scholarly journals 1002. Epidemiology of Pneumococcal Bacteremia in a Large Tertiary Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S298-S298
Author(s):  
Aristotle Asis ◽  
Esmeralda Gutierrez-Asis ◽  
Ali Hassoun
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
The United States ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
High Morbidity ◽  
Icu Stay ◽  
Pneumococcal Bacteremia ◽  
Tertiary Center

Abstract Background Streptococcus pneumoniae remains an important cause of bacteremia in the United States with high morbidity and mortality despite readily available treatment and vaccines. Increased incidence of bacteremia observed during 2017–2018 season. Methods Retrospective chart review of patients admitted with pneumococcal bacteremia over the last two winter seasons. Demographics, laboratory data, ICU stay, need for ventilation or pressor, comorbidities, and mortality were collected. Results Fifty-three patients enrolled. 62% admitted during 2017–2018. Sixty-six percent white, 60% male, mean BMI 27 (38% had normal BMI). Mean age was 55 years (1–93) (57% > 61). Mean hospital length of stay was 7.8 days (1–30). More than 40% required ICU stay. The use of NPPV, vasopressors, and mechanical ventilation were 6%, 15%, and 17%, respectively. Most common presentation: dyspnea 30% and fever 18%. Smoking history (55%). Eighty percent of these patients had pneumonia. Resistance to penicillin 9% and intermediate susceptibility 6%. Resistance to erythromycin 44% and trimethoprim-sulfamethoxazole 12% which increased during winter 2017 (52% and 12%) compared with winter 2016 (30% and 10%). Only 2% of patients with pneumonia had positive sputum culture for pneumococcus and 62% had positive serum pneumococcal antigen with bacteremia. Positive co-detection of bacterial or viral targets in sputum using Multiplex PCR did not correlate with mortality and hospital stay but they were more likely needed ICU stay, use of vasopressor and mechanical ventilation. 43% of empiric therapy was as recommended by IDSA guidelines. Comparing 2016 vs. 2017 seasons, mortality (15% vs. 6%), hospital stay (9 days vs. 7 days), use of NPPV (5% vs. 6%) mechanical ventilation (15% vs. 18%) and vasopressor (5% vs. 21%). No correlation between influenza infection and bacteremia. Overall 6-month mortality and re-admission rate was 9% and 2%, respectively. Mortality was higher in overweight patients (60% vs. 20%), non-smokers (40% vs. 20%), coronary artery disease (40%) and congestive heart failure (40%). Conclusion Pneumococcal bacteremia cause significant morbidity and mortality, we observed less mortality and hospital stay, but more use of NPPV, mechanical ventilation, and vasopressor during 2017–2018 season which had widespread influenza like activity. Disclosures All authors: No reported disclosures.

scholarly journals Clinical outcomes among patients infected with Omicron (B.1.1.529) SARS-CoV-2 variant in southern California

2022 ◽  
Author(s):  
Joseph A Lewnard ◽  
Vennis X Hong ◽  
Manish M Patel ◽  
Rebecca Kahn ◽  
Marc Lipsitch ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Southern California ◽  
Hospital Admissions ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Hospital Length Of Stay ◽  
Gene Target ◽  
Icu Admission

Background: The Omicron (B.1.1.529) variant of SARS-CoV-2 has rapidly achieved global dissemination, accounting for most infections in the United States by December 2021. Risk of severe outcomes associated with Omicron infections, as compared to earlier SARS-CoV-2 variants, remains unclear. Methods: We analyzed clinical and epidemiologic data from cases testing positive for SARS-CoV-2 infection within the Kaiser Permanente Southern California healthcare system from November 30, 2021 to January 1, 2022, using S gene target failure (SGTF) as assessed by the ThermoFisher TaqPath ComboKit assay as a proxy for Omicron infection. We fit Cox proportional hazards models to compare time to any hospital admission and hospital admissions associated with new-onset respiratory symptoms, intensive care unit (ICU) admission, mechanical ventilation, and mortality among cases with Omicron and Delta (non-SGTF) variant infections. We fit parametric competing risk models to compare lengths of hospital stay among admitted cases with Omicron and Delta variant infections. Results: Our analyses included 52,297 cases with SGTF (Omicron) and 16,982 cases with non-SGTF (Delta [B.1.617.2]) infections, respectively. Hospital admissions occurred among 235 (0.5%) and 222 (1.3%) of cases with Omicron and Delta variant infections, respectively. Among cases first tested in outpatient settings, the adjusted hazard ratios for any subsequent hospital admission and symptomatic hospital admission associated with Omicron variant infection were 0.48 (0.36-0.64) and 0.47 (0.35-0.62), respectively. Rates of ICU admission and mortality after an outpatient positive test were 0.26 (0.10-0.73) and 0.09 (0.01-0.75) fold as high among cases with Omicron variant infection as compared to cases with Delta variant infection. Zero cases with Omicron variant infection received mechanical ventilation, as compared to 11 cases with Delta variant infections throughout the period of follow-up (two-sided p<0.001). Median duration of hospital stay was 3.4 (2.8-4.1) days shorter for hospitalized cases with Omicron variant infections as compared to hospitalized patients with Delta variant infections, reflecting a 69.6% (64.0-74.5%) reduction in hospital length of stay. Conclusions: During a period with mixed Delta and Omicron variant circulation, SARS-CoV-2 infections with presumed Omicron variant infection were associated with substantially reduced risk of severe clinical endpoints and shorter durations of hospital stay.

