Incidence of Laryngotracheal Stenosis after Thermal Inhalation Airway Injury

2019 ◽  
Vol 40 (6) ◽  
pp. 961-965 ◽  
Author(s):  
Anne Sun Lowery ◽  
Greg Dion ◽  
Callie Thompson ◽  
Liza Weavind ◽  
Justin Shinn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Patient Characteristics ◽  
Inhalation Injury ◽  
Interquartile Range ◽  
Laryngotracheal Stenosis ◽  
Chi Square ◽  
Laryngeal Function ◽  
Airway Injury ◽  
Incidence Risk

Abstract Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients’ records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann–Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7–57.5 vs 10.5, Interquartile Range 0–15.12, P = .01), higher grade of inhalation injury (mean 2.63 vs 1.80, P = .05), longer duration of intubation (12.63 vs 5.44; P < .001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P = .02, mean hyperglycemia on presentation 176.4 vs 136.9, P = .01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P < .001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.

scholarly journals Ectopic pregnancy at the Gambian Tertiary hospital

2021 ◽  
Vol 21 (1) ◽  
pp. 295-303
Author(s):  
Matthew Anyanwu ◽  
Grace Titilope
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Tertiary Hospital ◽  
Clinical Feature ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Significant Burden ◽  
Incidence Risk ◽  
Ectopic Pregnancies ◽  
The Tropics

Background/Aims: Ectopic pregnancy is a gynaecological emergency with significant burden of maternal mortality and morbidity in the tropics. The incidence reported in the literature range from 1:60 to 1:250 pregnancies. The aim was to determine incidence and risk factors of ectopic pregnancy in the Gambia. Methodology: A longitudinal study of ectopic pregnancy at Gambian tertiary hospital from January 2016 to April 2018. Data was collected from patients’ folders, entered into SPSS version 20 and analysed with de- scriptive statistics. The test of variation and significance was by ANOVA and Chi-square respectively with error margin set at 0.05 and confidence interval of 95%. Results: A total number of 2562 pregnancies were recorded, 43 were ectopic pregnancies. The estimated incidence was 0.2%. Majority of the patients were between 26 – 35 years (56%), primiparous (32%), heterogeneous marriage (82%) and housewives (86%). Occupation was not associated with ruptured or unruptured ectopic pregnancy (p-0.421). Low parity was associated with more ectopic pregnancy than high parity (p-0.001). The commonest clinical feature was abdominal pain (65.1%), whilst the most prominent risk factors were pelvic inflamma- tory disease (27.9%) and previous abortion (23.3%). Ectopic pregnancy was seasonal. Conclusion: The incidence rate of 0.2% was in the range reported in the literature. Low parity, previous abortion and pelvic inflammatory disease were the risk factors. Keywords: Ectopic; pregnancy; incidence; risk factors.

scholarly journals Incidence and outcome of gestational trophoblastic disease in lower Egypt

2020 ◽  
Vol 20 (1) ◽  
pp. 73-82
Author(s):  
Ahmed Zakaria ◽  
Reda Hemida ◽  
Waleed Elrefaie ◽  
Ehsan Refaie
Keyword(s):  
Risk Factors ◽  
Patient Characteristics ◽  
Gestational Trophoblastic Disease ◽  
Treatment Modalities ◽  
Progression Rate ◽  
Molar Pregnancy ◽  
Live Births ◽  
Trophoblastic Disease ◽  
Rate Of Progression ◽  
Incidence Risk

Background. Gestational trophoblastic disease (GTD) defines a spectrum of proliferative disorders of trophoblastic epitheli- um of the placenta. Incidence, risk factors, and outcome may differ from one country to another. Objective. To describe incidence, patient characteristics, treatment modalities, and outcome of GTD at Mansoura University which is a referral center of Lower Egypt. Methods. An observational prospective study was conducted at the GTD Clinic of Mansoura University. The patients were recruited for 12 months from September 2015 to August 2016. The patients’ characteristics, management, and outcome were reported. Results. We reported 71 clinically diagnosed GTD cases, 62 of them were histologically confirmed, 58 molar (33 CM and 25 PM) in addition to 4 initially presented GTN cases. Mean age of the studied cases was 26.22 years ± 9.30SD. Mean pre-evacu- ation hCG was 136170 m.i.u/ml ±175880 SD. Most of the cases diagnosed accidentally after abnormal sonographic findings (53.2%). Rate of progression of CM and PM to GTN was 24.2% and 8%, respectively. Conclusion. The incidence of molar pregnancy and GTN in our locality was estimated to be 13.1 and 3.2 per 1000 live births respectively. We found no significance between CM and PM regarding hCG level, time to hCG normalization, and progression rate to GTN. Keywords. Molar pregnancy; incidence; outcome.   

