The epidemiology of primary and secondary adrenal malignancies and associated adrenal insufficiency in hospitalised patients: an analysis of hospital admission data, NSW, Australia

Abstract Background Adrenal insufficiency (AI) causes considerable morbidity but may remain undiagnosed in patients with adrenal malignancy (AM). The epidemiology of AI and adrenal crises (AC) in AM is uncertain. Methods This was a retrospective study examining hospital admission data from 2006 to 2017. All admissions to all hospitals in NSW, Australia over this period with a principal or comorbid diagnosis of an adrenal malignancy were selected. Data were examined for trends in admissions for AM and associated AI/AC using population data from the corresponding years. Results There were 15,376 hospital admissions with a diagnosis of AM in NSW over the study period, corresponding to 1281 admissions/year. The AM admission rate increased significantly over the study period from 129.9/million to 215.7/million (p < 0.01). An AI diagnosis was recorded in 182 (1.2%) admissions, corresponding to an average of 2.1/million/year. This rate increased significantly over the years of the study from 1.2/million in 2006 to 3.4/million in 2017 (p < 0.01). An AC was identified in 24 (13.2%) admissions with an AI diagnosis. Four patients (16.7%) with an AC died during the hospitalisation. Conclusion Admission with a diagnosis of AM has increased over recent years and has been accompanied by an increase in AI diagnoses. While AI is diagnosed in a small proportion of patients with AM, ACs do occur in affected patients.

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Hospital admission trends due to respiratory diseases in England and Wales between 1999 and 2019: an ecologic study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01736-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abdallah Y. Naser ◽

Munthir M. Mansour ◽

Abeer F. R. Alanazi ◽

Omar Sabha ◽

Hassan Alwafi ◽

...

Keyword(s):

Hospital Admission ◽

Respiratory Diseases ◽

Hospital Admissions ◽

Respiratory Infections ◽

Admission Rate ◽

Poisson Model ◽

Trend Test ◽

Hospital Admission Rate ◽

England And Wales ◽

Admission Data

Abstract Background Identifying trends of hospital admissions for respiratory diseases is crucial for public health and research to guide future clinical improvements for better outcomes. This study aims to define the trends of respiratory disease-related hospital admissions (RRHA) in England and Wales between 1999 and 2019. Methods An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for respiratory diseases were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model. Results Hospital admission rate increased by 104.7% [from 1535.05 (95% CI 1531.71–1538.38) in 1999 to 3142.83 (95% CI 3138.39–3147.26) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common causes were influenza and pneumonia, chronic lower respiratory diseases, other acute lower respiratory infections, which accounted for 26.6%, 26.4%, and 14.9%, respectively. The age group 75 years and above accounted for 34.1% of the total number of hospital admissions. Males contributed to 50.5% of the total number of hospital admissions. Hospital admission rate in females increased by 119.8% [from 1442.18 (95% CI 1437.66–1446.70) in 1999 to 3169.38 (95% CI 3163.11–3175.64) in 2019 per 100,000 persons, trend test, p < 0.001]. Hospital admission rate increased by 92.9% in males [from 1633.25 (95% CI 1628.32–1638.17) in 1999 to 3149.78 (95% CI 3143.46–3156.09) in 2019 per 100,000 persons, trend test, p < 0.001]. Conclusion During the study period, hospital admissions rate due to respiratory diseases increased sharply. The rates of hospital admissions were higher among males for the vast majority of respiratory diseases. Further observational studies are warranted to identify risk factors for these hospital admissions and to offer relevant interventions to mitigate the risk.

