scholarly journals How Does Frailty Factor Into Mortality Risk Assessment of a Middle-Aged and Geriatric Trauma Population?

2017 ◽  
Vol 8 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Sanjit R. Konda ◽  
Ariana Lott ◽  
Hesham Saleh ◽  
Sebastian Schubl ◽  
Jeffrey Chan ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Functional Independence ◽  
High Energy ◽  
Low Energy ◽  
Geriatric Trauma ◽  
Inpatient Mortality ◽  
Middle Aged ◽  
Trauma Population ◽  
Increased Risk ◽  
Significant Difference

Introduction: Frailty in elderly trauma populations has been correlated with an increased risk of morbidity and mortality. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of additional frailty variables to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population. Methods: A total of 1486 patients aged 55 years and older who met the American College of Surgeons Tier 1 to 3 criteria and/or who had orthopedic or neurosurgical traumatic consultations in the emergency department between September 2014 and September 2016 were included. The STTGMAORIGINAL and STTGMAFRAILTY scores were calculated. Additional “frailty variables” included preinjury assistive device use (disability), independent ambulatory status (functional independence), and albumin level (nutrition). The ability of the STTGMAORIGINAL and the STTGMAFRAILTY models to predict inpatient mortality was compared using area under the receiver operating characteristic curves (AUROCs). Results: There were 23 high-energy inpatient mortalities (4.7%) and 20 low-energy inpatient mortalities (2.0%). When the STTGMAORIGINAL model was used, the AUROC in the high-energy and low-energy cohorts was 0.926 and 0.896, respectively. The AUROC for STTGMAFRAILTY for the high-energy and low-energy cohorts was 0.905 and 0.937, respectively. There was no significant difference in predictive capacity for inpatient mortality between STTGMAORIGINAL and STTGMAFRAILTY for both the high-energy and low-energy cohorts. Conclusion: The original STTGMA tool accounts for important frailty factors including cognition and general health status. These variables combined with other major physiologic variables such as age and anatomic injuries appear to be sufficient to adequately and accurately quantify inpatient mortality risk. The addition of other common frailty factors that account for does not enhance the STTGMA tool’s predictive capabilities.

scholarly journals ASA Physical Status Classification Improves Predictive Ability of a Validated Trauma Risk Score

2021 ◽  
Vol 12 ◽  
pp. 215145932198953
Author(s):  
Sanjit R. Konda ◽  
Rown Parola ◽  
Cody Perskin ◽  
Kenneth A. Egol
Keyword(s):  
Hip Fracture ◽  
Risk Score ◽  
Mortality Risk ◽  
Risk Scores ◽  
Inpatient Mortality ◽  
Physical Status ◽  
Middle Aged ◽  
Physical Status Classification ◽  
Significant Difference ◽  
Status Classification

Introduction: The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of ASA physical status classification system to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population. Methods: A total of 1332 patients aged 55 years and older who sustained a hip fracture through a low-energy mechanism between October 2014 and February 2020 were included. The STTGMA and STTGMAASA mortality risk scores were calculated. The ability of the models to predict inpatient mortality was compared using area under the receiver operating characteristic curves (AUROCs) by DeLong’s test. Patients were stratified into minimal, low, moderate, and high risk cohorts based on their risk scores. Comparative analyses between risk score stratification distribution of mortality, complications, length of stay, ICU admission, and readmission were performed using Fisher’s exact test. Total cost of admission was fitted by univariate linear regression with STTGMA and STTGMAASA. Results: There were 27 inpatient mortalities (2.0%). When STTGMA was used, the AUROC was 0.742. When STTGMAASA was used, the AUROC was 0.823. DeLong’s test resulted in significant difference in predictive capacity for inpatient mortality between STTGMA and STTGMAASA (p = 0.04). Risk score stratification yielded significantly different distribution of all outcomes between risk cohorts (p < 0.01). STTGMAASA stratification produced a larger percentage of all negative outcomes with increasing risk cohort. Total hospital cost was statistically correlated with both STTGMAASA (p < 0.01) and STTGMA (p = 0.02). Conclusion: Including ASA physical status as a variable in STTGMA improves the model’s ability to predict inpatient mortality and risk stratify middle-aged and geriatric hip fracture patients.

