Should COVID-19 Patients > 75 Years be Ventilated? An Outcome Study

Abstract Background Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population is limited. Aim To delineate the adverse factors associated with outcomes of COVID- 19 patients ≥75 years of age. Design Retrospective cohort study. Methods Patients were classified into mild/moderate, severe/very severe, and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. Results 355 patients aged ≥75 years hospitalized with COVID-19 between March 19th and April 25th, 2020 were included. Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease : 17.4%, severe/very severe disease : 71.3%, critical disease: 94.9%, p < 0.001). Increased age, dementia, and severe/very severe and critical disease groups were each significantly associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR : 0.12, 95% CI : 0.02-0.60, p < 0.05)]. None of the cardiovascular comorbidities were significantly associated with mortality. Conclusion Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

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Colorectal Cancer in Inflammatory Bowel Disease

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1713748 ◽

2020 ◽

Vol 33 (05) ◽

pp. 305-317

Author(s):

Martina Nebbia ◽

Nuha A. Yassin ◽

Antonino Spinelli

Keyword(s):

Colorectal Cancer ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Severe Disease ◽

Critical Role ◽

Mucosal Inflammation ◽

Surgical Approaches ◽

Increased Risk ◽

Significant Difference ◽

Inflammatory Bowel

AbstractPatients with inflammatory bowel disease (IBD) are at an increased risk for developing colorectal cancer (CRC). However, the incidence has declined over the past 30 years, which is probably attributed to raise awareness, successful CRC surveillance programs and improved control of mucosal inflammation through chemoprevention. The risk factors for IBD-related CRC include more severe disease (as reflected by the extent of disease and the duration of poorly controlled disease), family history of CRC, pseudo polyps, primary sclerosing cholangitis, and male sex. The molecular pathogenesis of inflammatory epithelium might play a critical role in the development of CRC. IBD-related CRC is characterized by fewer rectal tumors, more synchronous and poorly differentiated tumors compared with sporadic cancers. There is no significant difference in sex distribution, stage at presentation, or survival. Surveillance is vital for the detection and subsequently management of dysplasia. Most guidelines recommend initiation of surveillance colonoscopy at 8 to 10 years after IBD diagnosis, followed by subsequent surveillance of 1 to 2 yearly intervals. Traditionally, surveillance colonoscopies with random colonic biopsies were used. However, recent data suggest that high definition and chromoendoscopy are better methods of surveillance by improving sensitivity to previously “invisible” flat dysplastic lesions. Management of dysplasia, timing of surveillance, chemoprevention, and the surgical approaches are all areas that stimulate various discussions. The aim of this review is to provide an up-to-date focus on CRC in IBD, from laboratory to bedside.

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Outcomes of Infants with Mild Hypoxic Ischemic Encephalopathy Who Did Not Receive Therapeutic Hypothermia

Biomedicine Hub ◽

10.1159/000502936 ◽

2019 ◽

Vol 4 (3) ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Jonathan Reiss ◽

Mridu Sinha ◽

Jeffrey Gold ◽

Julie Bykowski ◽

Shelley M. Lawrence

Keyword(s):

Therapeutic Hypothermia ◽

Severe Disease ◽

Significant Risk ◽

Brain Magnetic Resonance Imaging ◽

Adverse Outcomes ◽

Hypoxic Ischemic Encephalopathy ◽

Neurodevelopmental Outcomes ◽

Specific Patient ◽

Increased Risk ◽

Ischemic Encephalopathy

Introduction: Accurately diagnosing and treating infants with mild forms of hypoxic ischemic encephalopathy (HIE) is important, as the majority of neonates with signs and symptoms of HIE after birth do not meet clinical criteria for moderate or severe disease. Emerging evidence, however, suggests that infants with mild HIE (mHIE) have an increased risk for neurodevelopmental impairment (NDI). Methods: This retrospective descriptive study examined all inborn infants ≥35 week’s gestational age at a single, level III neonatal intensive care unit (NICU) in California between January 1, 2012, and December 31, 2015. International Classification of Diseases codes were used as a proxy to identify neonates with mHIE but who did not receive therapeutic hypothermia (TH). Short- and long-term neurodevelopmental outcomes were documented, including abnormal (1) brain magnetic resonance imaging within 10 days of birth suggestive of HIE, (2) electroencephalogram with electrographic seizures, (3) neurologic discharge examination, or (4) NDI following NICU discharge. Results: Over the 4-year study period, 25 infants met inclusion criteria. Eight of 25 (32%) infants demonstrated neurologic impairment, defined by an abnormality in at least one of the four categories. The remaining 17 infants were without documented evidence for adverse outcomes. Conclusion: Our results indicate that children with mHIE are at significant risk for neurologic injury and may benefit from more aggressive interventions. Further prospective studies should be completed to determine the efficacy of TH in this specific patient population.

