scholarly journals Exercise-induced hypoxia among emergency department patients admitted for suspected COVID-19

2021 ◽  
pp. emermed-2021-211220
Author(s):  
Peter Davies ◽  
Timothy Jones ◽  
Francisca Bartilotti-Matos ◽  
Tim Crowe ◽  
Andrew Russell ◽  
...  
Keyword(s):  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Clinical Parameters ◽  
Radiographic Findings ◽  
Additional Tool ◽  
Sit To Stand ◽  
Emergency Department Patients ◽  
Exercise Induced ◽  
Radiographic Changes

BackgroundExercise-induced hypoxia (EIH) has been assessed at ED triage as part of an assessment of COVID-19; however, evidence supporting this practice is incomplete. We assessed the use of a 1-minute sit-to-stand exercise test among ED patients admitted for suspected COVID-19.MethodsA case note review of all ED patients assessed for suspected COVID-19 between March and May 2020 at Monklands University Hospital was conducted. Demographic characteristics, clinical parameters, baseline blood tests and radiographic findings, hospital length of stay, intensive care and maximum oxygen requirement were obtained for those admitted. Using logistic regression, the association between EIH at admission triage and COVID-19 diagnosis was explored adjusting for confounding clinical parameters.ResultsOf 127 ED patients admitted for possible COVID-19, 37 were ultimately diagnosed with COVID-19. 36.4% of patients with COVID-19 and EIH had a normal admission chest radiograph. In multivariate analysis, EIH was an independent predictor of COVID-19 (adjusted OR 3.73 (95% CI (1.25 to 11.15)), as were lymphocyte count, self-reported exertional dyspnoea, C-reactive peptide and radiographic changes.ConclusionsThis observational study demonstrates an association between EIH and a COVID-19 diagnosis. Over one-third of patients with COVID-19 and EIH exhibited no radiographic changes. EIH may represent an additional tool to help predict a COVID-19 diagnosis at initial presentation and may assist in triaging need for admission.

scholarly journals A comparison of burn related injuries following the natural disaster Super Storm Hurricane Sandy to the National Burn Repository of the American Burn Association

2016 ◽  
Vol 4 ◽  
pp. 1-4 ◽  
Author(s):  
Michael Kalina ◽  
Grigoriy Malyutin ◽  
Michael L. Cooper
Keyword(s):  
Natural Disasters ◽  
Natural Disaster ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Outcome Data ◽  
Hurricane Sandy ◽  
University Hospital ◽  
Hospital Length Of Stay

Abstract Background Burn related injuries from natural disasters are not well described and natural disasters are not identified as an etiology of burn injury in the National Burn Repository (NBR) of the American Burn Association. The natural disaster Super Storm Hurricane Sandy had devastating effects. Our goal was to detail the burn related injuries following this natural disaster and to compare the data to the NBR. Methods This was a retrospective chart review of thirty four patients who sustained burn related injuries following Super Storm Hurricane Sandy (SSHS) and were managed at Staten Island University Hospital Burn Center. Institutional Review Board approval was obtained. Data variables included age, gender, race, past medical history (PMHx), burn type, percentage total body surface area (%TBSA), hospital length of stay (HLOS), and mortality. We compared data from SSHS to the 2003-2013 NBR. Categorical data were summarized using frequency counts, percentages and Clopper-Pearson 95 % confidence interval for proportion. Continuous outcome data were summarized by descriptive statistics. Data analyses performed with SAS® System Version 9.3 (SAS Institute Inc., Cary, NC) and p < 0.05 was significant. Results In the SSHS group, average age was 36 + 24 years, range 1-80 years, and 44.1 % were males (15/34, 95 % CI: 27.2 - 62.1). Caucasians comprised 58.8 %, (20/34, 95 % CI: 40.7, 75.4) and 73.5 % had no PMHx (25/34, 95 % CI: 55.6, 87.1). The most common burn type was scald, 55.9 %, (19/34, 95 % CI: 37.9, 72.8) and %TBSA ranged 1 %–47 %, average of 7 % + 12 %. The average HLOS was 13 + 26 days, range of 1–113 days. Mortality was 2.9 % (1/34, 95 % CI: 0.07–15). In comparison, the NBR reported an average age of 32 years and 69 % were males. Caucasians comprised 59.1 %. The most common burn type was flame, 43.2 % and the %TBSA ranged 1 %–9.9 %. HLOS ranged 8.4–10.2 days and mortality was 3.4 %. Conclusion We conclude that burn related injuries following a natural disaster differ as compared to those most commonly reported in the NBR.

