10 Hypoglycemic Episodes Predict Length of Stay in Patients with Acute Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S9-S10
Author(s):  
Christopher H Pham ◽  
Sebastian Q Vrouwe ◽  
Karen Tsai ◽  
Zachary J Collier ◽  
Andrea C Grote ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Inhalation Injury ◽  
Hypoglycemic Episode ◽  
Hospital Outcomes ◽  
Patient Demographics ◽  
Burn Center ◽  
Chi Squared ◽  
High Hba1c ◽  
History Of ◽  
Hba1c Levels

Abstract Introduction Hypoglycemic episodes are associated with worse hospital outcomes, and their incidence varies by institution. We sought to define the prevalence of hypoglycemic episodes at our burn center and determine their association with hospital outcomes. Methods We retrospectively reviewed all consecutive adult and pediatric patients admitted to our burn center from 2015 to 2019. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length of stay (LOS) and intensive care unit LOS (ICU LOS). All patients experiencing hypoglycemic episodes were compared to patients who did not experience hypoglycemic episodes (controls) using two-tailed t, chi-squared, and multivariate logistic and multiple linear regression analyses. Results A total of 914 patients with acute burns were admitted during the study period. Thirty-three patients (4%) experienced hypoglycemic episodes (< 60 mg/dL). Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder (N=16) experienced multiple hypoglycemic episodes. There were no significant differences in age, sex, or presence of inhalation injury between hypoglycemic patients and controls. Patients that experienced a hypoglycemic episode had significantly greater TBSA involvement (23% vs. 11%, p< 0.00), higher prevalence of diabetes (48% vs. 20%, p< 0.00), higher mortality (18% vs. 7%, p=0.01), longer total LOS (39 vs. 13 days, p< 0.00), and longer ICU LOS (28 vs. 4 days, p< 0.00). A single hypoglycemic episode was associated with prolonging total LOS by 19 days (p< 0.00) and ICU LOS by 18 days (p< 0.00). Hypoglycemic episodes were not associated with higher odds of mortality (OR=0.9, 95% CI 0.3–3.0, p >0.05). There were no differences in outcomes between patients with single or multiple hypoglycemic episodes. Patients with multiple hypoglycemic episodes more frequently had a history of diabetes (81% vs. 18%, p< 0.00), and worse glucose control (HbA1c, 9% vs. 7%, p=0.04) compared to patients with single episodes. Conclusions Hypoglycemic episodes were associated with longer total and ICU LOS in our study but did not portend higher mortality. Applicability of Research to Practice Quality improvement efforts to prevent hypoglycemic episodes should focus efforts on known diabetics with high HbA1c levels.

scholarly journals Management of a pediatric burn center during the covid-19 pandemic

2021 ◽  
Author(s):  
Ahmet Erturk ◽  
Sabri Demir ◽  
Can İhsan Oztorun ◽  
Elif Emel Erten ◽  
Dogus Guney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Body Surface Area ◽  
Center Staff ◽  
Staff Members ◽  
Burn Center ◽  
History Of ◽  
Group 2 ◽  
Travel Abroad ◽  
Pcr Test ◽  
Group 1

Abstract The aim of this study was to evaluate the results of an algorithm that was created to prevent coronavirus disease-2019 (COVID-19) transmission during the management of children with burns in a tertiary pediatric burn center. Children admitted to the burn center between May 2020 and November 2020 were prospectively evaluated for cause, burn depth, total body surface area (TBSA), length of stay, symptoms suggesting COVID-19, suspicious contact history, history of travel abroad, and COVID-19 polymerase chain reaction (PCR) test results. Patients were divided into two groups: unsuspected (Group 1) and suspected (Group 2), depending on any history of suspicious contact, travel abroad, and/or presence of symptoms. A total of 101 patients were enrolled in the study, which included 59 boys (58.4%) and 42 girls (41.6%). Group 1 included 79 (78.2%) patients, and Group 2 consisted of 22 (21.8%) patients. The most common cause of the burns was scald injuries (74.2%). The mean age, TBSA, and length of stay were 4.5 years, 12.0%, and 13.2 days, respectively. Four patients (3.9%) had a positive PCR test (two patients in each group). Comparing groups, males were more commonly found in Group 2 (p=0.042), but no differences were found for the other variables. No patients or burn center staff members developed COVID-19 during the course of hospitalization. In conclusion, every child should be tested for COVID-19 upon admission to a burn unit, and a modified algorithm should be constructed for the handling and management of pediatric burn patients.

