Abstract TP231: Every IV Thrombolysis Case Should be Less Than 45 Minutes: Not So Easy All the Time

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sean Cavanaugh ◽  
Jennifer Williams ◽  
Andria Ford ◽  
Peter Panagos ◽  
Laura Heitsch
Keyword(s):  
Tertiary Care ◽  
Patient Characteristics ◽  
Analysis Data ◽  
Time Of Arrival ◽  
Continuous Variables ◽  
Chi Square ◽  
Stroke Registry ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Ed Crowding

Background: Target Stroke establishes the goal to administer IV Alteplase within 60 minutes of ED arrival. High-performing centers frequently treat within 45 minutes. Median door-to-needle (DTN) times at our tertiary care academic hospital are consistently < 30 minutes. Monthly case reviews investigate factors associated with DTN times greater than 45 minutes. Methods: Utilizing our stroke registry, patients treated with Alteplase from 2013-2015 were identified. Baseline demographics, medical comorbidities, weekend or after hours (7PM-7AM) presentation, initial NIHSS, initial BP greater than 185/110 and management, posterior circulation symptoms and ED crowding using the National Emergency Department Overcrowding Scale (NEDOCS) were extracted. Arrival date and time of arrival were cross-referenced with NEDOCS. Patients were divided into cohorts of treatment less than 45 minutes vs. greater than 45 minutes. Continuous variables were tested for normal distribution using Shapiro-Wilk, then either an unpaired t test or Wilcoxon’s test was applied to test for significance. Dichotomous variables were tested for significance with Chi-square analysis. Results: A total of 239 patients were included in the analysis. Data is presented in Table 1. After adjusting for multiple comparisons, there was a statistically significant difference in the distribution of baseline NIHSS scores (p=0.0006), diabetes (p=0.0023), and minor strokes (NIHSS less than 3, p=0.0003). Conclusion: Diabetics and patients with minor symptoms are more likely to have longer DTN times. Elevated BP, ED crowding, weekend and after hour arrivals do not significantly delay evaluation and treatment. While not significant after adjusting for multiple tests, both posterior stoke recognition and method of treating BP should be scrutinized as they are modifiable risk factors. Future awareness of discrete patient characteristics may help identify patients at risk for prolonged DTN.DTN.

Does Gender Influence How Patients Rate Their Patient Experience after Total Knee Arthroplasty?

2017 ◽  
Vol 30 (07) ◽  
pp. 634-638 ◽  
Author(s):  
Marcelo Siqueira ◽  
Morad Chughtai ◽  
Anton Khlopas ◽  
Chukwuweike Gwam ◽  
Jaydev Mistry ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Experience ◽  
Knee Arthroplasty ◽  
Pay For Performance ◽  
Continuous Variables ◽  
Chi Square ◽  
Men And Women ◽  
Significant Difference ◽  
Total Knee ◽  
Chi Square Analysis

AbstractThe Centers for Medicare and Medicaid Services has implemented the Value-Based Purchasing (VBP) score as a pay-for-performance reimbursement model. Patient experience, as measured by the Press Ganey (PG) survey, currently comprises 20% of total VBP score. It is therefore beneficial for the orthopaedist to become familiar with these changes to maximize profits. Currently, a paucity of data exists that elucidates which factors influence PG scores between men and women following total knee arthroplasty (TKA). Therefore, we asked: (1) which PG survey factors most influences hospital ratings among men and women patients post-TKA and (2) is there a significant difference in overall hospital ratings among men and women cohorts post-TKA? We queried the PG database for patients who received a TKA between November 2009 and January 2015, yielding 224 men (mean age 64 years, range: 39–88) and 519 women (mean age 65 years; range, 25–92). A multiple regression analysis was performed for each cohort with overall hospital satisfaction as the dependent variable to assess the influence (β-weight) each PG domain imparted on overall hospital rating. A chi-square analysis and t-test were performed to assess categorical and continuous variables, respectively. For men, communication with nurses (β = 0.408, p = 0.016), followed by communication about medications (β = 0.261, p = 0.032), most influenced overall hospital rating. For women, communication with nurses (β = 0.479, p < 0.001) most influenced overall hospital rating. This was followed by staff responsiveness (β = 0.201, p = 0.046), pain management (β = 0.263, p = 0.015), and communication about medications (β = − 0.152, p = 0.029). It is of great advantage for the orthopaedist to focus on the PG domains most pertinent to each patient gender post-TKA. For both genders, overall hospital rating was significantly influenced by communication with nurses and information about medication. However, staff responsiveness and pain control were of significant importance in determining overall hospital rating for women. Therefore, orthopaedists should consider focusing on these factors depending on the gender of the patient to optimize satisfaction.

