scholarly journals Seasonal Variation in Autoimmune Hemolytic Anemia: A National Database Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4883-4883
Author(s):  
Srinandan Guntupalli ◽  
Dhara Patel ◽  
Ronak Gajendra kumar Soni ◽  
Sindhupriya Devarashetty ◽  
Richard Preston Mansour
Keyword(s):  
United States ◽  
Seasonal Variation ◽  
Immune System ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
National Database ◽  
Community Hospitals ◽  
The Mean

Abstract Background: Autoimmune hemolytic anemia (AIHA) is a decompensated acquired hemolysis caused by host's immune system acting against its own red cell antigens. Serologically, it can be divided to warm hemolytic anemia, cold hemolytic anemia, paroxysmal cold hemoglobinuria and mixed AIHA. Pathogenesis of AIHA comprises of a series of complex interactions between genetics, environmental either conferring to protective or deteriorating effects. Among these, climatic changes appears to be key as it involves many triggers such as viral infections, temperature and other host factors. We reviewed a large national hospitalization database to determine whether rates of autoimmune hemolytic anemia have a seasonal variation over the past decade. Methods: We examined the Nationwide Inpatient Sample (NIS), a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project in collaboration with participating states. It is the largest all-payer inpatient dataset in the United States and includes a 20% sample of United States community hospitals that approximates 20% of all US community hospitals. The Nationwide Inpatient Sample (NIS) database was used to estimate annual number of hospitalizations from 2000 - 2012. Identification of autoimmune hemolytic anemia related hospitalizations was based on the designation of the prior validated International Classification of Diseases (9th Edition) Clinical Modification (ICD-9-CM) diagnosis code 283 as the principal discharge diagnosis. The frequency of hospitalization per month cumulative over 13 years was calculated and divided by number of days in that month to determine the mean hospitalizations per day for each month. All calculations were carried out using the weighted estimates approximating nationwide population estimates. Results: An estimated 48,416 hospitalizations with primary diagnosis of autoimmune hemolytic anemia occurred in the US from 2000 to 2012 as per NIS database. More specifically, the mean number of hospitalizations per day in each month is shown in Fig. 1. The mean number of hospitalizations each day was highest in November (141 per day) and thereafter the hospitalization rate dropped to a nadir in May (122 per day). There was a significant rising trend of admissions from June towards winter months with peaks in November as depicted in the Fig.1. In general, the number of hospitalization was maximum in the winter months and minimum in summer months as demonstrated in Fig.2. Conclusion: We identified for the first time in United States an impressive pattern of seasonal variation in hospitalizations for autoimmune hemolytic anemia with a notable increase in winter and fall and a significant drop during summer months. The seasonal pattern may reflect viral or other triggers for immune system activation. Further efforts need to be made to identify triggers and methods to determine the relationship of these variations and reduce this predictive burden on the overall health care system. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States

2018 ◽  
Vol 35 (13) ◽  
pp. 1287-1296 ◽  
Author(s):  
Suneet Chauhan ◽  
Sean Blackwell ◽  
Han-Yang Chen
Keyword(s):  
United States ◽  
Hospital Cost ◽  
Maternal Morbidity ◽  
Nationwide Inpatient Sample ◽  
Hospital Costs ◽  
The United States ◽  
Severe Maternal Morbidity ◽  
The Mean ◽  
Procedure Codes ◽  
Mean Cost

Objective The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization. Study Design We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs. Results Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1–2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM. Conclusion The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden.