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Insulin Treatment May Increase Adverse Outcomes in Patients With COVID-19 and Diabetes: A Systematic Review and Meta-Analysis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.696087 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yan Yang ◽

Zixin Cai ◽

Jingjing Zhang

Keyword(s):

Hospital Admission ◽

Insulin Therapy ◽

Large Scale ◽

Insulin Treatment ◽

Meta Analysis ◽

Adverse Outcomes ◽

Cochrane Library ◽

Hospitalization Time ◽

Increased Risk ◽

Significant Difference

Background and ObjectiveRecently, insulin treatment has been found to be associated with increased mortality and other adverse outcomes in patients with coronavirus disease 2019 (COVID-19) and diabetes, but the results remain unclear and controversial, therefore, we conducted this meta-analysis.MethodsFour databases, namely, PubMed, Web of Science, EMBASE and the Cochrane Library, were used to identify all studies concerning insulin treatment and the adverse effects of COVID-19, including mortality, incidence of severe/critical complications, in-hospital admission and hospitalization time. To assess publication bias, funnel plots, Begg’s tests and Egger’s tests were used. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of insulin therapy on mortality, severe/critical complications and in-hospital admission. The association between insulin treatment and hospitalization time was calculated by the standardized mean difference (SMD) with 95% CIs.ResultsEighteen articles, involving a total of 12277 patients with COVID-19 and diabetes were included. Insulin treatment was significantly associated with an increased risk of mortality (OR=2.10; 95% CI, 1.51-2.93) and incidence of severe/critical COVID-19 complications (OR=2.56; 95% CI, 1.18-5.55). Moreover, insulin therapy may increase in-hospital admission in patients with COVID-19 and diabetes (OR=1.31; 95% CI, 1.06-1.61). However, there was no significant difference in the hospitalization time according to insulin treatment (SMD=0.21 95% CI, -0.02-0.45).ConclusionsInsulin treatment may increase mortality and severe/critical complications in patients with COVID-19 and diabetes, but more large-scale studies are needed to confirm and explore the exact mechanism.

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Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19

10.1101/2020.09.01.20186080 ◽

2020 ◽

Author(s):

Fangfei Xiang ◽

Jing Sun ◽

Po-Hung Chen ◽

Peijin Han ◽

Haipeng Zheng ◽

...

Keyword(s):

Regression Models ◽

Cox Regression ◽

Early Stage ◽

Severe Disease ◽

High Flow ◽

Adverse Outcomes ◽

Prolonged Hospitalization ◽

Severe Stage ◽

Increased Risk ◽

High Flow Oxygen

Background Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. The association of FIB-4 with COVID-19 outcomes has not been previously evaluated. Methods FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates. Results Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). Conclusions FIB-4 at early-stage of COVID-19 disease had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.

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Clonal Hematopoiesis Is Associated with Increased Risk of Progression of Asymptomatic Waldenström Macroglobulinemia

Blood ◽

10.1182/blood-2021-149711 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2678-2678

Author(s):

Sabrin Tahri ◽

Tarek H Mouhieddine ◽

Robert A. Redd ◽

Luisa Maria Lampe ◽

Katarina Nillson ◽

...

Keyword(s):

