Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Introduction: Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia. Methods: This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec’s data warehouse. Results: Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia ( P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001). Conclusion: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.

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Faculty Opinions recommendation of Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United States: findings from the nationwide inpatient sample.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161903.623526 ◽

2009 ◽

Author(s):

Imre Noth

Keyword(s):

United States ◽

Pulmonary Embolism ◽

Clinical Outcomes ◽

Resource Utilization ◽

Nationwide Inpatient Sample ◽

The United States ◽

Recent Trends

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Faculty Opinions recommendation of Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14029956.15487056 ◽

2012 ◽

Author(s):

Gregory Hawkins ◽

Rebecca Slager

Keyword(s):

United States ◽

Clinical Outcomes ◽

Acute Asthma ◽

The United States ◽

Age Related

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354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.549 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S246-S246

Author(s):

Kevin O’Laughlin ◽

Jennifer R Cope ◽

Zachary A Marsh

Keyword(s):

United States ◽

Case Reports ◽

The United States ◽

Severe Illness ◽

People Living With Hiv ◽

Cutaneous Lesions ◽

Free Living ◽

Organ Systems ◽

Free Living Ameba ◽

Soil And Water

Abstract Background Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States. Methods CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies. Results We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively. Conclusion Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment. Disclosures All Authors: No reported disclosures

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A scoping review of female drowning: an underexplored issue in five high-income countries

BMC Public Health ◽

10.1186/s12889-021-10920-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kym Roberts ◽

Ogilvie Thom ◽

Susan Devine ◽

Peter A. Leggat ◽

Amy E. Peden ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

United Kingdom ◽

New Zealand ◽

Clinical Outcomes ◽

Scoping Review ◽

The United States ◽

Clinical Treatment ◽

High Income ◽

Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

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Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States

JAMA Ophthalmology ◽

10.1001/jamaophthalmol.2017.5978 ◽

2018 ◽

Vol 136 (2) ◽

pp. 164 ◽

Cited By ~ 22

Author(s):

Michele C. Lim ◽

Michael V. Boland ◽

Colin A. McCannel ◽

Arvind Saini ◽

Michael F. Chiang ◽

...

Keyword(s):

United States ◽

Electronic Health Records ◽

Clinical Outcomes ◽

The United States ◽

Health Records ◽

Electronic Health

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Recent Trends in Clinical Outcomes and Resource Utilization for Pulmonary Embolism in the United States

CHEST Journal ◽

10.1378/chest.08-2258 ◽

2009 ◽

Vol 136 (4) ◽

pp. 983-990 ◽

Cited By ~ 103

Author(s):

Brian Park ◽

Louis Messina ◽

Phong Dargon ◽

Wei Huang ◽

Rocco Ciocca ◽

...

Keyword(s):

United States ◽

Pulmonary Embolism ◽

Clinical Outcomes ◽

Resource Utilization ◽

The United States ◽

Recent Trends

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Expanded HIV Screening in the United States: Effect on Clinical Outcomes, HIV Transmission, and Costs

Annals of Internal Medicine ◽

10.7326/0003-4819-145-11-200612050-00001 ◽

2006 ◽

Vol 145 (11) ◽

pp. I-30

Keyword(s):

United States ◽

Clinical Outcomes ◽

Hiv Transmission ◽

The United States ◽

Hiv Screening

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Warning against long-acting sulphonamides

Drug and Therapeutics Bulletin ◽

10.1136/dtb.4.4.13 ◽

1966 ◽

Vol 4 (4) ◽

pp. 13-13

Keyword(s):