scholarly journals Nutrition delivery after emergency laparotomy in surgical ward: a retrospective cohort study

2021 ◽  
Author(s):  
Juho Nurkkala ◽  
Sanna Lahtinen ◽  
Aura Ylimartimo ◽  
Timo Kaakinen ◽  
Merja Vakkala ◽  
...  
Keyword(s):  
Energy Demand ◽  
Caloric Intake ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Emergency Laparotomy ◽  
Oral Nutrition ◽  
Adequate Nutrition ◽  
Surgical Ward ◽  
Loss Of Appetite

Abstract Purpose Adequate nutrition after major abdominal surgery is associated with less postoperative complications and shorter hospital length of stay (LOS) after elective procedures, but there is a lack of studies focusing on the adequacy of nutrition after emergency laparotomies (EL). The aim of the present study was to investigate nutrition adequacy after EL in surgical ward. Methods The data from 405 adult patients who had undergone emergency laparotomy in Oulu University Hospital (OUH) between years 2015 and 2017 were analyzed retrospectively. Nutrition delivery and complications during first 10 days after the operation were evaluated. Results There was a total of 218 (53.8%) patients who were able to reach cumulative 80% nutrition adequacy during the first 10 postoperative days. Patients with adequate nutrition (> 80% of calculated calories) met the nutritional goals by the second postoperative day, whereas patients with low nutrition delivery (< 80% of calculated calories) increased their caloric intake during the first 5 postoperative days without reaching the 80% level. In multivariate analysis, postoperative ileus [4.31 (2.15–8.62), P < 0.001], loss of appetite [3.59 (2.18–5.93), P < 0.001] and higher individual energy demand [1.004 (1.003–1.006), P = 0.001] were associated with not reaching the 80% nutrition adequacy. Conclusions Inadequate nutrition delivery is common during the immediate postoperative period after EL. Oral nutrition is the most efficient way to commence nutrition in this patient group in surgical ward. Nutritional support should be closely monitored for those patients unable to eat. Trial registration number Not applicable.

scholarly journals 201. Healthcare utilization outcomes of patients prescribed fluoroquinolones on discharge from the hospital to nursing homes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S105-S105
Author(s):  
Tyler L Lantz ◽  
Brie N Noble ◽  
Christopher J Crnich ◽  
Jessina C McGregor ◽  
Dominic Chan ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Renal Disease ◽  
Hospital Admission ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Electronic Health Record Data ◽  
Adult Age ◽  
Increased Risk

Abstract Background Fluoroquinolones (FQs) are frequently prescribed in nursing homes (NHs) despite concerns regarding broad spectrum antibiotic selective pressure, increased risk of Clostridioides difficile infection, and other adverse events. NH antibiotics are also frequently initiated in hospitals prior to NH admission. We quantified the frequency and outcomes of patients prescribed FQs on discharge from the hospital to NHs. Methods This was a retrospective cohort study of adult (age ≥ 18 years) inpatients prescribed a FQ on discharge from Oregon Health & Science University Hospital (OHSU) to a NH between 1/1/2016 and 12/31/2018. Study data were collected from a repository of electronic health record data. The outcome of interest was a composite of 30-day hospital readmission or emergency department (ED) visit to OHSU. Associations were quantified using odds ratios (ORs) and 95% confidence intervals (CIs). Results Among 9,546 patients discharged to a NH, 2,410 (25%) were prescribed at least one antibiotic and 423 (17.6%) were prescribed a FQ. Of these patients, 36.9% were age ≤ 65, 53% were male, 11.6% received a specialty infectious diseases consultation, 34.8% had a surgical diagnosis, and 49.7% had a hospital length of stay &gt; 7 days. The most prevalent comorbidities were cancer (30.5%), chronic obstructive pulmonary disease (29.6%), and renal disease (26%). The most prevalent FQs prescribed were ciprofloxacin (56.7%), levofloxacin (40.2%), and moxifloxacin (3.1%). Duration of NH therapy &gt; 7 days occurred in 37.6% of patients. The most common infectious diagnoses were bloodstream infection and endocarditis (39%), pneumonia (17%), and urinary tract infection (14.2%). Of patients prescribed a FQ, 276 (65.3%) had an ED visit or hospital admission to index facility within 30 days of discharge. Patients who were ≤ 65 years old (OR 2.3, 95% CI 1.4–3.5), male (OR 1.6, 95% CI 1.1–2.5), had comorbid renal disease (OR 1.8, 95% CI 1.1–2.9), or osteomyelitis as infectious diagnosis (OR 2.4, 95% CI 1.0–5.7) were more likely to have a 30-day ED visit or hospital admission. Conclusion Patients prescribed FQs on discharge to NHs frequently returned to the hospital for an ED visit or inpatient admission within 30 days of discharge. Disclosures All Authors: No reported disclosures