Factors Associated with Respiratory Support after Cesarean Hysterectomy

2021 ◽  
Vol 104 (8) ◽  
pp. 1347-1353
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Blood Components ◽  
Factors Associated ◽  
Cesarean Hysterectomy ◽  
Asa Classification ◽  
The Relationship ◽  
Postoperative Mechanical Ventilation

Background: Cesarean hysterectomy is a major operation that causes massive hemorrhage and larger fluid resuscitation. Thus, postoperative mechanical ventilation support is required in some patients, involving longer hospital stay and high cost of hospital care. Objective: To find the predictive factors for postoperative respiratory support in pregnant women underwent cesarean hysterectomy. Materials and Methods: A retrospective review of patients underwent cesarean hysterectomy between January 2014 and June 2019 was conducted. Patient characteristics, anesthetic records and hospital length of stay were reviewed. The relationship between factors and postoperative mechanical ventilator (PMV) was also analyzed. Results: A total of 180 patients were included in the present study, wherein, 64 patients (35%) required PMV and 30 patients (16%) needed postoperative oxygen support. Multivariable logistic regression was used to identify the relationship between PMV and the associated factors. The authors found the American Society of Anesthesiologists (ASA) classification and the volume of intraoperative blood components replacement (packed red blood cells [PRC] and fresh frozen plasma [FFP]) were significantly related to PMV: ASA3 16.51 (95% CI 1.89 to 144.33), ASA4 183.25 (95% CI 2.92 to 11,500.65), p=0.003; PRC 1.0028 (95% CI 1.0008 to 1.0047), p=0.001; FFP 1.0022 (95% CI 1.0000 to 1.0043), p=0.029, respectively. Conclusion: Postoperative mechanical ventilation was found in one-third of the cesarean hysterectomy patients and associated with ICU admission along with increased in post-operative length of hospital stay. The ASA classification and intraoperative volume of blood components replacement were significantly associated with PMV. Factors associated significantly with respiratory support were ASA classification and duration surgery. Keywords: Factors associated; Respiratory support; Cesarean hysterectomy

scholarly journals Clinical Course and Outcomes of Sickle Cell Disease Patients with COVID-19 at a New York Hospital

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-36
Author(s):  
Anita Mazloom ◽  
Neil Nimkar ◽  
Sonal Paul ◽  
Ayanna Baptiste
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
Sickle Cell Disease ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Clinical Course ◽  
The United States ◽  
Acute Chest Syndrome ◽  
Cell Disease

