Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta-analysis

Abstract Background cognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes. Methods we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed. Results 23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71–0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A’s Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74–0.94). Conclusions high clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED. The review protocol was registered in PROSPERO (CRD42018082509).

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P62 RISK FACTORS AND OUTCOMES ASSOCIATED WITH ANASTOMOTIC LEAKS (AL) FOLLOWING OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doz092.62 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

K Kamarajah Sivesh ◽

Lin Aaron ◽

Tharmaraja Thahesh ◽

Bharwada Yashvi ◽

R Bundred James ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Major Complication ◽

Adverse Outcomes ◽

Cardiac Complications ◽

Modifiable Risk Factors ◽

Anastomotic Leaks ◽

Patient Counselling ◽

Prolonged Hospital

Abstract Introduction Anastomotic leaks (AL) are a major complication after oesophagectomy. This meta-analysis aimed to determine identify risks factors for AL (pre-operative, intra-operative and post-operative factors) and assess the consequences to outcome on patients who developed an AL. Methods This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 31st December 2018. A meta-analysis was conducted with the use of random-effects modelling and prospectively registered with the PROSPERO database (Registration CRD42018130732). Results This review identified 174 studies reporting outcomes of 74,226 patients undergoing oesophagectomy. The overall pooled AL rates were 11%, ranging from 0 - 49% in individual studies. Majority of studies were from Asia (n=79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative). AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99 - 6.89, p<0.001) and cardiac complications (OR: 2.44, CI95%: 1.77 - 3.37, p<0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10 - 21 days, p<0.001 and in-hospital mortality (OR: 5.91, CI95%: 1.41 - 24.79, p=0.015). Conclusion AL are a major complication following oesophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL which can be a target for interventions to reduce anastomotic leak rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counselling and informed consent.

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Bidirectional brain–gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis

Gut ◽

10.1136/gutjnl-2021-325985 ◽

2021 ◽

pp. gutjnl-2021-325985

Author(s):

Keeley M Fairbrass ◽

Jessica Lovatt ◽

Brigida Barberio ◽

Yuhong Yuan ◽

David J Gracie ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Psychological Health ◽

Common Mental Disorders ◽

Meta Analysis ◽

Subsequent Development ◽

Adverse Outcomes ◽

Emergency Department Attendance ◽

Relative Risks ◽

The Brain

ObjectiveThe role of the brain–gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues.DesignWe searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline.ResultsWe included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively).ConclusionBidirectional effects of the brain–gut axis are present in IBD and may influence both the natural history of the disease and psychological health.

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Prevalence and Risk Factors of Emergency Department Presentations with Methamphetamine Intoxication or Dependence: A Systematic Review and Meta-analysis

Issues in Mental Health Nursing ◽

10.1080/01612840.2018.1553003 ◽

2019 ◽

Vol 40 (7) ◽

pp. 567-578 ◽

Cited By ~ 1

Author(s):

Njabulo Churchill Sibanda ◽

Rachel Kornhaber ◽

Glenn E. Hunt ◽

Kirsten Morley ◽

Michelle Cleary

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Emergency Department ◽

Meta Analysis

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Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/doz089 ◽

2020 ◽

Vol 33 (3) ◽

Cited By ~ 3

Author(s):

Sivesh K Kamarajah ◽

Aaron Lin ◽

Thahesh Tharmaraja ◽

Yashvi Bharwada ◽

James R Bundred ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Major Complication ◽

Adverse Outcomes ◽

Cardiac Complications ◽

Modifiable Risk Factors ◽

Anastomotic Leaks ◽

Patient Counseling ◽

Prolonged Hospital

Summary Anastomotic leaks (AL) are a major complication after esophagectomy. This meta-analysis aimed to determine identify risks factors for AL (preoperative, intra-operative, and post-operative factors) and assess the consequences to outcome on patients who developed an AL. This systematic review was performed according to PRISMA guidelines, and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling and prospectively registered with the PROSPERO database (Registration CRD42018130732). This review identified 174 studies reporting outcomes of 74,226 patients undergoing esophagectomy. The overall pooled AL rates were 11%, ranging from 0 to 49% in individual studies. Majority of studies were from Asia (n = 79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative). AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99–6.89, P < 0.001) and cardiac complications (OR: 2.44, CI95%: 1.77–3.37, P < 0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10–21 days, P < 0.001), and in-hospital mortality (OR: 5.91, CI95%: 1.41–24.79, P = 0.015). AL are a major complication following esophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL, which can be a target for interventions to reduce AL rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counseling, and informed consent.

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