scholarly journals Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marika Toscano ◽  
Thomas J. Marini ◽  
Kathryn Drennan ◽  
Timothy M. Baran ◽  
Jonah Kan ◽  
...  
Keyword(s):  
Excellent Agreement ◽  
Rural Areas ◽  
Intraclass Correlation ◽  
Standard Of Care ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Second Trimester ◽  
Obstetric Ultrasound ◽  
Biometric Measurements

Abstract Background Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. Methods This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. Results Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. Conclusion This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.

scholarly journals A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401882456 ◽  
Author(s):  
Jacob Schultz ◽  
Nicholas Giordano ◽  
Hui Zheng ◽  
Blair A. Parry ◽  
Geoffrey D. Barnes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Risk Groups ◽  
The United States ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Exact Test ◽  
Advanced Therapy ◽  
Chi Squared

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

scholarly journals Medical cannabis use in the United States: a retrospective database study

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
V. Kishan Mahabir ◽  
Jamil J. Merchant ◽  
Christopher Smith ◽  
Alisha Garibaldi
Keyword(s):  
United States ◽  
Medical Condition ◽  
Statistical Tests ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Medical Conditions ◽  
Comorbid Conditions ◽  
Medical Cannabis ◽  
Number Of Patients

Abstract Introduction Growing interest in the medicinal properties of cannabis has led to an increase in its use to treat medical conditions, and the establishment of state-specific medical cannabis programs. Despite medical cannabis being legal in 33 states and the District of Colombia, there remains a paucity of data characterizing the patients accessing medical cannabis programs. Methods We retrospectively reviewed a registry with data from 33 medical cannabis evaluation clinics in the United States, owned and operated by CB2 Insights. Data were collected primarily by face-to-face interviews for patients seeking medical cannabis certification between November 18, 2018 and March 18, 2020. Patients were removed from the analysis if they did not have a valid date of birth, were less than 18, or did not have a primary medical condition reported; a total of 61,379 patients were included in the analysis. Data were summarized using descriptive statistics expressed as a mean (standard deviation (SD)) or median (interquartile range (IQR)) as appropriate for continuous variables, and number (percent) for categorical variables. Statistical tests performed across groups included t-tests, chi-squared tests and regression. Results The average age of patients was 45.5, 54.8% were male and the majority were Caucasian (87.5%). Female patients were significantly older than males (47.0 compared to 44.6). Most patients reported cannabis experience prior to seeking medical certification (66.9%). The top three mutually exclusive primary medical conditions reported were unspecified chronic pain (38.8%), anxiety (13.5%) and post-traumatic stress disorder (PTSD) (8.4%). The average number of comorbid conditions reported was 2.7, of which anxiety was the most common (28.3%). Females reported significantly more comorbid conditions than males (3.1 compared to 2.3). Conclusion This retrospective study highlighted the range and number of conditions for which patients in the US seek medical cannabis. Rigorous clinical trials investigating the use of medical cannabis to treat pain conditions, anxiety, insomnia, depression and PTSD would benefit a large number of patients, many of whom use medical cannabis to treat multiple conditions.

Clinical, sociodemographic, and pathological characteristics of breast cancer in the United States: A cross-sectional analysis from the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13623-e13623
Author(s):  
Zeina A. Nahleh ◽  
Nadeem Bilani ◽  
Leah Elson ◽  
Elizabeth Blessing Elimimian ◽  
Emily Craig Zabor
Keyword(s):  
Breast Cancer ◽  
Academic Research ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Integrated Network ◽  
Hormone Receptor Positive ◽  
Kaplan Meier ◽  
Facility Type

