scholarly journals Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sachin Gupta ◽  
Mayurathan Balachandran ◽  
Gaby Bolton ◽  
Naomi Pratt ◽  
Jo Molloy ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Medical Emergency ◽  
Secondary Outcome ◽  
Patient Deterioration ◽  
Discharge Home ◽  
Medical Emergency Teams ◽  
Acute Patient

Abstract Objective Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine whether NP-led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR)-led MET calls. Methods The composite primary outcome included recurrence of MET call, occurrence of code blue or ICU admission within 24 h. Secondary outcomes were mortality within 24 h of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group. Results A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR-led MET calls (26.7% vs. 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 h (3.4% vs. 7.7%, p = 0.002) and hospital mortality (12.7% vs. 20.5%, p = 0.001) were higher in ICUR-led MET calls. Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but NP-led group was associated with reduced risk of hospital mortality (OR 0.57, 95% CI 0.35–0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09–2.2, p = 0.015). Conclusion Acute patient deterioration was comparable between ICUR- and NP-led MET calls. NP-led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.

scholarly journals Comparison of Cinical Outcomes Between Nurse Practitioner and Registrar led Medical Emergency Teams – A Propensity Matched Analysis.

2020 ◽  
Author(s):  
Sachin Gupta ◽  
Mayurathan Balachandran ◽  
Gaby Bolton ◽  
Naomi Pratt ◽  
Jo Molloy ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Nurse Practitioners ◽  
Primary Outcome ◽  
Medical Emergency ◽  
Secondary Outcome ◽  
Patient Deterioration ◽  
Discharge Home ◽  
Medical Emergency Teams ◽  
Acute Patient

Abstract Objective: Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine if NP led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR) led MET calls.Methods: The composite primary outcome included recurrence of MET call, occurrence of Code blue or ICU admission within 24 hours. Secondary outcomes were mortality within 24 hours of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group.Results: A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR led MET calls (26.7% vs 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 hours (3.4% vs 7.7%, p = 0.002) and hospital mortality (12.7% vs 20.5%, p = 0.001) was higher in ICUR led MET calls. Propensity score matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups but NP led group was associated with reduced risk of hospital mortality (OR 0.57, 95%CI 0.35-0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09-2.2, p=0.015). Conclusion: Acute patient deterioration was comparable between ICUR and NP led MET Calls. NP led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.

scholarly journals Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan

2021 ◽  
Author(s):  
Yusuke Katayama ◽  
Tetsuhisa Kitamura ◽  
Kosuke Kiyohara ◽  
Kenichiro Ishida ◽  
Tomoya Hirose ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Regression Model ◽  
Traffic Accident ◽  
Logistic Regression Model ◽  
Cardiopulmonary Arrest ◽  
Population Based ◽  
Fluid Administration ◽  
Secondary Outcome

Abstract Purpose The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method. Methods The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene. Results During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045). Conclusion In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.

Clinical Effect of the Acrylonitrile-Co-Methallyl Sulfonate Surface-Treated Membrane as a Cytokine Adsorption Therapy for Sepsis due to Acute Panperitonitis: A Retrospective Cohort Study

2020 ◽  
Vol 49 (3) ◽  
pp. 364-371
Author(s):  
Kentarou Hayashi ◽  
Yusuke Sasabuchi ◽  
Hiroki Matsui ◽  
Mikio Nakajima ◽  
Hiroyuki Ohbe ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Primary Outcome ◽  
Clinical Effect ◽  
Primary Outcome Measure ◽  
Gastrointestinal Perforation ◽  
Disease Mechanism ◽  
Diagnosis Procedure Combination ◽  
Significant Difference