scholarly journals Delirium in Covid-19 Patients: Incidence, Risk Factors and Early Outcomes.

2021 ◽  
Author(s):  
Jorge Humberto Mejia-Mantilla ◽  
Andrés Gempeler ◽  
Leidy K Gaviria ◽  
Pablo Amaya ◽  
Jose Luis Aldana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Functional Outcomes ◽  
Patient Characteristics ◽  
Frequent Event ◽  
High Incidence ◽  
Incidence Risk ◽  
Prolonged Icu Stay ◽  
The Impact

Abstract Background Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes. Methods We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at discharge Results Among 333 patients, 58 (17.42%. 95% CI: 13.62–21.77%) presented delirium 16 (IQR: 11 − 20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR = 11.72, (95%CI = 4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs > 2 (70.7% vs 24.7%, p < 0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p < 0.0001) compared to patients without delirium. Conclusion Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium might not be specially related to SARS-CoV-2 infections, its high frequency during this pandemic could be the result of concurring factors shared between critically-ill patients and severe COVID-19 patients. Further research is granted to clarify this aspect

scholarly journals Duration of antibody responses following severe acute respiratory syndrome coronavirus 2 infection

2022 ◽  
Author(s):  
Yao Jiang ◽  
Xiuqi Wei ◽  
Hui Wang ◽  
Guiling Li
Keyword(s):  
Risk Factors ◽  
Severe Acute Respiratory Syndrome ◽  
Short Duration ◽  
Immunoglobulin G ◽  
Symptom Onset ◽  
Patient Characteristics ◽  
Antibody Responses ◽  
Multivariable Logistic Regression Analysis ◽  
Igg Antibodies ◽  
Chi Square

Abstract Background Little is known on the duration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies in patients following SARS-CoV-2 infection. Aims We aimed to determine the duration of the immunoglobulin G (IgG) and M (IgM) antibody responses following SARS-CoV-2 infection and to evaluate the risk factors for a short duration of anti-SARS-CoV-2 IgG. Methods We measured antibody responses in 94 patients who had recovered from SARS-CoV-2 infection. The chi-square test and multivariable logistic regression analysis were used to identify risk factors for a short duration (< 6 months) of anti-SARS-CoV-2 IgG. Results IgG antibodies were detectable in all patients until 4 months; 19 (21.8%) convalescent patients reverted to IgG negative 4–6 months after symptom onset. IgM antibodies decreased significantly to 5.7% at 4–6 months after symptom onset. Patient characteristics were not associated with a short duration of detectable IgG. Conclusions A substantial fraction of convalescents may exhibit a transient IgG response following SARS-CoV-2 infection. Our findings suggest that patients who have recovered from SARS-CoV-2 infection should also be vaccinated if their anti-SARS-CoV-2 IgG antibodies are undetectable.

599 Critical Burn Injury in Young Children: A New Challenge of Success

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S142-S143
Author(s):  
Rachelle J Lodescar ◽  
Palmer Q Bessey ◽  
Angela Rabbitts ◽  
Bruce M Greenwald ◽  
James Gallagher
Keyword(s):  
Young Children ◽  
Burn Injury ◽  
Wound Care ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Optimal Care ◽  
Chi Square ◽  
Joint Decision ◽  
Cooperative Approach ◽  
Vulnerable Patients

