scholarly journals Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: an observational cohort

2021 ◽  
Author(s):  
Matthew Hall ◽  
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Symptom Onset ◽  
Time Trends ◽  
Time Course ◽  
Case Fatality ◽  
Treatment Modalities ◽  
Rapid Decline ◽  
Hospitalised Patients

There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an ongoing infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high density unit (HDU), while novel treatment modalities may reduce the time course of illness. On the other hand, limited resources at times of high demand may lead to rationing of resources, with less beneficial consequences. Despite little evidence on how the values of such variables change over the course of a crisis (such as the current COVID-19 pandemic), they may nevertheless be used as proxies for disease severity, outcome measures for clinical trials, and to inform planning and logistics. In this study, we investigate such time trends in an extremely large international cohort of 142,540 patients with symptom onset of, or hospital admission for, COVID-19 during 2020. The variables investigated are time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, case fatality ratio (CFR) and total length of hospital stay. Time from hospital symptom onset to hospital admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December. ICU/HDU admission was more frequent from June to August, while there were only modest time trends in time from hospital admission to ICU/HDU. The CFR was lowest from June to August, a trend mostly driven by patients with no ICU/HDU admission. Raw numbers for overall hospital stay showed little overall variation over the time period, but further examination reveals a clear decline in time to discharge for ICU/HDU survivors. Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly-evolving situation.

scholarly journals Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: an observational cohort

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
◽  
Matthew D Hall ◽  
Joaquín Baruch ◽  
Gail Carson ◽  
Barbara Wanjiru Citarella ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Rapid Decline ◽  
Design Data ◽  
Hospitalised Patients ◽  
Gates Foundation ◽  
The Uk

Background: There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high density unit (HDU). On the other hand, limited resources at times of high demand may lead to rationing. Nevertheless, these variables may be used as static proxies for disease severity, as outcome measures for trials, and to inform planning and logistics.Methods: We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay.Results: Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors.Conclusions: Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly-evolving situation.Funding: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill and Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

scholarly journals SARS-CoV-2 viral load as a predictor for disease severity in outpatients and hospitalised patients with COVID-19: A prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258421
Author(s):  
Fredrikke Christie Knudtzen ◽  
Thøger Gorm Jensen ◽  
Susan Olaf Lindvig ◽  
Line Dahlerup Rasmussen ◽  
Lone Wulff Madsen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Hospital Admission ◽  
Disease Severity ◽  
Prospective Cohort Study ◽  
Symptom Onset ◽  
Prospective Cohort ◽  
Severe Disease ◽  
Adult Patients ◽  
Hospitalised Patients

Introduction We aimed to examine if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) cycle quantification (Cq) value, as a surrogate for SARS-CoV-2 viral load, could predict hospitalisation and disease severity in adult patients with coronavirus disease 2019 (COVID-19). Methods We performed a prospective cohort study of adult patients with PCR positive SARS-CoV-2 airway samples including all out-patients registered at the Department of Infectious Diseases, Odense University Hospital (OUH) March 9-March 17 2020, and all hospitalised patients at OUH March 10-April 21 2020. To identify associations between Cq-values and a) hospital admission and b) a severe outcome, logistic regression analyses were used to compute odds ratios (OR) and 95% Confidence Intervals (CI), adjusting for confounding factors (aOR). Results We included 87 non-hospitalised and 82 hospitalised patients. The median baseline Cq-value was 25.5 (interquartile range 22.3–29.0). We found a significant association between increasing Cq-value and hospital-admission in univariate analysis (OR 1.11, 95% CI 1.04–1.19). However, this was due to an association between time from symptom onset to testing and Cq-values, and no association was found in the adjusted analysis (aOR 1.08, 95% CI 0.94–1.23). In hospitalised patients, a significant association between lower Cq-values and higher risk of severe disease was found (aOR 0.89, 95% CI 0.81–0.98), independent of timing of testing. Conclusions SARS-CoV-2 PCR Cq-values in outpatients correlated with time after symptom onset, but was not a predictor of hospitalisation. However, in hospitalised patients lower Cq-values were associated with higher risk of severe disease.

