scholarly journals Resource utilisation among patients transferred for intracerebral haemorrhage

2019 ◽  
Vol 4 (4) ◽  
pp. 223-226 ◽  
Author(s):  
Kori Sauser Zachrison ◽  
Emily Aaronson ◽  
Sadiqa Mahmood ◽  
Jonathan Rosand ◽  
Anand Viswanathan ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Surgical Intervention ◽  
Intraventricular Haemorrhage ◽  
Resource Utilisation ◽  
Academic Hospital ◽  
Factors Associated ◽  
Icu Stay ◽  
Frequent Use ◽  
Lower Baseline ◽  
Ich Score

BackgroundPatients with intracerebral haemorrhage (ICH) are frequently transferred between hospitals for higher level of care. We aimed to identify factors associated with resource utilisation among patients with ICH admitted to a single academic hospital.MethodsWe used a prospectively collected registry of consecutive patients with primary ICH at an urban academic hospital between 1 January 2005 and 31 December 2015. The primary outcome was use of either intensive care unit (ICU) admission or surgical intervention. Logistic regression examined factors associated with the outcome, controlling for age, sex, Glasgow coma score (GCS) and ICH score.ResultsOf the 2008 patients included, 887 (44.2%) received ICU stay or surgical intervention. These patients were younger (71 vs 74 years, p<0.001), less often white (83.9% vs 89.3%, p<0.001), had lower baseline GCS (12 vs 14, p<0.001) and more frequently had intraventricular haemorrhage (58.6% vs 43.4%, p<0.001). Factors independently associated with ICU stay or surgical intervention were age >65 years (OR 0.38, 95% CI 0.21 to 0.69), GCS <15 (1.23, 95% CI 1.01 to 1.52) and ICH score >0 (OR 2.23, 95% CI 1.70 to 2.91).ConclusionAmong this cohort of primary patients with ICH, GCS of 15 and ICH score of 0 were associated with less frequent use of ICU or intervention. These results should be validated in a larger sample but may be valuable for hospitals considering which patients with ICH could safely remain at the referring facility.

scholarly journals Clinical Profile and Outcomes in Patients with Acute Intracerebral Haemorrhage Presenting to the Emergency Department at a Tertiary Care Teaching Hospital, South India

2021 ◽  
Vol 10 (21) ◽  
pp. 1575-1582
Author(s):  
Subramanyam Penubaku ◽  
Madhusudhan Mukkara ◽  
Kanchi Mitra Bhargav ◽  
, Ramesh Chandra V.V. ◽  
Sadasiva Raju S. ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Intraventricular Haemorrhage ◽  
World Health ◽  
P Value ◽  
Study Population ◽  
Ich Score ◽  
Gcs Score ◽  
Time Of Admission

BACKGROUND World Health Organisation (WHO) defined stroke as rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin. Prognostic factors for predicting functional outcome and mortality play a major role in determining the treatment outcome. We intended to study the clinical charecteristics and outcome of patients with intracerebral bleeding coming to emergency room. METHODS Patients more than 18 years of age who were diagnosed to have intracerebral haemorrhage (ICH) on CT brain plain scan were included in the study. Age < 18 years, patients not willing to participate in the study were excluded from the study. Type of clinical presentation, imaging findings, ICH score, and Glasgow coma scale (GCS) score, were calculated for each patient at the time of admission. The condition of the patient, whether death / discharge (alive) was documented in all study population at the time of discharge. RESULTS Hypertension was the most common risk factor present in 68 % of study population. Most of the patients were between 41 - 70 years of age with a male preponderance. High ICH score, low GCS score at the time of admission, presence of intraventricular haemorrhage, and midline shift (P - value 0.000) were significantly associated with poor clinical outcome. Mortality was high in patients with infratentorial bleed and volume > 40 c.c. CONCLUSION Males in their sixth decade were the most affected in our study on ICH. Cerebellar and brainstem haemorrhages had higher mortality, though putamen is the commonest site of haemorrhage, low Glasgow Coma Scores and high ICH scores were associated with increased mortality. KEY WORDS Stroke, Haemorrhage, Intracerebral, Prognosis, Bleed

scholarly journals Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021719 ◽  
Author(s):  
Sonia Rodríguez-Fernández ◽  
Encarnación Castillo-Lorente ◽  
Francisco Guerrero-Lopez ◽  
David Rodríguez-Rubio ◽  
Eduardo Aguilar-Alonso ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intracerebral Haemorrhage ◽  
Demographic Data ◽  
Intraventricular Haemorrhage ◽  
Apache Ii ◽  
Mortality Ratio ◽  
Ich Score ◽  
Data Location