e13623 Background: Breast cancer (BC) remains the most commonly-diagnosed malignancy in women. BC encompasses great heterogeneity in patient pathologic and clinical characteristics, as well as treatment approaches and outcome by stage and subtype. This study aims to explore recent differences in characteristics and overall survival (OS) of BC across different facility types. Methods: We conducted a retrospective analysis of patients with BC, diagnosed between 2004-2016, based on the NCDB. Categorical variables were summarized using frequencies/percentages, whereas continuous variables were summarized using the median/interquartile range (IQR). OS was explored using the Kaplan-Meier method. Results: A total of 2,671,549 patients with BC were captured in this dataset. The median age at diagnosis was 61 (range 18-90 years). The majority n = 1,986,450 (75%) were non-Hispanic (NH) white; 286,176 (11%) were NH-black; 124,877 (4.7%) were Hispanic-white; 2,977 (0.1%) were Hispanic-black and 90,484 (6.1%) were Asian. The most common BC subtype was hormone receptor-positive (HR+)/HER2- (58%), followed by HR+/HER2+ (26%), HR-/HER2-negative (10%) and HR-/HER2+ (6.4%). 73% of cases were ductal; 15% lobular; the remaining histological subtypes included 0.9% epithelial-myoepithelial, 0.1% fibroepithelial, 0.4% metaplastic, < 0.1% mesenchymal, 1.6% rare breast carcinomas and 7% other carcinomas. The majority of patients received therapy at comprehensive community cancer programs (CPs) (45%), followed by academic/research CPs (30%), integrated network CPs (15%) and community CPs (9.5%). OS was best at academic (72% 10-year OS), followed by integrated network (69% 10-year OS), comprehensive community (68% 10-year OS) and community (63% 10-year OS) CPs. Significant differences in OS according to facility type remained when stratified by stage of disease (all p < 0.0001). OS was also significantly better for white (69% 10-year OS) versus black (63% 10-year OS) patients. Conclusions: This large database from the NCDB provides a comprehensive, recent overview of BC over the last 12 years. Facility type appears to be significantly associated with OS, such that academically designated centers have superior OS across all stages.

Abstract 17063: Enhanced Prediction of Heart Failure 30-Day Readmission Risk With Four Readily-Available Clinical Variables

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nicholas Wettersten ◽  
Machelle Wilson ◽  
Kathleen Tong ◽  
Javier E López
Keyword(s):  
Heart Failure ◽  
Standard Of Care ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Clinical Predictors ◽  
Clinical Variables ◽  
Academic Center ◽  
Multivariate Prediction ◽  
Readmission Risk

Introduction: Heart failure (HF) readmissions, with ~25% within 30 days of discharge, can be reduced with costly post-hospitalization interventions. Determining which patients will benefit from these interventions remains a critical challenge. Hypothesis: We aimed to devise a simple model to predict 30-day HF readmission risk. Methods: Patients ≥21 years of age admitted for HF to a single academic center from July 1st, 2008 to December 31st, 2009 were identified by billing codes for HF. Patients were excluded if they died within 90 days, were transferred, discharged to hospice or prison, or later admitted electively or for a surgical emergency not related to HF. Demographics, co-morbidities, laboratories, vitals, and discharge medications (27 variables) were tested as predictors for risk of 30 day readmission. First, independent univariate testing of categorical variables was performed utilizing a retention p-value of < 0.2. Next, continuous variables and retained categorical variables were tested in a multivariable model with retention of variables with p-value < 0.1. False discovery rate was controlled by the method of Benjamini and Hochberg. Statistical analyses were performed using SAS® software version 9.3. Results: Of 1253 HF admissions, 657 (55.8% men, age 60.9 ± 13.8 men, 66.8 ± 14.5 women) met criteria with complete data. Twenty percent were readmitted within 30 days. Odds for readmission increased 1.6% for every 100 pg/ml increase in BNP (p=0.082), 5.6% for each additional discharge medication (p=0.003), 200% if not discharged on an ACE-I/ARB (p=0.001), and 7% for every 10 mmHg increase in systolic blood pressure at discharge compared to admission (p=0.078). Conclusion: One laboratory value and 3 clinical variables were predictive of 30-day HF readmission risk in a multivariate prediction model. The 3 clinical predictors provoke the idea that “in hospital” care is a predictor and potential target for intervention to reduce 30-day readmission risk. Future validation studies should help define standard-of-care interventions that could still be improved to reduce readmission rates in HF patients as well as address the relative cost of more intense hospital interventions over outpatient interventions.

scholarly journals Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

2017 ◽  
Vol 05 (04) ◽  
pp. E261-E271 ◽  
Author(s):  
Moiz Ahmed ◽  
Ritesh Kanotra ◽  
Ghanshyambhai Savani ◽  
Fenilkumar Kotadiya ◽  
Nileshkumar Patel ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Cost Of Care ◽  
Categorical Variables ◽  
Significant Shift ◽  
Continuous Variables ◽  
Endoscopic Retrograde ◽  
Cross Sectional ◽  
The Mean

Abstract Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013.There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.

