyoti Ranjan Swain ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Eastern India ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Colorectal Cancer Patients

scholarly journals Neurological diagnoses in the emergency room: differences between younger and older patients

2011 ◽  
Vol 69 (2a) ◽  
pp. 212-216 ◽  
Author(s):  
Marcos C. Lange ◽  
Vera L. Braatz ◽  
Carolina Tomiyoshi ◽  
Felipe M. Nóvak ◽  
Artur F. Fernandes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Room ◽  
Older Patients ◽  
Tertiary Care Hospital ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Primary Headache ◽  
Care Hospital ◽  
National Guidelines ◽  
And Training

Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, <;50 years old and >50 years old. RESULTS: Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the <;50 years old group. CONCLUSION: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training.

scholarly journals A study of Acute Liver Failure in adults in a tertiary care hospital

2019 ◽  
Vol 5 (6) ◽  
pp. 204-207
Author(s):  
Dr. Mohini Singh ◽  
◽  
Dr. Srilakshmi Sathiyaseelan ◽  
Devarasetty Shashank ◽  
Dr. S.R. Ramakrishnan ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Arterial Blood ◽  
Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

scholarly journals A Descriptive Study on Sepsis: Causes, Outcomes, and Adherence to Guidelines on Patients with Sepsis at a Tertiary Care Hospital in Sri Lanka

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Anne Thushara Matthias ◽  
J. Indrakumar ◽  
Tharushi Ranasinghe ◽  
Shalini Wijekoon ◽  
Charuni Yashodara
Keyword(s):  
Sri Lanka ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Bundle ◽  
Common Source ◽  
Care Hospital ◽  
Poor Countries ◽  
Arterial Blood ◽  
Resource Poor ◽  
Sepsis Care

The global incidence of sepsis is increasing, and mortality remains high. The mortality is even higher in resource-poor countries where facilities and equipment are limited. The Surviving Sepsis Campaign (SSC) recommends an updated hour-1 bundle based on the evidence from the International Guidelines for Management of Sepsis and Septic Shock 2018. To reduce mortality from sepsis, compliance with the “bundle” is essential. Data from developing countries like Sri Lanka on the management of sepsis according to the SSC guidelines are not available. Hence, this study looks at the patient characteristics and management of septic patients at a tertiary care hospital in Sri Lanka. Patients admitted to the University Medical Unit of Colombo South Teaching Hospital from January to August 2019 fulfilling the inclusion criteria were included. The hour-1 sepsis bundle adherence, demographic data, and management were recorded. There were 387 patients: 163 males and 224 females. The age range was 15-95 with a mean age of 63. 83.7% were direct admissions while 16.3% were transfers from a peripheral hospital. The most common source of infection was urine (82 (21.2%)) followed by blood stream (105 (27.1%)) and skin and soft tissue (114 (29.5%)). One-hour SSC bundle compliance is as follows: administration of intravenous fluids: 42 (10.9%), blood cultures before antibiotics: 225 (58.1%), first dose antibiotic: 15 (3.9%), and arterial blood gas: 60 (15.5%). Staffing capacity did not make a difference to adherence to the bundle. The study mortality rate was 37 (9.6%). Binary logistic regression indicates that quick sequential organ failure assessment (qSOFA) score is a significant predictor of mortality (chi‐square=35.08, df=3, and p=0.001 (<0.05)) with an odds ratio (OR) of 7.529 (95% CI 3.597-14.323). The other predictors, age, sex, adherence to sepsis care bundle, and comorbidities, were not significant. In conclusion, mortality of sepsis is high and adherence to sepsis care bundle is poor in Sri Lanka even at a tertiary care hospital. Education and training of staff are needed to boost adherence. This will in turn improve quality of care and outcomes of septic patients in resource-poor countries.

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