scholarly journals 364. Baseline characteristics, comorbidities, and outcomes of COVID-19 patients hospitalized in Southwest Georgia, U.S. – an interim analysis of an early hot spot

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S251-S251
Author(s):  
Daniel B Chastain ◽  
Sharmon P Osae ◽  
Ashley M Burt ◽  
Kevin VanLandingham ◽  
Natalie Sibold ◽  
...  
Keyword(s):  
Chart Review ◽  
Hot Spot ◽  
Case Fatality ◽  
Retrospective Chart Review ◽  
Radiographic Findings ◽  
Mechanically Ventilated ◽  
Comorbidity Index ◽  
Baseline Characteristics ◽  
The U.S ◽  
Overall Mortality

Abstract Background Understanding the spectrum of disease severity and death are critical for identifying unrecognized risk factors associated with morbidity and mortality from coronavirus disease 19 (COVID-19). The purpose of this study was to describe the baseline characteristics, clinical presentation, and outcomes among patients hospitalized with COVID-19 in a major hotspot in the U.S. Southeast. Methods This multicenter retrospective chart review included adult patients hospitalized with COVID-19, defined by laboratory-detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in Southwest Georgia. The primary outcome was mortality, which was assessed through discharge or June 14, 2020, whichever occurred first. Secondary outcomes included comorbidities, laboratory and radiographic findings, as well as clinical course. Results A total of 120 patients were included with a median age of 61 years (IQR 50–72). The majority were African American (73%) and female (56%). Comorbidities on admission were present in 88% of patients; most prevalent were hypertension (76%), diabetes mellitus (55%), and chronic pulmonary disease (27%). Median Charlson comorbidity index was 4 (IQR 2–6) and BMI was 32.8 kg/m2 (IQR 26.2–39.5). On presentation, patients most often complained of dyspnea (69%), fever (63%), and cough (53%), with a median SOFA score of 2 (IQR 2–4). Most patients were admitted to the general ward (71%), of which 17% were subsequently transferred to ICU. During hospitalization, 27% were mechanically ventilated for a median 11 days (IQR 5–13.5), 18% developed ARDS, and 43% developed AKI. Median length of stay was 9.5 days (IQR 3.75–14). Overall mortality was 20%, which was significantly higher among patients with comorbidities (p = 0.047), as well as those who developed ARDS (p < 0.001) or AKI (p = 0.027). Conclusion Most reports of COVID-19 have focused on large urban settings. However, early during the pandemic, we identified a large cluster of cases with a high-case fatality rate in a semirural setting in Southwest Georgia in the U.S. Disclosures All Authors: No reported disclosures

scholarly journals Outcomes of Patients with Intestinal Failure after the Development and Implementation of a Multidisciplinary Team

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Sabrina Furtado ◽  
Najma Ahmed ◽  
Sylviane Forget ◽  
Ana Sant’Anna
Keyword(s):  
Multidisciplinary Team ◽  
Chart Review ◽  
Intestinal Failure ◽  
Retrospective Chart Review ◽  
Historical Cohort ◽  
Transplant Program ◽  
Multidisciplinary Program ◽  
Tertiary Center ◽  
The Impact ◽  
Overall Mortality

Aim. A multidisciplinary team was created in our institution to manage patients with intestinal failure (INFANT: INtestinal Failure Advanced Nutrition Team). We aimed to evaluate the impact of the implementation of the team on the outcomes of this patient population.Methods. Retrospective chart review of patients with intestinal failure over a 6-year period was performed. Outcomes of patients followed up by INFANT (2010–2012) were compared to a historical cohort (2007–2009).Results. Twenty-eight patients with intestinal failure were followed up by INFANT while the historical cohort was formed by 27 patients. There was no difference between the groups regarding remaining length of small and large bowel, presence of ICV, or number of infants who reached full enteral feeds. Patients followed up by INFANT took longer to attain full enteral feeds and had longer duration of PN, probably reflecting more complex cases. Overall mortality (14.8%/7.1%) was lower than other centers, probably illustrating our population of “early” intestinal failure patients.Conclusions. Our data demonstrates that the creation and implementation of a multidisciplinary program in a tertiary center without an intestinal and liver transplant program can lead to improvement in many aspects of their care.

