P1092Syncope in the emergency department: can 24-hour holter monitoring be of any help?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Lopes ◽  
C Saleiro ◽  
D Campos ◽  
J Sousa ◽  
L Puga ◽  
...  
Keyword(s):  
Emergency Department ◽  
Readmission Rate ◽  
Holter Monitoring ◽  
Readmission Rates ◽  
Chi Square ◽  
Loop Recorder ◽  
Device Implantation ◽  
One Year ◽  
Group B ◽  
Syncope Episode

Abstract Background  Syncope is a very common reason for presenting to the emergency department (ED). The existence of a telemetry unit is crucial but it is not the reality in some hospitals. In order to avoid unnecessary ward admission, 24-hour Holter (24HH) monitoring could be useful to help with the diagnosis (when the arrhythmic etiology is suspected and the symptoms are frequent enough) and also be important to safely discharge a patient.  Purpose  The purpose of this study is to evaluate the diagnostic performance of 24HH monitoring, during a syncope episode in the ER, and to compare the readmission rates between patients with normal and abnormal not diagnostic 24HH monitoring.  Methods  A cohort study of consecutive patients (P) who were monitored with 24HH in one hospital in the ED, between January 2015 and December 2017, were included. All the 24HH results were seen by a senior cardiologist and divided in three groups: A - normal, B - abnormal Holter study unlikely to explain syncope and C- Holter study considered to be diagnostic.  Groups A and B were compared using chi-square independence test to evaluate association between the result of the 24HH and readmission rates at 30 days and 1 year, as well as mortality and device implantation at 1 year. Multivariate logistic regression was used to look for other confounders.  Results  A total of 111 P were included in this study. Mean age was 75 ± 14 years old, with 55.6% male patients.  A previous emergency episode with syncope was present in 56.9% of P. The mortality at one-year follow-up was 11.9%. The 24HH was considered diagnostic in 25.2% of P (28 P), with 18.9% of all the P with necessity of pacemaker (PM) implantation. In the patients with a non-diagnostic 24HH, 6,4% implanted a loop recorder before discharge.  Group B patients had a higher 30-day readmission rate to the ED when compared with group A (OR = 4.050 CI 95 [1.13 – 14.497], p = 0.033), but no difference in one-year readmission rate (p= 0.065). There was no difference in one-year mortality between the two groups (p= 0.731) or in one-year implantation of pacemaker (p= 0.431).  Conclusion  The use of 24HH in the ED could be a valuable tool in the diagnosis of rhythm disorders that cause syncope.  An abnormal non diagnostic result can still be a predictor of 30-day readmission to the ED with similar complaints.

scholarly journals Implantable loop recorders in patients with heart disease: comparison between patients with and without syncope

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001748
Author(s):  
Amira Assaf ◽  
Rafi Sakhi ◽  
Michelle Michels ◽  
Jolien W Roos-Hesselink ◽  
Judith M A Verhagen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Primary Endpoint ◽  
Underlying Disease ◽  
Clinical Value ◽  
Loop Recorder ◽  
Device Implantation ◽  
Inherited Cardiomyopathy ◽  
Increased Risk ◽  
Group A ◽  
Group B

ObjectivePatients with heart disease are at increased risk for sudden cardiac death. Guidelines recommend an implantable loop recorder (ILR) for symptomatic patients when symptoms are sporadic and possibly arrhythmia-related. In clinical practice, an ILR is mainly used in patients with unexplained syncope. We aimed to compare the clinical value of an ILR in patients with heart disease and a history of syncope versus those with non-syncopal symptoms.MethodsIn this observational single-centre study, we included symptomatic patients with heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to device implantation.ResultsOne hundred and twenty patients (mean age 47±17 years, 49% men) were included. The underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%) and other (18%). Group A consisted of 43 patients with prior syncope and group B consisted of 77 patients with palpitations and/or near-syncope. The median follow-up duration was 19 months (IQR 8–36). The 3-year cumulative event rate was similar between groups with regard to the primary endpoint (38% vs 39% for group A and B, respectively, logrank p=0.54). There was also no difference in the 3-year cumulative rate of device implantation (21% vs 13% for group A and B, respectively, logrank p=0.65).ConclusionIn symptomatic patients with heart disease, there is no difference in the yield of an ILR in patients presenting with or without syncope.

