57 Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of 2495 Children

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S38-S38
Author(s):  
Bronwyn R Griffin ◽  
Cody Frear ◽  
Ed Oakley ◽  
Roy M Kimble
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Skin Grafting ◽  
First Aid ◽  
Hospital Length Of Stay ◽  
Early Management ◽  
Running Water ◽  
Pediatric Burns

Abstract Introduction First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective was to analyze the associations between first aid and skin grafting requirements in children with burns. Methods This cohort study utilized a prospectively collected registry of patients managed at a tertiary children’s hospital. Multivariate logistic regression models were used to evaluate the relation ship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and theater interventions. Adequate first aid was defined as 20 minutes of cool running water within three hours of injury. Results In our cohort of 2495 children, 2259 (90.6%) received first aid involving running water, but only 1780 (71.3%) were given the adequate duration. A total of 236 (9.5%) children required grafting. The odds of grafting were decreased in the adequate first aid group (OR 0.6, 95% CI 0.4 to 0.8). The provision of adequate running water was further associated with reductions in the full-thickness depth (OR 0.4, 95% CI 0.2 to 0.6), hospital admission (OR 0.7, 95% CI 0.5 to 0.9) and theater operations (OR 0.7, 95% CI 0.5 to 0.9), but not hospital length of stay (HR=0.9, 95% CI 0.7 to 1.2, p=0.48). Conclusions Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by pre-hospital and emergency services in the preliminary management of pediatric burns. Applicability of Research to Practice Although children are at particularly high risk of burn injuries there was a paucity of literature addressing the relationship between burn first aid and clinical outcomes in pediatric populations. Due to differences in volume, surface area and skin thickness it was unknown whether benefits in adults applied to children. This study supports the prioritization of the administration of cool running water for 20 minutes to be adhered to immediately after a pediatric burn to decrease the severity and improve patient outcomes.

scholarly journals Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children

2020 ◽  
Vol 75 (1) ◽  
pp. 75-85 ◽  
Author(s):  
Bronwyn R. Griffin ◽  
Cody C. Frear ◽  
Franz Babl ◽  
Ed Oakley ◽  
Roy M. Kimble
Keyword(s):  
Cohort Study ◽  
Skin Grafting ◽  
First Aid ◽  
Running Water ◽  
Pediatric Burns

scholarly journals Treatment with a DPP-4 inhibitor at time of hospital admission for COVID-19 is not associated with improved clinical outcomes: data from the COVID-PREDICT cohort study in The Netherlands

2021 ◽  
Author(s):  
Rick I. Meijer ◽  
Trynke Hoekstra ◽  
Niels C. Gritters van den Oever ◽  
Suat Simsek ◽  
Joop P. van den Bergh ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Infectious Complications ◽  
Glucose Lowering ◽  
Diabetes Severity ◽  
Outcome Mortality

Abstract Purpose Inhibition of dipeptidyl peptidase (DPP-)4 could reduce coronavirus disease 2019 (COVID-19) severity by reducing inflammation and enhancing tissue repair beyond glucose lowering. We aimed to assess this in a prospective cohort study. Methods We studied in 565 patients with type 2 diabetes in the CovidPredict Clinical Course Cohort whether use of a DPP-4 inhibitor prior to hospital admission due to COVID-19 was associated with improved clinical outcomes. Using crude analyses and propensity score matching (on age, sex and BMI), 28 patients using a DPP-4 inhibitor were identified and compared to non-users. Results No differences were found in the primary outcome mortality (matched-analysis = odds-ratio: 0,94 [95% confidence interval: 0,69 – 1,28], p-value: 0,689) or any of the secondary outcomes (ICU admission, invasive ventilation, thrombotic events or infectious complications). Additional analyses comparing users of DPP-4 inhibitors with subgroups of non-users (subgroup 1: users of metformin and sulphonylurea; subgroup 2: users of any insulin combination), allowing to correct for diabetes severity, did not yield different results. Conclusions We conclude that outpatient use of a DPP-4 inhibitor does not affect the clinical outcomes of patients with type 2 diabetes who are hospitalized because of COVID-19 infection.

scholarly journals Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi-Yong Zeng ◽  
Shao-Dan Feng ◽  
Gong-Ping Chen ◽  
Jiang-Nan Wu
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Characteristic Curve ◽  
Adverse Outcomes ◽  
Neutrophil To Lymphocyte Ratio ◽  
Predictive Values ◽  
Lymphocyte Ratio

Abstract Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.