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Biphasic pattern in the effect of severe measles infection; the difference between additive and multiplicative scale

BMC Infectious Diseases ◽

10.1186/s12879-021-06930-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nhat Thanh Hoang Le ◽

Nhan Thi Ho ◽

Bryan Grenfell ◽

Stephen Baker ◽

Ronald B. Geskus

Keyword(s):

Infectious Diseases ◽

Hospital Admission ◽

Measles Virus ◽

Hospital Admissions ◽

Admission Rate ◽

Second Phase ◽

Before And After ◽

The Difference ◽

Two Phases ◽

Additive Scale

Abstract Background Infection with measles virus (MeV) causes immunosuppression and increased susceptibility to other infectious diseases. Only few studies reported a duration of immunosuppression, with varying results. We investigated the effect of immunosuppression on the incidence of hospital admissions for infectious diseases in Vietnamese children. Methods We used retrospective data (2005 to 2015; N = 4419) from the two pediatric hospitals in Ho Chi Minh City, Vietnam. We compared the age-specific incidence of hospital admission for infectious diseases before and after hospitalization for measles. We fitted a Poisson regression model that included gender, current age, and time since measles to obtain a multiplicative effect measure. Estimates were transformed to the additive scale. Results We observed two phases in the incidence of hospital admission after measles. The first phase started with a fourfold increased rate of admissions during the first month after measles, dropping to a level quite comparable to children of the same age before measles. In the second phase, lasting until at least 6 years after measles, the admission rate decreased further, with values up to 20 times lower than in children of the same age before measles. However, on the additive scale the effect size in the second phase was much smaller than in the first phase. Conclusion The first phase highlights the public health benefits of measles vaccination by preventing measles and immune amnesia. The beneficial second phase is interesting, but its strength strongly depends on the scale. It suggests a complicated interaction between MeV infection and the host immunity.

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Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00984-1 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Hanne Irene Jensen ◽

Sevim Ozden ◽

Gitte Schultz Kristensen ◽

Mihnaz Azizi ◽

Siri Aas Smedemark ◽

...

Keyword(s):

Hospital Admission ◽

Patient Involvement ◽

Hospital Admissions ◽

Primary Diagnosis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Patient Cohort ◽

Hospitalised Patients ◽

Treatment Limitation ◽

Life Sustaining Treatment

Abstract Background The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions. Methods A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality. Results A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement. Conclusions Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.

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Previous Comorbidity and Lack of Patient Free Choice of Technique Predict Early Mortality in Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080902900208 ◽

2009 ◽

Vol 29 (2) ◽

pp. 150-157 ◽

Cited By ~ 20

Author(s):

José Portolés ◽

Gloria del Peso ◽

M. José Fernández-Reyes ◽

M. Auxiliadora Bajo ◽

Paula López-Sánchez

Keyword(s):

Peritoneal Dialysis ◽

Prognostic Factors ◽

Hospital Admission ◽

Hospital Admissions ◽

Risk Estimation ◽

Admission Rate ◽

Individual Characteristics ◽

Hospital Admission Rate ◽

Predialysis Patient ◽

Choice Of Technique

Objective To study the prognostic factors for mortality and hospital admission for patients on peritoneal dialysis (PD). Method Biannual data on individual characteristics, clinical and analytical progress, treatment, and events were studied for a cohort of incident patients undergoing PD (2003-2006) in a reference area of 8.8 million people. Results 489 patients (age 53.58 years, 61.6% male) with 3-year follow-up were included. They presented at inclusion with Charlson Comorbidity Index (CCI) of 5.25; previous cardiovascular (CV) event, 23.7%; diabetes mellitus (DM), 19.1%; and hypertension (HT), 89.9%. Annual hospitalization rate per patient-year at risk was 0.6. The variables that predicted admission were CCI [odds ratio (OR) 1.14 per point], DM (OR 1.66), and previous CV event (OR 1.90). Anemia maintained significance when corrected for CCI: hemoglobin, 0.79 per 1 g/dL Hb; CCI, 1.15 per point. Annual mortality rate was 5.4%. Those that died were older (67.47 vs 52.78 years) and had a higher CCI (8.35 vs 5.0), a lower initial Hb (11.5 vs 12.2 g/dL), a higher hospital admission rate, a higher annual rate of peritonitis, more previous CV events (50.0% vs 22.1%), and higher prevalence of DM (38.5% vs 17.9%). Survival analysis identified the following prognostic factors: CCI [hazard ratio (HR) 1.51 per point], CV event (HR 2.85), DM (HR 2.52), age (HR 1.06 per year), and mandatory referral to PD (HR 6.54). The effect of CV events and DM persisted after correction for age, and that of choice of technique after correcting for CCI and/or age. Conclusions The CCI is useful for risk estimation in PD patients. Previous CV event, DM, and age are the most relevant risk factors. Control of anemia has prognostic value for hospital admissions. Mandatory referral to PD is associated with higher mortality. The prognosis in PD depends on predialysis patient management.