Fatality of Suicide Attempts in Amsterdam 1996–2005

Crisis ◽  
2009 ◽  
Vol 30 (4) ◽  
pp. 180-185 ◽  
Author(s):  
Evertjan Jansen ◽  
Marcel C.A. Buster ◽  
Annemarie L. Zuur ◽  
Cees Das
Keyword(s):  
Health Service ◽  
Time Trends ◽  
Suicide Attempts ◽  
Preventive Measures ◽  
Case Fatality ◽  
Absolute Number ◽  
Demographic Differences ◽  
Demographic Groups ◽  
Wish To Die ◽  
Municipal Health

Background: According to recent figures, Amsterdam is the municipality with the highest absolute number of suicides and the second highest suicide rate in the Netherlands. Aims: The aim of the study was to identify time trends and demographic differences in the occurrence of nonfatal suicide attempts versus suicides. Methods: We used registrations of forensic physicians and ambulance services of the Municipal Health Service of Amsterdam to study 1,004 suicides and 6,166 nonfatal attempts occurring in Amsterdam over the period 1996–2005. Results: The number of nonfatal attempts declined from 1996 to 2005, but the number of completed suicides remained relatively stable. Although case fatality was strongly associated with method used, we also found higher case fatalities for men and older people independent of method. Conclusions: The case fatality results suggest differences in motive among different demographic groups: possibly the wish to die is stronger among men and elderly. This finding had implications for the success to be expected from different preventive measures.

Indications and practice of enteral nutrition

2014 ◽  
Vol 155 (51) ◽  
pp. 2028-2033 ◽  
Author(s):  
Judit Hallay ◽  
Dániel Nagy ◽  
Béla Fülesdi
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
Enteral Nutrition ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Nutrition Therapy ◽  
Present Review ◽  
Hospitalised Patients ◽  
Impact On Treatment ◽  
Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

scholarly journals Risk of infection in antimicrobial-resistant Gram-negative bacteria carriers: A systematic review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Arzilli ◽  
G Scardina ◽  
V Casigliani ◽  
M Moi ◽  
E Lucenteforte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Admission ◽  
Infection Rate ◽  
High Income ◽  
Attributable Mortality ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Hospitalised Patients ◽  
Risk Of Progression

Abstract Background Antimicrobial-resistant Gram-negative bacteria (AMR-GNB) have emerged as important health care-associated pathogens. Infections with AMR-GNB are associated with high patient morbidity and attributable mortality. Colonization is a prerequisite for infection, however the extent to which colonized patients develop infection is unclear. This systematic review explored the risk of developing infection during hospitalisation among AMR-GNB faecal carriers. Also, we investigated the acquisition rate for AMR-GNB colonization among patients not colonized at admission. Methods We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on hospitalised patients ≥18 years old in high-income countries (excluding long-term care facilities). Results Out of 9496 articles, 55 studies fulfilled our inclusion criteria. Forty-two studies reported data from EU/EEA, 6 from USA and 7 from other regions. Almost all studies (n = 45) were conducted in university hospitals. Most studies (n = 41;74.5%) were performed in high-risk wards (ICU, haematology, burn units and transplant units). Out of 55 studies, 8 examined AMR-GNB, 27 Enterobacteriaceae, while the others investigated specific pathogens: Klebsiella spp. (n = 11), E. Coli (n = 2), A. Baumannii (n = 3) and P. Aeruginosa (n = 4). The rate of AMR-GNB carriage acquisition was 10.5% (n = 40 studies; 95% CI:8.2-13.1). The risk of progression to infection among patients colonized at hospital admission was 13.9% (n = 15; 5.4-24.9), while the infection rate in patients who acquired carriage during hospitalization was 23.0% (n = 7; 5.9-45.2). Patients with an undefined time of colonization presented an infection rate of 16.9% (n = 13; 11.2-23.4). Considering these three populations as a whole, the risk of developing infection was 16.0% (11.0-21.0). Conclusions Our results suggest that risk of progression to infection in AMR-GNB colonized patients in hospital setting is high. Key messages The aim of our study was to estimate the risk of progression to infection, during hospital stay, in patients colonized by AMR-GNB at hospital admission in high-income countries. Our results suggest that faecal colonization with AMR-GNB poses a 16.0% risk of subsequent AMR-GNB infection. This risk in higher (23.0%) in patients who acquired colonization during hospitalisation.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

scholarly journals Response to commentaries by Kildemoes and Kristiansen

2005 ◽  
Vol 21 (3) ◽  
pp. 419-420
Author(s):  
Christian Juhl Terkelsen
Keyword(s):  
Hospital Admission ◽  
Case Fatality ◽  
Treatment Delay ◽  
Cost Data ◽  
Diagnostic Strategy ◽  
Primary Pci ◽  
Danish Health ◽  
Dutch Study ◽  
Prehospital Diagnosis ◽  
Meta Analyses

