scholarly journals Reversal of warfarin anticoagulation in geriatric traumatic brain injury due to ground-level falls

2019 ◽  
Vol 4 (1) ◽  
pp. e000352
Author(s):  
Michael John Paisley ◽  
Arianne Johnson ◽  
Spencer Price ◽  
Bernard Chow ◽  
Liliana Limon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vitamin K ◽  
Geriatric Patients ◽  
Oral Anticoagulants ◽  
Ground Level ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Of Evidence

BackgroundThe efficacy of prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for reversal of oral anticoagulants has not been investigated in geriatric patients suffering intracranial hemorrhage (ICH) due to a ground-level fall (GLF).MethodsPatients 65 years and older who were treated at Santa Barbara Cottage Hospital between January 2011 and March 2018 with ICH after a GLF while taking warfarin were reviewed. Patients were reversed with either FFP (n=25) or PCC (n=27) and patient outcomes were compared. Separate analyses were conducted for patients who received adjuvant vitamin K administration and those who did not.ResultsMortality rates, hospital length of stay, intensive care unit admission and length of stay were similar for both FFP and PCC intervention. There was no difference in radiological progression of hemorrhage within the first 24 hours of admission (FFP: 36%, PCC: 43%, p=0.365). In patients who had international normalized ratio (INR) values measured prior to intervention, 81% (17 out of 21) of the PCC group reached an INR value below 1.5 within an 8-hour period, whereas only 29% (4 out of 14) of the FFP group did (p=0.002). Vitamin K was concomitantly given to 28% of the patients receiving FFP, and 81% of those patients receiving PCC. No significant differences in outcomes were found whether adjunctive vitamin K was administered or not, in either FFP or PCC group. However, when vitamin K was not administered, the PCC group had a higher rate of INR reversal (80% vs. 10% for FFP, p=0.006).ConclusionAdministration of PCC is as effective in short-term outcomes as FFP in treating geriatric patients on warfarin sustaining an ICH after a GLF. INR reversal was more successful, significantly faster, and required lower infusion volumes in patients receiving PCC.Level of evidenceLevel III.

scholarly journals Comparison of hospital length of stay in patients treated with non–vitamin K oral anticoagulants or parenteral agents plus warfarin for venous thromboembolism

2017 ◽  
Vol 5 ◽  
pp. 205031211771962 ◽  
Author(s):  
Catherine A Saint ◽  
Michelle R Castelli ◽  
Andrew J Crannage ◽  
Zachary A Stacy ◽  
Erin K Hennessey
Keyword(s):  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Hospital Length ◽  
Hospital Length Of Stay

Associations of medical comorbidity, psychosis, pain, and capacity with psychiatric hospital length of stay in geriatric inpatients with and without dementia

2014 ◽  
Vol 27 (2) ◽  
pp. 313-321 ◽  
Author(s):  
Zahinoor Ismail ◽  
Tamara Arenovich ◽  
Robert Granger ◽  
Charlotte Grieve ◽  
Peggie Willett ◽  
...  
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Geriatric Patients ◽  
Hospital Length ◽  
Geriatric Psychiatry ◽  
Assessment Instrument ◽  
Hospital Length Of Stay ◽  
Psychotic Symptoms ◽  
Discharge Data ◽  
Use Of Resources

ABSTRACTBackground:Geriatric psychiatry hospital beds are a limited resource. Our aim was to determine predictors of hospital length of stay (LOS) for geriatric patients with dementia admitted to inpatient psychiatric beds.Methods:Admission and discharge data from a large urban mental health center, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the resident assessment instrument - mental health (RAI-MH), an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 169 geriatric patients with dementia were compared with 308 geriatric patients without dementia. Predictors of hospital LOS were determined using a series of general linear models.Results:A diagnosis of dementia did not predict a longer LOS in this geriatric psychiatry inpatient population. The presence of multiple medical co-morbidities had an inverse relationship to length of hospital LOS – a greater number of co-morbidities predicted a shorter hospital LOS in the group of geriatric patients who had dementia compared to the without dementia study group. The presence of incapacity and positive psychotic symptoms predicted longer hospital LOS, irrespective of admission group (patients with dementia compared with those without). Conversely, pain on admission predicted shorter hospital LOS.Conclusions:Specific clinical characteristics generally determined at the time of admission are predictive of hospital LOS in geriatric psychiatry inpatients. Addressing these factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.

scholarly journals Predicting Hospital Length of Stay for Geriatric Patients with Mood Disorders

2012 ◽  
Vol 57 (11) ◽  
pp. 696-703 ◽  
Author(s):  
Zahinoor Ismail ◽  
Tamara Arenovich ◽  
Charlotte Grieve ◽  
Peggie Willett ◽  
Gautam Sajeev ◽  
...  
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Mood Disorder ◽  
Mood Disorders ◽  
Geriatric Patients ◽  
Hospital Length ◽  
Assessment Instrument ◽  
Hospital Length Of Stay ◽  
Discharge Data ◽  
Use Of Resources