ObjectiveValidation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU).MethodsA multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated.ResultsA total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50–70) years. APACHE-II: 21(15–26) points, GCS: 7 (4–11) points, ICH score: 2 (2–3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79).ConclusionsICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.

scholarly journals Factors associated with high healthcare resource utilisation among COPD patients

2012 ◽  
Vol 106 (12) ◽  
pp. 1734-1742 ◽  
Author(s):  
Cayo García-Polo ◽  
Bernardino Alcázar-Navarrete ◽  
Luis Alberto Ruiz-Iturriaga ◽  
Alberto Herrejón ◽  
José Antonio Ros-Lucas ◽  
...  
Keyword(s):  
Healthcare Resource ◽  
Resource Utilisation ◽  
Factors Associated ◽  
Healthcare Resource Utilisation ◽  
Copd Patients

scholarly journals One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

2020 ◽  
Vol 40 (4) ◽  
pp. 298-304
Author(s):  
Khalid A. Alsheikh ◽  
Firas M. Alsebayel ◽  
Faisal Abdulmohsen Alsudairy ◽  
Abdullah Alzahrani ◽  
Ali Alshehri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
One Year

ABSTRACT BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years of age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

Loop diuretic use following fluid resuscitation in the critically ill

2021 ◽  
Author(s):  
Mashael A Alaskar ◽  
Joshua D Brown ◽  
Stacy A Voils ◽  
Scott M Vouri
Keyword(s):  
Hospital Discharge ◽  
Fluid Resuscitation ◽  
Loop Diuretic ◽  
Medical Center ◽  
Academic Medical Center ◽  
Loop Diuretics ◽  
Intravenous Fluid ◽  
Factors Associated ◽  
Icu Stay ◽  
Potential Factors

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To identify the incidence of continuation of newly initiated loop diuretics upon intensive care unit (ICU) and hospital discharge and identify factors associated with continuation. Methods This was a single-center retrospective study using electronic health records in the setting of adult ICUs at a quaternary care academic medical center. It involved patients with sepsis admitted to the ICU from January 1, 2014, to June 30, 2019, who received intravenous fluid resuscitation. The endpoints of interest were (1) the incidence of loop diuretic use during an ICU stay following fluid resuscitation, (2) continuation of loop diuretics following transition of care, and (3) potential factors associated with loop diuretic continuation after transition from the ICU. Results Of 3,591 patients who received intravenous fluid resuscitation for sepsis, 39.4% (n = 1,415) were newly started on loop diuretics during their ICU stay. Among patients who transitioned to the hospital ward from the ICU, loop diuretics were continued in 33% (388/1,193) of patients. At hospital discharge, 13.4% (52/388) of these patients were prescribed a loop diuretic to be used in the outpatient setting. History of liver disease, development of acute kidney injury, being on vasopressors while in the ICU, receiving blood products, and receiving greater than 90 mL/kg of bolus fluids were significant potential factors associated with loop diuretic continuation after transition from the ICU. Conclusion New initiation of loop diuretics following intravenous fluid resuscitation in patients with sepsis during an ICU stay is a common occurrence. Studies are needed to assess the effect of this practice on patient outcomes and resource utilization.

P112 Management and outcome of subarachnoid haemorrhage (SAH) in older people: a centre series

2019 ◽  
Vol 90 (3) ◽  
pp. e51.3-e50
Author(s):  
T Boumrah ◽  
J Fahmy ◽  
S Trippier ◽  
A Hainsworth ◽  
J Madigan ◽  
...  
Keyword(s):  
Rank Order ◽  
External Ventricular Drain ◽  
Intraventricular Haemorrhage ◽  
Medical Complications ◽  
Motor Score ◽  
Head Ct ◽  
Factors Associated ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group

