Can an App-Based Maxillofacial Trauma Score Predict the Operative Time, ICU Need and Length of Stay?

2021 ◽  
pp. 194338752110555
Author(s):  
Ashutosh Kumar Singh ◽  
Safal Dhungel ◽  
Zeeshan Ahmad ◽  
Simon Holmes
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Operative Time ◽  
Retrospective Chart Review ◽  
Maxillofacial Trauma ◽  
Secondary Outcome ◽  
Facial Trauma ◽  
Trauma Scoring ◽  
Trauma Score ◽  
Trauma Scores

Study design Retrospective chart review Objective Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma scoring system. Our study was designed to seek the application of an app-based ZS maxillofacial trauma score to predict the operative time, intensive care unit (ICU) need and length of stay. Methods We performed a retrospective chart review of patients who presented to a university medical college teaching hospital with maxillofacial fractures from October 2018 until October 2019. ZS maxillofacial trauma scoring app was used to calculate the ZS maxillofacial trauma severity score, which was our primary predictor variable. Our primary outcome of interest was operative time. Our secondary outcome of interest was ICU need and length of stay. Correlation analysis, linear regression and logistic regression were performed for statistical analysis. A statistical P-value of .05 was considered significant at a 95% confidence interval. Results There were 95 male and 5 female patients included in the study. The age ranged from 3 to 84 years with a mean of 30.76 (SD = 14.04). A statistically significant correlation between the ZS score and operative time ( r = 0.67, P < .001) was observed. ZS score predicted operative time ( b 1 = 7.67, P < .001) in our study sample . Increasing ZS trauma score was also significantly associated with ICU requirement ( X 2(3) = 13.682, P = .003), but the length of stay could not be predicted based on ZS score. Conclusion: ZS maxillofacial trauma score can predict the operative time, and an association was seen with the need for ICU with increasing ZS score, but could not predict the length of stay or the ICU need. It has potential for future integration with electronic health record systems.

106 Frailty Assessment in the Burn Population: A Single Center Retrospective Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S71-S72
Author(s):  
Erin Wolf Horrell ◽  
Ronnie Mubang ◽  
Sarah A Folliard ◽  
Robel Beyene ◽  
Stephen Gondek ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Level Of Care ◽  
Post Discharge ◽  
Patients Âgés ◽  
Injury Characteristics ◽  
Frail Patients ◽  
Discharge Care ◽  
Patients Experience

Abstract Introduction Burn morbidity and mortality increases with advancing age. Frailty is characterized by reduced homeostatic reserves and is associated with an increased biological age compared to chronological age. Our primary aim was to determine whether frailty as assessed on admission would be predictive of outcomes in the burn population. Methods We conducted a single institution 7-month retrospective chart review of all admitted acute burn patients ages 45 and older. Patient and injury characteristics were collected and compared using standard statistical analysis. Frailty scores were assessed upon admission using the FRAIL Scale. Results Eighty-five patients met inclusion criteria and were able to complete the FRAIL assessment. Patient and injury characteristics are listed in Table 1. Mean burn size was 6.7%TBSA (95%CI 4.9–8.4%). 34 patients (40%) were classified as robust (FRAIL score 0), 26(30.6%) as pre-frail (FRAIL score 1-Patients in the pre-frail/frail cohort received more palliative care consultations (p=.096) and had a longer length of stay (3.3d vs 7.55d p = .002), while prefrail patients had a similar LOS to frail patients (7.46 vs 7.64d p =.938). Patients in the pre-frail/frail cohort were also more likely to be discharged to a higher level of care than they were admitted from(p=.032) with prefrail patients experience an escalation in level of care more frequently than frail patients. The distribution by age by half-decade ranges is in Figure 1. By age 55–59, the majority of patients were prefrail or frail. Conclusions We demonstrated that frailty as assessed by the FRAIL score was predictive of increased length of stay and an escalation in post discharge care. In addition, patients characterized as pre-frail experience outcomes similar to frail patients and should be managed as such. Given the prevalence of frailty and prefrailty in the younger group of patients, we advocate for routine frailty screening beginning at age 55.