scholarly journals Quantitative Breast Density in Contrast-Enhanced Mammography

2021 ◽  
Vol 10 (15) ◽  
pp. 3309
Author(s):  
Gisella Gennaro ◽  
Melissa L. Hill ◽  
Elisabetta Bezzon ◽  
Francesca Caumo
Keyword(s):  
Breast Density ◽  
Potential Role ◽  
Multiple Correlation Coefficient ◽  
Low Energy ◽  
Coefficient Of Determination ◽  
Contrast Enhanced ◽  
Increased Risk ◽  
Significant Difference ◽  
Automatic Software ◽  
The Relationship

Contrast-enhanced mammography (CEM) demonstrates a potential role in personalized screening models, in particular for women at increased risk and women with dense breasts. In this study, volumetric breast density (VBD) measured in CEM images was compared with VBD obtained from digital mammography (DM) or tomosynthesis (DBT) images. A total of 150 women who underwent CEM between March 2019 and December 2020, having at least a DM/DBT study performed before/after CEM, were included. Low-energy CEM (LE-CEM) and DM/DBT images were processed with automatic software to obtain the VBD. VBDs from the paired datasets were compared by Wilcoxon tests. A multivariate regression model was applied to analyze the relationship between VBD differences and multiple independent variables certainly or potentially affecting VBD. Median VBD was comparable for LE-CEM and DM/DBT (12.73% vs. 12.39%), not evidencing any statistically significant difference (p = 0.5855). VBD differences between LE-CEM and DM were associated with significant differences of glandular volume, breast thickness, compression force and pressure, contact area, and nipple-to-posterior-edge distance, i.e., variables reflecting differences in breast positioning (coefficient of determination 0.6023; multiple correlation coefficient 0.7761). Volumetric breast density was obtained from low-energy contrast-enhanced spectral mammography and was not significantly different from volumetric breast density measured from standard mammograms.

Abstract WP112: Thrombolysis for AIS in the Unwitnessed or Extended Therapeutic Time Window: A Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aristeidis H Katsanos ◽  
Konark Malhotra ◽  
Amrou Sarraj ◽  
Andrew Barreto ◽  
Martin Köhrmann ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Time Window ◽  
Meta Analysis ◽  
Onset Time ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Functional Improvement ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Introduction: We sought to assess the utility of intravenous thrombolysis (IVT) treatment in acute ischemic stroke (AIS) patients with unclear symptom onset time or outside the 4.5 hour time window, selected by advanced neuroimaging. Methods: We performed random-effects meta-analyses on the unadjusted and adjusted for potential confounders associations of IVT (alteplase 0.9 mg/kg) with the following outcomes: 3-month favorable functional outcome [FFO, modified Rankin Scale (mRS) scores: 0-1], 3-month functional independence (FI, mRS-scores: 0-2), 3-month mortality, 3-month functional improvement (assessed with ordinal analysis on the mRS-scores), symptomatic intracranial hemorrhage (sICH) and complete recanalization (CR). Results: We identified 4 eligible RCTs (859 total patients). In unadjusted analyses IVT was associated with higher likelihood of 3-month FFO (OR=1.48, 95%CI:1.12-1.96), FI (OR=1.42, 95%CI:1.07-1.90), sICH (OR=5.28, 95%CI:1.35-20.68) and CR (OR=3.29, 95%CI:1.90-5.69), with no significant difference in the odds of all-cause mortality risk at three months (OR=1.75, 95%CI: 0.93-3.29). In the adjusted analyses IVT was also associated with higher odds of 3-month FFO (OR adj =1.62, 95%CI:1.20-2.20), functional improvement (OR adj =1.42, 95%CI: 1.11-1.81) and sICH (OR adj =6.22, 95%CI: 1.37-28.26). There was no association between IVT and FI (OR adj =1.61, 95%CI: 0.94-2.75) or all-cause mortality at three months (OR adj =1.75, 95%CI: 0.93-3.29). No evidence of heterogeneity was evident in any of the analyses (I 2 =0). Conclusion: IVT in AIS patients with unknown symptom onset time or elapsed time from symptom onset more than 4.5 hours, selected with advanced neuroimaging, results in a higher likelihood of complete recanalization and functional improvement at three months despite the increased risk of sICH.