scholarly journals 2005. Successful Implementation of a Procalcitonin Algorithm Associated with Reduction in Antibiotic Days

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S672-S673
Author(s):  
John B McCoury ◽  
Randolph V Fugit ◽  
Mary T Bessesen
Keyword(s):  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Successful Implementation ◽  
Continuous Variables ◽  
Chi Square ◽  
Clinician Training ◽  
Significant Difference ◽  
Mortality Table

Abstract Background Randomized controlled trials of procalcitonin (PCT)-based algorithms for antibacterial therapy have been shown to reduce antimicrobial use and improve survival. Translation of PCT algorithms to clinical settings has often been unsuccessful. Methods We implemented a PCT algorithm, supported by focus groups prior to introduction of the PCT test in April 2016 and clinician training on the PCT algorithm for testing and antimicrobial management after test roll-out. The standard PCT algorithm period (SPAP) was defined as October 1, 2017 to March 31, 2018. The antimicrobial stewardship team (AST) initiated an AST-supported PCT algorithm (ASPA) in August 2018. The AST prospectively evaluated patients admitted to ICU for sepsis and ordered PCT per algorithm if the primary medical team had not ordered them. The ASPA period was defined as October 1, 2018–March 31, 2019. The AST conducted concurrent review and feedback for all antibiotic orders during both periods, using PCT result when available. We compared patient characteristics and outcomes between the two periods. The primary outcome was adherence to the PCT algorithm, with subcomponents of appropriate PCT orders and antimicrobial discontinuation. Secondary outcomes were total antibiotic days, excess antibiotic days avoided, ICU and hospital length of stay (LOS), 30-day readmission and mortality. Continuous variables were analyzed with Student t-test. Categorical variables were analyzed with chi-square or Mann–Whitney test, as appropriate. Results There were 35 cases in the SPAP cohort and 57 cases in the ASPA cohort. There were no differences in demographics or infection site (Table 1). Baseline PCT was ordered in 57% of the SPAP cohort and 90% of the ASPA cohort (P = 0.0006) (Table 2). Follow-up PCT was performed in 23% of SPAP and 76% of ASPA (P < 0.0001). Antibiotics were discontinued per algorithm in 2/35 (7%) in the SPAP cohort and 25/57 (44%) in the ASPA cohort (P < 0.0001). Total antibiotic days was 7 (IQR 4–10) in the SPAP cohort and 5 (IQR 2–7) in the ASPA cohort (P = 0.02). There was no significant difference in LOS, ICU LOS, 30-day readmission, or mortality (Table 4). Conclusion A PCT algorithm successfully implemented by an AST was associated with a significant decrease in total antibiotic days. There were no differences in mortality or LOS. Disclosures All authors: No reported disclosures.

Abstract T P197: Early Improvement In NIHSS Is Common During Inter-hospital Transfer And Is Associated With Lower In-hospital Mortality

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Khawja A Siddiqui ◽  
Abigail S Cohen ◽  
Syed F Ali ◽  
Lee H Schwamm
Keyword(s):  
Tertiary Care ◽  
Patient Characteristics ◽  
Stroke Severity ◽  
Inhospital Mortality ◽  
Chi Square ◽  
Altered Level ◽  
Early Improvement ◽  
Stroke Registry ◽  
Interhospital Transfer ◽  
Number Of Patients

Introduction: A significant number of patients are transferred from outside referral hospitals (OSH) to larger tertiary care centers for specialized care or post-tPA management. As efforts to risk adjust stroke mortality and patient outcomes increase, better understanding of early changes in stroke severity are needed, especially changes in stroke severity that occur during interhospital transfer. We evaluated the percentage of patients with significant early improvement after transfer and associated patient characteristics and outcomes. Method: Using our Get with the Guidelines-Stroke registry, we identified 302 acute ischemic stroke transfer patients with documented initial NIHSS at the OSH from 12/10 - 12/13. Patients with early improvement after interhospital transfer (≥ 4 points improvement in NIHSS between initial NIHSS at receiving hospital minus initial at OSH) were compared to those without (< 4 points improvement or worsening). Baseline clinical characteristics, tPA treatment and outcomes were compared with Chi-square test and student's t-test. Results: There were 76/302 (25.2%) patients with ≥ 4 points improvement in NIHSS. Compared to those without early improvement, those with early improvement were less likely to have history of hyperlipidemia and carotid stenosis, presented with altered level of consciousness less often, and had higher median initial NIHSS at OSH. They had substantially lower inhospital mortality (3.9% vs. 12.4%). Discussion: Early improvement in stroke severity during interhospital transfer is common, and is not confined to patients receiving thrombolysis. These early improvement patients have very low mortality, and it is substantially lower than in those without early improvement, despite higher initial NIHSS. This has important implications for assessing the safety and efficacy of drip and ship thrombolysis or other pre-transfer interventions. Further research is warranted.

