scholarly journals Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes

2008 ◽  
Vol 31 (2) ◽  
pp. 349-355 ◽  
Author(s):  
S. Kruger ◽  
S. Ewig ◽  
R. Marre ◽  
J. Papassotiriou ◽  
K. Richter ◽  
...  
Keyword(s):  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Risk Of Death

scholarly journals Development and Implementation of a clinical pathway to reduce inappropriate admissions among patients with Community acquired pneumonia in a private health system in Brazil: An observational cohort study and a promising tool for efficiency improvement.

2019 ◽  
Author(s):  
Rodrigo Moreira ◽  
Hugo T. F. Mendonça ◽  
Ayla M. Farias ◽  
Henry Sznejder ◽  
Eddy Lang ◽  
...  
Keyword(s):  
Clinical Pathway ◽  
Hospital Admissions ◽  
Clinical Decision ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Promising Tool ◽  
Inappropriate Admissions ◽  
Prolonged Hospital

Abstract Background: Patients with community-acquired pneumonia (CAP) at low risk of death by CURB-65 scoring system are usually unnecessarily treated as inpatients generating additional economic and clinical burden. We aimed to implement an evidence based clinical pathway to reduce hospital admissions of low risk CAP and investigate factors related to mortality and readmissions within 30 days.Methods: From November 2015 to August 2017 a clinical pathway was implemented at twenty hospitals. We included patients aged >18 years, with a diagnosis of CAP by the attendant physician. The main outcome was the monthly proportion of low risk CURB-65 admission after implementation of the clinical pathway. Logistic regression models were performed to assess variables associated with mortality and readmission in the admitted population within 30 days.Results: We included 10909 participants with suspected CAP. The proportion of low risk CAP admitted decreased from 22.1% to 12.8% in the period. Among participants with low risk, there has been no perceptible increase in deaths (0.80%) or readmissions (6.92%). Regression analysis identified that CURB-65 variables, presence of pleural effusion (OR= 1.74; 95%IC=1.08-2.8; p=0.02) and leucopenia (OR= 2.47; 95%IC=1.11-5.48;p=0.02) were independently associated with 30-day mortality whereas a prolonged hospital stay (OR= 2.09; 95%=1.14-3.83;p=0.01) were associated with 30-day readmission in the low risk population.Conclusion: The implementations of a clinical pathway diminished the proportion of low risk CAP admissions with no apparent increase of clinical outcomes within 30 days. Nonetheless, additional factors influences the clinical decision about site of care management in low risk CAP.

scholarly journals Sernbo score predicts survival after intracapsular hip fracture in the elderly

2013 ◽  
Vol 95 (1) ◽  
pp. 29-33 ◽  
Author(s):  
EJC Dawe ◽  
E Lindisfarne ◽  
T Singh ◽  
I McFadyen ◽  
P Stott
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Risk Group ◽  
Characteristic Curve ◽  
Social Situation ◽  
High Risk Group ◽  
Low Risk ◽  
Risk Of Death ◽  
Intracapsular Hip Fracture ◽  
The Mean

Introduction The Sernbo score uses four factors (age, social situation, mobility and mental state) to divide patients into a high-risk and a low-risk group. This study sought to assess the use of the Sernbo score in predicting mortality after an intracapsular hip fracture. Methods A total of 259 patients with displaced intracapsular hip fractures were included in the study. Data from prospectively generated databases provided 22 descriptive variables for each patient. These included operative management, blood tests and co-mobidities. Multivariate analysis was used to identify significant predictors of mortality. Results The mean patient age was 85 years and the mean follow-up duration was 1.5 years. The one-year survival rate was 92% (±0.03) in the low-risk group and 65% (±0.046) in the high-risk group. Four variables predicted mortality: Sernbo score >15 (p=0.0023), blood creatinine (p=0.0026), ASA (American Society of Anaesthesiologists) grade >3 (p=0.0038) and non-operative treatment (p=0.0377). Receiver operating characteristic curve analysis showed the Sernbo score as the only predictor of 30-day mortality (area under curve 0.71 [0.65–0.76]). The score had a sensitivity of 92% and a specificity of 51% for prediction of death at 30 days. Conclusions The Sernbo score identifies patients at high risk of death in the 30 days following injury. This very simple score could be used to direct extra early multidisciplinary input to high-risk patients on admission with an intracapsular hip fracture.

scholarly journals Determinants for hospitalization in " low-risk" community acquired pneumonia

2003 ◽  
Vol 3 (1) ◽  
Author(s):  
Zakari Y Aliyu ◽  
Muktar H Aliyu ◽  
Ken McCormick
Keyword(s):  
Community Acquired Pneumonia ◽  
Low Risk

Monotherapy Anticoagulation to Expedite Home Treatment of Patients Diagnosed With Venous Thromboembolism in the Emergency Department: A Pragmatic Effectiveness Trial

2021 ◽  
Author(s):  
Jeffrey A. Kline ◽  
David H. Adler ◽  
Naomi Alanis ◽  
Joseph R. Bledsoe ◽  
Daniel M. Courtney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
The United States ◽  
Home Treatment ◽  
Low Risk ◽  
Severe Bleeding ◽  
Effectiveness Trial ◽  
Risk Of Death ◽  
Recurrent Vte