System intervention in community pharmacy setting: Leading to better patient care through reducing harm associated with coprescribing benzodiazepines and opioids

2021 ◽  
Vol 17 (6) ◽  
pp. 445-453
Author(s):  
Angelina Vascimini, PharmD ◽  
Kevin Duane, PharmD ◽  
Stacey Curtis, PharmD
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Community Pharmacists ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Improvement Project ◽  
System Intervention ◽  
Secondary Outcomes ◽  
Pharmacy Setting

Objective: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death.Design: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020.Setting: Independent community pharmacy.Patients/participants: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status.Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up.Results: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance.Conclusion: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.

scholarly journals P.007 Autoimmune Encephalitis Timing and Incidence: the Manitoba Experience

2021 ◽  
Vol 48 (s3) ◽  
pp. S22-S22
Author(s):  
DH Nguyen ◽  
C Xu ◽  
M Ng
Keyword(s):  
Chart Review ◽  
Autoimmune Encephalitis ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Early Group ◽  
Intensive Care Admission ◽  
Receive Treatment ◽  
Late Group

Background: Early treatment of autoimmune encephalitis (AE) can improve outcomes. Despite expert recommendation, it remains unclear if suspected AE patients consistently receive empiric treatments prior to availability of antibody results. Methods: Retrospective chart review of patients referred for AE testing in Manitoba. Primary outcomes were the proportion of patients treated empirically prior to the availability of antibody results. Incidence, clinical presentation, investigations, complications, mortality rates, and hospital course were secondary outcome measures. Results: We identified 151 patients from 2012-2018. 43 patients met inclusion criteria. The annual incidence of AE in Manitoba was 0.37/100,000. 28/43 (65%) patients were treated prior to availability of antibody results (“Early group”). 15/43 (35%) patients did not receive treatment (“Late group”). Significantly more Early group patients had repeat immunotherapy (p=0.001), abnormal MRI (p=0.027), and investigations for malignancy (p=0.015). Durations of hospital and intensive care admission, complication rates, and mortality rates were not different between the two groups. Conclusions: This is the first-ever AE incidence, timing, and management study of a comprehensive Canadian geopolitical and medical catchment area. Just over 1/3 of suspected AE over seven years were not treated prior to antibody results becoming available. Patients treated earlier did not experience greater complication rates.

scholarly journals Unusual obstetric trauma in newborn

2020 ◽  
Vol 9 ◽  
pp. 21
Author(s):  
Haif Assia ◽  
Ketfi Mounir ◽  
Achouri Djelloul ◽  
Sinacer Samira ◽  
Soualili Zineddine
Keyword(s):  
Umbilical Cord ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Birth Trauma ◽  
The Body ◽  
Facial Trauma ◽  
Bilateral Pneumothorax ◽  
Pertinent Data ◽  
Cord Injury ◽  
The Impact

Background: Birth injuries during delivery are rare but can be the most common cause of morbidity and mortality. All parts of the body can be damaged. The aim of this study is to determine the impact of these uncommon injuries on the newborn. This is a retrospective chart review of 11 newborn babies who had concurrent birth trauma. Pertinent data on the cause of injury treatment and the outcome were recorded. Methods: It is a retrospective chart review of newborns who sustained a birth trauma during delivery. These patients presented to the Department of Pediatric Surgery, SETIF, Algeria from 2010 to 2020. Results: A total of 11 cases with birth trauma occurred during delivery were managed during the study tenure. Of these 11, 9 were males and 2 females. Two cases sustained scalp laceration including one extensive laceration exposing the brain tissue with uncontrollable hemorrhage. One newborn sustained facial trauma secondary to the forceps delivery. One newborn who needed resuscitation and ventilation at birth developed bilateral pneumothorax secondary to the barotrauma. One patient sustained a femur fracture whereas another had a humerus fracture along with brachial plexus injury during delivery. Three cases had umbilical cord injury including two cases of clamped hernia of the umbilical cord resulting in neonatal intestinal obstruction. Two cases had scrotal trauma including one with testicular evisceration. Two cases were expired in this cohort. Conclusion: We have presented a diversity of birth trauma in newborns and their management. Proper antenatal follow-up and better planning for the delivery can avoid such injuries in newborns which often require surgical interventions for the management and at times can lead to mortality as well.

