scholarly journals Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040441 ◽  
Author(s):  
Zichen Wang ◽  
Amanda Zheutlin ◽  
Yu-Han Kao ◽  
Kristin Ayers ◽  
Susan Gross ◽  
...  
Keyword(s):  
Observational Study ◽  
Health System ◽  
Clinical Features ◽  
White Cell Count ◽  
Tertiary Care ◽  
Significant Risk ◽  
Retrospective Observational Study ◽  
Markers Of Inflammation ◽  
Hospitalised Patients ◽  
Mount Sinai

ObjectiveTo assess association of clinical features on COVID-19 patient outcomes.DesignRetrospective observational study using electronic medical record data.SettingFive member hospitals from the Mount Sinai Health System in New York City (NYC).Participants28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.Main outcomes and measuresPositive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.ResultsHispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray’s T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.ConclusionsWhile race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.

scholarly journals Analysis of hospitalized COVID-19 patients in the Mount Sinai Health System using electronic medical records (EMR) reveals important prognostic factors for improved clinical outcomes

2020 ◽  
Author(s):  
Zichen Wang ◽  
Amanda B. Zheutlin ◽  
Yu-Han Kao ◽  
Kristin L. Ayers ◽  
Susan J. Gross ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Health System ◽  
Electronic Medical Records ◽  
Clinical Features ◽  
Medical Records ◽  
Tertiary Care ◽  
Significant Risk ◽  
Markers Of Inflammation ◽  
Mount Sinai ◽  
The Impact

AbstractImportanceThere is an urgent need to understand patient characteristics of having COVID-19 disease and evaluate markers of critical illness and mortality.ObjectiveTo assess association of clinical features on patient outcomes.Design, Setting, and ParticipantsIn this observational case series, patient-level data were extracted from electronic medical records for 28,336 patients tested for SARS-CoV-2 at the Mount Sinai Health System from 2/24/ to 4/15/2020, including 6,158 laboratory-confirmed cases.ExposuresConfirmed COVID-19 diagnosis by RT-PCR assay from nasal swabs.Main Outcomes and MeasuresEffects of race on positive test rates and mortality were assessed. Among positive cases admitted to the hospital (N = 3,273), effects of patient demographics, hospital site and unit, social behavior, vital signs, lab results, and disease comorbidities on discharge and death were estimated.ResultsHispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to population base rates (p<2e-16); however, no differences in mortality rates were observed in the hospital. Outcome differed significantly between hospitals (Gray’s T=248.9; p<2e-16), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR=1.05 [95% CI, 1.04-1.06]; p=1.15e-32), oxygen saturation (HR=0.985 [95% CI, 0.982-0.988]; p=1.57e-17), care in ICU areas (HR=1.58 [95% CI, 1.29-1.92]; p=7.81e-6), and elevated creatinine (HR=1.75 [95% CI, 1.47-2.10]; p=7.48e-10), alanine aminotransferase (ALT) (HR=1.002, [95% CI 1.001-1.003]; p=8.86e-5) white blood cell (WBC) (HR=1.02, [95% CI 1.01-1.04]; p=8.4e-3) and body-mass index (BMI) (HR=1.02, [95% CI 1.00-1.03]; p=1.09e-2). Asthma (HR=0.78 [95% CI, 0.62-0.98]; p=0.031) was significantly associated with increased length of hospital stay, but not mortality. Deceased patients were more likely to have elevated markers of inflammation. Baseline age, BMI, oxygen saturation, respiratory rate, WBC count, creatinine, and ALT were significant prognostic indicators of mortality.Conclusions and RelevanceWhile race was associated with higher risk of infection, we did not find a racial disparity in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. We identified clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk and evaluate the impact on survival.

scholarly journals Clinical profile of congenital hypothyroidism identified through new-born screening: a retrospective observational study

2020 ◽  
Vol 7 (10) ◽  
pp. 1968
Author(s):  
Sudhakar Palanisamy ◽  
Ramesh Srinivasan
Keyword(s):  
Observational Study ◽  
Clinical Features ◽  
Congenital Hypothyroidism ◽  
Screening Program ◽  
Tertiary Care ◽  
Growth Patterns ◽  
Retrospective Observational Study ◽  
Care Hospital ◽  
Common Etiology