scholarly journals LO006: Interarm blood pressure differential as a clinical marker for acute aortic dissection in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S32-S32
Author(s):  
S.W. Um ◽  
R. Ohle ◽  
J.J. Perry
Keyword(s):  
Back Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Tertiary Care ◽  
Mean Difference ◽  
Healthy Population ◽  
Chi Square ◽  
Significant Difference ◽  
Life Threatening ◽  
Chi Square Analysis

Introduction: Acute Aortic Dissection (AAD) is life threatening, requiring early diagnosis. Although previous literature suggest interarm BP differential is an independent predictor of AAD, up to 20% of a healthy population can have a significant differential. Our objectives were to assess the rate of bilateral BP measurement in acute non-traumatic truncal pain patients, and the association of BP differential with non-traumatic AAD. Methods: This is a historical matched case control study: participants were adults >18 years old presenting to two tertiary care EDs with a triage diagnosis of truncal (i.e. chest, abdominal, flank, back) pain. Cases were selected based on an ED or in-hospital diagnosis of non-traumatic AAD confirmed by CT or Echo. Controls were from a single calendar year matched in a 1:1.5 ratio by sex and age within 5 years. ED and referral consult BP measurements were used. Exclusion criteria: clear diagnosis on basic investigation (i.e. UTI, pneumonia, pneumothorax, acute fracture) or pain >14 days/no pain. Sample size of 126 cases and 183 controls was calculated based on 20% exposure in controls (80% power and alpha of 5%), to detect an OR >2. P-values were calculated using chi square analysis. Results: A total of 294 (119 cases, 175 controls) patients were included (mean 66+/-14.5yrs, 59.5% male). Cases (199 potential: 119 included; 80 excluded). Controls (8239 potential: 305 reviewed; 175 included; 130 excluded). Bilateral BP was measured in 70.6% of cases (n=84, mean difference=15.5mmHg) versus 31.3% of controls (n=55, mean difference=10.9mmHg). Among included controls, most common diagnoses were: Unspecified Chest (36.0%) or Abdominal (9.7%) Pain, ACS (12.6%), Muscular Back Pain (5.1%), and Renal Colic (4.0%). BP differential >10mmHg was found in 58.8% of cases and 40.7% of controls (P=0.10). A BP differential >20mmHg was found in 31.3% of cases and 22.2% of controls (P=0.37). BP differential >20mmHg did not significantly increase the odds of AAD (OR 2.0 (95%CI 0.82-4.90), p<0.129). Conclusion: Interarm BP differential is not routinely measured in ED patients with acute non-traumatic truncal pain, and there is no significant difference in the presence or magnitude of differentials in patients with or without AAD. Therefore, physicians should not rely on BP differentials to aid in their diagnosis or exclusion of AAD.

Abstract T P399: Patient Characteristics and Outcomes in Pregnancy-Related Subarachnoid Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Lisa Leffert ◽  
Caitlin Clancy ◽  
Brian Bateman ◽  
Margueritte Cox ◽  
Phillip Schulte ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Patient Characteristics ◽  
Stroke Onset ◽  
Hospital Death ◽  
Continuous Variables ◽  
Chi Square ◽  
Stroke Registry ◽  
Hospital Deaths ◽  
Get With The Guidelines ◽  
Initial Blood Pressure