Abstract P400: Racial Disparities in Subarachnoid Hemorrhage Outcomes-A Single Center Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jerome Deas ◽  
Eyad Almallouhi ◽  
Chirantan Banerjee
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
P Value ◽  
High Morbidity ◽  
Chi Square ◽  
Single Center Experience ◽  
Discharge Outcomes

Introduction: Subarachnoid hemorrhage (SAH) has high morbidity and mortality, and prior studies have reported outcome disparities between African American (AA) and Caucasian patients. We compared demographics, risk factors, and discharge outcomes among different ethnicities treated at our comprehensive stroke center. Methods: We used data on all SAH patients admitted between July 2014 and March 2020 to our university hospital in the Southeast United States. Race was categorized into AA, Caucasian, and “other.” Pearson chi-square test and analysis of variance were used to compare these variables between the different groups. Results: A total of 578 SAH patients were identified (39% AA patients, 54% Caucasian, and 7% other). Admission Glascow Coma Score (GCS) and Hunt & Hess scores were comparable between the 3 groups. AA patients were significantly younger (51 vs 59 in Caucasian group vs 56 years in Other, p-value <0.001) and had higher BP at admission (systolic BP 152 vs 144 vs 145, p=0.002, diastolic BP 86 vs 80 vs 81, p<0.001). AA patients were more likely to have a history of hypertension (p<0.001) and had higher BMI (30 vs 28.1 vs 26, p=0.003) and Hemoglobin A1c (5.8 vs 5.6 vs 6.1, p=0.013). Modified Rankin scale (mRS) at discharge, in-hospital mortality, and discharge destination were similar between the groups, but AA patients had a longer mean hospital length of stay (19 vs 14 vs 17 days, p=0.035). Conclusion: In our cohort, AA SAH patients were significantly younger and had more comorbidities at admission. Although they had a higher length of stay, discharge outcomes were comparable to other races.

Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Fabrice Mowbray ◽  
Audrey-Anne Brousseau ◽  
Eric Mercier ◽  
Don Melady ◽  
Marcel Émond ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Frailty Index ◽  
Secondary Analysis ◽  
Binary Logistic Regression ◽  
Hospital Length ◽  
Study Data ◽  
Hospital Length Of Stay ◽  
Emergency Department Patients ◽  
The Relationship