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Future projections of child oral-related hospital admission rates in Western Australia

Australian Journal of Primary Health ◽

10.1071/py15132 ◽

2016 ◽

Vol 22 (6) ◽

pp. 491 ◽

Cited By ~ 1

Author(s):

Alla Alsharif ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Dental Caries ◽

Hospital Admission ◽

Hospital Admissions ◽

Admission Rate ◽

Projection Data ◽

Impacted Teeth ◽

Admission Rates ◽

The Future ◽

Hospital Morbidity ◽

Western Australian

This study aimed to project the hospital admission rates of Western Australian children for oral conditions, with a particular focus on dental caries, embedded and impacted teeth, and pulp and periapical conditions through to the year 2026. Two methods were used to generate projection data through to the year 2026, using the Western Australian Hospital Morbidity Dataset for the period 1999–2000 to 2008–2009. The projected admission rate increase in those children aged 14 years and younger from 2000 to 2026 was 43%. The admission rates are expected to more than double over time (7317 cases in 2026 compared to only 3008 cases in 2000) for those children living in metropolitan areas. Dental caries, embedded and impacted teeth, and pulp and periapical conditions will remain the top (mostly) preventable causes of admission throughout this time. Anticipating the future burden of oral-related hospital admissions in children, in terms of expected numbers of cases, is vital for optimising the resource allocation for early diagnosis, prevention and treatment. A concerted effort will be required by policymakers and oral healthcare communities to effect substantial change for the future.

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The Safety of Non-Transport Decisions Made by Ambulance Personnel: A Retrospective Study of Subsequent Hospital Admission and 30-Day Mortality

10.21203/rs.3.rs-276252/v1 ◽

2021 ◽

Author(s):

Kjersti Amundsen ◽

Marie Svanes Elden ◽

Lars Myrmel ◽

Jörg Assmus ◽

Audun Lange ◽

...

Keyword(s):

Retrospective Study ◽

Hospital Admission ◽

Hospital Admissions ◽

Information Age ◽

Time Of Day ◽

Ambulance Personnel ◽

Icd 10 ◽

Health Trust ◽

Reason For Admission ◽

Mental And Behavioral Disorders

Abstract BackgroundAmbulance missions do not always result in the patient being transported to a doctor or hospital after evaluation at the scene by ambulance personnel. Sometimes a patient is discharged at the scene but should have been transported for further examination and treatment. In this study, we aimed to identify and describe this group, and to investigate subsequent hospital admission within 72 hours and 30-day mortality, which may indicate the safety of leaving a patient at the scene after examination. MethodThis retrospective study was carried out in the Bergen health trust in western Norway and included ambulance missions from 2018. For each mission, we recorded the patient’s demographic information (age, gender, time of day), initial reason for contacting the emergency medical service (EMS), hospital admissions after non-transport, and time of death if within 30 days, in addition to some other variables. ResultsAmong 33,183 included acute and urgent ambulance missions, 7.3% of the patients were discharged at the scene after evaluation by ambulance personnel. The median age in this group was 47 years (IQR 28–70 years), compared to 64 years (IQR 39–80 years) for all included missions. Following a non-transport decision, 4.8% of the patients were admitted to a public hospital within 72 hours (median age, 59 years; IQR 35–76 years), with mental and behavioral disorders (ICD-10 chapter V) being the most common reason for admission (24.8%). The 30-day mortality rate following non-transport mission was 2.4%. In this group, the median age was 83 years (IQR 73–90 years), and the most common reasons for contacting EMS were breathing difficulties or lung diseases (25.4%), and injuries or fractures (18.6%). ConclusionOur present analysis revealed low rates of hospital admission within 72 hours, and 30-day mortality, among patients left at the scene following evaluation by ambulance personnel. These findings do not suggest an unsafe rate of non-transport in the Bergen EMS. There remains a need for further evaluation of the factors involved in the decision not to transport a patient, and the safety of these decisions.