scholarly journals Missing the Mark: Inaccuracy of administrative data in identification of hospitalized patients with pneumonia and results of a systematic clinical reclassification process on readmission rates

2017 ◽  
Vol 6 (6) ◽  
pp. 35
Author(s):  
Marcus D. Ruopp ◽  
Joel C. Boggan ◽  
Thomas L. Holland ◽  
Mary Jane Stillwagon ◽  
Joseph A. Govert ◽  
...  
Keyword(s):  
Administrative Data ◽  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Final Diagnosis ◽  
Healthcare Systems ◽  
Readmission Rates ◽  
Control And Prevention ◽  
One Year

Objective: Pneumonia readmissions carry financial ramifications under the Hospital Readmissions Reduction Program (HRRP). As readmission determination utilizes administrative data, healthcare systems should evaluate accuracy of pneumonia diagnoses. We sought to develop a systemic process for pneumonia classification review and determine potential effects on pneumonia readmissions in a tertiary academic medical center in the United States.Methods: We performed independent reviews of all pneumonia discharges within 48 hours of discharge over a one-year period. We reclassified all pneumonia discharges into four categories based on the Centers for Disease Control and Prevention reference standard. Secondary review of discordant classifications was performed by discharging providers to determine final diagnosis. The primary outcome was readmission rate within 30 days by pneumonia clinical classification category.Results: Two hundred seventy-eight discharges were reviewed, with overall readmission rate of 18.0%. Independent review confirmed 191 cases (68.7%) as definite or probable pneumonia, while 87 cases (31.3%) were classified as either probably not or not pneumonia. Readmission rates differed significantly between cases reviewed as pneumonia vs. those reviewed as unlikely to be pneumonia (14.1% vs. 26.4%, p < .02). Discharging attending physicians agreed with independent reviewers in 58/87 cases (66.6%), attenuating readmission differences (rate 16.8% for those finalized as pneumonia vs. 22.4% for another diagnosis, p = .32). Pneumonia readmissions were reduced by 1.2% using the classification standard.Conclusions: Complex conditions such as pneumonia may be inaccurately diagnosed in many patients, potentially affecting penalties associated with readmission rates. Therefore, it is imperative that healthcare systems adopt systematic review processes to standardize diagnoses and improve comparative administrative data.

scholarly journals The Type of Gastrectomy and Modified Frailty Index as Useful Predictive Indicators for One-Year Readmission Due to Nutritional Difficulty in Patients Who Undergo Gastrectomy for Gastric Cancer.

2021 ◽  
Author(s):  
Tomohiro Osaki ◽  
Hiroaki Saito ◽  
Wataru Miyauchi ◽  
Yuji Shishido ◽  
Kozo Miyatani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Readmission Rate ◽  
Frailty Index ◽  
Partial Gastrectomy ◽  
Readmission Rates ◽  
Modified Frailty Index ◽  
One Year ◽  
Distal Partial Gastrectomy ◽  
Predictive Indicators

Abstract Background Patients who undergo gastrectomy for gastric cancer are likely to have nutritional difficulty after surgery. Therefore, readmission due to nutritional difficulty is frequently observed in such patients. This study aimed to identify predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for gastric cancer. Methods We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for gastric cancer. Results The readmission rate within one year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%), and nutritional difficulty was the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index were independent predictive indicators of readmission due to nutritional difficulty. The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients who underwent distal partial gastrectomy and had low modified frailty index, in those who underwent distal partial gastrectomy and had high modified frailty index or those who underwent either proximal partial or total gastrectomy and had low modified frailty index, and in those who underwent either proximal partial or total gastrectomy and had high modified frailty index, respectively (P = 0.0008). Conclusions Because the readmission rate due to nutritional difficulty is high in patients who underwent either total or proximal partial gastrectomy with high modified frailty index, intensive follow-up and nutritional support is needed to reduce readmission due to nutritional difficulty, which can help improve the patients’ quality of life and reduce additional medical costs.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

