Concomitant Sternal Fractures: Harbinger of Worse Pulmonary Complications and Mortality in Patients With Rib Fractures

2021 ◽  
pp. 000313482199197
Author(s):  
Jeff Choi ◽  
Bianca Mulaney ◽  
Beatrice Sun ◽  
Richard Trimble ◽  
Lakshika Tennakoon ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Subgroup Analysis ◽  
Flail Chest ◽  
Rib Fractures ◽  
Morbidity And Mortality ◽  
Increased Risk ◽  
The Impact ◽  
Pulmonary Morbidity ◽  
Sternal Fractures

Background Sternal and rib fractures are common concomitant injuries. However, the impact of concurrent sternal fractures on clinical outcomes of patients with rib fractures is unclear. We aimed to unveil the pulmonary morbidity and mortality impact of concomitant sternal fractures among patients with rib fractures. Methods We identified adult patients admitted with traumatic rib fractures with vs. without concomitant sternal fractures using the 2012-2014 National Inpatient Sample (NIS). After 2:1 propensity score matching and adjustment for residual imbalances, we compared risk of pulmonary morbidity and mortality between patients with vs. without concomitant sternal fractures. Subgroup analysis in patients with flail chest assessed whether sternal fractures modify the association between undergoing surgical stabilization of rib fractures (SSRF) and pulmonary morbidity or mortality. Results Of 475 710 encounters of adults admitted with rib fractures, 24 594 (5%) had concomitant sternal fractures. After 2:1 propensity score matching, patients with concomitant sternal fractures had 70% higher risk (95% CI: 50-90% higher, P < 0.001) of undergoing tracheostomy, 40% higher risk (30-50% higher, P <.001) of undergoing intubation, and 20% higher risk of respiratory failure (10-30% higher, P <.001) and mortality (10-40% higher, P =.007). Subgroup analysis of 8600 patients with flail chest showed concomitant sternal fractures did not impact the association between undergoing SSRF and any pulmonary morbidity or mortality. Conclusion Concomitant sternal fractures are associated with increased risk for pulmonary morbidity and mortality among patients with rib fractures. However, our findings are limited by a binary definition of sternal fractures, which encompasses heterogeneous injury patterns with likely variable clinical relevance.

scholarly journals Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1363
Author(s):  
Firas Mourad ◽  
Giacomo Rossettini ◽  
Erasmo Galeno ◽  
Alberto Patuzzo ◽  
Giuseppe Zolla ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Road Traffic ◽  
Physical Therapists ◽  
Healthcare Providers ◽  
Positive Outcome ◽  
Cervical Collar ◽  
Increased Risk ◽  
The Impact

Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included; those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included; of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p < 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069; p < 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668; p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar.

Abstract P551: Impact of Chronic Kidney Disease on Stroke Outcomes After Endovascular Thrombectomy - A Matched Cohort Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aaron Ravelo ◽  
Chris Hackett ◽  
Russell Cerejo ◽  
David G Wright ◽  
Richard Williamson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Subgroup Analysis ◽  
Inpatient Mortality ◽  
Stroke Outcomes ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Length Of Hospitalization

Objective: To determine the impact of chronic kidney disease (CKD) on stroke outcomes stratified by severity of renal impairment among acute ischemic strokes (AIS) patients treated with endovascular therapy (EVT). Methods: Single center retrospective analysis was conducted from January 2012 to December 2019 involving AIS patients with CKD undergoing EVT. We evaluated following primary safety and efficacy outcomes: inpatient mortality and reperfusion status according to TICI score, respectively. Our secondary safety outcomes were symptomatic intracranial hemorrhage (sICH) per SITS-MOST definition, whereas secondary efficacy outcomes were length of hospitalization and favorable discharge disposition (discharge to home or inpatient rehabilitation). CKD was defined with estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60-89 mL/ min) to moderate (eGFR 30-59 mL/min) to severe (eGFR 15-29 mL/min). We performed propensity score matching to eliminate confounding variables between CKD and non-CKD patients (1:2). In our subgroup analysis, we compared patients with mild-moderate CKD patients and severe CKD and evaluated their association with various clinical outcomes. Results: From a total of 466 AIS patients undergoing EVT, 84 CKD and 165 patients with normal renal function were selected based on 1:2 propensity score matching. CKD was associated with increased risk of in-hospital mortality (Odds ratio [OR] 2.58, 95% confidence interval [CI] 1.49-4.64, p <0.001), whereas favorable discharge disposition, length of hospitalization, sICH, TICI 2B/3 were comparable between the two groups. Subgroup analysis showed that patients with mild and moderate CKD were observed to have favorable discharge disposition (p=0.002), whereas patients with severe CKD were noted to have a higher risk of sICH ( p = 0.03) and prolonged hospitalization 11.54 ± 11.87 days (OR; 1.10, 95% CI 1.03-1.18, p = 0.006). Conclusion: History of CKD among AIS patients undergoing EVT were associated with a higher rate of inpatient mortality. In comparison to patients with mild and moderate CKD, patients with severe CKD were noted to have an increased risk of sICH, prolonged hospitalization, and poor discharge disposition.