scholarly journals Prevalence, Clinical Features, and Outcome of Pseudomonas Bacteremia in Under-Five Diarrheal Children in Bangladesh

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Farhana Akram ◽  
Mark A.C. Pietroni ◽  
Pradip Kumar Bardhan ◽  
Samira Bibi ◽  
Mohammod Jobayer Chisti
Keyword(s):  
Chart Review ◽  
Case Fatality ◽  
Severe Pneumonia ◽  
Retrospective Chart Review ◽  
Diarrhoeal Disease ◽  
Multidrug Resistant ◽  
Under Five ◽  
Disease Research ◽  
Resource Poor ◽  
Hospital Management System

We sought to evaluate the prevalence, associated factors, and outcome of under-five diarrheal children with either sex having Pseudomonas bacteremia. A retrospective chart review of under-five diarrheal children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 2011 to December 2011 was performed using an online hospital management system. Children with Pseudomonas bacteremia constituted the cases (n = 31), and the controls (n = 124), without Pseudomonas bacteremia, were randomly selected. The prevalence of Pseudomonas bacteremia was 1% (31/5,179). The Pseudomonas was multidrug resistant but was 84% sensitive to ceftazidime and 100% to imipenem. The case-fatality rate was significantly higher among the cases than the controls (26% versus 5%; P = 0.003). In logistic regression analysis, after adjusting for potential confounders such as severe wasting, severe underweight, severe pneumonia, and young age (11.71 (4.0, 18.0) months), the cases more often presented with absent peripheral pulses in absence of dehydration (95% CI = 2.31–24.45) on admission. This finding underscores the importance of early identification of this simple clinical sign to ensure prompt management including fluid resuscitation and broad spectrum antibiotics to help reduce morbidity and mortality in such children, especially in resource-poor settings.

Minimally Invasive Scoliosis Correction in Parkinson Disease: Retrospective Case Series

2020 ◽  
Author(s):  
Ravi S Nunna ◽  
Richard G Fessler
Keyword(s):  
Minimally Invasive ◽  
Parkinson Disease ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The United States ◽  
Invasive Technique ◽  
Radiographic Findings ◽  
Presenting Symptoms ◽  
Scoliosis Correction

Abstract BACKGROUND Parkinson disease (PD) is the second most common neurodegenerative disease in the United States. In the context of the disability inherent to PD, the additional physical challenges and pain from scoliosis can be debilitating for these patients. However, the magnitude of surgery required to correct the deformity combined with the medical co-morbidities and frailty in this population of patients makes surgery very risky. OBJECTIVE To investigate clinical presentations and outcomes of patients with PD that underwent minimally invasive long-segment fusion for scoliosis correction. METHODS A retrospective chart review was performed over the years 2007 to 2017 for patients diagnosed with PD undergoing long-segment spinal fusion (5 or more levels) with the use of circumferential minimally invasive spine surgery techniques. Data including age, sex, race, medical co-morbidities, presenting symptoms, radiographic findings, surgical procedure, case history, and complications were collected from the medical record. RESULTS Retrospective chart review revealed three patients that met the inclusion criteria. They included 2 males and 1 female, with a mean age of 68.7 yr (range 63-75 yr). Ability to maintain upright posture, return to activities of daily living, and visual analog scale (VAS)-back improved in all patients at 1-yr follow-up. Results were durable at 2-yr follow-up. No medical complications were observed. CONCLUSION The generally positive results suggest that minimally invasive technique could have significant benefits in this high-risk group of patients.

scholarly journals Initial Therapy of Bacterial Meningitis with Cefuroxime: Experience in 167 Children

1992 ◽  
Vol 3 (4) ◽  
pp. 162-166
Author(s):  
Lissette Navas ◽  
Susan M King ◽  
Ronald Gold
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Case Fatality Rate ◽  
Chart Review ◽  
Case Fatality ◽  
Retrospective Chart Review ◽  
Initial Therapy ◽  
Fatality Rate ◽  
Sick Children ◽  
Previous Prospective Study

