Validation and Calibration of the Risk Stratification Index

2017 ◽  
Vol 126 (4) ◽  
pp. 623-630 ◽  
Author(s):  
George F. Chamoun ◽  
Linyan Li ◽  
Nassib G. Chamoun ◽  
Vikas Saini ◽  
Daniel I. Sessler
Keyword(s):  
Length Of Stay ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Analysis Data ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Data Set ◽  
Procedure Codes ◽  
The Impact ◽  
Present On Admission

Abstract Background The Risk Stratification Index was developed from 35 million Medicare hospitalizations from 2001 to 2006 but has yet to be externally validated on an independent large national data set, nor has it been calibrated. Finally, the Medicare Analysis and Provider Review file now allows 25 rather than 9 diagnostic codes and 25 rather than 6 procedure codes and includes present-on-admission flags. The authors sought to validate the index on new data, test the impact of present-on-admission codes, test the impact of the expansion to 25 diagnostic and procedure codes, and calibrate the model. Methods The authors applied the original index coefficients to 39,753,036 records from the 2007–2012 Medicare Analysis data set and calibrated the model. The authors compared their results with 25 diagnostic and 25 procedure codes, with results after restricting the model to the first 9 diagnostic and 6 procedure codes and to codes present on admission. Results The original coefficients applied to the 2007–2012 data set yielded C statistics of 0.83 for 1-yr mortality, 0.84 for 30-day mortality, 0.94 for in-hospital mortality, and 0.86 for median length of stay—values nearly identical to those originally reported. Calibration equations performed well against observed outcomes. The 2007–2012 model discriminated similarly when codes were restricted to nine diagnostic and six procedure codes. Present-on-admission models were about 10% less predictive for in-hospital mortality and hospital length of stay but were comparably predictive for 30-day and 1-yr mortality. Conclusions Risk stratification performance was largely unchanged by additional diagnostic and procedure codes and only slightly worsened by restricting analysis to codes present on admission. The Risk Stratification Index, after calibration, thus provides excellent discrimination and calibration for important health services outcomes and thus appears to be a good basis for making hospital comparisons.

Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 33 (7) ◽  
pp. 383-393 ◽  
Author(s):  
Jing Chen ◽  
Dalong Sun ◽  
Weiming Yang ◽  
Mingli Liu ◽  
Shufan Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

scholarly journals P080: What is the impact of post-intubation hypotension on mortality and in-hospital length of stay?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S92
Author(s):  
D. Lachance-Perreault ◽  
J. Turgeon ◽  
V. Boucher ◽  
M. Émond
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Vital Signs ◽  
Mortality Rates ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Historical Cohort ◽  
Resuscitation Room ◽  
Post Intubation ◽  
The Impact

Introduction: Hypotension is known to severely impact the prognosis of patients in need of acute care. Endotracheal intubation (EI) is a procedure that is often used in the emergency room for patients with severe conditions. Post-intubation hypotension (PHI) is a well-known adverse effect of EI, although the impact of PHI on mortality is still unclear. The objective of this study was therefore to evaluate the association between post-intubation hypotension (PIH) and in-hospital mortality rates and length of stay (LOS). Methods: Design: A historical cohort of patients admitted in a university-affiliated emergency department (ED) between 06/2011 and 05/2016 was constituted. Population: Patients aged ≥16 were included if pre-EI vital signs were available, if their intubation was performed in the resuscitation room, if no surgical access was needed and if EI was performed in ≤3 attempts. Measures: All clinical data including vitals were prospectively recorded using the software ReaScribe. Hypotension was defined as a systolic blood pressure ≤90 mmHg. The occurrence of PIH was assessed at 5, 15, 30 minutes and any time after intubation. Main outcomes were in-hospital mortality and hospital length of stay. Analyses: Univariate and multivariate analyses assessed the relation between PHI and outcomes. Results: A total of 497 patients were included in our analyses. Of these patients, 63 (12.7%) suffered from PIH at 5 minutes, 120 (24,1%) at 15 minutes, 168 (33,8%) at 30 minutes and 209 (42%) at any moment after intubation. Mortality rates were 42.9% (n = 27), 35.8% (n = 43), 33.9% (n = 57) and 30.6%(n = 64) for patients who presented PIH at the 4 time periods, respectively, while 26.74% patients died in the normotensive group. PIH at 5 (p = 0.006), 15 (p = 0.04) and 30 minutes (p = 0.05) was associated with a significant increase in overall post-intubation mortality. Mean LOS for patients who suffered from PIH was 16.7, 18.9, 17.3, 17.4 days compared to 19.5 (p = 0.22) days for the normotensive group. Conclusion: Early post-intubation hypotension at 5 minutes was strongly associated with an increased mortality. As for the in-hospital length of stay, PIH was not associated with an increased LOS. Our results show that PIH within 30 minutes of intubation is associated with an increased mortality rate and should therefore be aggressively treated or prevented.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Outcomes of Neutropenic Patients with Clostridium difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s339-s340
Author(s):  
Roopali Sharma ◽  
Deepali Dixit ◽  
Sherin Pathickal ◽  
Jenny Park ◽  
Bernice Lee ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Treatment Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
End Point ◽  
Neutropenic Patients