Overutilization of Helicopter Transport in the Minimally Burned—A Healthcare System Problem That Should Be Corrected

2019 ◽  
Vol 41 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Jordan Roman ◽  
William Shank ◽  
Joseph Demirjian ◽  
Andrew Tang ◽  
Gary A Vercruysse
Keyword(s):  
Length Of Stay ◽  
Early Discharge ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Admission Rates ◽  
Burn Center ◽  
Transport Distance ◽  
Hospital Transfer ◽  
Hospital Stays

Abstract Eighty-eight percent of all patients burned in North America suffer burns of less than 20% TBSA. These patients may need care at a burn center, but barring any inhalation injury or polytrauma, these patients do not require helicopter transport (HEMS). We sought to identify a cohort of patients suffering smaller burns who do not benefit from HEMS to establish significant health care system savings. A 5-year retrospective analysis of data collected from our trauma registry was performed. Patients were separated into two groups: HEMS and ground transport (EMS). A subanalysis was performed between those with smaller burns (<20% TBSA and no ICU/OR requirement). ED disposition, hospital length of stay, distance transported, and cost was analyzed. Of 616 burn patients presenting to our center, 13% were transported by HEMS, 46% by ambulance, and 61% by private vehicle. Of those transported via HEMS, 38% had been evaluated and treated at an outside hospital before transfer. Patients transported via HEMS had larger burns (13 vs 9 %TBSA; P = .002) and deeper burns (P < .001), longer hospital stays (P = .003), higher ICU admission rates (P < .001), and mortality rates (P = .003) compared with those transported by EMS. Transport distance was a mean 5.5 times greater (88 vs 16 mi) in the HEMS group (P < .001). Within this cohort, 53% of patients transported via HEMS suffered smaller burns, compared with 73% transported by EMS. A subanalysis of the smaller burns cohort showed increased distances of transport via HEMS (91 vs 18 mi; P < .001) and increased rates of admission from the ED in the EMS group (93% vs 68% by HEMS; P = .005), yet no difference in length of stay, or rates of early discharge, defined as <24-hour hospital stay. Fully 1/4 of those transported via HEMS with smaller burns were discharged from the ED after burn consultation, debridement, and dressing. Mortality in both was nil. Average cost per helicopter transport was US$29K. Accurate triage and burn center consultation before scene transport or hospital transfer could help identify patients not benefiting from HEMS yet safely transferrable by ground, or better served by early clinic follow-up, which would reduce cost without compromising care in this cohort. Annual patient savings approximating US$444K could be multiplied were non-HEMS transport universally adopted for smaller burns.

scholarly journals Brain smart – Let's play safely: Evaluation of a concussion education program in schools

2021 ◽  
Vol 5 ◽  
pp. 205970022110244
Author(s):  
Katie Alison Falla ◽  
Sarah Randall ◽  
Carol DeMatteo
Keyword(s):  
School Board ◽  
Education Program ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Concussion Management ◽  
Chi Squared ◽  
Post Test ◽  
History Of ◽  
Concussion Knowledge ◽  
Concussion Education