United States ◽

Mortality Rate ◽

Erythema Multiforme ◽

The United States ◽

Stevens Johnson Syndrome ◽

Warning Letter ◽

Johnson Syndrome ◽

The Us ◽

Mucous Membranes ◽

Long Acting

Last month the US Food and Drug Administration required American manufacturers of long-acting sulphonamides (sulphamethoxypyridazine, Lederkyn - Lederle and Midicel - PD; sulphadimethoxine - Madribon - Roche) to warn prescribers that in rare cases the Stevens-Johnson syndrome may develop as a severe and sometimes fatal side effect. This syndrome is a type of erythema multiforme in which large blisters appear on the skin and especially on the mucous membranes. The manufacturers were also to advise doctors ‘to consider prescribing short-acting sulphonamides first because they are effective for most of the same conditions’. The three drug firms concerned accordingly sent a joint warning letter to all doctors, pointing out that the Stevens-Johnson syndrome is a serious complication with a mortality rate of about 25%. So far 116 cases of this syndrome have been reported in association with the use of long-acting sulphonamides, most of them in the United States. Almost two thirds of the patients were children.

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Abstract 1122‐000121: Integrated Geomapping Tool of Certified Stroke Centers in United States: A SVIN MT2020+ Committee Collaboration

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000121 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Evan Kolesnick ◽

Alfredo Munoz ◽

Kaiz Asif ◽

Santiago Ortega‐Gutierrez ◽

...

Keyword(s):

United States ◽

Acute Stroke ◽

Clinical Outcomes ◽

Healthcare Disparities ◽

Systems Of Care ◽

Stroke Care ◽

The United States ◽

Time Dependent ◽

Stroke Systems Of Care ◽

Stroke Center

Introduction : Stroke is a leading cause of morbidity, mortality and healthcare spending in the United States. Acute management of ischemic stroke is time‐dependent and evidence suggests improved clinical outcomes for patients treated at designated certified stroke centers. There is an increasing trend among hospitals to obtain certification as designated stroke centers. A common source or integrated tool providing both information and location of all available stroke centers in the US irrespective of the certifying organization is not readily available. The objective of our research is to generate a comprehensive and interactive electronic resource with combined data on all geographically‐coded certified stroke centers to assist in pre‐hospital triage and study healthcare disparities in stroke including availability and access to acute stroke care by location and population. Methods : Data on stroke center certification was primarily obtained from each of the three main certifying organizations: The Joint Commission (TJC), Det Norske Veritas (DNV) and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of all stroke center locations was performed using the ArcGIS Pro application. The most current data on stroke centers is presented in an interactive electronic format and the information is frequently updated to represent newly certified centers. Utility of the tool and its analytics are shown. Role of the tool in improving pre‐hospital triage in the stroke systems of care, studying healthcare disparities and implications for public health policy are discussed. Results : Aggregate data analysis at the time of submission revealed 1,806 total certified stroke centers. TJC‐certified stroke centers represent the majority with 106 Acute Stroke Ready (ASR), 1,040 Primary Stroke Centers (PSCs), 49 Thrombectomy Capable Centers (TSCs) and 197 Comprehensive Stroke Centers (CSCs). A total of 341 DNV‐certified programs including 36 ASRs, 162 PSCs, 16 PSC Plus (thrombectomy capable) and 127 CSCs were identified. HFAP‐certified centers (75) include 16 ASRs, 49 PSCs, 2 TSCs and 8 CSCs. A preliminary map of all TJC‐certified CSCs and TSCs is shown in the figure (1). Geospatial analysis reveals distinct areas with currently limited access to certified stroke centers and currently, access to certified stroke centers is extremely limited to non‐existent in fe States (for example: Idaho, Montana, Wyoming, New Mexico and South Dakota). Conclusions : Stroke treatment and clinical outcomes are time‐dependent and prompt assessment and triage by EMS directly to appropriate designated stroke centers is therefore critical. A readily available electronic platform providing location and treatment capability for all nearby certified centers will enhance regional stroke systems of care, including enabling more rapid inter‐hospital transfers for advanced intervention. Identifying geographic areas of limited access to treatment can also help improve policy and prioritize the creation of a more equitable and well‐distributed network of stroke care in the United States.

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