ABSTRACTBackgroundThe 2016 Canadian Triage and Acuity Scale (CTAS) updates introduced frailty screening within triage to more accurately code frail patients who may deteriorate waiting for care. The relationship between triage acuity and frailty is not well understood, but may help inform which supplemental geriatric assessments are beneficial to support care in the emergency department (ED). Our objectives were to investigate the relationship between triage acuity and frailty, and to compare their associations with a series of patient outcomes.MethodsWe conducted a secondary analysis of the Canadian cohort from a multinational prospective study. Data were collected on ED patients 75 years of age and older from eight ED sites across Canada between November 2009 and April 2012. Triage acuity was assigned using the CTAS, whereas frailty was measured using an ED frailty index. Spearman rank and binary logistic regression were used to examine associations.ResultsA total of 2,153 ED patients were analyzed. No association was found between the CTAS and ED frailty index scores assigned to patients (r = .001; p = 0.99). The ED frailty index was associated with hospital admission (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.4–1.6), hospital length of stay (OR = 1.4; 95% CI = 1.2–1.6), future hospitalization (OR = 1.1; 95% CI = 1.05–1.2), and ED recidivism (OR = 1.1; 95% CI = 1.04–1.2). The CTAS was associated with hospital admission (e.g., CTAS 2 v. 5; OR = 6; 95% CI = 3.3–11.4).ConclusionOur findings demonstrate that frailty and triage acuity are independent but complementary measures. EDs may benefit from comprehensive frailty screening post-triage, as frailty and its associated geriatric syndromes drive outcomes separate from traditional measures of acuity.

scholarly journals The correlation of anti-heart antibodies levels with clinical manifestations and outcomes in patients with COVID-19

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Blagova ◽  
N V Varionchik ◽  
V A Zaidenov ◽  
P O Savina ◽  
N D Sarkisova
Keyword(s):  
Pericardial Effusion ◽  
Clinical Manifestations ◽  
Hospital Length ◽  
University Hospital ◽  
Inflammatory Activity ◽  
Hospital Length Of Stay ◽  
Blood Levels ◽  
Direct Role ◽  
Inflammatory Heart Disease ◽  
Chronic Myocarditis

Abstract Purpose To evaluate the blood level of anti-heart antibodies (AHA) and its correlation with clinical outcomes in patients with severe and moderate COVID-19. Methods The study included 34 patients (11 females and 23 males, mean age 58.3±17.6 years, from 20 to 87 years) who underwent treatment for moderate and severe COVID-19 at the Sechenov University hospital in April-June 2020. The diagnosis was confirmed by 50% using nasopharyngeal smears. In other cases, the diagnosis of COVID-19 was based on the following criteria: contact with a serologically confirmed COVID-19 patient, persistent fever of at least 38 degrees Celsius, typical CT findings of viral pneumonia, typical changes in blood tests in the absence of evidence for other diseases. Besides standard medical examination the AHA blood levels by immunoassay were observed, including antinuclear antibodies (ANA), antiendothelial cell antibodies (AECA), anti-cardiomyocyte antibodies (AbC), anti-smooth muscle antibodies (ASMA) and cardiac conducting tissue antibodies (CCTA). Median hospital length of stay was 14 [13; 18] days. Results AHA levels were increased in 25 (73.5%) patients. The patients were divided into the five groups: 1.Patients with previous chronic myocarditis who had already been receiving immunosuppressive therapy at the admission (n=4). Moderate titer increase was noted only in one patient. 2.Patients with severe COVID-19 and high inflammatory activity, in whom the degree of AHA increase matched the general disease activity. 3. Patients with severe COVID-19 and high inflammatory activity without AHA increase. 4. Patients with moderate COVID-19, in whom high AHA titers may reflect chronic latent myocarditis not associated with SARS-Cov2. 5. Patients with moderate COVID-19 and nearly normal / normal AHA titers. Significant correlation (p&lt;0.05) of AHA levels with cardiovascular manifestations (r=0.459) was found. AbC levels correlated significantly with pneumonia severity (r=0.472), respiratory failure (r=0.387), need for invasive ventilation (r=0.469), chest pain (r=0.374), low QRS voltage (r=0.415) and high levels of CRP (r=0.360) and LDH (r=0.360). ASMA levels were found to correlate significantly with atrial fibrillation (r=0.414, p&lt;0.05). ANA and AbC levels correlated significantly with pericardial effusion (r=0.721 and r=0.745 respectively, p&lt;0.05). The lethality rate was 8.8%. AbC and ASMA levels correlated significantly with lethality (r=0.363, and r=0.426 respectively, p&lt;0.05) and were prognostically important. Conclusion Elevated titres of AHA were found in 73.5% of patients. AHA correlated with lethality, in most cases reflecting the overall activity and severity of the disease and may be considered within the systemic immune and inflammatory response in COVID-19. At the same time, the correlation with signs of myocardial injury and pericardial effusion, confirms the direct role of AHA in the inflammatory heart disease (myopericarditis). FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals New-onset nontuberculous mycobacterial pulmonary disease in bronchiectasis: tracking the clinical and radiographic changes