Objectives There are two objectives for this paper. First, to determine effects of a concussion education program in a local school board in terms of concussion-specific knowledge in children and confidence in identifying and managing concussion in adults. Second, to identify differences and similarities in concussion knowledge between children who participate in sports and those who do not and between children with a history of one or more concussions and those without. Design A cross sectional survey regarding concussion knowledge was distributed randomly to students and adults at both pre- and posteducation timepoints. A concussion education program was disseminated across the school board for students between the distribution survey timepoints. Following the education program, adults and students completed their respective post-test surveys. Chi-squared tests in SPSS determined the significance of between-group differences. Results All 17 adults (100.0%) who had received concussion education recently reported confidence in their knowledge of concussion management, compared to 35.7% adults who had not received education for over a year (p = 0.020). For students, all of whom completed the concussion education training between the pre- and post-tests, there were no significant differences in concussion knowledge scores between athletes and non-athletes (either in or outside of school) or between those with a history of concussion and those without. There were no significant changes in concussion knowledge between the pre- and post-tests, except for one question. Conclusion Concussion education programs increase confidence of concussion management protocols in adults involved in sport, but they require improvements to better support knowledge amelioration, particularly for target groups that are at high risk of sustaining another injury.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

scholarly journals Evaluation of whole-body modalities for diagnosis of multifocal osteonecrosis—a pilot study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shunichi Yokota ◽  
Keita Sakamoto ◽  
Yukie Shimizu ◽  
Tsuyoshi Asano ◽  
Daisuke Takahashi ◽  
...  
Keyword(s):  
Study Data ◽  
Whole Body ◽  
Hematologic Disease ◽  
Hip Joints ◽  
Patient Demographics ◽  
Examination Time ◽  
History Of ◽  
Body Magnetic Resonance Imaging ◽  
The Cost ◽  
Body Bone

Abstract Background This study aimed to investigate the ability of whole-body bone scintigraphy (WB-BS) in the detection of multifocal osteonecrosis (ON) compared to whole-body magnetic resonance imaging (WB-MRI) and to clarify the characteristics of patients with multifocal ON among those with ON of the femoral head (ONFH) using WB-MRI. Methods Forty-six patients who had symptomatic ONFH and underwent surgery in our hospital from April 2019 to October 2020 were included in the study. Data on patient demographics, including age, sex, body mass index (BMI), history of corticosteroid intake, alcohol abuse, smoking, and symptomatic joints, were collected from their medical records. All patients underwent WB-MRI and WB-BS before surgery. Results The agreement in the detection of ON by WB-MRI vs the uptake lesions by WB-BS in the hip joints was moderate (κ = 0.584), while that in other joints was low (κ < 0.40). Among the 152 joints with ON detected by WB-MRI, 92 joints (60.5%) were symptomatic, and 60 joints (39.5%) were asymptomatic. Twelve out of the 46 (26.0%) patients had multifocal (three or more distinct anatomical sites) ON. Nonetheless, while WB-BS detected symptomatic ON detected by WB-MRI as uptake lesions in 82.6% (76/92) of the joints, asymptomatic ON detected by WB-MRI was detected as uptake lesions in 21.7% (13/60) of the joints. All patients with multifocal ON had a history of steroid therapy, which was significantly higher than that in patients with oligofocal ON (P = 0.035). The patients with a hematologic disease had multifocal ON at a higher rate (P = 0.015). Conclusions It might be difficult for WB-BS to detect the asymptomatic ON detected by WB-MRI compared to symptomatic ON. Considering the cost, examination time, and radiation exposure, WB-MRI might be useful for evaluating multifocal ON. Larger longitudinal studies evaluating the benefits of WB-MRI for detecting the risk factors for multifocal ON are required.

Abstract WP266: Microembolic Signals and Association With Stroke Etiology in Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael M Chen ◽  
Simin Mahinrad ◽  
Arth K Srivastava ◽  
Eric Liotta ◽  
Richard A Bernstein ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Transcranial Doppler Ultrasound ◽  
Small Vessel ◽  
Stroke Recurrence ◽  
Additional Information ◽  
Vessel Disease ◽  
Stroke Etiology ◽  
Chi Squared ◽  
Prognostic Utility ◽  
History Of