Introduction: The outbreak of a novel infection, COVID-19, has greatly impacted the well-being of individuals worldwide. Persons with sickle cell disease (SCD) constitute a vulnerable population, subject to health disparities, who may have worse outcomes from COVID-19. Within the United States, New York has a large population of patients with SCD. Here, we analyze the clinical course and outcomes of SCD patients with COVID-19 who were admitted to a community teaching hospital in Brooklyn, NY. Methods: We conducted a retrospective chart review of adult patients with SCD hospitalized with laboratory- confirmed COVID-19. Electronic health records were reviewed to identify patients and analyze their clinical course. Clinical characteristics, laboratory and radiology data were assessed. Rates of acute chest syndrome (ACS), acute kidney injury (AKI) and venous thromboembolism (VTE) were determined. ACS was defined by the presence of fever and/or respiratory symptoms accompanied by a new pulmonary infiltrate on chest Xray. Data on use of blood transfusion, treatments, length of stay and mortality were collected. Results: Between March 1 to June 30, 2020, 53 adults with SCD were hospitalized at our institution. Of these, 13 patients had COVID-19 infection. The mean (±SD) age of the COVID-19 patients was 34±10 years (range, 22 to 50) with 54% being female. Seven patients (54%) were Hb SS, and 6 patients (46%) were Hb SC. Comorbid conditions included Diabetes Mellitus (1 patient), SLE (1), End-stage renal disease (1), prior VTE (4) and Avascular necrosis of hip (3). Four patients were on hydroxyurea. Clinical, laboratory and radiological findings are summarized in Table 1. While all the Hb SS patients presented with vaso-occlusive crisis, 4 of the 6 patients with Hb SC did not have symptoms of pain crisis. Chest pain and cough were the most common symptoms at presentation. During the hospital stay, 12 patients (92%) had at least one febrile episode &gt;38°C, with 77% having recurrent fevers above 38.5°C. Eleven patients (85%) met criteria for ACS. Seventy-seven percent of all patients required supplemental oxygen. Nine patients (69%) were transfused, with 4 patients undergoing exchange transfusion. Sixty-seven percent of the transfused patients were transfused within 48 hours of admission. No patients required intubation or mechanical ventilation and none were admitted to the intensive care unit (ICU). Five patients (38.5%) received hydroxychloroquine while 84.6% were treated with antibiotics. No patient received remdesivir. Three patients (23%) developed AKI: of these, one patient required acute hemodialysis, the other two cases were mild with peak creatinine less than 2.0 mg/dl. Ninety-two percent of patients received prophylactic anticoagulation with either unfractionated heparin, enoxaparin or fondaparinux. One patient who did not receive an anticoagulant due to thrombocytopenia developed an acute deep vein thrombosis which was also catheter-related. Of note, during the initial phase of the pandemic standard dosing of prophylactic anticoagulants were used but in the later months, some patients received higher prophylactic doses in keeping with hospital protocol. The median length of hospital stay was 9.4 days (interquartile range, 8.1 to 13.3). There were no deaths - all patients were discharged home. Summary: Panepinto et al (Emerg Infect Dis.) reported a mortality of 7% in 178 SCD patients with COVID-19 in the United States. Other published reports have detailed more favorable outcomes (Arlet et al, Lancet and Appiah-Kubi et al, Br J Haematol.). In this small retrospective analysis of hospitalized SCD patients, there was no mortality. Acute chest syndrome was the most common complication observed. VTE and severe AKI were infrequent. Blood transfusion was performed in the majority of patients (69%); two thirds of the patients transfused received blood within 48 hours of hospitalization. There were no ICU admissions and no use of mechanical ventilation indicative perhaps of less severe COVID-19 disease. This may have been due to the young age of the cohort. Early use of blood transfusion may have been a factor in reducing disease severity and improving outcomes. The best approach to managing these patients is unclear. We advocate for the development and dissemination of evidence-based guidelines to manage SCD patients with COVID-19 to reduce morbidity and mortality in this at-risk population. Disclosures No relevant conflicts of interest to declare.

scholarly journals P035 EMERGENCY BILATERAL GORIN HERNIA REPAIR IN UNILATERAL COMPLICATED INGUINAL HERNIA REAPIR WITH CONCOMITNAT CONTRALATERAL HERNIA. COHORTS COMPARATIVE OUTCOMES ANALYSIS USING PROPENSITY SCORE MATCHING

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Alejandro Bravo-Salva ◽  
Francisco Rómulo Ochoa-Segarra ◽  
Ana María Gonzálz-Castillo ◽  
Joan Sancho-Insenser ◽  
Miguel Pera-Roman ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Propensity Score ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Inguinal Hernia Repair ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Bilateral Inguinal Hernia ◽  
Bilateral Hernia

Abstract Aim Aim of our study was to analyze outcomes and safety of bilateral inguinal hernia repair in unilateral groin complicated hernia with contralateral groin hernia. Material and Methods Retrospective cohorts study following STROBE statements on a prospective Emergency Surgery Department database. Inclusion criteria were: patients with emergency hernia repair from 2008 to 2018, 18 years old. Unilateral or bilateral inguinal hernia repair without other abdominal wall hernia repairs. Comparative analysis between two group unilateral hernia repair (UH) vs bilateral hernia repair (BH) those patients with unilateral complicated inguinal hernia with contralateral inguinal hernia. Propensity score matching (PSM) between groups was performed to eliminate statistically groups differences. Outcomes between groups were analyzed with special attention to postoperative morbimortality and hernia recurrence. Results 341 patients were included, 38(11.1%) were performed bilateral hernia repair. Groups differences were: higher rate of inguinoscrotal inguinal hernia (36.8 vs 22.8), prophylactic antibiotics use (94.7 vs 81.8) and general Anesthesia use (52.6% vs 50.2%). General high rates of morbidity and mortality were observed (5.9% and 41.9) and 22 (6.5%) hernia repair recurrence were detected. After PSM no differences between surgery outcomes groups were observed with similar morbidity, recurrence or hospital stay. Conclusions Emergency inguinal hernia repair has high morbidity and mortality rates in our experience. Emergency Bilateral inguinal hernia repair in context of hernia complication seems safe without recurrence or hospital stay increase.

