External validation of the San Francisco Syncope Rule in the Australian context

ABSTRACT Objective: The San Francisco Syncope Rule (SFSR) aims to identify patients with syncope who are at risk for short-term serious adverse outcomes. It has been reported to have high sensitivity and the potential to decrease admission rates. The aim of this study was to validate the SFSR in the Australasian setting. Methods: Our prospective, observational cohort study identified patients with syncope using emergency department (ED) databases. Data, including demographics, the presence of SFSR predictors and ED disposition, were collected either during ED stay or by explicit medical record review. Patients were followed up after 7 days for defined serious outcomes (i.e., death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage or unplanned ED re-presentation). We analyzed sensitivity, specificity, and positive and negative predictive values. We compared the results with current physician-based clinical practice. Results: We studied 89 patients with a median age of 74 years. Of them, 42% were male and the admission rate was 39%. Ten patients (11%) suffered a serious event. The SFSR was 90% sensitive (95% confidence interval [CI] 60%–98%) and 57% specific (95% CI 46%–67%) for predicting patients with a defined serious adverse event. The SFSR also categorized 48% of patients as “high risk.” If the SFSR had been strictly applied, the admission rate would have increased by 9% and 1 serious adverse event would have been missed. Conclusion: The SFSR demonstrated 90% sensitivity in this validation study. Strict application of the SFSR would have increased hospital admissions but would not have identified all adverse outcomes. In our setting, clinician judgement performed as well as the syncope rule, with a baseline admission rate of 36%.

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Abstract 3107: Arm Exercise Stress Testing Variables Predict Survival and Adverse Clinical Outcomes

Circulation ◽

10.1161/circ.116.suppl_16.ii_696-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Nasreen Ilias ◽

Xian Hong ◽

Cindi Inman ◽

Wade Martin

Keyword(s):

Heart Rate ◽

Adverse Event ◽

Stress Testing ◽

Cox Regression ◽

Coronary Revascularization ◽

Adverse Outcomes ◽

Exercise Stress ◽

Peak Heart Rate ◽

Predictive Values ◽

Event Rates

Valuable prognostic and clinical information from treadmill exercise testing (GXT) includes exercise capacity (METs), heart rate, and electrocardiographic (ECG) responses. However, little or no prognostic data are available for arm ergometer stress testing (AXT). To determine whether AXT variables predict survival, myocardial infarction (MI), or coronary revascularization (CVASC), we performed AXT from 1997 to 2002 in 359 patients, mean age 63 +/− 11 (SD) years, referred for clinical reasons but unable to perform GXT, and followed for 63 +/− 24 months, during which 98 deaths occurred (27%). Average annual mortality, MI, CVASC, and combined adverse event rates were 5.2%, 1.7%, 2.2%, and 7.1%, respectively. Student’s t-tests were used to assess differences between outcome groups. Cox regression models were employed to determine hazard ratios (HR) and 95% confidence intervals (CI). Kaplan-Meier survival models were used to compare survival curves among AXT groups. AXT METs was highly predictive of survival after adjustment for age and beta blocker treatment (p < 0.001; when stratified by tertiles; death HR 0.47, CI 0.22– 0.71 middle vs. lowest; HR 0.61, CI 0.28 – 0.94 highest vs. middle). A greater delta (peak-rest) heart rate was associated with survival (p = 0.0003) and/or event-free outcome as were faster % age-predicted peak heart rate (death HR 0.58, CI 0.36 – 0.80 for >70% vs.> 70%), higher exercise systolic blood pressure (SBP) (p = 0.002) and peak heart rate x SBP product (PRPP) (p = 0.0006). A positive (+) AXT ECG was observed in 22% of deaths and 10% of survivors, 27% of MI and 12% with no MI, and 32% of CVASC versus 11% with no CVASC. A+AXT ECG was a powerful predictor of adverse outcome, even after accounting for peak heart rate, peak SBP and PRPP (death HR 2.2, CI 1.94 –2.43; MI HR 2.9, CI 2.48 –3.30; CVASC HR 4.1, CI 3.73– 4.43; combined events HR 2.8, CI 2.55–2.98). Sensitivity, specificity, positive and negative predictive values of a +AXT ECG in prognosticating adverse outcomes ranged from 22–31%, 88 –92%, 18 – 61%, and 62–92%, respectively. Thus, in veterans who are older and have more comorbidities than most other study populations based on adverse event rates, AXT is an alternative to GXT for predicting clinical outcome in patients with lower extremity disabilities.