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nakwon Kwak ◽  
Jong Hyuk Lee ◽  
Hyung-Jun Kim ◽  
Sung A. Kim ◽  
Jae-Joon Yim
Keyword(s):  
Pulmonary Disease ◽  
Close Association ◽  
Severity Index ◽  
University Hospital ◽  
Radiographic Findings ◽  
National University ◽  
Seoul National University ◽  
Radiographic Changes ◽  
Observation Period ◽  
New Onset

Abstract Background The close association between bronchiectasis and nontuberculous mycobacterial pulmonary disease (NTM-PD) is well-known. However, the clinical impact of subsequent new-onset NTM-PD in bronchiectasis patients has not been elucidated. The aim of this study is to investigate the clinical courses and radiographic changes of patients with bronchiectasis in whom NTM-PD subsequently developed. Methods A total of 221 patients with bronchiectasis who had participated in a non-NTM bronchiectasis cohort between July 1st 2011 and August 31st 2019 at Seoul National University Hospital were included in this study. The data of patients in whom NTM-PD developed during this observation period were analyzed; specifically, changes in the Bronchiectasis Severity Index (BSI) and lesions on computerized tomography (CT) scan of the chest arising during the observation period. Results During the observation period, NTM was isolated from 35 patients. A total of 31 patients (14.0%) satisfied the diagnostic criteria of NTM-PD. The median time from enrollment in the cohort to the development of subsequent NTM-PD was 37 months (Interquartile range [IQR], 18–78 months). Mycobacterium avium complex was the most common pathogen (80.6%). Twelve patients underwent antibiotic treatment for NTM-PD with a median interval of 20 months (IQR, 13–30) from the time of NTM-PD diagnosis. When NTM-PD developed, the severity and extent of bronchiectasis, cellular bronchiolitis, and the extent of nodules worsened on CT scans, while BSI did not change. Conclusions NTM-PD can develop in previously negative bronchiectasis patients. It is associated with worsening radiographic lesions. Active screening of non-NTM bronchiectasis patients for new-onset NTM infection should be considered, especially if radiographic findings worsen. The BSI is not a reliable predictor of new-onset NTM-PD. Trial registration This study was performed at Seoul National University Hospital (NCT01616745).

Characteristics and Outcomes of Patients Discharged Directly Home From a Medical Intensive Care Unit: A Retrospective Cohort Study

2020 ◽  
pp. 088506662096063
Author(s):  
Preeyal M. Patel ◽  
Michele A. Fiorella ◽  
Ann Zheng ◽  
Lauren McDonnell ◽  
Mina Yasuoka ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Wait Time ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Urban University ◽  
Medical Intensive Care ◽  
Transfer Order

Objective: To evaluate the safety of directly discharging patients home from the medical intensive care unit (MICU). Materials and Methods: Single-center retrospective observational study of consecutive MICU direct discharges to home from an urban university hospital between June, 1, 2017, and June 30, 2019. Results: Of 1061 MICU discharges, 331 (31.2%) patients were eligible for analysis. Patients were divided into 2 groups based on duration of wait-time (< or ≥24 hours) between ward transfer order and ultimate hospital discharge. Most patients (68.2%) were discharged in <24 hours. Patients who waited for a floor bed for ≥24 hours prior to discharge had longer hospital length-of-stay (LOS, median 3.83 versus 2.00 days) and ICU LOS (median 3.51 versus 1.74 days). Overall, 44 (13.3%) direct MICU discharges were readmitted to the hospital within 30-days, but there was no difference in this outcome or in 30-day mortality when comparing the 2 wait-time groups. Conclusions: The practice of directly discharging MICU patients home does not negatively influence patient outcomes. Patients who overstay in the ICU after being deemed transfer-ready are unlikely to be benefiting from critical care, but impact hospital throughput and resource utilization. Prospective investigation into this practice may provide further confirmation of its feasibility and safety.

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