scholarly journals Quality of life based on level of physical activity among elderly residents of urban and rural areas

2017 ◽  
Vol 20 (3) ◽  
pp. 330-339 ◽  
Author(s):  
Cezar Grontowski Ribeiro ◽  
Fátima Ferretti ◽  
Clodoaldo Antônio de Sá
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Rural Areas ◽  
The Elderly ◽  
Categorical Variables ◽  
Elderly Persons ◽  
Continuous Variables ◽  
Place Of Residence ◽  
Cross Sectional

Abstract Objective: To analyze quality of life (QOL) according to level of physical activity among elderly persons living in rural (RA) and urban (UA) areas. Method: A descriptive cross-sectional study, analyzing 358 elderly residents of RA and 139 of UA, in the municipal region of Palmas, Paraná, Brazil was performed. Quality of life, level of physical activity and economic condition were evaluated. For the analysis of the continuous variables, the student’s t-test or the Mann-Whitney test were used, based on the normality or otherwise of the data. Pearson's chi-squared or Fischer’s exact test were used to analyze the categorical variables. Results: The general perception of QOL reported in RA was better than in UA (p<0.05). The analysis of the level of physical activity according to place of residence showed that the elderly are more physically active in RA (p<0.05), whereas insufficiently active or sedentary subjects prevail in UA. The variables age and gender were not associated with QOL (p>0.05), irrespective of place of residence, and active elderly persons had better QOL scores than insufficiently active or sedentary individuals, again irrespective of place of residence (p<0.05). Conclusion: The present study provides evidence that QOL is positively influenced by both maintaining satisfactory levels of physical activity and by residing in RA. It is important to establish public policies aimed at ensuring a more active and independent old age, thus generating greater health and quality of life.

scholarly journals Cardiac Arrests and Deaths Associated with Malignant Hyperthermia in North America from 1987 to 2006

2008 ◽  
Vol 108 (4) ◽  
pp. 603-611 ◽  
Author(s):  
Marilyn Green Larach ◽  
Barbara W. Brandom ◽  
Gregory C. Allen ◽  
Gerald A. Gronert ◽  
Erik B. Lehman
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Malignant Hyperthermia ◽  
Odds Ratio ◽  
Anesthetic Management ◽  
The United States ◽  
Exclusion Criterion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Increased Risk

Background The authors determined associated cardiac arrest and death rates in cases from Canada and the United States as reported to The North American Malignant Hyperthermia (MH) Registry and analyzed factors associated with a higher risk of poor outcomes. Methods The authors searched the database for AMRA (adverse metabolic/musculoskeletal reaction to anesthesia) reports with inclusion criteria as follows: event date between January 1, 1987, and December 31, 2006; "very likely" or "almost certain" MH as ranked by MH Clinical Grading Scale; location in Canada or the United States; and one or more anesthetic agents given. The exclusion criterion was a pathologic condition other than MH independently judged by the authors. Severe MH outcomes were analyzed as regards clinical history and presentation, using Wilcoxon rank sum tests for continuous variables and Pearson exact chi-square tests for categorical variables. A Bonferroni correction adjusted for multiple comparisons. Results Of 291 events, 8 (2.7%) resulted in cardiac arrests and 4 (1.4%) resulted in death. The median age in cases of cardiac arrest/death was 20 yr (range, 2-31 yr). Associated factors were muscular build (odds ratio, 18.7; P = 0.0016) and disseminated intravascular coagulation (odds ratio, 49.7; P &lt; 0.0001). Increased risk of cardiac arrest/death was related to a longer time period between anesthetic induction and maximum end-tidal carbon dioxide (216 vs. 87 min; P = 0.003). Unrelated factors included patient or family history, anesthetic management, and the MH episode. Conclusions Modern US anesthetic practice did not prevent MH-associated cardiac arrest and death in predominantly young, healthy patients undergoing low- to intermediate-risk surgical procedures.

scholarly journals Outcomes of Hydroxyurea Dose Adjustment Via Telehealth

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 24-24
Author(s):  
Sarah Shaner ◽  
Lee M Hilliard ◽  
Thomas H. Howard ◽  
Brandi Pernell ◽  
Smita Bhatia ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Dose Adjustment ◽  
Standard Of Care ◽  
Clinic Visit ◽  
Pain Clinic ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Academic Center ◽  
Clinic Visits