BACKGROUND: The objective was to test if low-risk emergency department patients with vitamin K antagonist (venous thromboembolism [VTE]; including venous thrombosis and pulmonary embolism [PE]) can be safely and effectively treated at home with direct acting oral (monotherapy) anticoagulation in a large-scale, real-world pragmatic effectiveness trial. METHODS: This was a single-arm trial, conducted from 2016 to 2019 in accordance with the Standards for Reporting Implementation Studies guideline in 33 emergency departments in the United States. Participants had newly diagnosed VTE with low risk of death based upon either the modified Hestia criteria, or physician judgment plus the simplified PE severity index score of zero, together with nonhigh bleeding risk were eligible. Patients had to be discharged within 24 hours of triage and treated with either apixaban or rivaroxaban. Effectiveness was defined by the primary efficacy and safety outcomes, image-proven recurrent VTE and bleeding requiring hospitalization >24 hours, respectively, with an upper limit of the 95% CI for the 30-day frequency of VTE recurrence below 2.0% for both outcomes. RESULTS: We enrolled 1421 patients with complete outcomes data, including 903 with venous thrombosis and 518 with PE. The recurrent VTE requiring hospitalization occurred in 14/1421 (1.0% [95% CI, 0.5%–1.7%]), and bleeding requiring hospitalization occurred in 12/1421 (0.8% [0.4%–1.5%). The rate of severe bleeding using International Society for Thrombosis and Haemostasis criteria was 2/1421 (0.1% [0%–0.5%]). No patient died, and serious adverse events occurred in 2.5% of venous thrombosis patients and 2.3% of patients with PE. Medication nonadherence was reported by patients in 8.0% (6.6%–9.5%) and was associated with a risk ratio of 6.0 (2.3–15.2) for VTE recurrence. Among all patients diagnosed with VTE in the emergency department during the period of study, 18% of venous thrombosis patients and 10% of patients with PE were enrolled. CONCLUSIONS: Monotherapy treatment of low-risk patients with venous thrombosis or PE in the emergency department setting produced a low rate of bleeding and VTE recurrence, but may be underused. Patients with venous thrombosis and PE should undergo risk-stratification before home treatment. Improved patient adherence may reduce rate of recurrent VTE. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03404635

Mortality Associated with Acinetobacter baumannii Complex Bacteremia among Patients with War-Related Trauma

2010 ◽  
Vol 31 (1) ◽  
pp. 92-94 ◽  
Author(s):  
Grace Kang ◽  
Joshua D. Hartzell ◽  
Robin Howard ◽  
Robert N. Wood-Morris ◽  
Mark D. Johnson ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Acinetobacter Baumannii ◽  
Young Patients ◽  
Multidrug Resistant ◽  
Low Risk ◽  
Risk Of Death ◽  
High Prevalence ◽  
Acinetobacter Baumannii Complex ◽  
Resistant Strains

We investigated the mortality associated with Adnetobacter baumannii complex bacteremia among a cohort of patients hospitalized for war-related trauma. Despite a high prevalence of multidrug-resistant strains, the 30-day mortality rate was 2%. For relatively young patients with war-related trauma, A. baumannii complex bacteremia appears to be associated with a low risk of death.

scholarly journals A negative D-dimer identifies patients at low risk of death within 30 days: a prospective observational emergency department cohort study

QJM ◽  
2019 ◽  
Vol 112 (9) ◽  
pp. 675-680 ◽  
Author(s):  
L E Lyngholm ◽  
C H Nickel ◽  
J Kellett ◽  
S Chang ◽  
T Cooksley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vital Signs ◽  
Low Risk ◽  
Clinical Indication ◽  
Medical Patients ◽  
Prognostic Information ◽  
Registration System ◽  
Civil Registration ◽  
Risk Of Death ◽  
D Dimer

Abstract Objective To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. Design In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. Setting The Hospital of South West Jutland. Patients All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. Main results The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02–0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. Conclusion Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.

scholarly journals Acute upper gastrointestinal nonvariceal bleeding: How to determine low risk patients for rebleeding and mortality after endoscopic sclerotherapy?

2007 ◽  
Vol 54 (1) ◽  
pp. 107-114
Author(s):  
S. Djuranovic ◽  
M. Spuran ◽  
N.S. Mijalkovic ◽  
D. Stanisavljevic ◽  
M. Ugljesic ◽  
...  
Keyword(s):  
Low Risk ◽  
Endoscopic Sclerotherapy ◽  
First Line ◽  
Risk Levels ◽  
Risk Of Death ◽  
Bleeding Lesion ◽  
Risk Patients ◽  
Initial Hospitalization ◽  
Upper Gastrointestinal

Introduction: Successful endoscopic sclero-therapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question. AIM: To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB. Patients and methods: Prospective study included 315 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity. Results: Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts? mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values <4 had low risk of rebleeding. We identified 59 pts (18,7% of all) with score for rebleeding <4. Score values for mortality risk ranged from 3 to 8 and the values <5 revealed negligible risk of death. In our group we found 290 pts (92,1% of all) with low mortality score values. Conclusion: Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.

Sign in / Sign up

Export Citation Format

Share Document