The morbidity and mortality of patients with bacterial meningitis treated initially with cefuroxime were studied and compared with the results of a previous prospective study of patients treated initially with ampicillin plus chloramphenicol in the same institution from 1979 to 1983. A retrospective chart review was completed in all cases of microbiologically confirmed bacterial meningitis admitted to the Hospital for Sick Children in Toronto, Ontario between January 1, 1984 and August 1, 1988. During this period all patients were treated initially with intravenous cefuroxime. The 167 children reviewed ranged in age from six weeks to 17.1 years (median 11.6 months). The case fatality rate was 7.8% and the rate of hearing deficit 13%. There were no statistically significant differences in abnormal neurological outcome (20 versus 20%, respectively), hearing loss (12.9 versus 13%, respectively), and case fatality rate (6.4 versus 7.8%, respectively) between the cohort of 1979–83 and the present study. The rate of hearing loss following meningitis caused byHaemophilus influenzaetype b increased from 7.3 to 11.7% (P=0.26).

scholarly journals Factors and outcomes related to the use of guideline-recommended antibiotics in patients with neutropenic fever at the Uganda Cancer Institute

2021 ◽  
Author(s):  
Elizabeth A Gulleen ◽  
Scott V Adams ◽  
Bickey Chang ◽  
Lauren Falk ◽  
Riley Hazard ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Chart Review ◽  
Case Fatality ◽  
Retrospective Chart Review ◽  
Neutropenic Fever ◽  
Sub Saharan Africa ◽  
Antibiotic Management ◽  
Delayed Initiation ◽  
Sub Saharan ◽  
Selection Of

Abstract Background Neutropenic fever (NF) is associated with significant morbidity and mortality for patients receiving cancer treatment in sub-Saharan Africa (sSA). However, the antibiotic management of NF in sSA has not been well described. We evaluated the timing and selection of antibiotics for patients with NF at the Uganda Cancer Institute (UCI). Methods We conducted a retrospective chart review of adults with acute leukemia admitted to UCI from January 1, 2016, to May 31, 2017, who developed NF. For each NF event, we evaluated the association of clinical presentation and demographics with antibiotic selection as well as time to both initial and guideline-recommended antibiotics. We also evaluated the association between ordered antibiotics and the in-hospital case fatality ratio (CFR). Results Forty-nine NF events occurred among 39 patients. The time to initial antibiotic order was <1 day. Guideline-recommended antibiotics were ordered for 37 (75%) NF events. The median time to guideline-recommended antibiotics was 3 days. Fever at admission, a documented physical examination, and abdominal abnormalities were associated with a shorter time to initial and guideline-recommended antibiotics. The in-hospital CFR was 43%. There was no difference in in-hospital mortality when guideline-recommended antibiotics were ordered as compared to when non-guideline or no antibiotics were ordered. (HR: 0.51, 95%CI: [0.10, 2.64] and 0.78, 95%CI: [0.20, 2.96], respectively). Conclusions Patients with acute leukemia and NF had delayed initiation of guideline-recommended antibiotics and a high CFR. Prospective studies are needed to determine optimal NF management in sSA, including choice of antibiotics and timing of antibiotic initiation.

scholarly journals Enterococcal Bacteremia in a Tertiary Care Centre in Winnipeg

1999 ◽  
Vol 10 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Tariq AA Madani ◽  
Amin Kabani ◽  
Pamela Orr ◽  
Lindsay Nicolle
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Clinical Microbiology Laboratory ◽  
Tertiary Care Centre ◽  
Vancomycin Resistant ◽  
Polymicrobial Bacteremia ◽  
High Level ◽  
Enterococcal Bacteremia ◽  
Overall Mortality