scholarly journals Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

2020 ◽  
Vol 11 ◽  
pp. 215145932095508
Author(s):  
Sanjit R. Konda ◽  
Ariana Lott ◽  
Jessica Mandel ◽  
Thomas R. Lyon ◽  
Jonathan Robitsek ◽  
...  
Keyword(s):  
Age Groups ◽  
Quality Measures ◽  
High Energy ◽  
Cost Of Care ◽  
Hospital Quality ◽  
Geriatric Trauma ◽  
Inpatient Cost ◽  
Orthopedic Trauma ◽  
Age Related ◽  
Trauma Population

Purpose: The purpose of this study was 2-fold: 1) to investigate the age-related frequency, demographics and distribution of the middle-aged and geriatric orthopedic trauma population and 2) to describe the age-related frequency and distribution of hospital quality measure outcomes and inpatient cost. Methods: All patients > 55 years of age who required orthopedic, trauma, or neurosurgery consults at 3 hospitals within an academic medical center from 2014 to 2017 were prospectively followed. On initial evaluation, each patient’s demographics, injury severity, and functional status were collected. Patients were grouped into low and high-energy mechanism cohorts and divided into 5 groups based on age. Hospital quality measures including length of stay, complications, discharge location, and cost of care was compared between age groups. Data were analyzed using ANOVA and Chi-square tests. Results: A total of 3965 patients were included in this study of which 3268 (82%) sustained low-energy trauma and 697 (18%) sustained high-energy trauma. With increasing age, more patients had more comorbidities, were less likely to be community ambulators, and more likely to use assistive devices (p < 0.05). Patients in older age groups had longer lengths of stay, more complications, were more likely to need ICU level care, and were less likely to be discharged home (p < 0.05). Rates of mortality were also greater in patients of more advanced age in both low and high-energy cohorts, and the calculated risk triage tool (STTGMA) score increased with each age bracket (p < 0.05). Total cost of care differed between age groups in the low-energy cohort (p = 0.003). Conclusion: This epidemiological study provides a clear picture of the frequency and distribution of demographic, physiologic characteristics, outcomes, and cost of care in a middle-aged and geriatric orthopedic trauma population as evaluated by the STTGMA risk tool. Risk profiling of geriatric trauma patients allows for the establishment of baseline norms.

scholarly journals Healthy behaviours and risk of all-cause mortality

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Lahti ◽  
E Mauramo ◽  
E Lahelma ◽  
T Lallukka ◽  
O Pietiläinen ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cox Regression ◽  
Leisure Time Physical Activity ◽  
Premature Mortality ◽  
Middle Aged ◽  
A Value ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Healthy Behaviour

Abstract Introduction Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees. Methods Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health. Results Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality. Conclusions A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality. Key messages Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.

Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis

2017 ◽  
Vol 10 (7) ◽  
pp. 620-624 ◽  
Author(s):  
Hamidreza Saber ◽  
Sandra Narayanan ◽  
Mohan Palla ◽  
Jeffrey L Saver ◽  
Raul G Nogueira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Functional Independence ◽  
Vessel Occlusion ◽  
Increased Risk ◽  
Significant Difference