Introduction: Sepsis is a systemic inflammatory response syndrome caused by infectious diseases, with cytokines possibly having an important role in the disease mechanism. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane is expected to improve the outcomes of patients with sepsis through cytokine adsorption. Objective: This study aimed to investigate the clinical effect of the AN69ST membrane in comparison to standard continuous renal replacement therapy (CRRT) membranes for panperitonitis due to lower gastrointestinal perforation. Methods: Using the Diagnosis Procedure Combination database, we identified adult patients with sepsis due to panperitonitis receiving any CRRT. Propensity score matching was used to compare patients who received CRRT with the AN69ST membrane (AN69ST group) and those who received CRRT with other membranes (non-AN69ST group). The primary outcome measure was in-hospital mortality. Results: A total of 528 and 1,445 patients were included in the AN69ST group and in the non-AN69ST group, respectively. Propensity score matching resulted in 521 pairs. There was no significant difference in in-hospital mortality (32.1 vs. 35.5%; p = 0.265) and 30-day mortality (41.3 vs. 42.8%, p = 0.074) between the AN69ST group and the non-AN69ST group. Conclusion: There is no significant difference in-hospital mortality between CRRT with the AN69ST membrane and CRRT with standard CRRT membranes for panperitonitis due to lower gastrointestinal perforation. These results indicate that the AN69ST membrane is not superior to the standard CRRT membrane.

scholarly journals Association of Pediatric Medical Emergency Teams With Hospital Mortality

Circulation ◽  
2018 ◽  
Vol 137 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Shelby Kutty ◽  
Philip G. Jones ◽  
Quentin Karels ◽  
Navya Joseph ◽  
John A. Spertus ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Medical Emergency ◽  
Medical Emergency Teams

scholarly journals Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Zongjie Shi ◽  
Shunyuan Guo ◽  
Jie Pan ◽  
Chao Xu ◽  
Yu Geng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Fasting Glucose ◽  
Independent Predictor ◽  
Secondary Outcome ◽  
Vessel Occlusion ◽  
Glucose Levels ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage

Background and objective: Hyperglycemia on admission was associated with worse clinical outcomes after mechanical thrombectomy (MT) of acute ischemic stroke (AIS). We evaluated whether increased postoperative fasting glucose (PFG) was also related to poor clinical outcomes in patients who underwent MT treatment.Methods: Consecutive patients with large vessel occlusion underwent MT in our center were included. Admission glucose and fasting glucose levels after MT treatment were evaluated. Primary outcome was 90-day unfavorable outcomes (modified Rankin Scale score of 3–6). Secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH) after MT treatment. The association of PFG and 90-day clinical outcome after MT treatment was determined using logistic regression analyses.Results: One hundred twenty seven patients were collected. The median postoperative fasting glucose level was 6.27 mmol/L (IQR 5.59–7.62). Fourteen patients (11.02%) had sICH, and fifty-eight patients (45.67%) had unfavorable outcomes at 90-day after MT. After adjustment for potential confounding factors, PFG level was an independent predictor of 90-day unfavorable outcome (OR 1.265; 95% CI 1.017–1.575; p = 0.035) and sICH (OR 1.523; 95% CI 1.056–2.195; p = 0.024) after MT. In addition, older age, higher baseline NIHSS score, and higher postoperative NLR were also associated with unfavorable outcomes at 90-day after MT treatment.Conclusions: Increased PFG is associated with unfavorable outcomes at 90-day and an increased risk of sICH in patients underwent MT treatment.

scholarly journals Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

2021 ◽  
Author(s):  
Jung Hwa Lee ◽  
Yun Im Lee ◽  
Joonghyun Ahn ◽  
Jeong-Am Ryu
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Multivariable Analysis ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Clinical Prognosis ◽  
Adverse Cardiac Events ◽  
Neurosurgical Patients ◽  
Enzyme Elevation

Abstract To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

scholarly journals The effect of dobutamine in sepsis: a propensity score matched analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Youfeng Zhu ◽  
Haiyan Yin ◽  
Rui Zhang ◽  
Xiaoling Ye ◽  
Jianrui Wei
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Large Scale ◽  
Primary Outcome ◽  
Severity Of Illness ◽  
Public Database ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Secondary Outcomes ◽  
Mimic Iii

Abstract Background The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients. Methods Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. Results In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01–2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01–2.37; P = 0.044). Conclusions Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.