Background: Congenital hypothyroidism is one of the most common preventable causes of mental retardation. The incidence and etiology of congenital hypothyroidism varies significantly across the globe.Methods: In this retrospective observational study we aimed to find out the incidence and etiology of congenital hypothyroidism identified by neonatal screening program. We included all neonates who had their thyroid stimulating hormone screening done in a tertiary care hospital of South India between January 2014 and June 2020 and were diagnosed as a case of congenital hypothyroidism. The growth patterns, clinical features, thyroxine dose requirement during follow-up were also studied.Results: There were 23 babies diagnosed with congenital hypothyroidism during the study period. The incidence rate was 1 in 917 live births for inborn babies, and dyshormogenesis (60%) was the most common etiology. Two babies had clinical features associated with congenital hypothyroidism. None of the babies had clinical features of congenital hypothyroidism during follow-up and their growth & development were normal for age. Babies who required dose increments of thyroxine supplement turned out to be permanent congenital hypothyroidism. Conclusion: Incidence of congenital hypothyroidism was high in our population. Dyshormogenesis was the most common etiology. Majority of congenital hypothyroidism babies were asymptomatic at diagnosis, so screening is a vital tool for early diagnosis. Babies who required thyroxine dose increment with age tend to be permanent congenital hypothyroidism.

scholarly journals Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Isao Nagata ◽  
Tetsuhiro Takei ◽  
Junji Hatakeyama ◽  
Masafumi Toh ◽  
Hiroyuki Yamada ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Clinical Features ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Extended Period ◽  
Nationwide Survey ◽  
Retrospective Observational Study ◽  
Multivariable Logistic Regression Analysis ◽  
Care Hospital

Abstract Background Information on epidemiology of prolonged mechanical ventilation (PMV) patients in the acute care setting in Japan is totally lacking. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients. Methods This was a retrospective observational study conducted in a tertiary care hospital. Adult patients who were admitted to our intensive care unit (ICU) from April 2009 to March 2014 and required mechanical ventilation (MV) for ≥ 2 days were included. PMV was defined as having MV for ≥ 21 consecutive days. Results Among 1282 MV patients, 93 (7.3%) required PMV, and median duration of MV was 37.0 days. Compared with the non-PMV patients, PMV patients had longer total ICU and high care unit (HCU) stay (34.0 vs. 7.0 days, p < 0.001), longer hospital stay (74.0 vs. 35.0 days, p < 0.001), and higher hospital mortality (54.8 vs. 21.4%, p < 0.001). In multivariable logistic regression analysis, emergency ICU admission and steroid use during MV were associated with PMV. The Kaplan–Meier curves for MV withdrawal and ICU/HCU discharge were almost identical. Among PMV patients, 52 (55.9%) died, 29 (31.2%) were successfully liberated from MV during hospitalization, and 12 (12.9%) still required MV at discharge. Conclusion In this investigation, 7.3% of the patients with MV required PMV. Most PMV patients were liberated from MV during hospitalization, while occupying critical care beds for an extended period. A nationwide survey is required to further elucidate the overall picture of PMV patients and to discuss whether specialized weaning centers to treat PMV patients are required in Japan.

scholarly journals Analysis of Management Approach to Newborn Care of Infants Delivered to COVID-19 Positive Mothers at Five Tertiary Care Centers in the UAE over a 7 Month Period 

2021 ◽  
Author(s):  
Monika Kaushal ◽  
Yamuna Tulasi ◽  
Ayush Kaushal ◽  
Aditya Rakhecha ◽  
Rafiq Memon ◽  
...  
Keyword(s):  
Observational Study ◽  
Tertiary Care ◽  
Newborn Care ◽  
Retrospective Observational Study ◽  
Management Approach ◽  
Post Discharge ◽  
Formula Milk ◽  
Increased Risk ◽  
Care Practices ◽  
Tertiary Care Centers

Abstract ObjectivesTo assess newborn care practices, clinical characters and risks of mother to child transmission during rooming in and breastfeeding in infants born to mothers with COVID-19.DesignRetrospective observational study.Participants5 Tertiary care centers located in the UAE. Infants born to mothers diagnosed with COVID-19 at the time of delivery, born between April 1st and October 30th 2020.MethodsIn this retrospective observational study, we analyzed the newborn care practices in various tertiary care hospitals and the rate of transmission of SARS-CoV-2 from mother to infant (vertical or horizontal) while rooming in, breastfeeding and post discharge. Results40 infants were born to mothers with COVID-19 at the time of delivery. One infant tested positive for SARS-CoV-2 after birth and had respiratory symptoms and fever. 23 of the well infants were roomed in during their hospital stay and were breastfed. In 8 cases, the mother and baby were separated and isolated from the time of birth till discharge. 95% of the discharged infants were rooming in with mothers, 45% of the infants were exclusively breastfed and 55% were on mixed feeding (breast milk and formula milk) at the follow-up. None of the infants developed significant health issues or symptoms attributable to SARS-CoV-2.ConclusionThe risk of mother to infant transmission of COVID-19 in the perinatal period is very low. Our study reaffirms the AAP guidelines that rooming in and breastfeeding of newborns born to COVID-19 positive mothers is safe without an increased risk of transmission by following mandated safety precautions.