The UAB Pediatric Sickle Cell Clinic cares for patients at both an academic center and satellite clinics. One difference in clinics is that CBC results are not available at the time of patient care during satellite clinics, but are available at the academic center. Therefore, hydroxyurea (HU) dosing adjustments are made within seven days through telehealth; after reviewing faxed CBC results, a sickle cell nurse calls families and educates them on any revised HU dosing plans and reinforces adherence to HU. We hypothesized that this type of telehealth HU dosing adjustments would not impact HU laboratory response. Methods: We performed a one-year retrospective review of 172 HbSS and HbSB0 thalassemia patients prescribed HU during 2019 that were cared for in both the academic center (Birmingham) and satellite clinics (Montgomery, Tuscaloosa, Opelika). We excluded patients on HU and a second sickle cell disease modifying therapy. We abstracted from the EMR: age, sex, clinic location, diagnosis, HU dose (mg/kg), WBC, Hb, MCV, Platelets, Absolute Reticulocyte, HbF, and ANC. We recorded the total number of well-clinic visits and categorized clinic visit/year as ≤ 2or &gt;2; satellite clinic visits are fixed either monthly to every three months which limited our ability to reschedule patients with missed visits. We also recorded the number of ED visits and admissions to the hospital for a) pain and b) all sickle cell complications except for scheduled procedures. We collected acute visit data from the EMR at the academic center for onsite participants and from patient report from satellite participants. We evaluated dosing adjustment as whether dosing was increased for ANC &gt; 4000 per institutional standard of care. We categorized correct dosing adjustments if &gt; 65% of visits had a dose adjustment per institutional protocol; we categorized patients as a deviation from protocol if the physician did not increase the dose based on ANC. We performed descriptive statistics, t-test for continuous variables, chi-square for categorical variables, and regression modeling using JMP Pro 14 (Cary, NC). P-values &lt;0.05 were considered statistically significant. Results: The mean age of the 172 participants was 11±5 years, mean Hb was 8.5±1.1g/dL, mean MCV was 91.3±10.1 fL, mean HbF% was 12.7±6.7, and mean ANC was 4.9±2.3. Fifty two percent of participants were female. We identified 107 participants prescribed HU at the academic center and 65 participants from satellite clinics. We identified no significant differences in HU monitoring laboratory values for Hb (p=0.6), MCV (p=0.7), HbF (p=0.13), ANC (p=0.9) by clinic location. We did not identify a difference in sex of participants by clinic location (p=0.9); also, HbF% (p=0.6) and HU dose (p=0.3) were not associated with sex. We did not identify a difference in all admissions to the hospital (p=0.5) or pain admissions to the hospital (p=0.6) between academic center vs. satellite clinic patients. However, academic center patients did have a higher number of acute pain visits (p=0.03) to either the ED or UAB pediatric pain clinic. As expected, among all participants, non-adherence to HU (HbF &lt;5%) was associated with the highest number of admissions (p=0.02). Among 149 patients with more than one clinic visit, 97 (65%) patients had more than 65% of clinic visits with a correct dose adjustment; we identified no statistical difference in correct dosing adjustment deviations among Birmingham patients (67%) and satellite clinic patients (62%, p=0.5). Patients cared for at the academic center had a statistically higher number of clinic visits (p=0.01) and more patients that attended &gt;2 clinic visits. HbF response was significantly associated with clinic visits (p=0.03). Finally, HbF response was significantly inversely correlated with age (p=0.003). Adjusting for clinic location, number of clinic visits, and age, HbF % was associated with age (p=0.006) and clinic visits (p=0.006), but not associated with clinic location. Conclusion: Our data demonstrate that telehealth for HU dosing provided a similar level of HU response to in-person HU dosing adjustments. This finding importantly suggests that telehealth for monitoring and adjusting HU in patients with poor access to a Pediatric Hematologist or during a pandemic should not impact HU response. Strategies to improve overall adherence need prospective evaluation at our institution, but are not related to telehealth dosing of HU. Disclosures Lebensburger: Novartis: Consultancy.

scholarly journals 750. Retrospective Evaluation of the Three-Step EIA/PCR Algorithm as a Cost-Effective Method for Detection and Treatment of Clostridium Difficile Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S472-S473
Author(s):  
Bakri Kulla ◽  
patrick Haggerty
Keyword(s):  
United States ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Continuous Variables ◽  
True Positive ◽  
Positive Rate ◽  
Step Algorithm