Medical Comorbidity in Psychiatric Inpatients: Relation to Clinical Outcomes and Hospital Length of Stay

2002 ◽  
Vol 43 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Constantine G. Lyketsos ◽  
Gary Dunn ◽  
Michael J. Kaminsky ◽  
William R. Breakey
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Psychiatric Inpatients ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medical Comorbidity

scholarly journals Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bindu Vekaria ◽  
Christopher Overton ◽  
Arkadiusz Wiśniowski ◽  
Shazaad Ahmad ◽  
Andrea Aparicio-Castro ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Failure Time ◽  
National Level ◽  
Hospital Length ◽  
Survival Model ◽  
Data Driven ◽  
Hospital Length Of Stay ◽  
Similar Data ◽  
Model Complex

Abstract Background Predicting hospital length of stay (LoS) for patients with COVID-19 infection is essential to ensure that adequate bed capacity can be provided without unnecessarily restricting care for patients with other conditions. Here, we demonstrate the utility of three complementary methods for predicting LoS using UK national- and hospital-level data. Method On a national scale, relevant patients were identified from the COVID-19 Hospitalisation in England Surveillance System (CHESS) reports. An Accelerated Failure Time (AFT) survival model and a truncation corrected method (TC), both with underlying Weibull distributions, were fitted to the data to estimate LoS from hospital admission date to an outcome (death or discharge) and from hospital admission date to Intensive Care Unit (ICU) admission date. In a second approach we fit a multi-state (MS) survival model to data directly from the Manchester University NHS Foundation Trust (MFT). We develop a planning tool that uses LoS estimates from these models to predict bed occupancy. Results All methods produced similar overall estimates of LoS for overall hospital stay, given a patient is not admitted to ICU (8.4, 9.1 and 8.0 days for AFT, TC and MS, respectively). Estimates differ more significantly between the local and national level when considering ICU. National estimates for ICU LoS from AFT and TC were 12.4 and 13.4 days, whereas in local data the MS method produced estimates of 18.9 days. Conclusions Given the complexity and partiality of different data sources and the rapidly evolving nature of the COVID-19 pandemic, it is most appropriate to use multiple analysis methods on multiple datasets. The AFT method accounts for censored cases, but does not allow for simultaneous consideration of different outcomes. The TC method does not include censored cases, instead correcting for truncation in the data, but does consider these different outcomes. The MS method can model complex pathways to different outcomes whilst accounting for censoring, but cannot handle non-random case missingness. Overall, we conclude that data-driven modelling approaches of LoS using these methods is useful in epidemic planning and management, and should be considered for widespread adoption throughout healthcare systems internationally where similar data resources exist.

scholarly journals Thoracic muscle cross-sectional area is associated with hospital length of stay post lung transplantation: a retrospective cohort study

2017 ◽  
Vol 30 (7) ◽  
pp. 713-724 ◽  
Author(s):  
Dmitry Rozenberg ◽  
Sunita Mathur ◽  
Margaret Herridge ◽  
Roger Goldstein ◽  
Heidi Schmidt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Lung Transplantation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Sectional Area ◽  
Cross Sectional ◽  
Muscle Cross Sectional Area

scholarly journals Clinical outcomes of colistin in combination with either 6-g sulbactam or carbapenems for the treatment of extensively drug-resistant Acinetobacter baumannii pneumonia with high MIC to sulbactam, a prospective cohort study

2019 ◽  
Author(s):  
Chutchawan Ungthammakhun ◽  
Vasin Vasikasin ◽  
Dhitiwat Changpradub
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mortality Rates ◽  
P Value ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is an important cause of nosocomial pneumonia with limited therapeutic options. Colistin based regimen is recommended treatment. Which drugs should be combined with colistin remains uncertain. The aim of this study was to investigate the clinical outcomes of patients with XDRAB pneumonia who were treated with colistin, combined with either 6-g sulbactam or carbapenems, in the setting of high MIC to sulbactam. Methods: In this prospective cohort study, hospitalized patients diagnosed with XDRAB pneumonia in Phramongkutklao Hospital were enrolled. The primary outcome was the 28-day mortality. Secondary outcomes were 7 and 14-day mortality, length of stay, ventilator days and factors associated with mortality. Results: From 1 July 2016 to 30 September 2017, 192 patients were included; 92 received colistin plus sulbactam and 90 received colistin plus carbapenems. Most of the patients were male diagnosed with ventilator associated pneumonia in medical intensive care unit. Overall mortality rates at 7, 14, 28 days were 24.2%, 37.4%, 53.3%, respectively. Mortality rates did not differ between sulbactam group and carbapenems groups at 7 days (19.6% vs. 28.9%, p-value 0.424, adjusted HR 1.277; 95% CI = 0.702-2.322), 14 days (34.8% vs. 40%, p = 0.658, adjusted HR 1.109; 95% CI = 0.703-1.749) and 28 days (51.1% vs. 55.6%, p = 0.857, adjusted HR 1.038; 95% CI = 0.690-1.562). Length of stay, ICU days and ventilator days did not differ. Complications of treatment including acute kidney injury were not statistically different. Conclusions: In XDRAB pneumonia with high MIC to sulbactam, mortality rates were not statistically significant between colistin plus 6-g sulbactam and colistin plus carbapenems. Keywords: XDR A. baumannii pneumonia, mortality rate, colistin based, sulbactam, carbapenems

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