Operative morbidity and mortality in octogenarians after carotid endarterectomy: a propensity score matching study

2020 ◽  
Vol 60 (6) ◽  
Author(s):  
Laura Pasin ◽  
Massimiliano M. Marrocco Trischitta ◽  
Giovanni Landoni ◽  
Desiderio Piras ◽  
Pasquale Nardelli ◽  
...  
Keyword(s):  
Propensity Score ◽  
Carotid Endarterectomy ◽  
Propensity Score Matching ◽  
Morbidity And Mortality ◽  
Operative Morbidity

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

scholarly journals Adoption of improved agricultural technology and its impact on household income: a propensity score matching estimation in eastern Ethiopia

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Muluken G. Wordofa ◽  
Jemal Y. Hassen ◽  
Getachew S. Endris ◽  
Chanyalew S. Aweke ◽  
Dereje K. Moges ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Technology Use ◽  
Household Income ◽  
Agricultural Technology ◽  
Primary Data ◽  
Farm Income ◽  
Agricultural Technologies ◽  
Eastern Ethiopia ◽  
The Impact

Abstract Background Adoption of improved agricultural technologies remains to be a promising strategy to achieve food security and poverty reduction in many developing countries. However, there are limited rigorous impact evaluations on the contributions of such technologies on household welfare. This paper investigates the impact of improved agricultural technology use on farm household income in eastern Ethiopia. Methods Primary data for the study was obtained from a random sample of 248 rural households, 119 of which are improved technology users and the rest are non-users. The research employed the Propensity Score Matching (PSM) procedure to establish the causal relationship between adoption of improved crop and livestock technologies and changes in farm income. Results Results from the econometric analysis show that households using improved agricultural technologies had, on average, 23,031.28 Birr (Birr is the official currency of Ethiopia. The exchange rate according to the National Bank of Ethiopia (NBE) was 1 USD = 27.6017 Birr on 04 October 2018.) higher annual farm income compared to those households not using such technologies. Our findings highlight the importance of promoting multiple and complementary agricultural technologies among rural smallholders. Conclusions We suggest that rural technology generation, dissemination and adoption interventions be strengthened. Moreover, the linkage among research, extension, universities and farmers needs to be enhanced through facilitating a multistakeholders innovation platforms.

scholarly journals Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Stéphanie Baggio ◽  
Vladan Starcevic ◽  
Patrick Heller ◽  
Karen Brändle ◽  
Irina Franke ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aggressive Behavior ◽  
Propensity Score Matching ◽  
Potential Role ◽  
Behavioral Disinhibition ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Logistic Regressions ◽  
Relationship Of ◽  
The Relationship

Abstract Background Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. Methods Data were extracted from the electronic database of an “open” Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010–2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. Results After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. Conclusions Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

Was it worth it? The impact of the German minimum wage on union membership of employees

2021 ◽  
pp. 0143831X2110358
Author(s):  
Simon Ress ◽  
Florian Spohr
Keyword(s):  
Propensity Score ◽  
Social Security ◽  
Labour Market ◽  
Propensity Score Matching ◽  
Minimum Wage ◽  
Trade Union ◽  
Union Membership ◽  
Difference In Differences ◽  
German Trade ◽  
The Impact

This contribution scrutinises how introducing a statutory minimum wage of EUR 8.50 per hour, in January 2015, impacted German employees’ decision with regard to union membership. Based on representative data from the Labour Market and Social Security panel, the study applies a logistic difference-in-differences propensity score matching approach on entries into and withdrawals from unions in the German Trade Union Confederation (Deutscher Gewerkschaftsbund, DGB). The results show no separate effect on withdrawals from or entries into unions after the minimum wage introduction for those employees who benefited financially from it, but a significant increase of entries overall. Thus, unions’ campaign for a minimum wage strengthened their position in total but did not reverse the segmentation of union membership patterns.

scholarly journals USING PROPENSITY SCORE MATCHING METHOD TO ESTIMATE THE IMPACT OF VIETGAP PROGRAM ON THE HEALTH OF FARMERS IN THUA THIEN HUE PROVINCE, VIETNAM

2017 ◽  
Vol 126 (5B) ◽  
pp. 17
Author(s):  
Trần Huỳnh Bảo Châu
Keyword(s):  
Health Status ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Pesticide Exposure ◽  
Agricultural Practices ◽  
Health Problems ◽  
Vegetable Production ◽  
Matching Method ◽  
Environment Friendly ◽  
The Impact

<p><strong>Abstract:</strong></p><p>This study estimates the impact value of the VietGAP program when applied to vegetable production on the health of farmers in Thua Thien Hue province. By employing the propensity score matching (PSM) method, our findings show that the VietGAP program has a significant impact on farmers’ health. In particular, the program reduces farmers’ health problems due to pesticide exposure by 15.6 %, 22.9 %, 25.5 %, and 23.6 %, respectively, from four types of matching. This study provides evidence of the positive impacts of the VietGAP program on the health status of farmers in Thua Thien Hue province. It is therefore hoped that the production, consumption, and management solutions provided by the VietGAP program can encourage farmers to use environment-friendly agricultural practices.</p><p><strong>Keywords: </strong>propensity score matching (PSM) method, VietGAP program, farmers’ health</p>

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