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LO92: Development of a predictive model for hospital admissions by utilizing frequencies of specific CEDIS presenting complaints

CJEM ◽

10.1017/cem.2018.154 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S40-S40

Author(s):

D. Lewis ◽

G. Stoica ◽

J. P. French ◽

P. Atkinson

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Hospital Admissions ◽

Admission Rate ◽

Emergency Admission ◽

Altered Level ◽

Admission Rates ◽

Likelihood Model ◽

Predictive Strength

Introduction: With hospital occupancy rates frequently approaching 100%, even small variations in daily admission numbers can have a large impact. The ability to predict variance in emergency admission rates would provide administrators with a significant advantage in managing hospital daily bed requirements. There is a growing interest in patterns of hospital admissions, and many EDs utilize historical admission patterns to attempt to predict daily bed requirements. Previous studies have utilized patient demographics and past medical history to develop an admission likelihood model. We wished to examine the predictive strength of individual CEDIS presenting complaints (PC) on admission likelihood Methods: Using a database analysis of over 285,000 ED presentations (2013-2017), we calculated visit frequencies and admission rates by PC. Using a logistic regression analysis PCs were ordered from high to medium predictive strength. Results: Of 285,155 presentations, there were 38,090 hospital admissions, a rate of 13.36%. Based on the number of visit frequencies and admission rates, the PCs demonstrating high predictive strength were Direct Referral (effect=0.36, binomial CI: 0.28 to 0.44); Shortness of Breath (0.32: 0.26 to 0.41); General Weakness; Weakness/Query CVA; & Chest Pain Cardiac Features (each 0.30: 0.25 to 0.42); Altered level of consciousness (0.24: 0.16 to 0.31); and Confusion (0.18: 0.08 to 0.26). With our sample size, all remaining CEDIS PCs had low predictive value (the effect is <0.1), or were not predictive at all. Conclusion: We have demonstrated that, for our population, certain PCs are associated with an increased likelihood of admission and have quantified this effect using logistic regression analysis. Variance from the average daily admission rate may be predicted, in our population, by identifying these PCs at registration.We plan to develop a tool, based on this data and implemented at registration, to predict cumulative likely daily admission requirements as patients present over a 24hr period.

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Future projections of child oral-related hospital admission rates in Western Australia

Australian Journal of Primary Health ◽

10.1071/py15132 ◽

2016 ◽

Vol 22 (6) ◽

pp. 491 ◽

Cited By ~ 1

Author(s):

Alla Alsharif ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Dental Caries ◽

Hospital Admission ◽

Hospital Admissions ◽

Admission Rate ◽

Projection Data ◽

Impacted Teeth ◽

Admission Rates ◽

The Future ◽

Hospital Morbidity ◽

Western Australian

This study aimed to project the hospital admission rates of Western Australian children for oral conditions, with a particular focus on dental caries, embedded and impacted teeth, and pulp and periapical conditions through to the year 2026. Two methods were used to generate projection data through to the year 2026, using the Western Australian Hospital Morbidity Dataset for the period 1999–2000 to 2008–2009. The projected admission rate increase in those children aged 14 years and younger from 2000 to 2026 was 43%. The admission rates are expected to more than double over time (7317 cases in 2026 compared to only 3008 cases in 2000) for those children living in metropolitan areas. Dental caries, embedded and impacted teeth, and pulp and periapical conditions will remain the top (mostly) preventable causes of admission throughout this time. Anticipating the future burden of oral-related hospital admissions in children, in terms of expected numbers of cases, is vital for optimising the resource allocation for early diagnosis, prevention and treatment. A concerted effort will be required by policymakers and oral healthcare communities to effect substantial change for the future.

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638Reporting of gestational diabetes and chronic conditions of pregnancy: validation of routinely collected hospital data

International Journal of Epidemiology ◽

10.1093/ije/dyab168.056 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Heather Baldwin ◽

Siranda Torvaldsen ◽

Kristen Rickard ◽

Tanya Nippita ◽

Jillian Patterson

Keyword(s):