Research Funding ◽

Adverse Outcomes ◽

Waldenström Macroglobulinemia ◽

Clonal Hematopoiesis ◽

Non Hodgkin Lymphoma ◽

Dana Farber Cancer Institute ◽

Waldenstrom Macroglobulinemia ◽

Increased Risk ◽

Significant Difference ◽

Risk Of Progression

Abstract Introduction Clonal hematopoiesis (CH) is associated with adverse outcomes in patients with non-Hodgkin lymphoma (NHL) and multiple myeloma undergoing autologous stem cell transplantation. Still, its implications for patients with indolent NHL have not been well studied. Here, we report the prevalence of CH in patients with Waldenström Macroglobulinemia (WM) and its association with clinical outcomes. Methods We retrospectively reviewed clinical data of 602 patients with IgM monoclonal gammopathy of undetermined significance (MGUS), smoldering WM (SWM), and WM who had clinical next-generation sequencing (NGS) performed on bone marrow aspirates or peripheral blood obtained between October 2014 and February 2020 at the Dana-Farber Cancer Institute. An Illumina Truseq amplicon-based NGS assay of 95 genes recurrently mutated in myeloid and lymphoid neoplasms was utilized. Each specimen yielded ~2 million reads and ~1500X average coverage, with 90% of amplicons having >200X coverage. Pathogenic driver variants were identified based on mutation type, position, and frequency in published reports and public databases. To unambiguously differentiate CH mutations from those in the WM clone, CH was defined by the presence of somatic mutations in DNMT3A, TET2, or ASXL1 (DTA). Results The cohort included 147 patients with MGUS or asymptomatic WM and 453 patients with symptomatic WM, with a median age of 66 years (range = 40-89) and 68 years (range = 33-93), respectively, at the time of first NGS assay. The prevalence of CH-DTA was 14% in symptomatic WM patients and did not differ significantly in MGUS (13%) or SWM (14%). Among precursor patients, there was an increased risk of progression to symptomatic WM for those with CH-DTA [7/20 patients with vs. 11/116 without CH-DTA progressed over a median of 54 months (P = 0.002)]. In symptomatic WM patients, CH-DTA was positively associated with older age (P < 0.001) at the time of NGS, with a median age of 72 vs. 67 years for patients with versus those without CH-DTA. CH-DTA was not associated with inferior overall survival (OS) with a relatively short median follow-up from diagnosis and NGS assay. OS was 6.7 years (95% CI = 6.1-7.6) for patients with CH-DTA and 2.5 years for patients without DH-DTA (95% CI = 2.2-2.8). The most common cause of death was disease progression, with no significant difference between those with or without CH-DTA. Patients with CH-DTA had an increased risk of cardiovascular disease (30% vs. 18%, P = 0.036). Conclusions We demonstrate that CH is common in WM patients and is associated with an increased risk of progression from precursor states but not with inferior survival. Further work is needed to determine how the presence of CH might promote progression to WM and whether it can be incorporated into future risk stratification models. Importantly, our data do not support changes in clinical management or alterations in therapy for patients with WM and coexistent CH and reinforce the need to interpret NGS results within their specific clinical context. Disclosures Steensma: Novartis: Current Employment. Castillo: Abbvie: Consultancy, Research Funding; BeiGene: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Janssen: Consultancy; Roche: Consultancy; TG Therapeutics: Research Funding. Treon: X4: Research Funding; Dana Farber Cancer Institute: Current Employment; Janssen: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; BeiGene: Consultancy, Research Funding; Self: Patents & Royalties: Holder of multiple patents related to testing and treatment of MYD88 and CXCR4 mutated B-cell malignancies; BMS: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding. Ghobrial: AbbVie, Adaptive, Aptitude Health, BMS, Cellectar, Curio Science, Genetch, Janssen, Janssen Central American and Caribbean, Karyopharm, Medscape, Oncopeptides, Sanofi, Takeda, The Binding Site, GNS, GSK: Consultancy. Sperling: Adaptive: Consultancy.

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P5323HDL-C and all-cause mortality in a high-risk population: impact of LDL-C

European Heart Journal ◽

10.1093/eurheartj/ehz746.0292 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Dhindsa ◽

P B Sandesara ◽

C Liu ◽

M Topel ◽

A Mehta ◽

...

Keyword(s):

Enzyme Inhibitor ◽

Reference Group ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

High Risk Population ◽

Angiotensin Ii Receptor Blocker ◽

Risk Population ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality

Abstract Background Previous studies have shown increased cardiovascular (CV) risk with both high (>60mg/dl) and low concentrations of high-density lipoprotein cholesterol (HDL-C). The effect of elevated HDL-C levels (>60mg/dL) at differing LDL-C concentrations on outcomes is unknown. Purpose To study the relationship between elevated HDL-C levels (>60mg/dl) in relation to LDL-C concentration (greater vs less than 70mg/dL) and adverse CV outcomes in an at-risk population. Methods Participants included 5,746 individuals (mean age 63.3±12.4 years, 35% female, 23% African American) enrolled in the cardiovascular biobank. Individuals were stratified by HDL-C categories (<30, 31–40, 41–50, 51–60 and ≥60 mg/dL) and LDL-C categories (≥70 and <70 mg/dL). A Cox proportional hazards model was used to examine the association between HDL-C and adverse outcomes, with HDL-C 41–50 mg/dL as the reference group. All models were adjusted for age, race, sex, body mass index, hypertension, smoking, triglycerides, heart failure history, myocardial infarction (MI) history, diabetes, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, beta blocker use, statin use, aspirin use, estimated glomerular filtration rate, obstructive coronary artery disease. Results Over a median follow-up of 6.2 years (25th-75th percentiles = 3.3–8.0 years), a total of 286 MIs, 691 CV deaths and 1,093 all-cause deaths occurred. Individuals with HDL-C ≥60 mg/dL (n=632) had an increased risk of all-cause mortality with an LDL-C ≥70mgdL (HR 1.59; 95% CI=1.10–2.29, p=0.013) after adjustment for the aforementioned variables. This association was not statistically significant with LDL-C <70mg/dL (HR 1.16; 95% CI 0.60–1.21, p=0.66). There was no statistically significant difference for CV death or MI at elevated HDL-C in either group. Conclusion Elevated HDL-C levels is associated with increased all-cause mortality with an LDL-C ≥70mg/dL, though does not appear to be associated with worse outcomes when LDL-C is <70mg/dL.