Objective: To determine predictors of hospital length of stay (LOS) for adult and geriatric patients with mood disorders admitted to inpatient psychiatric beds. Method: Admission and discharge data from a large urban mental health centre, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the Resident Assessment Instrument—Mental Health, an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 199 geriatric mood disorder admissions were compared with 570 adult mood disorder admissions. Predictors of hospital LOS were determined using a series of general linear models. Results: Living alone, number of recent psychiatric admissions, involuntary admission, and close or constant observation level predict longer hospital LOS in geriatric, but not in adult mood disorder, patients. Conversely, pain on admission predicts shorter hospital LOS in geriatric, but not among adult, mood disorder patients. Predictors of longer hospital LOS, irrespective of admission group (adult, compared with geriatric), include incapacity, negative symptoms, and increased dependence for instrumental activities of daily living. Conclusions: Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.

scholarly journals Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery

2018 ◽  
Vol 9 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Gaston Camino Willhuber ◽  
Cristina Elizondo ◽  
Pablo Slullitel
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Unplanned Readmission ◽  
Level Of Evidence ◽  
Clavien Classification ◽  
Surgical Complexity

Study Design: Retrospective study. Level of evidence III. Objective: Postoperative complications in spine surgery are associated with increased morbidity, hospital length of stay, and health care costs. Registry of complications in orthopedics and the spine surgery is heterogeneous. Methods: Between July 2016 and June 2017, 274 spinal surgeries were performed, the presence of postoperative complications was analyzed at 90 days (according to the classification of Dindo-Clavien, grades I-V), hospital length of stay, surgical complexity (low, medium, and high), unplanned readmission, and risk factors were evaluated. Results: A total of 79 patients suffered a complication (28.8%), of them 21 (26.7%) were grade I, 24 (30.3%) were grade II, 4 (5.7%) were grade IIIA, and 29 (37.3%) were grade IIIB. There were no IV and V grade cases. The most frequent complication was excessive pain followed by deep wound infection and anemia. Surgical complexity and surgical time were significantly associated with the risk of developing a complication. The average number of hospital length of stay in patients without and with complications were 2.7 and 10.6, respectively, and the unplanned readmission rate was 11%. Conclusions: Registry of postoperative complications allows the correct standardization and risk factors required to establish measures to decrease them, the application of Dindo-Clavien classification was useful for the purpose of our study.

scholarly journals Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls

Gerontology ◽  
2016 ◽  
Vol 63 (4) ◽  
pp. 299-307 ◽  
Author(s):  
Bellal Joseph ◽  
Nima Toosizadeh ◽  
Tahereh Orouji Jokar ◽  
Michelle R. Heusser ◽  
Jane Mohler ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Health Outcomes ◽  
Ground Level ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Upper Extremity Function

Background: Despite National Surgical Quality Improvement guidelines to integrate frailty into surgical elder assessments, a quick, accurate, and simple frailty assessment tool suitable for busy clinical settings is still not available. Recently, we have demonstrated that a simple upper-extremity function (UEF) test based on wearable sensors could identify frailty with high agreement with conventional assessments by testing 20-s repetitive elbow flexion and extension. Objective: We examined whether UEF parameters are sensitive for predicting adverse health outcomes in bedbound older adults admitted to hospital due to ground-level fall injuries. Study Design: Frailty was assessed in 101 eligible older adults (age: 79 ± 9 years) admitted to a trauma setting using the UEF test at the time of admission. All participants were followed up for 2 months using phone calls and chart reviews. The measured health outcomes included (1) discharge disposition (favorable: discharge home or rehabilitation; unfavorable: discharge to skilled nursing facility or death), (2) hospital length of stay, (3) 30-day readmission, (4) 60-day readmission, and (5) 30-day prospective falls. Multivariate analyses were used to identify independent predictors of adverse health outcomes based on participants' demographic parameters (i.e., age, gender, and body mass index [BMI]) and UEF index. Results: Based on the UEF frailty status, 53 (52%) of the participants were frail and 48 (48%) were non-frail. Among all adverse health outcomes, age was only a significant predictor of 30-day prospective falls (p = 0.023). On the other hand, the UEF index was a significant predictor of all measured outcomes except hospital length of stay (p < 0.010). Among the UEF parameters, those indicating slowness, weakness, and exhaustion had the highest effect sizes to predict an unfavorable discharge disposition (p < 0.010; effect size = 0.65-0.92). Conclusion: The results of this study suggest that a 20-s UEF test is practical in the trauma setting and could be used as a quick measure for predicting adverse events and outcomes among bedbound patients after discharge. Assessing frailty using UEF may assist in objective triage, treatment, and post-discharge decision-making with regard to geriatric trauma patients.

scholarly journals DEMOGRAPHIC ANALYSIS OF ACETABULAR FRACTURES TREATED IN A QUATERNARY CARE HOSPITAL FROM 2005 TO 2016

2019 ◽  
Vol 27 (6) ◽  
pp. 317-320 ◽  
Author(s):  
Marcelo Cortês Cavalcante ◽  
Frederico Augusto Alves de Arruda ◽  
Guilherme Boni ◽  
Gustavo Tadeu Sanchez ◽  
Daniel Balbachevsky ◽  
...  
Keyword(s):  
Length Of Stay ◽  
White Male ◽  
Age Distribution ◽  
Posterior Wall ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acetabular Fractures ◽  
Care Hospital ◽  
Level Of Evidence ◽  
Average Hospital

ABSTRACT Objective: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. Methods: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. Results: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). Conclusions: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

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