scholarly journals Cardiac Injuries at Estonian Major Trauma Facilities: A 23-year Perspective

2018 ◽  
Vol 108 (2) ◽  
pp. 159-163 ◽  
Author(s):  
M. Einberg ◽  
S. Saar ◽  
A. Seljanko ◽  
A. Lomp ◽  
U. Lepner ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Primary Outcome ◽  
Major Trauma ◽  
Alcohol Intoxication ◽  
Cardiac Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cardiac Trauma ◽  
Icd 10 ◽  
Overall Mortality

Background and Aims: Cardiac injuries are highly lethal lesions following trauma and most of the patients decease in pre-hospital settings. However, studies on cardiac trauma in Estonia are scarce. Thus, we set out to study cardiac injuries admitted to Estonian major trauma facilities during 23 years of Estonian independence. Materials and Methods: After the ethics review board approval, all consecutive patients with cardiac injuries per ICD-9 (861.0 and 861.1) and ICD-10 codes (S.26) admitted to the major trauma facilities between 1 January 1993 and 31 July 2016 were retrospectively reviewed. Cardiac contusions were excluded. Data collected included demographics, injury profile, and in-hospital outcomes. Primary outcome was mortality. Secondary outcomes were cardiac injury profile and hospital length of stay. Results: During the study period, 37 patients were included. Mean age was 33.1 ± 12.0 years and 92% were male. Penetrating and blunt trauma accounted for 89% and 11% of the cases, respectively. Thoracotomy and sternotomy rates for cardiac repair were 80% and 20%, respectively. Most frequently injured cardiac chamber was left ventricle at 49% followed by right ventricle, right atrium, and left atrium at 34%, 17%, and 3% of the patients, respectively. Multi-chamber injury was observed at 5% of the cases. Overall hospital length of stay was 13.5 ± 16.7 days. Overall mortality was 22% (n = 8) with uniformly fatal outcomes following left atrial and multi-chamber injuries. Conclusion: Overall, 37 patients with cardiac injuries were hospitalized to national major trauma facilities during the 23-year study period. The overall in-hospital mortality was 22% comparing favorably with previous reports. Risk factors for mortality were initial Glasgow Coma Scale < 9, pre-hospital cardiopulmonary resuscitation, and alcohol intoxication.

scholarly journals 562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S346-S346
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
David Reeves ◽  
Christian Cheatham
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Fungal Infections ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Matched Design ◽  
Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin &gt; 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer &gt; 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

scholarly journals Effects of Methylprednisolone on Ventilator-Free Days in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome and COVID-19

2021 ◽  
Author(s):  
Mohamed Badr ◽  
Bruno De Oliveira ◽  
Khaled Abdallah ◽  
Ashraf Nadeem ◽  
Yeldho Varghese ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Competing Risks ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay

Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone increases the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study Setting: Intensive care unit Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included Interventions: None Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) during the first 28 days, defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray&rsquo;s proportional subhazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg.kg-1 (IQR: 1-1.3 mg.kg-1) and median duration of 5 days (IQR:5-7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6-20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6-16.7) in patients who did not receive methylprednisolone (difference, 4.61; 95% CI, 1.10-8.12; P = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95%CI: 0.02-0.45; p=0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p=0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR:15-41 days] vs. 37 days [IQR:23-52 days], p=0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p=0.052). However, 91% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.

scholarly journals Nutritional Treatment of Patients Operated on for Acute Mesenteric Ischemia

Acta Medica ◽  
2021 ◽  
pp. 1-6
Author(s):  
Timuçin Erol ◽  
Şermin Ataç ◽  
Kezban Akçay ◽  
Nilgün Ölmez ◽  
Nezih Akkapulu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nutritional Management ◽  
Nutritional Treatment ◽  
Significant Difference ◽  
Overall Mortality

Objective: Acute mesenteric ischemia is a surgical emergency. During the course of treatment, most of the patients require nutritional treatment. However, achieving nutritional goals may not be always possible. This study aimed to investigate nutritional management of the patients who were operated on for acute mesenteric ischemia. Materials and Methods: Patients who were diagnosed and hospitalized for acute mesenteric ischemia between 2015 and 2018 were retrospectively analyzed. Nutritional management of patients was studied in terms of hospital length of stay, mortality rate and achieving of nutritional goals. Results: Thirty patient were included in the study and 18 patient received nutritional treatment. Median length of stay was 28.5 (range:9-220) days. Target nutrition goals were only achieved in 11 patients (61%). Overall mortality rate for nutritional treatment group was 50%. There was no significant difference between the patients whose treatment objectives were achieved or failed in terms of length of stay (p=0.375) or mortality [(p=0.630 (95% CI0,237-10,809)]. Conclusion: The management of nutritional treatment of acute mesenteric ischemia patients is challenging. Achieving the nutritional goals may not be possible in many patients.