Avaliação da prevalência da perda precoce de molares decíduos na dentição mista

2020 ◽  
Vol 13 (52) ◽  
pp. 102-106
Author(s):  
Ana de Lourdes Sá de Lira ◽  
Cassius Wander Coelho Martins ◽  
Luis Paulo da Silva Dias ◽  
Tito Cacau Sousa Santos
Keyword(s):  
Mixed Dentition ◽  
Deciduous Teeth ◽  
Chi Square ◽  
Space Maintainer ◽  
Chi Square Test ◽  
Fixed Space ◽  
Deciduous Molar ◽  
One Year ◽  
Deciduous Molars ◽  
Lower Arch

Objective: To assess primary molars early loss in mixed dentition prevalence. Method: A study was carried out in children aged 6 to 12 years. Deciduous molar loss was considered early when it occurred before Nolla stage 6 (full formed crown) of the permanent successor or one year before its physiological exfoliation. Periapical radiographs were obtained to verify the presence of the permanent successor and the level of root formation, as well as the need for placement of fixed space maintainer lingual arch or Nance button. For the study of frequency distribution of early dental loss in relation to gender and dentition, we used the Chi-square test of 5% probability level and the non-parametric Mann-Whitney test for adequate statistical analysis. Results: Of the 315 children examined, 159 (50.47%) were male and 156 (49.52%) were female. Only 25 (7.9%) presented multiple dental losses in the posterior region, 19 in the lower arch and 6 in the upper arch. In the inferior one there was predominance of first and second deciduous molars loss. There was no difference in the association between genders and the occurrence of multiple dental losses (χ² (1) = 0.03, p>0.05). Conclusion: The prevalence of deciduous teeth premature loss was of 7.9% and the most affected teeth were the first and second molars in the lower arch. Lingual arch space holders were installed in 6 children, who will remain with it until the permanent successors erupt into the oral cavity.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

Evaluation of Mandibular Arch Width Changes following Fixed Retention in Post Orthodontic Patients - a Randomized Clinical Trial

2020 ◽  
Author(s):  
Nasreen Iqbal Nagani
Keyword(s):  
Stainless Steel ◽  
Steel Wire ◽  
P Value ◽  
Chi Square ◽  
Mandibular Arch ◽  
Arch Width ◽  
Orthodontic Patients ◽  
Mean Differences ◽  
One Year ◽  
The Stability

Background: Retention is an integral phase in which teeth are maintained in their newly adapted position for which retainers are inserted. Retainers are generally of two types: removable and fixed. Fixed retainers are indicated in the mandibular arch for an indefinite period specifically in the non-extraction cases. Changes in intercanine and intermolar widths are valuable parameters to evaluate the stability. The objectives of this study were to assess and compare the mandibular intercanine and intermolar width changes following orthodontic treatment after insertion of two types of fixed lingual retainers for one year. Methods: Total 54 subjects were recruited in which two types of fixed lingual retainers were inserted in the mandibular arch randomly. Intercanine and intermolar arch widths were measured by digital caliper of 0.01 mm accuracy. Data was analyzed by using Statistical Package of Social Sciences (SPSS V-21). Chi-square and independent t tests were used to compare baseline characteristics. Intercanine and intermolar widths were assessed and compared using independent t test, p-value ≤ 0.05 is considered as statistically significant. Results: Intercanine width increased from baseline to T4 in both retainers. When mean differences of intercanine width were compared between two retainers significant differences were observed at T1, T2, T3 and T4 with significant p-values (< 0.05) and increased intercanine width with multistranded stainless steel wire (MSW) retainers. Conclusion: Mandibular intercanine width increases significantly in post retention phase with multistranded stainless steel retainers. Thus, fiber reinforced composite retainers are more effective in preserving the arch width changes.

Geriatrische revalidatiezorg na triage op de Spoedeisende Hulp: Patiëntkarakteristieken en revalidatie-uitkomsten

2019 ◽  
Keyword(s):  
Emergency Department ◽  
Residential Care ◽  
Functional Decline ◽  
Care Facility ◽  
Geriatric Rehabilitation ◽  
Residential Care Facility ◽  
Successful Group ◽  
Geriatrische Revalidatiezorg ◽  
One Year ◽  
Single Contact

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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