BackgroundEndovascular thrombectomy has demonstrated benefit for patients with acute ischemic stroke from proximal large vessel occlusion. However, limited evidence is available from recent randomized trials on the role of thrombectomy for M2 segment occlusions of the middle cerebral artery (MCA).MethodsWe conducted a systematic review and meta-analysis to investigate clinical and radiographic outcomes, rates of hemorrhagic complications, and mortality after M2 occlusion thrombectomy using modern devices, and compared these outcomes against patients with M1 occlusions. Recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 or modified TICI 2b/3.ResultsA total of 12 studies with 1080 patients with M2 thrombectomy were included in our analysis. Functional independence (modified Rankin Scale 0–2) rate was 59% (95% CI 54% to 64%). Mortality and symptomatic intracranial hemorrhage rates were 16% (95% CI 11% to 23%) and 10% (95% CI 6% to 16%), respectively. Recanalization rates were 81% (95% CI 79% to 84%), and were equally comparable for stent-retriever versus aspiration (OR 1.05; 95% CI 0.91 to 1.21). Successful M2 recanalization was associated with greater rates of favorable outcome (OR 4.22; 95% CI 1.96 to 9.1) compared with poor M2 recanalization (TICI 0–2a). There was no significant difference in recanalization rates for M2 versus M1 thrombectomy (OR 1.05; 95% CI 0.77 to 1.42).ConclusionsThis meta-analysis suggests that mechanical thrombectomy for M2 occlusions that can be safely accessed is associated with high functional independence and recanalization rates, but may be associated with an increased risk of hemorrhage.

scholarly journals Quantitative breast density in Contrast-Enhanced Mammography

2021 ◽  
Author(s):  
Gisella Gennaro ◽  
Melissa L. Hill ◽  
Elisabetta Bezzon ◽  
Francesca Caumo
Keyword(s):  
Breast Cancer ◽  
Breast Density ◽  
Breast Imaging ◽  
High Energy ◽  
Multiple Correlation Coefficient ◽  
Low Energy ◽  
Wilcoxon Test ◽  
Coefficient Of Determination ◽  
Contrast Enhanced ◽  
Significant Difference

Abstract Background: Breast density is an independent risk factor for breast cancer, and cancer detection in mammography is reduced in dense breasts. Quantitative tools are available to measure breast density from digital mammography (DM) or tomosynthesis (DBT). Contrast-enhanced mammography (CEM) is an emerging breast imaging technique, consisting of the acquisition of an image pair (low-energy, LE, and high-energy, HE) for each mammography view. LE-CEM images have been demonstrated to be visually equivalent to a standard mammogram, thereby, CEM examinations do not require additional mammography to complete the clinical information. In this study, volumetric breast density (VBD) measured in LE-CEM was compared with VBD obtained from DM/DBT images.Methods: Between Mar 2019 and Dec 2020 222 women were enrolled in a prospective clinical trial aiming to compare clinical performance of CEM with breast MRI in a population of women at intermediate and high risk for breast cancer. In this observational cohort study, 150 women enrolled in this trial having at least a DM/DBT study performed before/after CEM were selected. CEM and previous/subsequent DM/DBT images were processed by an automatic algorithm to calculate VBD for each view. VBD from LE-CEM and DM/DBT views were compared using a paired Wilcoxon test. P < 0.05 was considered indicative of a statistically significant difference. A multivariate regression model was applied to analyze the relationship between paired VBD differences and multiple independent variables certainly or potentially affecting VBD.Results: Mean age of women included in this study was 51.0±8.4 years. Median VBD was comparable for LE-CEM and previous/subsequent DM/DBT (12.73% vs. 12.39%), not evidencing any statistically significant difference (P = 0.5855). VBD differences between LE-CEM and DM were associated to significant differences of glandular volume, breast thickness, compression force and pressure, contact area, and nipple-to-posterior-edge distance i.e. variables reflecting differences in breast positioning (coefficient of determination 0.6023; multiple correlation coefficient 0.7761).Conclusions: Volumetric breast density can be obtained from low-energy contrast-enhanced spectral mammography and is not significantly different from volumetric breast density measured from standard mammograms.

scholarly journals 1609 Patient Demographics and Outcomes Following Acute Presentation with An Inguinal Hernia; A 15-Year Retrospective Cohort Study from The North of England