Morbid Obesity ◽

Gestational Diabetes ◽

Gestational Hypertension ◽

High Sensitivity ◽

Clinical Situation ◽

Adverse Outcomes ◽

Chronic Hypertension ◽

Hospital Data ◽

Predictive Values ◽

Low Sensitivity

Abstract Background Gestational diabetes, hypertension, thyroid conditions and morbid obesity in pregnancy are associated with increased risks of adverse outcomes. Hospital data are important for research on these conditions, however, up-to-date validation of reporting is needed to understand the extent to which the data reflect the clinical situation. Methods Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Obstetric data, from the ObstetriX system, was used as the gold standard to which linked hospital data, from the Electronic Medical Record, were compared. Results There were 35,928 births included. Gestational and pre-existing diabetes had high sensitivity (83.6% and 88.2%) and positive predictive values (PPV, 92.7% and 86.0%). Pre-eclampsia and eclampsia, gestational hypertension and any hypertension had good sensitivity (80.0%, 80.1%, 81.5%), but moderate PPVs (59.7%, 65.6%, 70.4%), while for chronic hypertension sensitivity (53.5%) and PPV (53.2%) were lower. Obesity and thyroid conditions showed low sensitivity (9.8%, 12.9%; PPV 65.6%, 82.3%). Specificity and NPV were high for all conditions. Conclusions We found reliable reporting of gestational diabetes, pre-existing diabetes and all types hypertension, except for chronic hypertension which was moderately well reported. Thyroid conditions and morbid obesity were very poorly reported. Key messages Diabetes appears well reported in the hospital data, and sensitivity for hypertension may be improved by using a grouped category. Hospital data on thyroid conditions and obesity should be used with caution.

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Abstract 135: Impact of Massachusetts Health Care Reform on the Risk of Hospitalization for Cardiovascular Ambulatory Care Sensitive Conditions.

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a135 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Danny McCormick ◽

Amresh D Hanchate ◽

Nancy R Kressin ◽

Mengyun Lin ◽

Meredith D'Amore ◽

...

Keyword(s):

Health Care ◽

Ambulatory Care ◽

Health Care Reform ◽

Ethnic Minorities ◽

Health Reform ◽

Hospital Admissions ◽

Admission Rate ◽

Ambulatory Care Sensitive Conditions ◽

Admission Rates ◽

Racial Ethnic

Research Objective: Massachusetts (MA) health reform increased the number of insured residents, particularly among racial/ethnic minorities. Yet, it is not known if this insurance expansion translated into improvements or decreased racial/ethnic disparities in access to medical care. Ambulatory care sensitive conditions (ACSCs) such as congestive heart failure (CHF), hypertension and angina are a set of medical conditions for which good outpatient care can potentially prevent the need for hospitalization. Thus, we used changes in rates of hospitalization for these 3 ACSCs to assess potential changes in access to care following MA health care reform. Methods: Using complete data on acute care hospital admissions in MA and in two states that did not implement comprehensive health care reform, New York (NY) and Pennsylvania (PA), we identified all hospital admissions for cardiovascular ACSCs (CHF, angina and hypertension) during the 21 months preceding and following health reform implementation (7/1/2006-12/31/2007). Using US census population data we calculated pre- and post-reform age- and sex-standardized admission rates for the 3 ACSCs combined among patients 18-64 (those affected by reform). Treating MA as the intervention cohort, and NY and PA together as the control cohort we used multivariate Poisson regression models to conduct “difference-in-difference” analyses to estimate post-reform changes in admission rates in MA adjusted for contemporaneous changes occurring in control states. The models were also adjusted for age, gender and race. Using this approach, we also assessed whether health reform was associated with decreases in admission rates for racial and ethnic minorities compared with whites. Principal Findings: There were 84,286 hospital admissions for CHF, angina and hypertension combined in the pre- and post-reform periods in MA and 535,726 during the same time periods in control states. The hospital admission rate (number/100k population) for ACSCs declined in MA (128.7 to 121.7 [5.4%]) and in control states (232.2 to 208.4 [10.2%] from the pre- to post-reform period. When adjusted for secular trends in control states, age, gender and race, however, there was a 6.2% (95% CI, 2.9-9.6) increase in admissions in MA. After adjustment, there was no significant change in the admission rate for blacks compared with whites in MA (+3.7% [95% CI, -11.1 - 4.5]) or for Hispanics compared with whites in MA (+9.3% [95% CI, -18.2 - 0.6]). Conclusions: Hospital admissions for cardiovascular ACSCs did not decline in MA as a whole, or for minorities relative to whites, in comparison with 2 large control states that did not implement health reform. Additional insurance or health care system reforms in MA may be needed to decrease potentially avoidable hospitalizations and improve access to care.

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Are more GPs associated with a reduction in emergency hospital admissions?