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Temperature and Humidity Effects on Acute Vaso-Occlusive Pain Episodes in Sickle Cell Disease

Blood ◽

10.1182/blood.v126.23.992.992 ◽

2015 ◽

Vol 126 (23) ◽

pp. 992-992

Author(s):

Fuad El Rassi ◽

Eldrida Randall ◽

Sidney F. Stein ◽

Hanna Jean Khoury ◽

James R. Eckman ◽

...

Keyword(s):

Sickle Cell Disease ◽

Hospital Admission ◽

Acute Care ◽

Sickle Cell ◽

Hospital Admissions ◽

Admission Rate ◽

Emergency Department Visits ◽

Cell Disease ◽

Temperature And Humidity ◽

The City

Abstract Background: Sickle cell patients suffer from painful vaso-occlusive episodes (VOE) that interrupt patients' lives and productivity and lead to emergency department visits and hospitalizations and, on occasion, death. The VOE in sickle cell disease (SCD) accounts for 90% of hospital admissions for patients with SCD and constitute a financial burden on both patients and hospitals. Efforts to prevent pain crises have failed to establish a causal relationship in about 40% of reported cases. The remaining 60% of known causes of VOE are related to dehydration, febrile illness, and infections. The Emory University Sickle Cell Center at Grady Memorial hospital has been providing specialized services for SCD patients for 30 years. The center includes a 24/7 acute care unit (ACU) that is staffed by SCD providers who specialize in the management of VOE. The patients are started on intravenous narcotics and fluids within 30 minutes of presenting to the ACC. After eight hours of management, the patient is then either discharged home if the VOE is controlled or admitted to the hospital for continued management. Annually, around 3000 ACU visits are recorded with a 17% hospital admission rate. When patients are questioned on the reason for their presentation, “weather change” is frequently reported as the trigger of the VOE. A review of the literature reveals scant data to support the hypothesis that weather-related changes trigger sickle cell pain crises. Methods: In a retrospective evaluation of patient visits over the last 4 years, we identified temperature and humidity measurements for that period of time and attempted to correlate them with the frequency of ACU visits. We used the “weatherspark” website that records weather changes for the city of Atlanta because > 90% of our patients reside in the city. Results: The four-year review of weather data and ACU visits did not show a direct correlation between graphs of temperature and humidity, and the number of ACU visits. The annual number of visits to the ACU was 2930, 2467, 3195 and 3370 for the years 2011, 2012, 2013 and 2014 respectively. The average admission rate was 16.6% overall, and the admission rate in the years 2011, 2012, 2013 and 2014 was 12.4%, 14.9%, 19.6% and 19.6% respectively. The attached figure has an example of the year 2013 charts for temperature, humidity, sickle cell acute care visits and hospital admission graphs. Conclusion: The retrospective analysis does not reflect a direct correlation between the temperature and humidity graphs and the number of ACU visits and hospital admissions. Given the volume of data analyzed, it is unlikely that there is any correlation between temperature and humidity variations and either acute care visits or admissions. Atlanta, GA- ACU visits, Hospital admissions, Temperature and Humidity Charts for 2013: DATA from weatherspark.com Figure 1. Figure 1. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures No relevant conflicts of interest to declare.

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Global and Regional Burden of Hospital Admissions for Pneumonia in Older Adults: A Systematic Review and Meta-Analysis

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz053 ◽

2019 ◽

Vol 222 (Supplement_7) ◽

pp. S570-S576 ◽

Cited By ~ 7

Author(s):

Ting Shi ◽

Angeline Denouel ◽

Anna K Tietjen ◽

Jen Wei Lee ◽

Ann R Falsey ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Hospital Admission ◽