Length of hospital stay in aneurysmal subarachnoid hemorrhage patients without vasospasm on angiography: potential for a fast-track discharge cohort

2021 ◽  
pp. neurintsurg-2021-017424
Author(s):  
Joshua S Catapano ◽  
Visish M Srinivasan ◽  
Kavelin Rumalla ◽  
Mohamed A Labib ◽  
Candice L Nguyen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Neurologic Outcome ◽  
Angiographic Vasospasm ◽  
Fisher Grade ◽  
Tertiary Center

BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) frequently suffer from vasospasm. We analyzed the association between absence of early angiographic vasospasm and early discharge.MethodsAll aSAH patients treated from August 1, 2007, to July 31, 2019, at a single tertiary center were reviewed. Patients undergoing diagnostic digital subtraction angiography (DSA) on post-aSAH days 5 to 7 were analyzed; cohorts with and without angiographic vasospasm (angiographic reports by attending neurovascular surgeons) were compared. Primary outcome was hospital length of stay; secondary outcomes were intensive care unit length of stay, 30 day return to the emergency department (ED), and poor neurologic outcome, defined as a modified Rankin Scale (mRS) score >2.ResultsA total of 298 patients underwent DSA on post-aSAH day 5, 6, or 7. Most patients (n=188, 63%) had angiographic vasospasm; 110 patients (37%) did not. Patients without vasospasm had a significantly lower mean length of hospital stay than vasospasm patients (18.0±7.1 days vs 22.4±8.6 days; p<0.001). The two cohorts did not differ significantly in the proportion of patients with mRS scores >2 at last follow-up or those returning to the ED before 30 days. After adjustment for Hunt and Hess scores, Fisher grade, admission Glasgow Coma Scale score, and age, logistic regression analysis showed that the absence of vasospasm on post-aSAH days 5–7 predicted discharge on or before hospital day 14 (OR 3.4, 95% CI 1.8 to 6.4, p<0.001).ConclusionLack of angiographic vasospasm 5 to 7 days after aSAH is associated with shorter hospitalization, with no increase in 30 day ED visits or poor neurologic outcome.

Accurate Medication Adherence Measurement Using Administrative Data for Frequently Hospitalized Patients

2020 ◽  
pp. 001857872091855
Author(s):  
Rafia S. Rasu ◽  
Suzanne L. Hunt ◽  
Junqiang Dai ◽  
Huizhong Cui ◽  
Milind A. Phadnis ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Hospital Stay ◽  
Claims Data ◽  
Medication Possession Ratio ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Administrative Claims ◽  
P2y12 Inhibitors ◽  
Over Time

Background: Pharmacy administrative claims data remain an accessible and efficient source to measure medication adherence for frequently hospitalized patient populations that are systematically excluded from the landmark drug trials. Published pharmacotherapy studies use medication possession ratio (MPR) and proportion of days covered (PDC) to calculate medication adherence and usually fail to incorporate hospitalization and prescription overlap/gap from claims data. To make the cacophony of adherence measures clearer, this study created a refined hospital-adjusted algorithm to capture pharmacotherapy adherence among patients with end-stage renal disease (ESRD). Methods: The United States Renal Data System (USRDS) registry of ESRD was used to determine prescription-filling patterns of those receiving new prescriptions for oral P2Y12 inhibitors (P2Y12-I) between 2011 and 2015. P2Y12-I-naïve patients were followed until death, kidney transplantation, discontinuing medications, or loss to follow-up. After flagging/censoring key variables, the algorithm adjusted for hospital length of stay (LOS) and medication overlap. Hospital-adjusted medication adherence (HA-PDC) was calculated and compared with traditional MPR and PDC methods. Analyses were performed with SAS software. Results: Hospitalization occurred for 78% of the cohort (N = 46 514). The median LOS was 12 (interquartile range [IQR] = 2-34) days. MPR and PDC were 61% (IQR = 29%-94%) and 59% (IQR = 31%-93%), respectively. After applying adjustments for overlapping coverage days and hospital stays independently, HA-PDC adherence values changed in 41% and 52.7% of the cohort, respectively. When adjustments for overlap and hospital stay were made concurrently, HA-PDC adherence values changed in 68% of the cohort by 5.8% (HA-PDC median = 0.68, IQR = 0.31-0.93). HA-PDC declined over time (3M-6M-9M-12M). Nearly 48% of the cohort had a ≥30 days refill gap in the first 3 months, and this increased over time ( P < .0001). Conclusions: Refill gaps should be investigated carefully to capture accurate pharmacotherapy adherence. HA-PDC measures increased adherence substantially when adjustments for hospital stay and medication refill overlaps are made. Furthermore, if hospitalizations were ignored for medications that are included in Medicare quality measures, such as Medicare STAR program, the apparent reduction in adherence might be associated with lower quality and health plan reimbursement.

Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1055-1059 ◽  
Author(s):  
Yi-Ren Chen ◽  
Maxwell Boakye ◽  
Robert T. Arrigo ◽  
Paul S. A. Kalanithi ◽  
Ivan Cheng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Treatment Modality ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Complication Rates ◽  
Term Survival ◽  
Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

scholarly journals Experience of Minimal Invasive Cardiac Surgery for repair of Atrial Septal Defects- A Single Center Study

2021 ◽  
Vol 14 (1) ◽  
pp. 37-43
Author(s):  
Mohammad Rokonujjaman ◽  
Naveen SK ◽  
Shaheedul Islam ◽  
Nusrat Ghafoor ◽  
Syed Tanvir Ahmad ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Median Sternotomy ◽  
Minimal Invasive ◽  
Aortic Occlusion ◽  
Invasive Technique ◽  
Safe Procedure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Icu Stay

Background: Atrial Septal Defects (ASD) can be closed surgically using conventional midline sternotomy or minimal invasive technique. This study was done to evaluate the outcome and safety of the minimal invasive cardiac surgical (MICS) approach using right vertical infra axillary incision (RVAI) for the repair of ASD. Methods: We performed a prospective observational cross-sectional analysis on 50 patients who were diagnosed as ASD of various types and not amenable to device closure. Their surgery was done RVAI using central cardiopulmonary bypass. Outcome of the study was evaluated using the following variables: length of the incision, satisfaction of patients, mortality, infection of surgical site, blood transfusion, duration of total operation, intensive care unit (ICU) stay, mechanical ventilation, hospital stay and aortic occlusion. Operations were done between December 2013 to December 2020. All the recruited patients were treated through RVAI as per patient’s choice. Results: Mean age was 11.4± 6.4 years. 18(36%) were male and 32(64%) were female. Body weight ranged from 10 to 65 kg. Mean length of incision was 6.2±0.8 cm. Mean aortic occlusion time was 42±14 min. ASD closed directly, using autologous treated pericardial patch or dacron patch. Mean total operation time was 4.08±0.6 hours and mean mechanical ventilation time was 8.3±5 hours. Average ICU stay was 35.6±6 hours and total hospital stay was 7.2±0.9 days. There was no significant blood loss. Only 10 patients required intravenous (IV) analgesics in the post-operative period. One patient required re-exploration, one conversion to median sternotomy and one suffered from superficial skin infection. There were no operative or late mortalities. Patient satisfaction was excellent. Conclusions: MICS technique using RVAI for surgical repair of ASD revealed a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard median sternotomy. Cardiovasc j 2021; 14(1): 37-43

Race Impacts Outcomes of Patients With Firearm Injuries

2020 ◽  
Vol 86 (9) ◽  
pp. 1113-1118
Author(s):  
Heather Peluso ◽  
John D. Cull ◽  
Marwan S. Abougergi
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Traumatic Shock ◽  
Hospital Length Of Stay ◽  
Firearm Injuries ◽  
Black Patients ◽  
Hospitalization Costs

Background To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. Methods The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). Results The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: −0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). Discussion Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.

Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database

2019 ◽  
Vol 35 (1) ◽  
pp. 48-54
Author(s):  
Marjorie Bateman ◽  
Ala Alkhatib ◽  
Thomas John ◽  
Malhar Parikh ◽  
Fayez Kheir
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Hospital Stay ◽  
Disease Severity ◽  
Pleural Fluid ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pleural Effusions ◽  
Icu Stay

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P < .0001), 1-month (43.1% vs 36.1%, P < .0001), 6-month (63.6% vs 55.7%, P < .0001), and 1-year mortality (73.8% vs 66.1%, P < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P < .0001), ICU stay (7.3 vs 5.1 days, P < .0001), need for mechanical ventilation (63.1% vs 55.7%, P < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P = .0002), 1-month (47.7% vs 39.7%, P = .0005), 6-month (67.1% vs 61.8%, P = .0161), and 1-year mortality (77.1% vs 72.1%, P = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P < .0001), ICU stay (9.2d vs 6.4 days, P < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P < .0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.

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