Length of Stay for Patients With Limited English Proficiency in Pediatric Urgent Care

2020 ◽  
Vol 59 (4-5) ◽  
pp. 421-428
Author(s):  
Aimy T. Patel ◽  
Brian R. Lee ◽  
Ravneet Donegan ◽  
Sharon G. Humiston
Keyword(s):  
Length Of Stay ◽  
Limited English Proficiency ◽  
Chart Review ◽  
English Proficiency ◽  
Retrospective Chart Review ◽  
Urgent Care ◽  
Starting Point ◽  
Significant Difference ◽  
English Speaking ◽  
Radiological Studies

This retrospective chart review compared the length of stay (LOS) of families with limited English proficiency (LEP) versus English-speaking families seen in 3 pediatric urgent care centers (PUCCs). Visits were included for patients aged 2 months to 17 years seen between January 1, 2016, and December 31, 2016, with 1 of 5 primary diagnoses. For each LEP encounter, we randomly selected 3 English-speaking encounters within the same PUCC and diagnosis class. We compared overall LOS between LEP and English-speaking encounters. Of our entire sample, 184 (1.03%) were LEP encounters, of which 145 (78.8%) preferred Spanish. Comparing the LEP visits to 552 matched English-speaking visits, we found a significant difference in average LOS (LEP 85.5 minutes; English-speaking 76.4 minutes) and in prescriptions provided ( P = .005) but not in triaged acuity nor number of medications administered, laboratory or radiological studies, or suction treatments. This study serves as a starting point to better care for patients/families with LEP in PUCCs.

Evaluation of oral chemotherapy prescribing at an outpatient oncology clinic.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 191-191
Author(s):  
George W. Carro ◽  
Bruce Brockstein ◽  
Thomas A. Hensing ◽  
Patrick Joseph Fleming ◽  
Shannon Maureen Gavin ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Electronic Medical Record System ◽  
Pharmacist Intervention ◽  
Primary Outcome Measure ◽  
Oral Chemotherapy ◽  
Secondary Outcome ◽  
Record System ◽  
Safety Standards ◽  
Chemotherapy Administration

191 Background: Oral chemotherapy’s exponentially increasing role in the treatment of malignancies continues to pose unique challenges to oncology. The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) drafted measures in the Chemotherapy Administration Safety Standards that help address some of these issues concerning oral chemotherapy. There is a lack of data describing the prescribing process for oral chemotherapy. In a retrospective chart review, prescriptions at a hospital-based outpatient oncology center were evaluated for completeness of prescribing and follow up measures. Methods: A retrospective chart review of ten oral chemotherapy medications from May 2012 to July 2012 was conducted. The primary outcome measure was compliance with ASCO and ONS Chemotherapy Administration Safety Standards. A secondary outcome was frequency of pharmacist interventions on oral chemotherapy prescriptions. Results: 412 prescriptions were evaluated. Prescriptions were graded on a scale from 1 to 8. One point was given for inclusion of each of the following: prescribing physician, patient name, drug name, dose, dosing methodology, quantity, refills, and accurate directions. Of all the prescriptions, 23% contained all aspects of a complete prescription. The most common reasons for point deductions were contradictory or unclear directions and allowing refills for oral chemotherapy which should not be refillable. Four percent of prescriptions had a documented pharmacist intervention. Conclusions: This study revealed areas for improvement in the prescribing process of oral chemotherapy. Targeting directions and refill fields within prescription templates will improve compliance with ASCO and ONS standards. This can be accomplished by implementing customized oral chemotherapy prescription templates within treatment plans in the electronic medical record system. Unlike chemotherapy administered in the clinic setting, oral chemotherapy prescriptions are not generally reviewed by oncology trained pharmacists. With the collaboration of medical and nursing staff, a new work flow was implemented which includes pharmacist review of electronic oral chemotherapy prescriptions.