ObjectivesTo study the management and factors associated with outcomes in SAH in elderly over 80 years of age.DesignRetrospective records review.SubjectsAll Patients with SAH confirmed on head CT admitted Jan 2012-Dec 2017.MethodsWe admitted 1079 patients with SAH, 32 were aged ≥80 y (3%). We subdivided the patients into a poor outcome group (POG) (Modified Rankin Scale (mRS) 4–6), (n=24, 14F/10M, mean age 83.7±0.7 y) and good outcome group (GOG) (mRS 0–3) (n=8, 7F/1M, mean age 82.6±0.6 y). Spearman’s rank-order test evaluated correlation between outcome (mRS) and all other variables (WFNS grade, GCS, Motor score of GCS, age, sex, smoking, hypertension, intraventricular haemorrhage (IVH) and intracerebral haemorrhages (ICH)).Results9 patients (38%) of POG were WFNS grades IV – V versus 1 patient (13%) in GOG. More POG than GOG patients had IVH (83% vs 38%, rs=−0.44 p=0.011). 20% of POG had ICH vs none in GOG. GOG patients had better GCS (rs=−0.37, p=0.04), lower WFNS grade (rs=0.43, p=0.01) and did not need external ventricular drain (EVD) (rs=0.51, p=0.003). There was no significant correlation between outcome and sex, smoking, hypertension, size of aneurysm (4.9 mm ±1.0 in GOG vs 5.4 mm ±1.1 in POG, rs=−0.29, p=0.28), percentage receiving coiling or clipping, GCS motor score, procedure complications and general medical complications.Conclusions75% of patients’ aged ≥80 y with SAH had poor outcome. WFNS grade (I-III), higher GCS patients who did not need EVD had better outcome.

Hospital admissions prior to primary intracerebral haemorrhage and relevant factors associated with survival

2020 ◽  
Vol 29 (9) ◽  
pp. 105026
Author(s):  
Wenwen Zhang ◽  
Craig S Anderson ◽  
Monique F Kilkenny ◽  
Joosup Kim ◽  
Helen M Dewey ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Hospital Admissions ◽  
Factors Associated ◽  
Relevant Factors

scholarly journals Baseline factors associated with early and late death in intracerebral haemorrhage survivors

2020 ◽  
Vol 27 (7) ◽  
pp. 1257-1263
Author(s):  
G. Banerjee ◽  
G. Ambler ◽  
D. Wilson ◽  
I. C. Hostettler ◽  
C. Shakeshaft ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Late Death ◽  
Factors Associated ◽  
Baseline Factors

scholarly journals Factors associated with more frequent diagnostic tests and procedures in patients with irritable bowel syndrome

2019 ◽  
Vol 12 ◽  
pp. 175628481881832 ◽  
Author(s):  
Brian Lacy ◽  
Rajeev Ayyagari ◽  
Annie Guerin ◽  
Andrea Lopez ◽  
Sherry Shi ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Diagnostic Tests ◽  
Depressive Disorders ◽  
Test Procedure ◽  
Comorbid Conditions ◽  
Factors Associated ◽  
Frequent Use ◽  
Radiologic Imaging ◽  
Irritable Bowel

Background: Irritable bowel syndrome (IBS) reduces quality of life and burdens healthcare systems. This study identified factors associated with frequent use of IBS diagnostic tests and procedures. Methods: Using a United States claims database (2001–2012), tests and procedures in IBS patients occurring in the 2-year study period (12 months before/following the first IBS diagnosis) were analyzed: endoscopy, GI transit testing, anorectal procedures, and radiologic imaging. Patients were classified based on test/procedure frequency (3+, 1–2, or 0). Multivariate logistic regression identified factors associated with more frequent tests/procedures. Results: Among 201,322 IBS patients, 41.7% had 3+ tests/procedures, 35.1% had 1–2, and 23.3% had 0. Patients with more tests/procedures were older [mean age 50.6 (3+ group), more likely to be female and had more comorbidities, including anxiety, depressive disorders, and somatization. Dyspepsia [odds ratio (95% confidence interval): 1.80 (1.72–1.87)], interstitial cystitis [1.60 (1.45–1.77)], gastroesophageal reflux disease [1.59 (1.55–1.63)], constipation [1.50 (1.45–1.54)], and dyspareunia [1.38 (1.25–1.52)] were significantly associated with more tests/procedures (3+ versus 1–2), while anxiety, depressive disorders, and somatization were not. Patients with more frequent specialist visits [emergency department (ED; 1.10 (1.09–1.11)) and gastroenterologists (1.26 (1.26–1.27))] or at least one GI-related ED visit or inpatient admission [1.95 (1.86–2.04) and 3.67 (3.48–3.87), respectively] were more likely to have more tests/procedures (all p < 0.05). Conclusions: Test frequency in patients with IBS is strongly associated with demographic and clinical characteristics, especially comorbid conditions related to IBS. Presence of common overlapping comorbid conditions should increase clinicians’ confidence in making the diagnosis of IBS, thus curtailing redundant testing and reducing healthcare costs.

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