Admission trends in pediatric isolated linear skull fracture across the United States

2021 ◽  
pp. 1-13
Author(s):  
Alan R. Tang ◽  
Rebecca A. Reynolds ◽  
Jonathan Dallas ◽  
Heidi Chen ◽  
E. Haley Vance ◽  
...  
Keyword(s):  
United States ◽  
Skull Fracture ◽  
The United States ◽  
Rural Hospitals ◽  
Hospital Charges ◽  
National Database ◽  
Skull Fractures ◽  
Urban Teaching ◽  
Level Data ◽  
The Mean

OBJECTIVE Pediatric isolated linear skull fractures commonly result from head trauma and rarely require surgery, yet patients are often admitted to the hospital—a costly care plan. In this study, the authors utilized a national database to investigate trends in admission for skull fractures across the United States. METHODS Children younger than 18 years with isolated linear skull fracture, according to ICD-9 diagnosis codes in the Kids’ Inpatient Database of the Healthcare and Utilization Project (HCUP), who presented between 2003 and 2016 were included. HCUP collected data in 2003, 2006, 2009, 2012, and 2016. Children with a depressed skull fracture, multiple traumatic injuries, and acute intracranial findings were excluded. Sample-level data were translated into population-level data by using an HCUP-specific discharge weight. RESULTS Overall, 11,355 patients (64% males) were admitted to 1605 hospitals. National admissions decreased from 3053 patients in 2003 to 1203 in 2016. The mean ± SD age at admission also decreased from 6.3 ± 5.9 years to 1.2 ± 3.0 years (p < 0.001). The proportion of patients in the lowest quartile of median household income increased by 9%, while that in the highest income quartile decreased by 7% (p < 0.001). Admission was generally more common in the summer months (June, July, and August) and on weekdays (68%). The mean ± SD hospital length of stay decreased from 2.0 ± 3.1 days to 1.4 ± 1.4 days between 2003 and 2012, and then increased to 2.1 ± 6.8 days in 2016 (p < 0.001). When adjusted for inflation, the mean total hospital charges increased from $13,099 to $21,204 (p < 0.001). The greatest proportion of admissions was in the South (35%), and the lowest was in the Northeast (17%). The proportion of patients admitted to large hospitals increased (59% to 72%, p < 0.001), which corresponded to a decrease in patients admitted to small hospitals (16% to 9%, p < 0.001). Overall, the total proportion of admissions to rural hospitals decreased by 6%, and that to urban teaching centers increased by 15% (p < 0.001). Since 2003, no child has undergone a neurosurgical procedure or died as an inpatient. CONCLUSIONS This study identified a general nationwide decrease in admissions for pediatric linear isolated skull fracture, but associated costs increased. Admissions became less common at smaller rural hospitals and more common at larger urban teaching hospitals. This patient population required no inpatient neurosurgical intervention after 2003.

Abstract 51: Seasonal Variation in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Awani Deshmukh ◽  
Nileshkumar J Patel ◽  
Abhishek Deshmukh ◽  
Neil Patel ◽  
Achint Patel ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Seasonal Variation ◽  
Seasonal Pattern ◽  
The United States ◽  
Annual Number ◽  
Inhospital Mortality ◽  
Nationwide Inpatient Sample Database ◽  
The Mean ◽  
Hospital Cardiac Arrest

Introduction: Heart Disease and Stroke Statistics_2014 Update suggests more than 424,000 people suffer out of hospital cardiac arrest (OHCA) in the United States. Hypothesis: We assessed seasonal variation in OHCA from a large national hospitalisation database in the past decade. Methods: The Nationwide Inpatient Sample database was used to estimate the annual number of hospitalisations with from 2000-2011. Identification of out of hospital cardiac arrest related hospitalisations was based on the designation of the International Classification of Diseases (9th Edition) Clinical Modification (ICD-9-CM) diagnosis code 427.5 (OHCA) as the principal discharge diagnosis. The frequency of hospitalisation for each month cumulative over 11 years was calculated and divided by number of days in that month to obtain the mean hospitalisations per day for each month. All calculations were carried out using the weighted estimates approximating nationwide population estimates. Results: An estimated 93,209 hospitalisations with primary diagnosis of OHCA occurred in the United States from the beginning of the calendar year 2000 to the end of the calendar year 2011. The number of hospitalisations per day in each month is shown in Figure 1.The number of hospitalisation was maximum in the winter months and minimum in summer months. Specifically, the mean number of hospitalisation each day (averaged over 11 years) was least in August (242). There was a rising trend from August to January. The average number of hospitalisation was highest in January (310); thereafter, the hospitalisation rate dropped to a nadir in August. There was however no seasonal pattern in inhospital mortality. Conclusions: We identified for the first time in United States an impressive pattern of seasonal variation in hospitalisations for OHCA. Further efforts must be made to identify triggers and methods to prevent OHCA and reduce its burden on health care system.

