scholarly journals Acute and sustained increase in endothelial biomarkers in COVID-19

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216797
Author(s):  
Raúl Méndez ◽  
Paula González-Jiménez ◽  
Ana Latorre ◽  
Mónica Piqueras ◽  
Leyre Bouzas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Respiratory Infections ◽  
Endothelial Damage ◽  
Diffusing Capacity ◽  
Emergency Department Admission ◽  
Poor Outcomes ◽  
Sustained Increase

Endothelial injury is related to poor outcomes in respiratory infections yet little is known in relation to COVID-19. Performing a longitudinal analysis (on emergency department admission and post-hospitalisation follow-up), we evaluated endothelial damage via surrogate systemic endothelial biomarkers, that is, proadrenomedullin (proADM) and proendothelin, in patients with COVID-19. Higher proADM and/or proendothelin levels at baseline were associated with the most severe episodes and intensive care unit admission when compared with ward-admitted individuals and outpatients. Elevated levels of proADM or proendothelin at day 1 were associated with in-hospital mortality. High levels maintained after discharge were associated with reduced diffusing capacity.

Risk factors for unplanned transfer to the intensive care unit after emergency department admission

2017 ◽  
Vol 35 (8) ◽  
pp. 1154-1158 ◽  
Author(s):  
Lena M. Boerma ◽  
Eef P.J. Reijners ◽  
Roger A.P.A. Hessels ◽  
Martijn A.A. v Hooft
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Emergency Department Admission

Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Manish Bastakoti ◽  
Mohamad Muhailan ◽  
Ahmad Nassar ◽  
Tariq Sallam ◽  
Sameer Desale ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Discharge ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Admission Diagnosis ◽  
Emergency Department Admission

Abstract Objectives Published discrepancy rates between emergency department (ED) and hospital discharge (HD) diagnoses vary widely (from 6.5 to 75.6%). The goal of this study was to determine the extent of diagnostic discrepancy and its impact on length of hospital stay (LOS), up-triage to the intensive care unit (ICU) and in-hospital mortality. Methods A retrospective chart review of adult patients admitted from the ED to a hospitalist service at a tertiary hospital was performed. The ED and HD diagnoses were compared and classified as concordant, discordant, or symptom diagnoses according to predefined criteria. Logistic regression analysis was conducted to examine the associations of diagnostic discordance with in-hospital mortality and up-triage to the ICU. A linear regression model was used for the length of stay. Results Of the 636 patients whose records were reviewed, 418 (217 [51.9%] women, with a mean age of 64.1 years) were included. Overall, 318 patients (76%) had concordant diagnoses, while 91 (21.77%) had discordant diagnoses. Only 9 patients (2.15%) had symptom diagnoses. A discordant diagnosis was associated with increased mortality (OR: 3.64; 95% CI: 1.026–12.91; p=0.045) and up-triage to the ICU (OR: 5.51; 95% CI: 2.43–12.5; p<0.001). The median LOS was significantly greater for patients with discordant diagnoses (7 days) than for those with concordant diagnoses (4.7 days) (p=0.004). Symptom diagnosis did not affect the mortality or ICU up-triage. Conclusions One in five hospitalized patients had discordant HD and admission diagnoses. This diagnostic discrepancy was associated with significant impacts on patient morbidity and mortality.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

scholarly journals In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 431
Author(s):  
Chun-Fu Lin ◽  
Yi-Syun Huang ◽  
Ming-Ta Tsai ◽  
Kuan-Han Wu ◽  
Chien-Fu Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Regression Analysis ◽  
Intensive Care ◽  
Medical Cost ◽  
Total Medical Cost ◽  
Hospital Outcomes ◽  
Return Visit ◽  
Icu Admission ◽  
Ed Visits

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

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