Background: Microembolic signals (MES) detected by the transcranial Doppler ultrasound (TCD) have established prognostic value for stroke recurrence in patients with carotid stenosis. However, the frequency of MES in the context of other stroke etiologies remains unknown. Methods: All stroke admissions to Northwestern Memorial hospital between 2016-2018 who underwent TCD within the first 48 hours of admission were reviewed. Final stroke diagnosis was extracted from chart review. Presence or absence of MES was extracted from clinical TCD reports. Frequency of stroke etiology among MES groups were compared using chi-squared test. Results: A total of 789 patient charts were reviewed (mean age 62±17 years, 55% male). MES were present in 95 patients. Demographics and medical history of patients were not different among those with and without MES. Compared to patients without MES, those with MES were more frequently diagnosed with cardioembolic stroke (36.4% vs 21%, p =0.001) and less frequently with small vessel disease stroke (5.7% vs 24%, p <0.001). However, there was no difference in the frequency of cryptogenic strokes between patients with and without MES ( p =0.844). Among patients with MES, the most frequent etiologies of stroke were cardioembolic (36.4%), cryptogenic (19.3%), large vessel disease (17.1%), and small vessel disease (5.7%). Conclusion: TCD detection of MES is seen across all stroke subtypes and may provide additional information for risk stratification in secondary stroke prevention. We are currently reviewing the prognostic utility of MES for stroke recurrence in this cohort.

SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Neil Donald ◽  
Lavanya Varatharajan ◽  
Kumaran Ratnasingham ◽  
Shashi Irukulla
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Ambulatory Care ◽  
Operating Time ◽  
District General Hospital ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Patient Demographics ◽  
Day Range ◽  
Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

Abstract 317: Costs and Benefits Associated with Transradial Percutaneous Coronary Intervention in China

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Chen Jin ◽  
Xin-ran Tang ◽  
Qiu-ting Dong ◽  
Wei Li ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Length Of Stay ◽  
Cost Saving ◽  
Coronary Intervention ◽  
Observational Research ◽  
Bleeding Complications ◽  
Costs And Benefits ◽  
Hospital Outcomes ◽  
Percutaneous Coronary

Background: Transradial percutaneous coronary intervention (TRI) has been increasingly used in the treatment of ischemic heart disease. While there are few studies examining the costs and benefits of transradial vs. transfemoral (TFI) in experienced centers among highly selected patients, treatment patterns and cost data obtained from the United States and European countries might not be generalizable to the developing world. Methods: We performed a retrospective analysis of patients undergoing PCI in the largest heart center in China between January and December 2010. Propensity score inverse probability weighting (IPW) method was used to compare costs and in-hospital outcomes between TRI and TFI, while controlling for potential treatment selection inherent in observational research. Results: Of 5,307patients undergoing PCI, 4,684 (88.3%) received TRI. Those undergoing TRI were younger, were less likely to be female, less likely to have prior myocardial infarction, PCI, or CABG, and more often presented with STEMI. After IPW adjustment, TRI was associated with fewer bleeding complications (BARC≥3 0.7% vs. 2.2%, OR 0.36, 95% CI 0.18-0.68), major adverse cardiovascular event (a composite of death, myocardial infarction, BARC bleeding≥3 or unplanned revascularization; 1.8% vs. 4.0%, OR 0.49, 95% CI 0.31-0.79), and shorter length of stay (6.1 vs 8.3 days, adjusted difference -1.5 days, 95% CI -1.9 to -1.2; Table ). TRI was associated with a cost saving of $1,261 (95% CI $967-$1,557) as compared with TFI. The cost saving was mainly driven by reduced procedural-related cost ($761) from differential use of vascular closure device and lower hospitalization cost ($217) related to shorter length of stay. Similar results were found in clinically relevant groups of myocardial infarction (STEMI and NSTEMI), acute coronary syndrome (STEMI, NSTEMI, and unstable angina), and stable angina. Conclusions: Compared with the TFI approach, TRI was associated with fewer complications, shorter length of stay, lower costs, and improved in-hospital outcomes.

Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael L James ◽  
Julian P Yand ◽  
Maria Grau-Sepulveda ◽  
DaiWai M Olson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Reference Group ◽  
Private Insurance ◽  
Quality Measures ◽  
Geographic Region ◽  
Insurance Status ◽  
Hospital Outcomes

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

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