scholarly journals Spinal Fractures in Ankylosing Spondylitis: Patterns, Management, and Complications in the United States – Analysis of Latest Nationwide Inpatient Sample Data

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 786-797
Author(s):  
Sandeep Kandregula ◽  
Harjus S. Birk ◽  
Amey Savardekar ◽  
William Chris Newman ◽  
Robbie Beyl ◽  
...  
Keyword(s):  
United States ◽  
Ankylosing Spondylitis ◽  
Nationwide Inpatient Sample ◽  
Spinal Fractures ◽  
The United States ◽  
Complication Rates ◽  
Comorbidity Score ◽  
Thoracic Level ◽  
The Mean ◽  
Cervical Level

Objective: Ankylosing spondylitis (AS) is a rheumatic inflammatory disease marked by chronic inflammation of the axial skeleton. This condition, particularly when severe, can lead to increased risk of vertebral fractures attributed to decreased ability of the stiffened spinal column to sustain normal loads. However, little focus has been placed on understanding the locations of spinal fractures and associated complications and assessing the correlation between these. In this review, we aim to summarize the complications and treatment patterns in the United States in AS patients with spinal fractures, using the latest Nationwide Inpatient Sample (NIS) database (2016–2018).Methods: We analyzed the NIS data of years 2016–2018 to compare the fracture patterns and complications.Results: A total of 5,385 patients were included. The mean age was 71.63 years (standard deviation [SD], 13.21), with male predominance (83.8%). The most common population is Whites (77.4%), followed by Hispanics (7.9%). The most common fracture level was thoracic level (58.3%), followed by cervical level (38%). Multiple fracture levels were found in 13.3% of the patients. Spinal cord injury (SCI) was associated with 15.8% of the patients. The cervical level had a higher proportion of SCI (26.5%), followed by thoracic level (9.2%). The mean Elixhauser comorbidity score was 4.82 (SD, 2.17). A total of 2,365 patients (43.9%) underwent surgical treatment for the fractures. The overall complication rate was 40.8%. Respiratory complications, including pneumonia and respiratory insufficiency, were the predominant complications in the overall cohort. Based on the regression analysis, there was no significant difference (p = 0.45) in the complication rates based on the levels. The presence of SCI increased the odds of having a complication by 2.164 times (95% confidence interval, 1.722–2.72; p ≤ 0.001), and an increase in Elixhauser comorbidity score predicted the complication and in-hospital mortality rate (p ≤ 0.001).Conclusion: In conclusion, AS patients with spinal fractures have higher postoperative complications than the general population. The most common fracture location was thoracic in our study, although it differs with few studies, with SCI occurring in 1/6th of the patients.

scholarly journals THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Haley E. Smith ◽  
Madeline M. Lyons ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
National Database ◽  
Control Group ◽  
Meniscal Allograft Transplantation ◽  
Children's Hospitals ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

System-wide seismic vulnerability of aging multiple-span multiple-girder bridges in low-to-moderate seismic hazard regions

2021 ◽  
Vol 37 (1_suppl) ◽  
pp. 1626-1651
Author(s):  
John E Lens M.EERI ◽  
Mandar M Dewoolkar ◽  
Eric M Hernandez M.EERI
Keyword(s):  
United States ◽  
Seismic Hazard ◽  
Cross Sections ◽  
Seismic Vulnerability ◽  
Time History ◽  
The United States ◽  
National Database ◽  
Eastern United States ◽  
Girder Bridges ◽  
The Status