§1.1. Recent data documents that not a “majority” but only 40% of Danish patients arrive at the hospital within 30 minutes of ambulance call (7;8). §1.2. The Dutch study confirmed that, even in areas with 13 minutes transport time to the hospital, comparable to the Danish scenery, a prehospital thrombolytic strategy reduced treatment delay by nearly 1 hour (5). §1.3. We appreciate that the authors confirm our viewpoint, that is, quoting that “the mortality reduction more than doubles up,” “if hospital delay is totally eliminated (corresponding to a delay reduction of 1 hour).” In the future, patients should be diagnosed before hospital admission and either treated before hospital admission with thrombolysis or transferred directly to interventional center for primary PCI. In both settings, the delay at the local hospital, averaging 1 hour, would be eliminated (1;8). §2.0. Kildemoes and Kristiansen may have misunderstood our arguments regarding the Boersma formula. We recommend that they read our previous viewpoint (9). We have no reason to believe that distribution of patient delay in Denmark differs significantly from other countries. Moreover, we are surprised that the case fatality estimates implemented by Kildemoes and Kristiansen differs significantly from findings in a recent Danish Health Technology Assessment and findings in previous meta-analyses (2;4;6). §3.1. For 7 years, the present group of authors have worked with telemedicine in the prehospital evaluation of patients. Our close collaborators, the ambulance operators and the company delivering telemedicine equipment, have confirmed our cost data, whereas they disagree with the cost data implemented by Kildemoes and Kristiansen. §3.2. Equipment for twelve-lead ECG acquisition is necessary when implementing prehospital diagnosis, irrespective of whether the diagnoses are established by telemedicine, by paramedics, or by physicians. §5. A 1-hour reduction in treatment delay is achievable by a prehospital diagnostic strategy, both in the setting of prehospital thrombolysis and in the setting of prehospital referral to interventional centers for primary PCI (6;8). This reduction in treatment delay should have a major impact on AMI fatality (also in Denmark; 3;6).

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

scholarly journals Variability of outcome measures in trials of intravenous therapy in acute severe paediatric asthma: a systematic review

2018 ◽  
Vol 36 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Charmaine S Gray ◽  
Colin V E Powell ◽  
Franz E Babl ◽  
Stuart R Dalziel ◽  
Simon Craig
Keyword(s):  
Length Of Stay ◽  
Outcome Measures ◽  
Treatment Modalities ◽  
International Consensus ◽  
Paediatric Asthma ◽  
Study Protocols ◽  
Registration Number ◽  
Secondary Outcomes ◽  
Clinical Trials Registry ◽  
Bedside Tests

ObjectiveTo determine the variability of primary and secondary outcomes used in trials of intravenous bronchodilators in children with acute severe paediatric asthma.MethodsSystematic search of MEDLINE, EMBASE, Cochrane CENTRAL and the WHO International Clinical Trials Registry Platform for randomised trials in children (less than18 years) with acute severe paediatric asthma comparing intravenous bronchodilator therapy to another treatment. Initial search was performed on 7 January 2016 with an updated search performed on 6 September 2018. Primary and secondary outcomes were collated.ResultsWe identified 35 published papers and four registered study protocols. 56 primary outcomes were found, the most common being a clinical asthma score (23/56; 41%). Other identified primary outcomes included bedside tests of respiratory function (11/56; 20%) and measures of length of stay (9/56; 16%). There were a total of 60 different secondary outcomes, the most common were various length of stay measures (24/60; 40%) and adverse events (11/60; 18%).ConclusionStudies comparing intravenous treatment modalities for children with acute severe paediatric asthma exhibit great variation in the type, number and timing of outcome measures used. There are no patient or family-specific outcomes reported. There is a need to develop international consensus.Trial registration numberCRD42017055331.

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