scholarly journals Clinical Correlation Analysis of Complications in Elderly Patients with Sequelae of Stroke with Different Barthel Index in Tianjin Emergency Department

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Xingzhen Zheng ◽  
Haidong Wang ◽  
Xiaolin Bian
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Barthel Index ◽  
Upper Gastrointestinal Bleeding ◽  
Severity Of Illness ◽  
Decubitus Ulcer ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Stroke Patients ◽  
Upper Gastrointestinal

Objective. The Barthel index (BI) is the most commonly used measure of poststroke disability. The purpose of this article is to explore the different complications and severity of the sequelae of elderly stroke patients with different BI in the emergency department, so as to provide a theoretical basis for strengthening the treatment of elderly patients with stroke sequelae. Methods. A retrospective study was adopted, and 1896 patients were divided into two groups according to the BI: 823 patients in the bedridden group ( BI ≤ 40   points ) and 1073 patients in the nonbedridden group ( BI > 40   points ). The type and number of complications and APACHE II score were compared between the two groups. Results. Compared with the two groups, pneumonia, renal insufficiency, respiratory failure, and decubitus ulcer in the bedridden group had a higher incidence, but the incidence of upper gastrointestinal bleeding and fractures in the nonbedridden group was significantly higher ( P < 0.05 ). The APACHE II score of the patients in the bedridden group was higher than that of the nonbedridden group, and they were critical ( P < 0.001 ). And the number of complications was higher than that in the nonbedridden group. Moreover, the BI was negatively correlated with the APACHE-II score and the number of complications, and the APACHE II score was positively correlated with the number of complications ( P < 0.001 ). Conclusion. Different complications and severity of illness occur in elderly patients with sequelae of stroke after different BI in the emergency department.

scholarly journals Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

2021 ◽  
Vol 8 (2) ◽  
pp. 105-111
Author(s):  
Sunil Adhikari ◽  
Suraj Rijal ◽  
Darlene Rose House
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Clinical Presentation ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Clinical Profile ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

scholarly journals Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11656
Author(s):  
Lan Chen ◽  
Han Zheng ◽  
Saibin Wang
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Area Under The Curve ◽  
Decision Curve Analysis ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Bleeding Score ◽  
Selection Operator ◽  
Upper Gastrointestinal ◽  
D Dimer

Background Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. Methods A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. Results Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794–0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. Conclusions The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

2006 ◽  
Vol 15 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Cindy L. Munro ◽  
Mary Jo Grap ◽  
R.K. Elswick ◽  
Jessica McKinney ◽  
Curtis N. Sessler ◽  
...  
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Dental Plaque ◽  
Severity Of Illness ◽  
Oral Health Status ◽  
Microbial Colonization ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia ◽  
Time Correlations

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. • Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. • Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. • ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P &lt; .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P&lt;.001), and interaction of day 1 CPIS and plaque (P=.01). • Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

scholarly journals Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

2018 ◽  
Vol 26 (1) ◽  
pp. 31-38
Author(s):  
Zeynep Konyar ◽  
Ozlem Guneysel ◽  
Fatma Sari Dogan ◽  
Eren Gokdag
Keyword(s):  
Emergency Department ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Venous Blood ◽  
Erythrocyte Suspension ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Lactate Levels ◽  
Upper Gastrointestinal

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

scholarly journals Assessment of Outcome over a 10-year Period of Patients Admitted to a Multidisciplinary Adult Intensive Care Unit with Haematological and Solid Tumours

2005 ◽  
Vol 33 (1) ◽  
pp. 26-35 ◽  
Author(s):  
J. L. Moran ◽  
P. J. Solomon ◽  
P. J. Williams
Keyword(s):  
Mechanical Ventilation ◽  
Cox Model ◽  
Severity Of Illness ◽  
Cohort Effect ◽  
Solid Tumours ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Over Time

The risk factors for time to mortality, censored at 30 days, of patients admitted to an adult teaching hospital ICU with haematological and solid malignancies were assessed in a retrospective cohort study. Patients, demographics and daily ICU patient data, from admission to day 8, were identified from a prospective computerized database and casenote review in consecutive admissions to ICU with haematological and solid tumours over a 10-year period (1989–99). The cohort, 108 ICU admissions in 89 patients was of mean age (±SD) 55±14 years; 43% were female. Patient diagnoses were leukaemia (35%), lymphoma (38%) and solid tumours (27%). Median time from hospital to ICU admission was five days (range 0–67). On ICU admission, 50% had septic shock and first day APACHE II score was 28±9. Forty-six per cent of patients were ventilated. ICU and 30-day mortality were 39% and 54% respectively. Multivariate Cox model predictors (P<0.05), using only ICU admission day data were: Charlson comorbidity index (CCI), time to ICU admission (days) and mechanical ventilation. For daily data (admission through day 8), predictors were: cohort effect (2nd vs 1st five-year period); CCI; time to ICU admission (days); APACHE II score and mechanical ventilation. Outcomes were considered appropriate for severity of illness and demonstrated improvement over time. Ventilation was an independent outcome determinant. Controlling for other factors, mortality has improved over time (1st vs 2nd five year period). Analysis restricted to admission data alone may be insensitive to particular covariate effects.

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