Abstract Introduction Critical burn injury in young children now happens rarely, thanks to many prevention efforts. The challenge that presents is that neither most burn center teams (BC) or pediatric critical care teams (PICU) have sufficient experience to maintain broad expertise in the care of these uncommon but vulnerable patients. Several years ago our BC team and PICU team agreed to co-manage these patients no matter where they were admitted in the hospital. The purpose of this report is to review the results of this cooperative approach. Methods We reviewed all pediatric admissions (age 0 to 15) admitted with acute burn injury from October 2015 – September 2019. We further identified those who were co-directed with the PICU. In those cases, senior members of both teams consulted either on the referral call or before the patient’s arrival, both teams rounded together on the patients, and most clinical decisions were made jointly. The burn team performed wound care with bedside caregivers from the PICU as needed. Where the patient was housed in the hospital (BC or PICU) was a secondary but joint decision, guided by the clinical needs of the patient and not by the preference of the team ‘in charge’ of the unit. Data were analyzed with SAS 9.4 and are expressed as Mean ± SEM. Differences in means were tested for significance with TTest and Chi Square. Results There were 799 patients admitted with burn injuries over the four-year period. Twenty-seven of them (3.4 ± 0.6 %) had a portion of their care co-directed. These were older than all other pediatric cases (4.9 ± 0.7 years vs 3.2 ± 1.5, p=0.03), and they had larger mean burn size (20 ± 7 % TBSA vs 4 ± 0.2, p=0.03). They more often had inhalation injury (40.7 ± 9.6 % vs 0.9 ± 0.3, p&lt; 0.01). The length of stay of the co-directed patients was longer than the other cases (14 ± 3 days vs 5 ± 1, p&lt; 0.01). Only two patients died: a four-year old with cardiac arrest at the scene from inhalation injury and a three-year old with inhalation injury and a deep burn &gt; 80% TBSA. Conclusions Critical burn injuries happen uncommonly in young children. They challenge burn centers, because they are unusual, and it is difficult for the burn team or the PICU team to maintain expertise in all aspects of their care. A cooperative, co-directed patient care model with both the BC and PICU teams may serve to provide optimal care to these infrequent but vulnerable patients. Applicability of Research to Practice Directly Applicable.

scholarly journals Delirium in Covid-19 patients: Incidence, Risk Factors and Early Outcomes.

2021 ◽  
Author(s):  
Jorge Humberto Mejia-Mantilla ◽  
Andrés Gempeler ◽  
Leidy K Gaviria ◽  
Pablo Amaya ◽  
Jose Luis Aldana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
High Frequency ◽  
Patient Characteristics ◽  
Frequent Event ◽  
High Incidence ◽  
Incidence Risk ◽  
Prolonged Icu Stay ◽  
The Impact

Abstract Background: Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes.Methods: We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at dischargeResults: Among 333 patients, 58 (17.42%. 95% CI: 13.62%–21.77%) presented delirium 16 (IQR: 11 –20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR=11.72, (95%CI=4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs>2 (70.7% vs 24.7%, p<0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p<0.0001) compared to patients without delirium.Conclusion: Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium is not specially related to SARS-CoV-2 infections, but rather its high frequency during this pandemic is the result of concurring factors shared between critically-ill patients and severe COVID-19 patients.

scholarly journals 117. Hospitalized Burn Patients with Fever and Leukocytosis: Blood Culture or Not?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S90
Author(s):  
Ruihong Luo ◽  
Paul Janoian
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Culture ◽  
Burn Injury ◽  
Central Venous Line ◽  
Inhalation Injury ◽  
Charlson Index ◽  
Burn Patients ◽  
Central Venous ◽  
Adjusted Model