OBJECTIVE: To review experience with enterococcal bacteremia before the emergence of vancomycin-resistant enterococcus at a tertiary care teaching hospital.DESIGN: Retrospective chart review of episodes of enterococcal bacteremia identified through the clinical microbiology laboratory from January 1990 to December 1994. Antimicrobial susceptibilities were performed for all isolates and pulsed-field gel electrophoresis for genetic typing of selected strains.RESULTS: One hundred and twenty-six episodes of bacteremia were identified in 109 patients: 108Enterococcus faecalis, 13Enterococcus faecium, four bothE faecalisandE faecium, and oneEnterococcus durans. Enterococcal isolates occurred with polymicrobial bacteremia in 62 (49%) episodes. The most common sites of infection were central venous catheters (45%) and the urinary tract (21%). Enterococcal bacteremia was usually nosocomially acquired (88%), and associated with older age, instrumentation, and prior or current antimicrobial therapy. Overall mortality was 22%, and 7.2% was partially or fully attributable to enterococcal bacteremia. Resistance to ampicillin, high level gentamicin and high level streptomycin were 0%, 32% and 31% forE faecalis, respectively, and 44%, 0% and 47% forE faecium, respectively.CONCLUSIONS: During this review, the frequency and impact of enterococcal bacteremia at this institution was relatively limited. Isolates resistant to ampicillin and aminoglycosides were emerging, but differences in patient outcomes were similar for resistant and susceptible isolates.

scholarly journals Tocilizumab for Treatment of Mechanically Ventilated Patients With COVID-19

2020 ◽  
Author(s):  
Emily C Somers ◽  
Gregory A Eschenauer ◽  
Jonathan P Troost ◽  
Jonathan L Golob ◽  
Tejal N Gandhi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Case Fatality ◽  
Severity Scale ◽  
Day Case ◽  
Mechanically Ventilated ◽  
Inverse Probability ◽  
Level Increase ◽  
Secondary Analyses ◽  
Baseline Characteristics

Abstract Background Severe coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is an approved treatment. Methods We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared with tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability of treatment weighting (IPTW). Results 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range, 28–67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean: 55 vs 60 years), less likely to have chronic pulmonary disease (10% vs 28%), and had lower D-dimer values at time of intubation (median: 2.4 vs 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death (HR, .55; 95% CI, .33–.90) and improved status on the ordinal outcome scale [OR per 1-level increase, .58; .36–.94). Although tocilizumab was associated with an increased proportion of patients with superinfections (54% vs 26%; P < .001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection (22% vs 15%; P = .42). Staphylococcus aureus accounted for ~50% of bacterial pneumonia. Conclusions In this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with lower mortality despite higher superinfection occurrence.

Diaphragmatic Injuries: What Has Changed over a 20-Year Period?

2010 ◽  
Vol 76 (5) ◽  
pp. 512-516 ◽  
Author(s):  
Peter P. Lopez ◽  
Jorge Arango ◽  
Theresa M. Gallup ◽  
Stephen M. Cohn ◽  
John Myers ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chart Review ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Retrospective Chart Review ◽  
Diaphragmatic Injury ◽  
Associated Injuries ◽  
Severity Scores ◽  
Diaphragm Injuries ◽  
Overall Mortality

Traumatic diaphragmatic injuries are uncommon events but are associated with a high mortality. We hypothesize that injury pattern has changed over time with increasing prevalence of blunt injuries. A retrospective chart review was performed of 124 patients who sustained traumatic diaphragmatic injuries over the 20-year period between January 1,1986 and December 31, 2005. Penetrating trauma accounted for 65 per cent (80/124) of all diaphragm injuries, and blunt trauma for 35 per cent (44/124). Mean Injury Severity Scores of 19 ± 9 and 34 ± 13 were observed for the penetrating and blunt trauma groups, respectively ( P = 0.001). Blunt traumatic diaphragm injuries increased from 13 per cent in the first 10-year period to 66 per cent in the second 10-year period ( P = 0.001). The overall mortality was 9 per cent (11/124) with 10 deaths resulting from blunt trauma and one resulting from penetrating trauma ( P < 0.001). The mortality rate increased from 3 to 17 per cent over the two decades ( P = 0.007). Our data suggests that over the last 20 years, the increase in mortality associated with traumatic diaphragmatic injury is primarily related to an increase in the proportion of patients with blunt trauma as a cause of their diaphragmatic injury and associated injuries.

