scholarly journals Vaccinating adolescents against SARS-CoV-2 in England: a risk–benefit analysis

2021 ◽  
pp. 014107682110525
Author(s):  
Deepti Gurdasani ◽  
Samir Bhatt ◽  
Anthony Costello ◽  
Spiros Denaxas ◽  
Seth Flaxman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Science ◽  
Hospital Admissions ◽  
Benefit Analysis ◽  
Analysis Methodology ◽  
Case Rate ◽  
Low Incidence ◽  
Risk Benefit Analysis ◽  
Future Case

Objective To offer a quantitative risk–benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. Setting England. Design Following the risk–benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12–17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. Participants All 12–17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. Main outcome measures Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12–17 year olds in England over a 16-week period under different estimates of future case incidence. Results At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. Conclusions Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10–19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

scholarly journals Low Incidence of Biphasic Allergic Reactions in Patients Admitted to Intensive Care after Anaphylaxis

2019 ◽  
Vol 130 (2) ◽  
pp. 284-291 ◽  
Author(s):  
Sofie Højlund ◽  
Peter Søe-Jensen ◽  
Anders Perner ◽  
Morten H. Bestle ◽  
Peder Carl ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Allergic Reaction ◽  
Respiratory Symptoms ◽  
Allergic Reactions ◽  
Total Incidence ◽  
Skin Symptoms ◽  
Initial Symptoms ◽  
Patient Groups ◽  
Low Incidence

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Biphasic allergic reactions—recurrence of allergy symptoms after a symptom-free period—are reported to occur in 1 to 23% of allergic reactions. Patients admitted to an intensive care unit after anaphylaxis potentially have more severe reactions and a higher risk of biphasic allergic reactions. The purpose of this study was to examine incidence, triggers, symptoms, and treatment of biphasic allergic reactions, in patients admitted to an intensive care unit. Methods Records of patients admitted to intensive care units with anaphylaxis from 2011 to 2014 were reviewed. Only patients with a reaction fulfilling internationally accepted criteria for anaphylaxis were included. Potential biphasic allergic reactions, defined as renewed allergy symptoms 1 to 72 h after initial symptoms had resolved, without further exposure to the trigger, were identified. Results A total of 83 cases of anaphylaxis were identified, and the most frequent triggers were medications (58 of 83 [70%]). Skin symptoms occurred in 69 (83%) cases, and circulatory and respiratory symptoms in 48 (58%) and 45 (54%) cases, respectively. In total, 82 (99%), 80 (96%), and 66 (80%) were treated with antihistamines, corticosteroids, and epinephrine, respectively. Only 10 patients presented with one or more relevant symptoms after the initial allergic reaction. Of these, three were possible, and one was a probable biphasic allergic reaction, giving a total incidence of 4 of 83 (4.8% [95% CI, 1.6 to 12.5]) or 1 of 83 (1.2% [95% CI, 0.1 to 7.46]), respectively. All cases were mild, presenting with skin symptoms only, occurring on average 14 h after initial reactions. Conclusions The authors observed a low incidence of biphasic reactions in patients admitted to an intensive care unit after anaphylaxis, at a rate equivalent to that reported in other patient groups.

scholarly journals Data Science for Extubation Prediction and Value of Information in Surgical Intensive Care Unit

2019 ◽  
Vol 8 (10) ◽  
pp. 1709 ◽  
Author(s):  
Tsung-Lun Tsai ◽  
Min-Hsin Huang ◽  
Chia-Yen Lee ◽  
Wu-Wei Lai
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Prediction Model ◽  
Value Of Information ◽  
Data Science ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Science Framework

Besides the traditional indices such as biochemistry, arterial blood gas, rapid shallow breathing index (RSBI), acute physiology and chronic health evaluation (APACHE) II score, this study suggests a data science framework for extubation prediction in the surgical intensive care unit (SICU) and investigates the value of the information our prediction model provides. A data science framework including variable selection (e.g., multivariate adaptive regression splines, stepwise logistic regression and random forest), prediction models (e.g., support vector machine, boosting logistic regression and backpropagation neural network (BPN)) and decision analysis (e.g., Bayesian method) is proposed to identify the important variables and support the extubation decision. An empirical study of a leading hospital in Taiwan in 2015–2016 is conducted to validate the proposed framework. The results show that APACHE II and white blood cells (WBC) are the two most critical variables, and then the priority sequence is eye opening, heart rate, glucose, sodium and hematocrit. BPN with selected variables shows better prediction performance (sensitivity: 0.830; specificity: 0.890; accuracy 0.860) than that with APACHE II or RSBI. The value of information is further investigated and shows that the expected value of experimentation (EVE), 0.652 days (patient staying in the ICU), is saved when comparing with current clinical experience. Furthermore, the maximal value of information occurs in a failure rate around 7.1% and it reveals the “best applicable condition” of the proposed prediction model. The results validate the decision quality and useful information provided by our predicted model.

scholarly journals The efficacy and safety of rifaximin-α: a 2-year observational study of overt hepatic encephalopathy