Background: Subarachnoid hemorrhage (SAH) accounts for up to 4.1% of all pregnancy-related in-hospital deaths, but is less often aneurysmal and is associated with better short term outcomes than in non-pregnant patients. We sought to describe the risk factors, management and outcomes of pregnant vs. non-pregnant patients with SAH in the Get With The Guidelines (GWTG) Stroke Registry. Methods: Using medical history or ICD-9 codes, we identified 152 pregnant and 5745 non-pregnant SAH female patients aged 18-44 with SAH in GWTG from 2008-2013. Differences in characteristics were compared by Chi-square tests for categorical and Wilcoxon Rank-Sum tests for continuous variables. Stratified logistic regression assessed the effect of pregnancy on outcomes conditional on age and adjusted for patient and hospital characteristics. Results: Pregnant SAH patients were younger, more often black and insured with Medicaid. They had higher initial blood pressure (BP) and were less likely to report prior hypertension. Arrival delays from stroke onset were common in both groups (median 340 vs. 277 min), but pregnant SAH patients were more often already hospitalized at stroke onset (16% vs. 10%). Fewer pregnant vs. non-pregnant SAH patients had initial neurologic exam findings recorded (Table). Pregnant SAH patients had lower in-hospital death than non-pregnant patients (aOR 0.17, 95% CI 0.06-0.45) and were more likely at discharge to ambulate independently (aOR 2.40, 95% CI 1.56-3.69) and return home (aOR 2.60, 95% CI 1.67-4.06). Conclusions: Several differences exist between pregnant and non-pregnant women with SAH. Many present with BP well below the threshold for hypertensive disorders of pregnancy, making prompt recognition and prevention of brain hemorrhage challenging. Overall, pregnancy-related SAH is associated with less morbidity and mortality than non-pregnancy related disease.

Abstract 168: Relation Between the Prehospital Administrated Doses of Epinephrine and the Acquisition of Return of Spontaneous Circulation in Patients With Cardiopulmonary Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kiyohiro Oshima ◽  
Makoto Aoki ◽  
Masato Murata ◽  
Jun Nakajima ◽  
Yusuke Sawada ◽  
...  
Keyword(s):  
Cardiopulmonary Arrest ◽  
Statistical Significance ◽  
Analysis Data ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Time Of Arrival ◽  
Chi Square ◽  
Significant Difference ◽  
Hospital Patients ◽  
O 11

Introduction: The efficacy of epinephrine (Ep) administration to cardiopulmonary arrest (CPA) patients is still controversial, and correlation between plasma Ep levels of and prognosis in CPA patients is unclear. Hypothesis: We hypothesized that the more EP is administered, the higher the rate of ROSC becomes in CPA patients. The purpose of this study is to evaluate whether a dose of Ep influenced the prognosis in CPA patients. Methods: This was a prospective, observational clinical study, approved by the ethics committee of Gunma University Hospital (IRB #14-13). CPA patients transferred to our hospital were enrolled prospectively between July 2014 and July 2017. The levels of Ep in the plasma were measured using blood samples immediately obtained at the time of arrival to our hospital. Patients were divided into the four groups based on the prehospital administered dose of EP; patients without prehospital Ep administration (group Z), prehospital administration of 1mg Ep (group O), 2mg Ep (group T) and 4mg Ep (group F). The plasma Ep levels and the conditions of resuscitation were compared among those groups. The IBM SPSS Statistics 25 software was used for statistical analysis. Data are shown as median (Q1, Q3). The Kruskal-Wallis or chi-square tests were used to conduct the comparisons among four groups. P<0.05 denoted statistical significance. Results: We analyzed 150 patients. There were 96 patients in group Z, 38 in group O, 11 in group T and 5 in group F. There was no significant difference in prehospital resuscitation time among 4 groups, and the level of Ep in the plasma obtained immediately after arrival at hospital was the highest in the group F with a significant difference {286.0 (247.2, 424.9) ng/ml in group F, 244.0 (22.1, 620.3) ng/ml in group T, 1.6 (0.5, 4.5) ng/ml in group O and 2.0 (0.4, 4.5) ng/ml in group Z, respectively, p<0.001}. However, the ratio of ROSC acquisition was the lowest in the group F with a significant difference (0 in group F, 18.2% in group T, 15.8% in group O and 35.4% in group Z). Conclusions: Our results suggest that the prehospital administered dose of Ep is not relates with the acquisition of ROSC in patients with CPA.

scholarly journals 291. Epidemiology of Candidemia Rates during COVID-19 and Comparison of Outcomes in Candidemia Between COVID-19 and Non-COVID-19 Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S253-S254
Author(s):  
Angela Beatriz Cruz ◽  
Jennifer LeRose ◽  
Kenisha J Evans ◽  
Monica Meyer ◽  
Teena Chopra ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Patient Characteristics ◽  
Continuous Variables ◽  
Central Venous ◽  
Chi Square ◽  
Patient Demographics ◽  
Icu Length Of Stay ◽  
Tertiary Healthcare ◽  
Chi Square Analysis ◽  
The Impact