Background: Data from Clostridium difficile infection (CDI) in neutropenic patients are still scarce. Objective: To assess outcomes of CDI in patients with and without neutropenia. Methods: The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results: Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P = .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P < .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P = .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions: Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding: NoneDisclosures: None

scholarly journals 562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S346-S346
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
David Reeves ◽  
Christian Cheatham
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Fungal Infections ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Matched Design ◽  
Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin &gt; 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer &gt; 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

In-Hospital Mortality and Related Outcomes for Elevated Risk Acute Pulmonary Embolism Treated With Mechanical Thrombectomy Versus Routine Care

2021 ◽  
pp. 088506662110364
Author(s):  
Jennifer R. Buckley ◽  
Brandt C. Wible
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Routine Care ◽  
Hospital Length ◽  
Elevated Risk ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay

Purpose To compare in-hospital mortality and other hospitalization related outcomes of elevated risk patients (Pulmonary Embolism Severity Index [PESI] score of 4 or 5, and, European Society of Cardiology [ESC] classification of intermediate-high or high risk) with acute central pulmonary embolism (PE) treated with mechanical thrombectomy (MT) using the Inari FlowTriever device versus those treated with routine care (RC). Materials and Methods Retrospective data was collected of all patients with acute, central PE treated at a single institution over 2 concurrent 18-month periods. All collected patients were risk stratified using the PESI and ESC Guidelines. The comparison was made between patients with acute PE with PESI scores of 4 or 5, and, ESC classification of intermediate-high or high risk based on treatment type: MT and RC. The primary endpoint evaluated was in-hospital mortality. Secondary endpoints included intensive care unit (ICU) length of stay, total hospital length of stay, and 30-day readmission. Results Fifty-eight patients met inclusion criteria, 28 in the MT group and 30 in the RC group. Most RC patients were treated with systemic anticoagulation alone (24 of 30). In-hospital mortality was significantly lower for the MT group than for the RC group (3.6% vs 23.3%, P < .05), as was the average ICU length of stay (2.1 ± 1.2 vs 6.1 ± 8.6 days, P < .05). Total hospital length of stay and 30-day readmission rates were similar between MT and RC groups. Conclusion Initial retrospective comparison suggests MT can improve in-hospital mortality and decrease ICU length of stay for patients with acute, central PE of elevated risk (PESI 4 or 5, and, ESC intermediate-high or high risk).

scholarly journals The Impact of Selenium Supplementation on Trauma Patients—Systematic Review and Meta-Analysis

Nutrients ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 342
Author(s):  
Jen-Fu Huang ◽  
Chih-Po Hsu ◽  
Chun-Hsiang Ouyang ◽  
Chi-Tung Cheng ◽  
Chia-Cheng Wang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Current Evidence ◽  
Trauma Patients ◽  
Positive Effects ◽  
Standard Difference ◽  
The Impact