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The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

10.21203/rs.3.rs-31124/v1 ◽

2020 ◽

Author(s):

Tianhang Zhang ◽

Lijing Yan ◽

Huashuai Chen ◽

Haiyu Jin ◽

Chenkai Wu

Keyword(s):

Older Adults ◽

Allostatic Load ◽

Adverse Outcomes ◽

Cox Models ◽

Chinese Older Adults ◽

Healthy Longevity ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality ◽

Wear And Tear

Abstract Background Allostatic load, as multiple biomarker measures of ‘wear and tear’ on physiological systems, has shown some promise that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest aging population in the world. This study is to examine the association between allostatic load (AL) and all-cause mortality among Chinese adults aged at least 60 years. Methods Data were from 2,439 participants in the Chinese Longitudinal Healthy Longevity Survey. The final analytic sample consisted of 1,519 participants. Cox models were used to examine the association between AL and mortality among men and women, separately. Analysis were also adjusted for potential confounders including age, ethnicity, education, and marital status, smoking and exercise. Results In the fully adjusted model, males with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 34% and 128% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden. Discussion Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong evidence about Allostatic load was associated with specific causes of death over the same follow-up period among women. In conclusion Intervention programs targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

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Syncope and Collapse Are Associated with an Increased Risk of Cardiovascular Disease and Mortality in Patients Undergoing Dialysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15102082 ◽

2018 ◽

Vol 15 (10) ◽

pp. 2082

Author(s):

Shih-Ting Huang ◽

Tung-Min Yu ◽

Tai-Yuan Ke ◽

Ming-Ju Wu ◽

Ya-Wen Chuang ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiovascular Events ◽

Incidence Rates ◽

Major Adverse Cardiovascular Events ◽

Study Cohort ◽

Coronary Syndrome ◽

Cardiovascular Comorbidities ◽

Increased Risk ◽

The Impact ◽

Overall Mortality

Objective: This study explored the impact of syncope and collapse (SC) on cardiovascular events and mortality in patients undergoing dialysis. Methods: Patients undergoing dialysis with SC (n = 3876) were selected as the study cohort and those without SC who were propensity score-matched at a 1:1 ratio were included as controls. Major adverse cardiovascular events (MACEs), including acute coronary syndrome (ACS), arrhythmia or cardiac arrest, stroke, and overall mortality, were evaluated and compared in both cohorts. Results: The mean follow-up periods until the occurrence of ACS, arrhythmia or cardiac arrest, stroke, and overall mortality in the SC cohort were 3.51 ± 2.90, 3.43 ± 2.93, 3.74 ± 2.97, and 3.76 ± 2.98 years, respectively. Compared with the patients without SC, those with SC had higher incidence rates of ACS (30.1 vs. 24.7 events/1000 people/year), arrhythmia or cardiac arrest (6.75 vs. 3.51 events/1000 people/year), and stroke (51.6 vs. 35.7 events/1000 people/year), with higher overall mortality (127.7 vs. 77.9 deaths/1000 people/year). The SC cohort also had higher risks for ACS, arrhythmia or cardiac arrest, stroke, and overall mortality (adjusted hazard ratios: 1.28 (95% confidence interval (CI) = 1.11–1.46), 2.05 (95% CI = 1.50–2.82), 1.48 (95% CI = 1.33–1.66), and 1.79 (95% CI = 1.67–1.92), respectively) than did the non-SC cohort. Conclusion: SC was significantly associated with cardiovascular events and overall mortality in the patients on dialysis. SC may serve as a prodrome for cardiovascular comorbidities, thereby assisting clinicians in identifying high-risk patients.