British Journal of General Practice ◽

10.3399/bjgp.2020.0737 ◽

2020 ◽

pp. BJGP.2020.0737

Author(s):

Catia Nicodemo ◽

Barry McCormick ◽

FD Richard Hobbs ◽

Raphael Wittenberg

Keyword(s):

Fixed Effects ◽

Hospital Admissions ◽

Admission Rate ◽

Emergency Admission ◽

Population Data ◽

Local Area ◽

Emergency Admissions ◽

Admission Rates ◽

Access To Primary Care ◽

Deprived Areas

Background: Recent studies have found an association between access to primary care and accident and emergency attendances, with better access associated with fewer attendances. Analyses of an association with emergency admissions however have produced conflicting findings. Aim: We investigate whether emergency admission rates in an area are associated with (i) the number of GPs, and (ii) mean size of GP practices. Design and Setting: Analysis was conducted utilising Hospital Episode Statistics, the numbers of GPs and GP practices, ONS population data, Quality and Outcomes Framework (QoF) prevalence data, and Index of Multiple Derivation data, from 2004/5 to 2011/12, for all practices in England. Method: Regression analysis of panel data with fixed effects to address (i) a potential two-way relationship between the numbers of GPs and emergency admissions, and (ii) unobservable characteristics of GP practices. Results: There is not a statistically significant relationship between the number of GPs in a local area and the number of emergency admissions when analysing all areas. However, in deprived areas, a higher number of GPs is associated with lower emergency admissions. There is also a lower emergency admission rate in areas in which practices are on average larger, holding constant GP supply. Conclusions In deprived areas an increase in GPs was found to reduce emergency admissions but does not do so elsewhere. Areas in which GPs became concentrated into larger practices experienced reduced levels of emergency admissions, all else equal.

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The risk of severe COVID-19: hospital and ICU admission rates in Norway

10.1101/2020.07.16.20155358 ◽

2020 ◽

Cited By ~ 1

Author(s):

Morten Munkvik ◽

Ingvild Vatten Alsnes ◽

Lars Vatten

Keyword(s):

Hospital Admissions ◽

Age Groups ◽

Admission Rate ◽

Epidemiological Studies ◽

Population Based ◽

Western Region ◽

Eastern Region ◽

Detailed Data ◽

Admission Rates ◽

Restrictive Measures

Background: Epidemiological studies of COVID-19 with population based information may add to the knowledge needed to prioritise resources and advice on how restrictive measures should be targeted. This study provides admission rates to hospitals and intensive care units (ICU) in Norway, aiming to better understand the risk of severe COVID-19 infection. Methods: Data from official reports from The Norwegian Institute of Public Health (NIPH) and the Norwegian Directorate of Health were used to calculate admission rates to hospitals and to ICU per 100 000 inhabitants. We compared rates of hospitalisation between the four health regions and provide separate rates for Oslo. We also assessed national admissions to ICU stratified by age. Results: The admission rate in the south-eastern region was 3.1 per 100 000, and the rate for Oslo was 5.8. Compared to the western region (reference), the Oslo rate was 4.0 times (confidence interval (CI) 3.0-5.5) higher. In Norway as a whole, the rate of ICU admissions was 3.9 per 100 000, and in the age groups 60-69 and 70-79, ICU rates were 10.3 and 11.5, respectively. These rates were 9.5 (CI 6.3-14.3) and 10.6 (CI 6.9-16.2) times higher compared to people younger than 50 years. Conclusion: Hospital admissions due to Covid-19 are much higher in Oslo than anywhere else in Norway, and in the country as a whole, ICU admissions are highest among people 60-79 years of age. These results and more detailed data could provide better advice on how restrictions can be safely lessened.

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The bimodal rise and fall acute coronary syndromes curves paralleling COVID-19 outbreaks

European Heart Journal ◽

10.1093/eurheartj/ehab724.1458 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D Trabattoni ◽

G Teruzzi ◽

P M Ravagnani ◽

G Santagostino Baldi ◽

P Montorsi ◽

...