Disease Burden ◽

Hospital Admissions ◽

Case Fatality ◽

Admission Rate ◽

Case Definition ◽

Hospital Admission Rate ◽

Hospital Deaths

AbstractPneumonia constitutes a substantial disease burden among adults overall and those who are elderly. We aimed to identify all studies investigating the disease burden among older adults (age, ≥65 years) admitted to the hospital with pneumonia. We estimated the hospital admission rate and in-hospital case-fatality ratio (CFR) of pneumonia in older adults, stratified by age and economic status (industrialized vs developing), with data from a systematic review of studies published from 1996 through 2017 and from 8 unpublished population-based studies. We applied these rate estimates to population estimates for 2015 to calculate the global and regional burden in older adults who would have been admitted to the hospital with pneumonia that year. We estimated the number of in-hospital pneumonia deaths by combining in-hospital CFRs with hospital admission estimates from hospital-based studies. We identified 109 eligible studies; 73 used clinical pneumonia as the case definition, and 36 used radiologically confirmed pneumonia as the case definition. We estimated that, in 2015, 6.8 million episodes (uncertainty range [UR], 5.8–8.0 episodes) of clinical pneumonia resulted in hospital admissions of older adults worldwide. The hospital admission rate increased with advancing age and was higher in men. The total disease burden was likely underestimated when using the definition of radiologically confirmed pneumonia. Based on data from 52 hospital studies reporting data on pneumonia mortality, we estimated that about 1.1 million in-hospital deaths (UR, 0.9–1.4 in-hospital deaths) occurred among older adults. The burden of pneumonia requiring hospitalization among older adults is substantial. Appropriate prevention and management strategies should be developed to reduce its impact.

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Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study

BMJ ◽

10.1136/bmj.n1135 ◽

2021 ◽

pp. n1135

Author(s):

Jacob Bodilsen ◽

Peter Brønnum Nielsen ◽

Mette Søgaard ◽

Michael Dalager-Pedersen ◽

Lasse Ole Zacho Speiser ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Admission ◽

Respiratory Diseases ◽

Hospital Admissions ◽

Admission Rate ◽

Mortality Rates ◽

Baseline Period ◽

Population Based ◽

Hospital Admission Rate ◽

Rate Ratios

AbstractObjectiveTo determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic.DesignNationwide, population based cohort study.SettingDenmark from 13 March 2019 to 27 January 2021.ParticipantsAll Danish residents >1 year of age.Main outcomes measuresPopulation based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk.Results5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95% confidence interval 0.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95% confidence interval 1.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods.ConclusionsHospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted.

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Are more GPs associated with a reduction in emergency hospital admissions?

British Journal of General Practice ◽

10.3399/bjgp.2020.0737 ◽

2020 ◽

pp. BJGP.2020.0737

Author(s):

Catia Nicodemo ◽

Barry McCormick ◽

FD Richard Hobbs ◽

Raphael Wittenberg

Keyword(s):

Fixed Effects ◽

Hospital Admissions ◽

Admission Rate ◽

Emergency Admission ◽

Population Data ◽

Local Area ◽

Emergency Admissions ◽

Admission Rates ◽

Access To Primary Care ◽

Deprived Areas

Background: Recent studies have found an association between access to primary care and accident and emergency attendances, with better access associated with fewer attendances. Analyses of an association with emergency admissions however have produced conflicting findings. Aim: We investigate whether emergency admission rates in an area are associated with (i) the number of GPs, and (ii) mean size of GP practices. Design and Setting: Analysis was conducted utilising Hospital Episode Statistics, the numbers of GPs and GP practices, ONS population data, Quality and Outcomes Framework (QoF) prevalence data, and Index of Multiple Derivation data, from 2004/5 to 2011/12, for all practices in England. Method: Regression analysis of panel data with fixed effects to address (i) a potential two-way relationship between the numbers of GPs and emergency admissions, and (ii) unobservable characteristics of GP practices. Results: There is not a statistically significant relationship between the number of GPs in a local area and the number of emergency admissions when analysing all areas. However, in deprived areas, a higher number of GPs is associated with lower emergency admissions. There is also a lower emergency admission rate in areas in which practices are on average larger, holding constant GP supply. Conclusions In deprived areas an increase in GPs was found to reduce emergency admissions but does not do so elsewhere. Areas in which GPs became concentrated into larger practices experienced reduced levels of emergency admissions, all else equal.

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