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Clyde ◽  
L Li ◽  
R Swan ◽  
R McLean ◽  
L Brown
Keyword(s):  
Inguinal Hernia ◽  
Length Of Stay ◽  
Inpatient Mortality ◽  
Median Length ◽  
Patient Demographics ◽  
Acute Presentation ◽  
The North ◽  
Emergency Presentation ◽  
Increased Risk ◽  
Significant Difference

Abstract Aim Although inguinal hernia repair is one of the most common elective procedures performed, emergency repair carries a far greater risk to patients. This study aimed to report on patient demographics and outcomes following emergency presentation with an inguinal hernia. Method Patients ≥18 years admitted acutely with an inguinal hernia across NHS trusts in the North of England between 2002-2016 were identified. Data were collected on demographics, investigations, and operative interventions. Outcomes including length of stay (LoS) and 30-day mortality were analysed. Results A total of 4698 patients presented over the 15-year study period. The cohort were predominantly male (n = 4133, 88.0%) with median age of 71 years (IQR: 56-81). Whilst no significant difference in age or gender were found across the study period, comorbidities, as measured by Charlson score, increased over time (p &lt; 0.001). In those who underwent operative intervention (n = 2580), median length of stay was 3 days (IQR: 2-5) and 30-day inpatient mortality rate was 2.5%. Advanced age and comorbidity were associated with higher overall 30-day mortality and post-operative 30-day mortality (both p &lt; 0.001). Conclusions This study highlights the frailty of patients presenting as emergency with complications secondary to inguinal hernia. Given the increased risk observed in this patient group, it is vital that perioperative care is optimised, and patients are counselled appropriately.

scholarly journals Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Sheng Ye ◽  
Dan Xu ◽  
Chenmei Zhang ◽  
Mengyao Li ◽  
Yanyi Zhang
Keyword(s):  
Mechanical Ventilation ◽  
Regression Model ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Risk Of Death ◽  
External Cooling ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Significant Difference

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

scholarly journals Cross-Verification of Monte Carlo Codes Geant4 and MCNP6 for Muon Tomography

2021 ◽  
Vol 21 (2) ◽  
pp. 49-60
Author(s):  
C. V. Hrytsiuk ◽  
◽  
А. M. Bozhuk ◽  
А. V. Nosovskyi ◽  
V. І. Gulik ◽  
...  
Keyword(s):  
Monte Carlo ◽  
Spent Nuclear Fuel ◽  
Nuclear Data ◽  
High Energy ◽  
Intermediate Energy ◽  
Low Energy ◽  
Physical Models ◽  
Heavy Nuclei ◽  
Muon Tomography ◽  
Significant Difference

Muon tomography is a promising detection technology that uses natural radiation, the muons of cosmic rays. In the last decade, a significant number of scientific papers have appeared that investigate the possibility of using muon tomography in various fields of science and technology. Especially remarkable is the considerable potential of this technology for detecting the illegal transport of radioactive materials and for no-invasive testing of the integrity of spent nuclear fuel in dry storage facilities for such fuel. For the implementation of muon tomography technology, the process of preliminary modeling of the experimental detector facility is important, which also requires verification of the obtained calculation results. For this purpose, the well-known Monte Carlo codes MCNP and Geant4 are mainly used. This results of the first cross-verification studies of MCNP6 and Geant4 codes are demonstrated in the paper. The study was performed on simple models for different materials and for different energies of the muons bombarding the research object. The recommended QGSP_BERT physics library was used in the Geant4 code. In the MCNP6 code, the recommended settings for cosmic particle simulations were used. The calculations showed that for low-energy muons, both codes give results that agree well with each other. This can be explained by the fact that similar libraries of evaluated nuclear data are used in the low-energy range. Regarding the muons of intermediate energies, there is a significant difference between the two codes, which may indicate differences in physical models. The modeling of high-energy muon transfer has better agreement between MCNP6 and Geant4 codes than for intermediate-energy muons, but significant differences are still observed for heavy nuclei.

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