Trends of hospitalization for major bipolar I (most recent episode-manic) in USA: A nationwide analysis

2016 ◽  
Vol 33 (S1) ◽  
pp. S76-S76
Author(s):  
A. Sutaria ◽  
Z. Mansuri ◽  
M. Rathod ◽  
S. Shambhu ◽  
U. Mansuri
Keyword(s):  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Additional Burden ◽  
Comorbidity Index ◽  
Competing Interest ◽  
The Cost ◽  
Mean Cost ◽  
Overall Mortality

ObjectivesBipolar I most recent episode-manic (BP-I-M) is an important cause of morbidity and mortality in hospitalized patients. While BP-I-M has been extensively studied in the past, the contemporary data for impact of BP-I-M on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 10,875 patients were analyzed; 57.13% were female and 42.87% were male (P < 0.0001); 74.78% were white, 14.51% black and 10.71% of other race (P < 0.0001). Rate of hospitalization increased from 528.71/million to 588.76/million from 1998–2011. Overall mortality was 0.42% and mean cost of hospitalization was 22,215.77$. The in-hospital mortality increased from 0.37% to 0.82% (P < 0.0001) and mean cost of hospitalization increased from 10,580.54$ to 40,737.65$. Total spending on BP-I-M related admissions have increased from $44.24 million/year to $187.00 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $44.24 million/year to $187.00 million/year, which leads to an estimated $ 142.76 million/year additional burden to US health care system from. In the era of cost conscious care, preventing BP-I-M related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for BP-I-M related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Impact of intensive care unit admission during handover on mortality: a propensity matched cohort study

2019 ◽  
Author(s):  
Thais Dias Midega ◽  
Newton Carlos Viana Leite Filho ◽  
Antônio Paulo Nassar ◽  
Roger Monteiro Alencar ◽  
Antônio Capone Neto ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Control Group ◽  
Matched Cohort ◽  
Single Center ◽  
Icu Admission ◽  
Matched Cohort Study

AbstractIntroductionHandover is a process of transferring information, responsibility and authority for providing care of critically ill patients from a departing intensivist to an oncoming intensivist. The effect of i admission during a medical handover on clinical outcomes is unknown.ObjectivesOur purpose was to evaluate the impact of ICU admission during a medical handover on clinical outcomes.MethodsPost hoc analysis of a cohort study addressing the effect of ICU admissions during the handover on outcomes. This retrospective, single center, propensity matched cohort study was conducted in a 41-bed open general ICU located in a private tertiary care hospital in São Paulo, Brazil. Based on time of ICU admission, patients were categorized into two cohorts: handover group (ICU admission between 6:30 am to 7:30 or 6:30 pm to 7:30 pm) or control group (admission between 7:31 am to 6:29 pm or 7:31 pm to 6:29 am). Patients in the handover group were propensity matched to patients in the control group at 1:2 ratio. Our primary outcome was hospital mortality.ResultsBetween June 1, 2013 and May 31, 2015, 6,650 adult patients were admitted to the ICU. Following exclusion of ineligible participants, 5,779 patients [389 (6.7%) in handover group and 5390 (93.3%) in control group] were eligible for propensity score matching, of whom 1,166 were successfully matched [389 (33.4%) handover group and 777 (66.6%) in control group]. Before matching, hospital mortality was 14.1% (55/389 patients) in handover group compared to 11.7% (628/5,390) in control group (p=0.142). After propensity-score matching, ICU admission during handover was not associated with increased risk of ICU (OR, 1.40; 95% CI, 0.92 to 2.11; p=0.11) and hospital (OR, 1.23; 95%CI, 0.85 to 1.75; p=0.26) mortality. ICU and hospital length of stay did not differ between the groups.ConclusionIn this propensity-matched single center cohort study, ICU admission during medical handover did not affect clinical outcomes.

scholarly journals Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

2021 ◽  
Author(s):  
Jung Hwa Lee ◽  
Yun Im Lee ◽  
Joonghyun Ahn ◽  
Jeong-Am Ryu
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Secondary Outcome ◽  
Rank Test ◽  
Cardiac Events ◽  
Clinical Prognosis ◽  
Neurosurgical Patients

Abstract Background: To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results: cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001).Conclusions: In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

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