Abstract Background Clostridium difficile infection (CDI) is the primary cause of infectious diarrhea in the United States. With an estimated 453,000-500,000 burden cases that are associated with 15,000-30,000 deaths annually in the United States. Because of its prevalence, there is a projected 3.2-4.8 billion dollar annual cost for inpatient care related to CDI. For these reasons, accurate and timely detection of CDI is crucial to reduce the morbidity, mortality, and medical costs. Methods This is a retrospective cohort study. Adult patients, aged 18 through 80 years, admitted between 9/1/2016 and 9/30/2017, who presented with diarrhea and received a CDI algorithm test. To assess bivariate associations between true positive and indeterminate positive groups, categorical variables were compared using Chi-Square or Fisher’s exact tests when appropriate, and continuous variables were analyzed using independent samples t-tests. Results The study included 1031 stool samples, of which 853 (82.7%) were CDI negative and 178 (17.3%) were CDI positive. Of the full sample, 265 (25.7%) were GDH (+), 94 (9.1%) were toxin (+), and 84 (8.1%) were PCR (+). In order to examine patient-level variables, the first positive from each patient was included to ensure independence of data points, resulting in 830 unique tests and patients. The true positive rate of this sub-sample was 9.4% (n = 78) and indeterminate positive rate was 8.7% (n = 72). An important findings of the study is that of the patients who were GDH (+)/toxin (-), 87 (50.9%) were PCR (-) and 84 (49.1%) were PCR (+).Table 1 Conclusion The study found that of the patients who are GDH (+) and Toxin (-), the PCR test serves as a proxy for the CDI test. In addition, we demonstrated that whether the patient was true positive by the GDH/Toxin test or indeterminate positive, the outcomes were the same. The only difference was the antibiotic selections for treatment. Performing PCR tests as a part of three-step algorithm prevented nearly half of discrepant patients from being unnecessarily treated with antibiotics and placed on enteric precaution, thereby extending their hospital stay. Finally, by preventing unnecessary antibiotic use, isolation and hospital length of stay, it is proposed that the three-step algorithm effectively reduces hospital cost. Disclosures All Authors: No reported disclosures

Abstract 17208: Trends in Hospitalizations Due to Cocaine-Induced Acute Myocardial Infarction: Results From National Inpatient Sample, 2005-2014

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Anshul Saxena ◽  
Muni Rubens ◽  
Sankalp Das ◽  
Venkataraghavan Ramamoorthy ◽  
Peter McGranaghan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Significant Risk ◽  
The United States ◽  
Categorical Variables ◽  
Age Group ◽  
Continuous Variables ◽  
National Inpatient Sample ◽  
Medicaid Coverage ◽  
Cocaine Use

Introduction: According to the National Institute on Drug Abuse, lifetime cocaine use has remained stable since 2009. An estimated 1.5 million individuals aged ≥12 years reported cocaine use in 2014. Cocaine use is a significant risk factor for acute myocardial infarction (AMI), especially in the age group 18-45 years. Hence, we examined trends in hospitalizations due to cocaine-induced AMI in the United States. Methods: The current study was a retrospective analysis of the National Inpatient Sample, collected during the period 2005-2014. Participants between 18 and 45 years were included in the analysis. Cocaine-induced AMI hospitalizations were identified using ICD-9-CM codes 304.2X and 305.6X for cocaine dependence or abuse, and 410.XX for AMI diagnosis. We used Cochran Armitage test for categorical variables and Cuzick nonparametric test for trends for continuous variables. Results: A total of 49,715 weighted cocaine-induced AMI hospitalizations were reported during the study period. Cocaine-induced AMI hospitalizations increased from 4,619 in 2005 to 5,065 in 2014 (relative increase, 9.7%, P trend =0.124). Majority of the patients were non-White (55.3%), men (79.3%), in the age group 41-45 years (83.1%), and with Medicare/Medicaid coverage (51.2%). Highest change in trend was observed for non-White population and Medicare/Medicaid payers. Conclusion: Our study showed that cocaine-induced AMI hospitalizations remained stable during the years 2005-2014. Initial results point towards structural and racial disparities in such hospitalizations, especially among non-White men and population with Medicare/Medicaid coverage. Effective interventions to reduce cocaine use are needed, and treatment must be based on 2008 AHA guidelines for cocaine-associated chest pain and myocardial infarction.

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