This study aimed to assess current evidence regarding the effect of selenium (Se) supplementation on the prognosis in patients sustaining trauma. MEDLINE, Embase, and Web of Science databases were searched with the following terms: “trace element”, “selenium”, “copper”, “zinc”, “injury”, and “trauma”. Seven studies were included in the meta-analysis. The pooled results showed that Se supplementation was associated with a lower mortality rate (OR 0.733, 95% CI: 0.586, 0.918, p = 0.007; heterogeneity, I2 = 0%). Regarding the incidence of infectious complications, there was no statistically significant benefit after analyzing the four studies (OR 0.942, 95% CI: 0.695, 1.277, p = 0.702; heterogeneity, I2 = 14.343%). The patients with Se supplementation had a reduced ICU length of stay (standard difference in means (SMD): −0.324, 95% CI: −0.382, −0.265, p < 0.001; heterogeneity, I2 = 0%) and lesser hospital length of stay (SMD: −0.243, 95% CI: −0.474, −0.012, p < 0.001; heterogeneity, I2 = 45.496%). Se supplementation after trauma confers positive effects in decreasing the mortality and length of ICU and hospital stay.

scholarly journals Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

2019 ◽  
Vol 14 (8) ◽  
pp. 492-495 ◽  
Author(s):  
Paul L Aronson ◽  
Andrea T Cruz ◽  
Stephen B Freedman ◽  
Fran Balamuth ◽  
Kendra L Grether-Jones ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Incident Rate ◽  
Neonatal Herpes Simplex ◽  
Simplex Virus ◽  
The Impact ◽  
Pcr Test

Although neonatal herpes simplex virus (HSV) causes significant morbidity, utilization of the cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) test remains variable. Our objective was to examine the association of CSF HSV PCR testing with length of stay (LOS) in a 20-center retrospective cohort of hospitalized infants aged ≤60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. Of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test. Infants who had a CSF HSV PCR test performed had a 23% longer hospital LOS (incident rate ratio 1.23; 95% CI: 1.14-1.33). Targeted CSF HSV PCR testing may mitigate the impact on LOS for low-risk infants.

Abstract 4603: Home Surveillance Results in Improved Interstage Weight Gain in Infants following the Norwood Operation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Karen Uzark ◽  
Paula Eldridge ◽  
William Border ◽  
Mary Pat Alfaro ◽  
Megan Donley ◽  
...  
Keyword(s):  
Weight Gain ◽  
Length Of Stay ◽  
Hospital Length ◽  
Stage I ◽  
Stage Ii ◽  
Hospital Length Of Stay ◽  
Complex Congenital Heart Disease ◽  
Norwood Operation ◽  
Weight Monitoring ◽  
The Impact

Infants with complex congenital heart disease are at increased risk for malnutrition and poor weight gain. At our institution, infants who undergo Stage I Norwood operation are discharged with a home surveillance (HomeSurv) program which includes weight monitoring. To evaluate the impact of home surveillance on interstage growth, a current cohort of patients enrolled in Home Surv (n=18) was compared to a cohort discharged immediately prior to the implementation of the Home Surv program (n=20). The cohorts were compared using parametric and non-parametric methods as appropriate. Results: Infants underwent Stage I at a median age of 3.5 days (range 1–26), and at a mean weight 3.0 ± 0.4 kg., 26 with a modified Blalock-Taussig shunt and 12 with a right ventricular-to-pulmonary artery shunt. There were 26 males and 12 females. There were no significant differences between the groups with and without HomeSurv with respect to Stage I age, sex, Stage I weight, or shunt type. Stage I discharge weights were similar between the two cohorts (p=0.23) and there was no significant difference in Stage I hospital length of stay (p=0.10). Mean age at Stage II was 5.1 mos in the HomeSurv group and 4.9 mos in the pre-HomeSurv group, (p = 0.63). Mean weight at Stage II was higher in the HomeSurv group, but not statistically significant (5.9 kg vs 5.5 kg, p=0.30). However, weight gain >15 gms/day post Stage I discharge (our minimum weight gain threshold) was achieved by 89% of infants with Home Surv in comparison to 60% of the pre-HomeSurv group, p<.05. Weight gain was not significantly correlated with weight at Stage I, Stage I hospital length of stay, or age at Stage II, and was not significantly different related to shunt type. Conclusion: Home surveillance including weight monitoring following Stage I Norwood positively impacts interstage weight gain. In particular, it appears to confer protection for at-risk infants who fall below the threshold weight gain of 15gms/day. Future studies should explore whether this improved weight gain is an important factor in interstage morbidity and mortality.

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