scholarly journals Invasive pneumococcal disease, pneumococcal pneumonia and all-cause pneumonia in Hong Kong during the COVID-19 pandemic compared with the preceding 5 years: a retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e055575
Author(s):  
King-Pui Florence Chan ◽  
Ting-Fung Ma ◽  
Mary Sau-Man Ip ◽  
Pak-Leung Ho
Keyword(s):  
Hong Kong ◽  
Length Of Stay ◽  
Observational Study ◽  
Pneumococcal Pneumonia ◽  
Transitional Period ◽  
Retrospective Observational Study ◽  
Health Seeking ◽  
Social Distancing ◽  
Hospitalised Patients ◽  
Secondary Outcomes

ObjectivesTo compare the incidence and severity of invasive pneumococcal diseases (IPDs), pneumococcal pneumonia and all-cause pneumonia during the COVID-19 pandemic period with universal masking and social distancing with that of previous 5 years.DesignRetrospective observational study on incidence of IPDs, pneumococcal pneumonia and all-cause pneumonia between January 2015–December 2019 and March 2020–March 2021. January–February 2020 was excluded from analysis as it was treated as a transitional period between normal time and pandemic.SettingEpisode-based data by retrieval of hospitalisation records from the Hospital Authority’s territory-wide electronic medical record database in Hong Kong.ParticipantsHospitalised patients with IPD (n=742), pneumococcal pneumonia (n=2163) and all-cause pneumonia (including COVID-19 pneumonia, n=453 999) aged 18 years or above. Control diagnoses were included to assess confounding from health-seeking behaviours.Primary and secondary outcomesPrimary outcome is the incidence of diseases between two periods. Secondary outcomes include disease severity surrogated by length of stay and mortality.ResultsMonthly average number of IPD, pneumococcal pneumonia and all-cause pneumonia hospitalisation significantly decreased by 88.9% (95% CI 79.8% to 98.0%, p<0.0005), 72.5% (95% CI 65.9% to 79.1%, p<0.0005) and 17.5% (95% CI 16.8% to 18.2%, p<0.0005), respectively. Changes in trend from January 2015–December 2019 to March 2020–March 2021 were −70% (95% CI −87% to −35%, p=0.0025), –43% (95% CI −59% to −19%, p=0.0014) and −11% (95% CI −13% to −10%, p<0.0005), respectively. Length of stay for IPD and pneumococcal pneumonia episodes were insignificantly different in the two periods. No reductions in hospitalisations for control diagnoses were observed.ConclusionsIncidence of IPD, pneumococcal pneumonia and all-cause pneumonia decreased during the COVID-19 pandemic. This was observed with universal masking and social distancing. We postulated this is related to reduced transmission of respiratory viruses and bacteria.

scholarly journals Predictors of Major Bleeding and Mortality in Dengue Infection: A Retrospective Observational Study in a Tertiary Care Centre in South India

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Kevin John John ◽  
Karthik Gunasekaran ◽  
John Davis Prasad ◽  
Divya Mathew ◽  
Sohini Das ◽  
...  
Keyword(s):  
Observational Study ◽  
Major Bleeding ◽  
South India ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Retrospective Observational Study ◽  
Total Leukocyte Count ◽  
Severe Dengue ◽  
Elderly Age ◽  
Tertiary Care Centre

We conducted a retrospective observational study to describe the clinical profile and outcomes of patients admitted with a diagnosis of dengue fever in a tertiary hospital in South India. A total of 159 patients admitted from April 2014 to October 2018 were included in the study. Vomiting (70.4%), myalgia (60.4%), headache (42.1%), abdominal pain (38.4%), bleeding (38%), and rash (37.1%) were the most common symptoms at presentation. The mean duration of hospital stay was 4.9 days (SD ± 2.4), and the median cost was INR 19,708 ($285) (IQR INR 12,968–32,056 ($188–$305)). Major bleeding was associated with elevated SGOT and SGPT, severe dengue, and secondary dengue. Mortality was associated with elderly age; elevated total leukocyte count, serum bilirubin, serum creatinine, SGOT, and SGPT; and high SOFA score. In view of these observations, we recommend stratifying patients according to the WHO classification of dengue and avoiding the use of thrombocytopenia as a single marker of the severity of the illness.

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