scholarly journals 2645. Clinical Outcomes of Oseltamivir vs. Baloxavir in Patients Hospitalized with Influenza A

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S925-S925 ◽  
Author(s):  
Sunish Shah ◽  
Dayna McManus ◽  
Nika Bejou ◽  
Samad Tirmizi ◽  
Ginger Rouse ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Influenza A ◽  
Chart Review ◽  
Primary Outcome ◽  
Influenza Infection ◽  
Antiviral Agent ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nasopharyngeal Swab

Abstract Background Baloxavir marboxil is a new antiviral agent for the treatment of acute uncomplicated influenza in patients > 12 years of age who have been symptomatic for no more than 48 hours. However, clinical trials to date have excluded patients hospitalized with influenza infection. Methods This study was a multi-center, retrospective chart review of adult patients admitted to the hospital who received oseltamivir or baloxavir for the treatment of influenza A. Patients were screened for inclusion between January 2018 and February 2018 in the oseltamivir group while patients in the baloxavir group were screened for inclusion between January 2019 and February 2019. Patients who had influenza diagnosed after 48 hours from hospital admission, were not admitted to the hospital, received baloxavir and > 2 doses of oseltamivir during their hospital stay, received > 1 dose of baloxavir during admission for influenza, received influenza therapy prior to admission, died within 48 hours of presentation to the hospital, were asymptomatic at the time of antiviral therapy, or who had left the hospital against medical advice were excluded. Influenza A diagnosis was confirmed by RT–PCR using a nasopharyngeal swab specimen. The primary outcome was hospital length of stay (LOS). Results Of the 699 patients reviewed, 359 met inclusion criteria. There were 221 patients who received baloxavir and 138 patients who received oseltamivir. Patients who received oseltamivir were older (65 years [55–78] vs. 82 years [69–88], P < 0.01) and were less likely to have a Body Mass Index > 40 kg/m2 (26 [12%] vs. 7 [5%], P = 0.03) compared with the baloxavir group. For the primary outcome of LOS, the baloxavir group had a shorter LOS compared with oseltamivir (4 days [3–6] vs. 5 days [3–8], P = 0.02). Of the 272 patients who were hypoxic at the time of antiviral administration, the baloxavir group was more likely to resolve their hypoxia (145 [88%] vs. 84 [79%], P = 0.04) and had a shorter time to resolution of hypoxia (43 hours [22–78] vs. 81 hours [33–135], P < 0.001) compared with oseltamivir. Conclusion This study supports the use of baloxavir for the treatment of influenza A in hospitalized patients with possible benefits of reduced length of stay and faster time to resolution of hypoxia compared with oseltamivir. Disclosures All authors: No reported disclosures.

scholarly journals Effects of Methylprednisolone on Ventilator-Free Days in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome and COVID-19: A Retrospective Study

2021 ◽  
Vol 10 (4) ◽  
pp. 760
Author(s):  
Mohamed Badr ◽  
Bruno De Oliveira ◽  
Khaled Abdallah ◽  
Ashraf Nadeem ◽  
Yeldho Varghese ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Competing Risks ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay

Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone is associated with increases in the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study. Setting: Intensive care unit. Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included. Interventions: None. Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) for the first 28 days. Defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray’s proportional sub hazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg·kg−1 (IQR: 1–1.3 mg·kg−1) and median duration for 5 days (IQR: 5–7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6–20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6–16.7) in patients who did not receive methylprednisolone (difference, 4.61, 95% CI, 1.10–8.12, p = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95% CI: 0.02–0.45, p = 0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p = 0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR: 15–41 days] vs. 37 days [IQR: 23–52 days], p = 0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p = 0.052). However, 81% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.

scholarly journals 751. Impact of Changing from a Three-step to Two-step Testing Algorithm for the Diagnosis of Clostridioides difficile

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S473-S473
Author(s):  
Jonathan Lapin ◽  
Vasilios Athans ◽  
Shawn Binkley ◽  
Tiffany Lee ◽  
Sonal Patel ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Primary Outcome ◽  
Hospital Length ◽  
Control Measures ◽  
Nucleic Acid Amplification ◽  
Targeted Treatment ◽  
Hospital Length Of Stay ◽  
Prior History ◽  
Clostridioides Difficile ◽  
Number Of Patients