scholarly journals Benzodiazepine Use and Morbidity-Mortality Outcomes in a Geriatric Palliative Care Unit: A Retrospective Review

2021 ◽  
pp. 1-9
Author(s):  
Helen Senderovich ◽  
Sandra Gardner ◽  
Anna Berall ◽  
Michael Ganion ◽  
Dennis Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Scale Score ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Hospice And Palliative Care ◽  
Performance Scale ◽  
Overall Mortality

<b><i>Introduction:</i></b> Patients often experience delirium at the end of life. Benzodiazepine use may be associated with an increased risk of developing delirium. Alternate medications used in conjunction with benzodiazepines may serve as an independent precipitant of delirium. The aim is to understand the role of benzodiazepines in precipitating delirium and advanced mortality in palliative care population at the end of life. <b><i>Methods:</i></b> A retrospective medical chart review was conducted at a hospice and palliative care inpatient unit between the periods of June 2017–December 2017 and October 2017–November 2018. It included patients in hospice and palliative care inpatient units who received a benzodiazepine and those who did not. Patient characteristics, as well as Palliative Performance Scale score, diagnosis, and occurrence of admission, terminal, and/or recurrent delirium, were collected and analyzed. <b><i>Results:</i></b> Use of a benzodiazepine was not significantly associated with overall mortality nor cause-specific death without terminal delirium rate. However, it was significantly associated with higher cause-specific death with terminal delirium rate and a higher recurrent delirium rate. <b><i>Discussion:</i></b> This retrospective chart review suggests an association between benzodiazepine use and specific states of delirium and cause-specific death. However, it does not provide strong evidence on the use of this drug, especially at the end of life, as it pertains to the overall mortality rate. Suggested is a contextual approach to the use of benzodiazepines and the need to consider Palliative Performance Scale score and goals of care in the administration of this drug at varying periods during patient length of stay.

scholarly journals Warfarin Quality Metrics for Hospitalized Older Adults

TH Open ◽  
2018 ◽  
Vol 02 (03) ◽  
pp. e242-e249 ◽  
Author(s):  
Jessica Cohen ◽  
Liron Sinvani ◽  
Jason Wang ◽  
Andrzej Kozikowski ◽  
Vidhi Patel ◽  
...  
Keyword(s):  
Chart Review ◽  
Adverse Drug Events ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Quality Metrics ◽  
Management Tools ◽  
Older Inpatients ◽  
History Of ◽  
Hospitalized Older Adults ◽  
Overall Mortality

Background Warfarin's adverse drug events are dangerous, common, and costly. While outpatient warfarin management tools exist, there is a dearth of guidance for inpatients. Objectives We sought to describe a health system's chronic warfarin quality metrics in older inpatients, defined by international normalized ratio (INR) control, explore associations between INR overshoots and clinical outcomes, and identify factors associated with overshoots. Patients/Methods Data on patients 65 years and older who were prescribed chronic warfarin and admitted during January 1, 2014, to June 30, 2016, were extracted through retrospective chart review. We defined overshoots as INRs 5 or greater after 48 hours of hospitalization. Logistic regression modeling was used to determine risks for overshoots and multivariate analysis for overshoots' association with length of stay (LOS), bleeding, and mortality. Results Of the 12,107 older inpatients on chronic warfarin, most were 75 years or older (75.7%), female (51.2%), and white (70.0%). While 1,333 (11.0%) of patients had overshoots during the admission, 449 (33.7%) of these reached overshoots after 48 hours. When stratified by overshoots versus no overshoots, LOS more than doubled (15.6 vs. 6.8 days) and the bleed rate was significantly higher (27.4 vs. 8.3%) in the overshoot group. While overall mortality was small (0.4%), the overshoot group's mortality was significantly higher (3.12 vs. 0.28%). Black race and weight were protective against overshoots; history of heart failure and antibiotic/amiodarone exposure were predictive of overshoots. Conclusion This is the largest study examining warfarin quality metrics for hospitalized adults, specifically older inpatients. Our model may serve as the basis for identifying high-risk warfarin patients to target interventions to reduce adverse drug events.

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