Assessment of Safety of Remdesivir in Covid −19 Patients with Estimated Glomerular Filtration Rate (eGFR) < 30 ml/min per 1.73 m^2

2021 ◽  
pp. 088506662110705
Author(s):  
Shan Wang ◽  
Christy Huynh ◽  
Shahidul Islam ◽  
Brian Malone ◽  
Naveed Masani ◽  
...  
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Therapeutic Option ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Oxygen Requirement ◽  
End Of Treatment ◽  
Review Study ◽  
T1 And T2

Purpose Safety of remdesivir in patients with renal impairment is unknown. Incidence of liver injury secondary to remdesivir is also unknown. The objective of this study is to assess the incidence of acute kidney injury (AKI) and to trend the liver enzymes during remdesivir treatment and change in eGFR from baseline to end of treatment as well as 48 h post completion of remdesivir therapy. Methods This is a retrospective chart review study including adult patients admitted with COVID-19 receiving remdesivir with a baseline eGFR < 30 ml/min per 1.73 m^2 from December 2020 to May 2021. The primary outcome was to assess the incidence of AKI and hepatic injury. The secondary outcome was to assess the efficacy of remdesivir defined by change in oxygen requirement. Results Seventy-one patients were included in the study. Patients experienced an improvement in eGFR from baseline (T0) to end of remdesivir treatment (T1), as well as 48 h after the end of the treatment (T2) ( + 30.3% and + 30.6% respectively, P < .0001). Creatinine reduced from baseline (T0) to T1 and T2 (-20.9% and −20.5% respectively, P < .0001). Creatinine clearance improved from baseline to T1 and T2 ( + 26.6% and + 26.2% respectively, p < .0001). Elevation of aminotransferase (AST) was observed at T1 ( + 2.5%, P  =  .727), however, AST reduction was seen at T2 (-15.8%, P  =  .021). Elevation in alanine transaminase (ALT) was observed at T1 and T2 ( + 25% and + 12%, P  =  .004 and P  =  .137 respectively). Both direct and total bilirubin remained stable and were not significantly changed from baseline. Conclusion Our study showed that remdesivir use in renally-impaired patients with eGFR < 30 ml/min is safe. Remdesivir may be considered as a therapeutic option in this population with COVID-19 infection.

The effect of polysomnography on pediatric adenotonsillectomy postoperative management

2005 ◽  
Vol 132 (2) ◽  
pp. 263-270 ◽  
Author(s):  
Anthony A. Rieder ◽  
Valerie Flanary
Keyword(s):  
Length Of Stay ◽  
Airway Obstruction ◽  
Complication Rate ◽  
Chart Review ◽  
Pediatric Patients ◽  
Upper Airway ◽  
Retrospective Chart Review ◽  
Postoperative Management ◽  
Postoperative Course

OBJECTIVE: We retrospectively investigated the effect and predictability of preoperative polysomnography (PSG) on the postoperative course of younger pediatric patients undergoing adenotonsillectomy. STUDY DESIGN AND SETTING: A retrospective chart review was performed for patients 3 years of age and younger who had undergone adenotonsillectomy between July 1997 and July 2002 at the Children's Hospital of Wisconsin. RESULTS: Two hundred eighty-two patients were identified. Forty-three patients had preoperative PSG. No correlation between the severity of PSG results and postoperative course was identified. CONCLUSIONS: The role of PSG in upper airway obstruction and OSA remains controversial. This study suggests that although the complication rate may be higher in this younger population, these complications do not appear to have a large impact on their length of stay. SIGNIFICANCE: This study suggests that the 3-years-and-younger group, in the absence of other comorbidities, can safely undergo adenotonsillectomy without undergoing preoperative PSG. EBM raing: C.

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