Abstract Background The optimal method for laboratory diagnosis of Clostridioides difficile infection (CDI) remains undefined and national guidelines do not make a recommendation for a preferred diagnostic algorithm. Aiming to improve infection control measures, the Hospital of the University of Pennsylvania changed its testing process for the diagnosis of CDI from a 3-step to a 2-step algorithm (Figure 1) in September 2018. Starting an algorithm with nucleic acid amplification testing (NAAT) has been hypothesized to lead to potential diagnostic uncertainty if the result is positive by NAAT alone, as this test cannot distinguish between active infection and colonization. Three-Step and Two-Step Diagnostic Testing Algorithms Methods This retrospective, single-center, quasi-experimental study included patients ≥ 18 years of age that tested positive for C. difficile between May 1st, 2018 and January 31st, 2019. The study period encompassed 4 months prior to the algorithm change, a 1-month washout immediately following the change, and the subsequent 4 months. The primary outcome was proportion of patients who tested positive for C. difficile and received targeted treatment for CDI. Secondary outcomes included total number of patients who tested positive for C. difficile and received targeted treatment for CDI, duration of treatment for CDI, and hospital length of stay. Results Sixty-nine patients in the pre-group (3-step) and 75 patients in the post-group (2-step) tested positive for C. difficile. A higher proportion of patients in the post-group tested positive by NAAT alone (59.4% vs. 73.3%). CDI severity and prior history of CDI were similar between groups. The primary outcome occurred in 89.9% of patients in the pre-group and 83.8% in the post-group (p=0.213). Sixty-two patients in each group received targeted treatment for CDI (p=0.213), median treatment duration was 15 (IQR 11.25-25.75) and 14 (IQR 11-25) days (p=0.505), and median hospital length of stay was 9 (IQR 3-15) and 6 (IQR 3-20) days (p=0.690) in the pre-group and post-group, respectively. Conclusion Although there was a higher percentage of patients in the post-group that tested positive for C. difficile by NAAT alone, there was no difference in the proportion or total number of patients who received targeted CDI treatment between time periods. Disclosures All Authors: No reported disclosures

Checklist-styled Daily Sign-out Rounds Improve Hospital Throughput in a Major Trauma Center

2014 ◽  
Vol 80 (5) ◽  
pp. 434-440 ◽  
Author(s):  
John C. Lee ◽  
Michael Horst ◽  
Amelia Rogers ◽  
Frederick B. Rogers ◽  
Daniel Wu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Major Trauma ◽  
Injury Severity ◽  
Clinical Care ◽  
Hospital Length ◽  
Organ System ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Trauma Service

The checklist concept has received much attention as a result of its ability to improve patient care by minimizing complications. We hypothesized daily sign-out rounds using a checklist, by improving team communication and consistency of clinical care, could lead to expedited throughput for patients at a major trauma center. A retrospective study examined patients admitted to a mature trauma center. Two time periods, PRE (September 2008 to January 2009) and POST (September 2009 to January 2010), were selected to match for seasonal variation in admission diagnosis. An organ system-based checklist was used during daily sign-out for all admitted trauma patients in the POST period. We examined discharge status, complications and rates, and intensive care unit (ICU) and overall hospital length of stay for differences. There were similar numbers of patients (824 PRE vs 798 POST) admitted in these two cohorts. We found no statistical differences in the incidence of complications or mortality rate. We did discover statistically significant differences in the median ICU days (2 PRE vs 1 POST, P = 0.007) as well as median hospital length of stay (2 days, interquartile differences Q1 to Q3 PRE [1 to 5] and POST [1 to 4] P = 0.000). These trends remained valid even among the severely injured (Injury Severity Score 16 or greater) with a hospital length of stay of 5 (PRE) versus 3 days (POST; P = 0.021). A simple, organ system-based checklist can be successfully adopted for daily sign-out round on a busy, multiprovider trauma service. We were able to expedite trauma patient throughput in both ICU and overall hospital stays with a trend toward decreasing mortality. This improved throughput may potentially translate into a cost saving for the hospital.

scholarly journals Effectiveness of repeated antivenom therapy for snakebite-related systemic complications

2019 ◽  
Vol 47 (10) ◽  
pp. 4808-4814 ◽  
Author(s):  
Kyung Hoon Park ◽  
Hyungoo Shin ◽  
Hyunggoo Kang ◽  
Changsun Kim ◽  
Hyuk Joong Choi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Primary Outcome ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Systemic Complications ◽  
Tertiary Center ◽  
Record Review ◽  
Retrospective Medical Record Review

Objective This study aimed to determine the effect of repeated antivenom therapy compared with that of single antivenom therapy for treating snakebite-related systemic complications. Methods A retrospective medical record review from January 2008 to September 2016 was performed. Patients with snakebite injury who visited the Emergency Department in one tertiary center of Korea were included. The primary outcome was the survival rate. The secondary outcome was the effect of repeated antivenom therapy for treating snakebite-related systemic complications compared with that of single antivenom therapy on hospital length of stay. Results A total of 110 patients with snakebites were included. All patients survived to discharge. Twenty-nine (26.4%) patients had snakebite-related systemic complications. Of these, nine patients received repeated antivenom therapy and 20 patients received single antivenom therapy. The length of stay was significantly longer in those who received repeated antivenom therapy compared with those who received single antivenom therapy (10.0 [4.0–11.0] vs. 3.5 [0–7.0] days). Conclusion We were unable to demonstrate any superiority of repeated versus single antivenom therapy. However, repeated antivenom therapy is associated with a longer hospital stay. The reason for this finding is unknown.

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