Abstract Background Fungemia is associated with high rates of morbidity, mortality and increase in length of hospital stay. Several studies have recognized increased rates of candidemia since the COVID-19 pandemic. Methods A retrospective cohort study was conducted at a tertiary healthcare system in Detroit, Michigan to evaluate the impact of the COVID-19 pandemic on incidence of candidemia. The “pre COVID-19” timeframe was defined as January – May 2019 while the “during COVID-19” timeframe was January – May 2020. To compare incidence and patient characteristics between cohorts, t-tests and chi-square analysis was used. Additional sub-analysis was performed in candidemia patients during COVID-19 timeframe comparing outcomes of patients based on COVID-19 status. A Fisher Exact and Satterthwaite Test were used for analysis of categorical and continuous variables, respectively. Results Overall, 46 cases of candidemia were identified in both the pre COVID-19 and during COVID-19 periods. Pre COVID-19, the average number of cases was 3.0 ± 1.2 per month. The incidence more than doubled during COVID-19 to 6.2 ± 4.2 cases per month (p = 0.14) (Figure 1). No significant differences in patient demographics were detected between cohorts, however, patients in the COVID-19 cohort had higher rates of corticosteroid use, mechanical ventilation and vasopressors (Table 1). In the 2020 period, 31 patients developed candidemia and 12 (38.7%) patients tested SARS-CoV-2 positive. On average, COVID-19 patients developed candidemia 12.1 days from admission, compared to 17.8 days in the COVID-19 negative cohort (p = 0.340). Additionally, COVID-19 patients with candidemia coinfection were significantly more likely to expire; 83.3% (n=10) COVID-19 patients expired compared to 36.8 (n=7) in the COVID-19 negative cohort (p = 0.025) (Table 2). Figure 1. Incidence of Candidemia in the Pre-COVID-19 (January 2019 – May 2019) and During COVID-19 (January 2020-May 2020) periods Table 1. Characteristics of Candidemia patients in the pre-COVID (January 2019-May 2019) and during-COVID periods (January 2020-May 2020) Table 2. Characteristics of Candidemia patients in the SARS-COV-2 negative and SARS-COV-2 positive cohorts from January 2020-May 2020 Conclusion The prevalence of fungemia markedly increased during the COVID-19 surge. Increased use of corticosteroids and broad spectrum antimicrobials, prolonged use of central venous catheters and prolonged ICU length of stay likely contributed to this increase. Patients who developed candidemia co-infection with COVID-19 were found to have poorer outcomes as compared to those who were SARS-CoV-2 negative or untested. Disclosures All Authors: No reported disclosures

Association of Rugae Pattern with Skeletal Malocclusion in Orthodontic Patients Visiting Tertiary Care Hospital

2020 ◽  
Author(s):  
Sarwat Memon
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Class Iii ◽  
Chi Square ◽  
Cross Sectional ◽  
Skeletal Malocclusion ◽  
Palatal Rugae ◽  
Significant Difference ◽  
Orthodontic Patients

Background: The palatal rugae are special constructions that are inalterable in their position and pattern during the lifestyles of an individual. This imparts them an exceptional role in the forensic dentistry and may play potential role in malocclusion identification. This study was aimed to see association of rugae pattern with sagittal skeletal malocclusion in orthodontic patients visiting tertiary care hospital. Methods: This cross-sectional examination was completed on pretreatment records (lateral Cephalometric radiographs and maxillary dental casts) of 384 subjects at the orthodontic department of Ziauddin Dental Hospital, Karachi. The study duration was from January to July 2019. The samples were sub-divided into three sagittal skeletal groups based on ANB angle proposed by Steiner’s on lateral Cephalometric radiographs (Class I with ANB angle between 0° to 4°; Class II: ANB angle greater than 5°; Class III: ANB angle less than 0°). The shapes of three most-anterior primary rugae were then evaluated bilaterally using Kapali et al., Classification. Chi Square test was applied to find association of rugae pattern among sagittal skeletal malocclusions groups. Results: Circular and curved rugae shapes were the most prevalent in all skeletal malocclusions. The primary palatal rugae pattern was seen to be significantly different among three skeletal malocclusion groups (p<0.05). The right and left sided palatal rugae pattern showed significant difference in all three skeletal malocclusion groups (p<0.05). Conclusion: The present study showed no specific palatal rugae pattern associated with sagittal skeletal malocclusion. Further studies on larger sample and use of modern 3D technologies to scan the maxillary casts are required for results that are more precise.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

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