Keyword(s):

Cardiogenic Shock ◽

Hospital Admission ◽

Clinical Outcomes ◽

Acute Coronary Syndromes ◽

Hospital Admissions ◽

Admission Rate ◽

Nasopharyngeal Swab ◽

Admission Rates ◽

Coronary Syndromes ◽

The Impact

Abstract Introduction Preliminary reports from the early phase of COVID-19 epidemic in Italy reported a dramatic reduction in hospital admission rates for acute coronary syndromes (ACS) coupled with longer times from symptoms onset to hospital presentation. Purpose To assess the impact of COVID-19 on hospital admission rates and ACS patterns, as well as time to presentation and clinical outcomes, following the acute pandemic phase in 2020 compared to previous year. Methods We conducted a single institution retrospective analysis conducted in a cardiovascular hub serving a large metropolitan area in Italy. Number and monthly distribution of hospital admissions for ACS from January 1 to December 31, 2020 were compared to the respective figures in 2019. Baseline clinical features, time from symptoms onset to hospital admission and main clinical outcomes were collected. Results A total of 599 ACS cases were recorded in 2020 vs. 386 cases in 2019, with a net 55% increase. ACS presentation rate in 2020 showed a bimodal pattern, paralleling the most contagious outbreak periods (Figure 1). SARS-CoB-2 nasopharyngeal swab or specific antibody tests were positive in 34 (5.7%) patients. Time from symptoms onset to hospital presentation tended to be longer in 2020 than in 2019, being two-fold longer during the peak epidemic phase (February 21-May 3, 2020; median time 2.0 vs. 5.0 hours, p=0.030). The proportion of late-presenting STEMI (>8 hrs from symptoms onset) was higher in 2020 compared to 2019 (30% vs. 18%, p=0.003),as well as higher was in-hospital mortality (15% in 2020 vs 6% in 2019, p=0.001), partly due to a three-fold increase in cardiogenic shock on ACS presentation. Conclusions ACS admission rate significantly increased during the 2020 COVID-19 epidemic outbreak for several reasons only partially explained by a SARS-CoV-2 infection trigger effect on ACS. Longer presentation times and higher rates of cardiogenic shock and mortality were observed, urging the need health-care systems to keep a high priority on cardiovascular emergencies response networks. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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Changing patterns of hospital admission for asthma, 1981–97

Thorax ◽

10.1136/thx.56.9.687 ◽

2001 ◽

Vol 56 (9) ◽

pp. 687-690

Author(s):

D S Morrison ◽

P McLoone

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Admission Rate ◽

Hospital Admission Rate ◽

Admission Rates ◽

Lengths Of Stay ◽

Icd 10 ◽

Changing Patterns ◽

Bed Days ◽

Age And Sex

BACKGROUNDHospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland.METHODSLinked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45–6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex.RESULTSThere were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children.CONCLUSIONSAfter a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

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Hospitalisation in Children with Adrenal Insufficiency and Hypopituitarism: Is There a Differential Burden between Boys and Girls and between Age Groups?

Hormone Research in Paediatrics ◽

10.1159/000479370 ◽

2017 ◽

Vol 88 (5) ◽

pp. 339-346 ◽

Cited By ~ 8

Author(s):

R. Louise Rushworth ◽

Georgina L. Chrisp ◽

Benjamin Dean ◽

Henrik Falhammar ◽

David J. Torpy

Keyword(s):

Adrenal Insufficiency ◽

Hospital Admissions ◽

Age Groups ◽

Admission Rate ◽

Adrenal Crisis ◽

Age Group ◽

Adrenal Hyperplasia ◽

Prevention Strategies ◽

Principal Diagnosis ◽

Admission Rates

Background/Aims: To determine the burden of hospitalisation in children with adrenal insufficiency (AI)/hypopituitarism in Australia. Methods: A retrospective study of Australian hospitalisation data. All admissions between 2001 and 2014 for patients aged 0–19 years with a principal diagnosis of AI/hypopituitarism were included. Denominator populations were extracted from national statistics datasets. Results: There were 3,779 admissions for treatment of AI/hypopituitarism in patients aged 0–19 years, corresponding to an average admission rate of 48.7 admissions/million/year. There were 470 (12.4%) admissions for an adrenal crisis (AC). Overall, admission for AI/hypopituitarism was comparable between the sexes. Admission rates for all AI, hypopituitarism, congenital adrenal hyperplasia (CAH), and “other and unspecified causes” of AI were highest among infants and decreased with age. Admissions for primary AI increased with age in both sexes. Males had significantly higher rates of admission for hypopituitarism. AC rates differed by both sex and age group. Conclusion: This nationwide study of the epidemiology of hospital admissions for a principal diagnosis of AI/hypopituitarism shows that admissions generally decreased with age; males had higher rates of admission for hypopituitarism; females had higher rates of admission for CAH and “other and unspecified causes” of AI; and AC incidence varied by age and sex. Increased awareness of AI and AC prevention strategies may reduce some of these admissions.

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