This article describes the approach, methods, and findings of a quantitative analysis of the seismic vulnerability in low-to-moderate seismic hazard regions of the Central and Eastern United States for system-wide assessment of typical multiple span bridges built in the 1950s through the 1960s. There is no national database on the status of seismic vulnerability of bridges, and thus no means to estimate the system-wide damage and retrofit costs for bridges. The study involved 380 nonlinear analyses using actual time-history records matched to four representative low-to-medium hazard target spectra corresponding with peak ground accelerations from approximately 0.06 to 0.3 g. Ground motions were obtained from soft and stiff site seismic classification locations and applied to models of four typical multiple-girder with concrete bent bridges. Multiple-girder bridges are the largest single category, comprising 55% of all multiple span bridges in the United States. Aging and deterioration effects were accounted for using reduced cross-sections representing fully spalled conditions and compared with pristine condition results. The research results indicate that there is an overall low likelihood of significant seismic damage to these typical bridges in such regions, with the caveat that certain bridge features such as more extensive deterioration, large skews, and varied bent heights require bridge-specific analysis. The analysis also excludes potential damage resulting from liquefaction, flow-spreading, or abutment slumping due to weak foundation or abutment soils.

scholarly journals Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

2020 ◽  
pp. 073346482097760
Author(s):  
Manka Nkimbeng ◽  
Yvonne Commodore-Mensah ◽  
Jacqueline L. Angel ◽  
Karen Bandeen-Roche ◽  
Roland J. Thorpe ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Confidence Interval ◽  
Physical Function ◽  
Racial Discrimination ◽  
African Immigrants ◽  
The United States ◽  
African Immigrant ◽  
High Discrimination ◽  
The Mean

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years ( SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years ( b = −2.62, 95% confidence interval [CI] = [–5.01, –0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations ( b = −2.51, 95% CI = [–4.91, –0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

scholarly journals A Retrospective Analysis of Softball-Related Head and Facial Injuries Treated in United States Emergency Departments, 2013-2017

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982566 ◽  
Author(s):  
John S. Strickland ◽  
Marie Crandall ◽  
Grant R. Bevill
Keyword(s):  
United States ◽  
Head Injuries ◽  
The United States ◽  
Weighted Estimate ◽  
Body Parts ◽  
Facial Injuries ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Mean ◽  
Race Ethnicity

Background: Softball is a popular sport played through both competitive and recreational leagues. While head and facial injuries are a known problem occurring from games, little is known about the frequency or mechanisms by which they occur. Purpose: To analyze head/face injury diagnoses and to identify the mechanisms associated with such injuries. Study Design: Descriptive epidemiological study. Methods: A public database was used to query data related to head/facial injuries sustained in softball. Data including age, sex, race/ethnicity, injury diagnosis, affected body parts, disposition, incident location, and narrative descriptions were collected and analyzed. Results: A total of 3324 head and face injuries were documented in the database over the time span of 2013 to 2017, resulting in a nationwide weighted estimate of 121,802 head/face injuries occurring annually. The mean age of the players was 21.5 ± 14.4 years; 72.1% of injured players were female, while 27.9% were male. The most common injury diagnoses were closed head injuries (22.0%), contusions (18.7%), concussions (17.7%), lacerations (17.1%), and fractures (15.1%). The overwhelming majority of injuries involved being struck by a ball (74.3%), followed by colliding with another player (8.3%), colliding with the ground or a fixed object (5.0%), or being struck by a bat (2.8%). For those injuries caused by a struck-by-ball incident, most occurred from defensive play (83.7% were fielders struck by a hit or thrown ball) as opposed to offensive play (12.3% were players hit by a pitch or runners struck by a ball). Although helmet usage was poorly tracked in the database, female players (1.3%) were significantly more likely to have been wearing a helmet at the time of injury than were male players (0.2%) ( P = .002). Conclusion: The present study demonstrates that a large number of head and face injuries occur annually within the United States as a result of softball play. A variety of injuries were observed, with the majority involving defensive players being struck by the ball, which highlights the need for more focus on player safety by stronger adherence to protective headgear usage and player health monitoring.

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