2019 ◽  
Vol 12 ◽  
pp. 175628481985825 ◽  
Author(s):  
Rosalie C. Oey ◽  
Lennart E.M. Buck ◽  
Nicole S. Erler ◽  
Henk R. van Buuren ◽  
Robert A. de Man
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hepatic Encephalopathy ◽  
Adverse Events ◽  
Bacterial Infections ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Interquartile Range ◽  
Overt Hepatic Encephalopathy ◽  
Bed Days

Background: After 5  years since the registration of rifaximin-α as a secondary prophylaxis for overt hepatic encephalopathy (HE) in the Netherlands, we aimed to evaluate the use of hospital resources and safety of rifaximin-α treatment in a real-world setting. Methods: We carried out prospective identification of all patients using rifaximin-α for overt HE. We assessed hospital resource use, bacterial infections, and adverse events during 6-month episodes before and after rifaximin-α initiation. Results: During 26 months we included 127 patients [71.7% male; median age 60.8 years (interquartile range: 56.2–66.1); median model for end-stage liver disease (MELD) score 15.0 (interquartile range: 12.1–20.4); 98% using lactulose treatment]. When comparing the first 6 months after rifaximin-α initiation with the prior 6 months, HE-related hospital admissions decreased (0.86 to 0.41 admissions/patient; p < 0.001), as well as the mean length of stay (8.85 to 3.79 bed days/admission; p < 0.001). No significant differences were found regarding HE-related intensive care unit admissions (0.09 to 0.06 admission/patient; p = 0.253), stay on the intensive care unit (0.43 to 0.57 bed days/admission; p = 0.661), emergency department visits (0.66 to 0.51 visits/patient; p = 0.220), outpatient clinic visits (2.49 to 3.30 bed visits/patient; p = 0.240), or bacterial infections (0.41 to 0.35 infections/patient; p = 0.523). Adverse events were recorded in 2.4% of patients. Conclusions: The addition of rifaximin-α to lactulose treatment was associated with a significant reduction in the number and length of HE-related hospitalizations for overt HE. Rifaximin-α treatment was well tolerated.

Moped Injuries in Children

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 820-822 ◽  
Author(s):  
Judith A. Westman ◽  
Grant Morrow
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Admissions ◽  
Average Length ◽  
Orthopaedic Injuries ◽  
Length Of Hospitalization

Moped injuries are an important cause of traffic-related injuries in children. An attempt was made to define the epidemiology as well as the nature and severity of injuries sustained in 88 moped-related accidents. Bicycle injuries among children (579) were used as a control. The patients with moped injuries were younger than expected (mean 12.8 years with a minimum legal driving age of 14 years in the study area). Among 26 hospital admissions due to moped accidents, there were 11 admissions to the intensive care unit, demonstrating the severe nature of the injuries. Fifty percent of the patients had orthopaedic injuries and 46% had neurologic injuries. These injuries resulted in an average length of hospitalization of 8.5 days (intensive care unit admissions lasted an average of 14.6 days). Recommendations are made to aid pediatricians in the counseling of patients and parents.

scholarly journals In-hospital emergencies versus out-of-hospital emergencies admitted to ICU: is the outcome different? An observational study

2021 ◽  
Author(s):  
Emi Cauchois ◽  
Jérémy Bourenne ◽  
Audrey Le Saux ◽  
Fouad Bouzana ◽  
Antoine Tilmont ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Rapid Response ◽  
University Hospital ◽  
Admission Diagnosis ◽  
Medical Systems ◽  
Rapid Response Systems ◽  
Response Systems

Abstract Background: Rapid Response Systems (RRS) are now commonly implemented throughout hospital health systems to manage in-hospital emergencies (IHE). There is limited data on characteristics and outcomes of such patients admitted to an intensive care unit (ICU). The goal was to determine whether the hospital mortality of ICU patients was different depending on their admission pathway: in-hospital via rapid response teams (RRT), or out-of-hospital emergencies (OHE) via prehospital emergency medical systems. Results: Out of 422 ICU admissions (Timone University Hospital ICU), 241 patients were retrospectively (2019-2020) included: 74 IHE versus 167 OHE. In-hospital mortality rates did not differ between both cohorts (n = 31(42%) vs. 63(39%) respectively, NS). IHE patients were older and had more comorbidities (immunosuppression and ongoing malignancy). OHE patients had more severe organ failures at presentation with more frequent mechanical ventilation support. Independent global hospital mortality risk factors were ongoing malignancy (OR = 10.4 [2.7-40], p < 0.001), SAPS II (OR = 1.05 [1.03-1.08], p < 0.0001) and SOFA scores (OR = 1.14 [1.01-1.3], p < 0.05), hemorrhagic stroke as admission diagnosis (OR = 8.4 [2.7-26], p < 0.001), and arterial lactate on arrival (OR = 1.11 [1.03-1.2], p < 0.01). Conclusion: This study provides a thorough and comprehensive analysis of characteristics and outcomes of ICU admissions following a mature rapid response activation system, compared to the “conventional” out-of-hospital admission pathway. Despite the more vulnerable background of IHE patients, hospital mortality does not differ, supporting the use of early RRS to identify deteriorating ward patients. Take-home message: Hospital mortality does not differ between in-hospital emergencies admitted to intensive care unit and conventional out-of-hospital admissions, supporting the use of early rapid response systems and the importance of early intensive care unit admission.

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