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Epidemiological Risk Factors Associated with Death and Severe Disease in Patients Suffering From COVID-19: A Comprehensive Systematic Review and Meta-analysis

10.1101/2020.06.19.20135483 ◽

2020 ◽

Cited By ~ 1

Author(s):

Kunchok Dorjee ◽

Hyunju Kim

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Fixed Effects ◽

Meta Analysis ◽

Severe Disease ◽

Case Series ◽

Adverse Outcomes ◽

Smoking History ◽

Increased Risk ◽

The Us

AbstractIntroductionProgression of COVID-19 to severe disease and death is insufficiently understood.ObjectiveSummarize the prevalence adverse outcomes, risk factors, and association of risk factors with adverse outcomes in COVID-19 patients.MethodsWe searched Medline, Embase and Web of Science for case-series and observational studies of hospitalized COVID-19 patients through May 22, 2020. Data were analyzed by fixed-effects meta-analysis, using Shore’s adjusted confidence intervals to address heterogeneity.ResultsForty-four studies comprising 20594 hospitalized patients met inclusion criteria; 12591 from the US-Europe and 7885 from China. Pooled prevalence of death [%(95% CI)] was 18% (15-22%). Of those that died, 76% were aged≥ 60 years, 68% were males, and 63%, 38%, and 29% had hypertension, diabetes and heart disease, respectively. The case fatality risk [%(95% CI)] were 62% (48-78) for heart disease, 51% (36-71) for COPD, and 42% (34-50) for age≥ 60 years and 49% (33-71) for chronic kidney disease (CKD). Summary relative risk (sRR) of death were higher for age≥ 60 years [sRR=3.8; 95% CI: 2.9-4.8; n=12 studies], males [1.3; 1.2-1.5; 17], smoking history [1.9; 1.1-3.3; n=6], COPD [2.0; 1.6-2.4; n=9], hypertension [1.8; 1.7-2.0; n=14], diabetes [1.5; 1.4-1.7; n=16], heart disease [2.0; 1.7-2.4; 16] and CKD [2.0; 1.3-3.1; 8]. The overall prevalence of hypertension (55%), diabetes (31%) and heart disease (16%) among COVODI-19 patients in the US were substantially higher than the general US population.ConclusionsPublic health screening for COVID-19 can be prioritized based on risk-groups. A higher prevalence of cardiovascular risk factors in COVID-19 patients can suggest increased risk of SARS-CoV-2 acquisition in the population.

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Outcome Disparities and Resource Utilization Among Limited English Proficient Patients After Tonsillectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211061996 ◽

2021 ◽

pp. 000348942110619

Author(s):

Michal Plocienniczak ◽

Batsheva R. Rubin ◽

Alekha Kolli ◽

Jessica Levi ◽

Lauren Tracy

Keyword(s):

Emergency Department ◽

Resource Utilization ◽

Limited English Proficiency ◽

English Proficiency ◽

Surgical Care ◽

Adverse Outcomes ◽

Utilization Rate ◽

Increased Risk ◽

Significant Difference ◽

The Impact

Objective: There is evidence to suggest adverse outcomes on patients’ medical and surgical care when there is language discordance in patient-physician relationships. No studies have evaluated the impact of limited English proficiency (LEP) on complications after common surgical procedures in otolaryngology. Furthermore, no studies have evaluated how patients with LEP utilize remote resources to connect with otolaryngology providers to better triage such complications. The purpose was to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) comparing patients with LEP to those with English proficiency (EP). Patients with PTH were retrospectively evaluated to identify preceding telephone encounters, a marker of resource utilization. Methods: Demographics, English proficiency, and PTH management (surgical vs non-surgical) were evaluated in addition to PTH-associated triage telephone encounters with otolaryngology providers. Results: Of 2466 tonsillectomies, there were 141 episodes of reported hemorrhage (50 LEP vs 91 EP) in the 5 years studied. Rates were not significantly different between LEP and EP patients (4.9% vs 6.3%, P = .127). There was no statistically significant difference in rate of preceding telephone encounters between LEP and EP patients (24% vs 40%, P = .062). Of patients presenting directly to the Emergency Department without a triage telephone encounter, there was no difference in operative versus non-operative management when comparing LEP versus EP patients. However, patients presenting directly to the Emergency Department were nearly twice as likely to undergo operative intervention compared to patients with preceding telephone encounters (RR = 1.79). Conclusion: Patients with limited English proficiency are not at increased risk for developing PTH. There is equitable access to remote otolaryngologic triage care, although overall the utilization rate of this resource was low for both cohorts.

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