Abstract Background Fever and leukocytosis are very common in patients with burn injury. Many patients had to do blood cultures frequently during their hospitalization given the concern of bacteremia. We opt to utilize the clinical characters of the patients to evaluate the risk for bacteremia and avoid unnecessary blood culture. Methods The adult patients (≥18 years) with burn injury were selected from the Nationwide Inpatient Sample database (2005–2014). Using ICD-9 codes, we further identified bacteremia, total body surface area (TBSA) of burn, inhalation injury, pneumonia, urinary tract infection, wound infection, escharotomy, placement of central venous line, indwelling urinary catheter, gastrostomy tube (G-tube), intubation, and total parenteral nutrition (TPN). The risk factors for bacteremia were evaluated by Logistic regression. A risk-adjusted model to predict the occurrence of bacteremia was developed by discriminant analysis. Results In total, 241,323 hospitalized patients with burn injury were identified. The incidence of bacteremia was 1.1% (n = 2,634). Comparing with the patients without bacteremia, those with bacteremia were older (51.1 vs. 46.7 year old, P < 0.001), had more severe burn injury (50.7% vs. 12% with burn TBSA over 20%, P < 0.001) and comorbidities (22.7% vs. 14.9% with Charlson index ≥2, P < 0.001), higher in-hospital mortality (5.6% vs. 3.7%, P < 0.001), longer hospital stay (26 vs. 5 days, P < 0.001) and more hospital charges ($206,028 vs. $30,339, P < 0.001). When the age, sex, race, and Charlson index of the patients were adjusted by Logistic regression, it was found that the factors of inhalation injury (OR = 1.25, 95% CI 1.03–1.51), intubation (OR = 1.62, 95% CI 1.44–1.82), TPN (OR = 1.56, 95% CI 1.16–2.11), placement of central venous line (OR = 1.86, 95% 1.57–2.01), and G-tube (OR = 2.04, 95% CI 1.60–2.60) were associated with increased risk for bacteremia. A risk-adjusted model composed of the patient’s age, Charlson index, burn TBSA, inhalation injury, intubation, TPN, placement of central venous line, and G-tube could predict the occurrence of bacteremia with an accurate rate of 85.4% (Table 1). Conclusion The risk factors and risk-adjusted model for bacteremia may assist to decide whether a blood culture is needed in the hospitalized burn patients. Disclosures All authors: No reported disclosures.

scholarly journals Survival analysis and mortality predictors of hospitalized severe burn victims in a Malaysian burns intensive care unit

2019 ◽  
Vol 7 ◽  
Author(s):  
Henry Tan Chor Lip ◽  
Jih Huei Tan ◽  
Mathew Thomas ◽  
Farrah-Hani Imran ◽  
Tuan Nur’ Azmah Tuan Mat
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Survival Analysis ◽  
Burn Injury ◽  
Survival Curve ◽  
Inhalation Injury ◽  
Burn Victims ◽  
Kaplan Meier ◽  
Simple Logistic ◽  
Meier Survival Curve

Abstract Background Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims. This is an important process of triaging patients with high risk of mortality that may be nursed in the acute care setting. Malaysian burn research is lacking with only one publication identified which describes the epidemiology of burn victims. Therefore, the objective of this study was to go one step further and identify the predictors of burn mortality from a Malaysian burns intensive care unit (BICU) which may be used to triage patients at higher risk of death. Methods This is a retrospective cohort study of all admissions to Hospital Sultan Ismail’s BICU from January 2010 till October 2015. Admission criteria were in accordance with the American Burn Association guidelines, and risk factors of interest were recorded. Data was analyzed using simple logistic regression to determine significant predictors of mortality. Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with log-rank test. Results Through the 6-year period, 393 patients were admitted with a male preponderance of 73.8%. The mean age and length of stay were 35.6 (±15.72) years and 15.3 (±18.91) days. There were 48 mortalities with an overall mortality rate of 12.2%. Significant risk factors identified on simple logistic regression were total body surface area (TBSA) &gt; 20% (p &lt; 0.001), inhalation injury (p &lt; 0.001) and presence of early systemic inflammatory response syndrome (SIRS) (p &lt; 0.001). Survival analysis using Kaplan-Meier survival curve showed similar results with TBSA &gt; 20%, presence of SIRS, mechanical ventilation and inhalation injury which were associated with poorer survival (p &lt; 0.001). Conclusion The predictors of mortality identified in a Malaysian BICU were TBSA &gt; 20%, early SIRS, mechanical ventilation and inhalation injury which were associated with poorer survival outcome. The immunological response differs from individual patients and influenced by the severity of burn injury. Early SIRS on admission is an important predictor of death and may represent the severity of burn injury. Patients who required mechanical ventilation were associated with mortality and it is likely related to the severity of pulmonary insults sustained by individual patients. This data is important for outcome prognostication and mortality risk counselling in severely burned patients.

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