scholarly journals Clinical characteristics and outcomes of methamphetamine-associated intracerebral hemorrhage

Neurology ◽  
2019 ◽  
Vol 93 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Dionne E. Swor ◽  
Matthew B. Maas ◽  
Sandeep S. Walia ◽  
David P. Bissig ◽  
Eric M. Liotta ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Functional Ability ◽  
Clinical Characteristics ◽  
Age At Onset ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Antihypertensive Medications ◽  
Methamphetamine Use ◽  
Hospital Stays

ObjectiveTo compare the clinical characteristics and outcomes of primary intracerebral hemorrhage (ICH) with and without methamphetamine exposure.MethodsWe performed a retrospective analysis of patients diagnosed with spontaneous, nontraumatic ICH over a 3-year period between January 2013 and December 2016. Demographics, clinical measures, and outcomes were compared between ICH patients with positive methamphetamine toxicology tests vs those with negative methamphetamine toxicology tests.ResultsMethamphetamine-positive ICH patients were younger than methamphetamine-negative ICH patients (52 vs 67 years, p < 0.001). Patients with methamphetamine-positive ICH had higher diastolic blood pressure (115 vs 101, p = 0.003), higher mean arterial pressure (144 vs 129, p = 0.01), longer lengths of hospital (18 vs 8 days, p < 0.001) and intensive care unit (ICU) stay (10 vs 5 days, p < 0.001), required more days of IV antihypertensive medications (5 vs 3 days, p = 0.02), and had more subcortical hemorrhages (63% vs 46%, p = 0.05). The methamphetamine-positive group had better premorbid modified Rankin Scale (mRS) scores (p < 0.001) and a greater change in functional ability as measured by mRS at the time of hospital discharge (p = 0.001). In multivariate analyses, methamphetamine use predicted both hospital length of stay (risk ratio [RR] 1.54, confidence interval [CI] 1.39–1.70, p < 0.001) and ICU length of stay (RR 1.36, CI 1.18–1.56, p < 0.001), but did not predict poor outcome (mRS 4–6).ConclusionsMethamphetamine use is associated with earlier age at onset of ICH, longer hospital stays, and greater change in functional ability, but did not predict outcome.

scholarly journals Multimodal Analgesia in Lumbar Fusion Surgery: Impact Amidst the Opioid Epidemic

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yi Lu ◽  
Erica Bertoncini
Keyword(s):  
Length Of Stay ◽  
Lumbar Fusion ◽  
Multimodal Analgesia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
P Value ◽  
Standard Group ◽  
Fusion Surgery ◽  
Hospital Stays

Abstract INTRODUCTION Spine surgery traditionally relies on opioid analgesics for postoperative pain management. Opioids are associated with prolonged hospital stays and opioid use disorders. Opioid-focused prescribing habits in surgery have partially contributed to the opioid epidemic. METHODS A retrospective analysis was performed comparing patients receiving a multimodal analgesia regimen after lumbar fusion surgery vs control group receiving standard analgesia regimen. The multimodal regimen consisted of Acetaminophen 975 mg TID, Toradol 7.5 mg Q6 hours for 24-ho followed by Celebrex 100 mg BID for 7-d, Robaxin 500 mg Q6 hours prn for muscle spasms, Gabapentin 300 mg/100 mg TID for 4-wk, and prn narcotic. The standard regimen consisted of Acetaminophen 975 mg TID, narcotic prn, and muscle relaxant prn. There were 12 patients in the multimodal group and 26 patients in the control group evaluated over 3-mo and 6-mo time periods respectively. Primary outcomes included hospital length-of-stay, total and IV narcotic requirements in Morphine Milligram Equivalent (MME), and VASS pain scores. RESULTS Study results demonstrate differences between patient populations when focusing on the opioid-naïve participants. Opioid-naïve patients in the multimodal group were found to have significantly lower IV narcotic requirement than the control (0.22+/−0.67 mg/d for multimodal vs 5.36+/−5.56 mg/d for standard group, P-value = .001). These patients also had shorter hospital stays than the control (2.78+/−0.83 d for multimodal vs 3.53+/−1.17 d for standard group) but the difference was just below our threshold for significance (P-value = .066). Including both opioid-naïve and opioid-tolerant patients, no significant differences were found in hospital length-of-stay, MME, IV narcotic requirement nor VASS score between the multimodal group and the control groups (P-values of .46, .81, .36, and .91, respectively). CONCLUSION Overall, the study favors using multimodal analgesia in those undergoing lumbar spinal fusion surgeries as evident by considerably reduced IV narcotic requirement and nearly significant shortened hospital length-of-stay in opioid-naïve patients compared to control.

scholarly journals Safety and Costs of Stroke Unit Admission for Select Acute Intracerebral Hemorrhage Patients

2017 ◽  
Vol 8 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Corey R. Fehnel ◽  
Kimberly M. Glerum ◽  
Linda C. Wendell ◽  
N. Stevenson Potter ◽  
Brian Silver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Stroke Unit ◽  
Skilled Nursing Facility ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Group 5

Background and Purpose: There are limited data to guide intensive care unit (ICU) versus dedicated stroke unit (SU) admission for intracerebral hemorrhage (ICH) patients. We hypothesized select patients can be safely cared for in SU versus ICU at lower costs. Methods: We conducted a retrospective cohort study of consecutive patients with predefined minor ICH (≤20 cm3, supratentorial, no coagulopathy) receiving care in either an ICU or an SU. Multiple linear regression and inverse probability weighting were used to adjust for differences in patient characteristics and nonrandom ICU versus SU assignment. The primary outcome was poor functional status at discharge (modified Rankin score [mRS] ≥3). Secondary outcomes included complications, discharge disposition, hospital length of stay, and direct inpatient costs. Results: The study population included 104 patients (41 admitted to the ICU and 63 admitted to the SU). After controlling for differences in baseline characteristics, there were no differences in poor functional outcome at discharge (93% vs 85%, P = .26) or in mean mRS (2.9 vs 3.0, P = .73). Similarly, there were no differences in the rates of complications (6% vs 10%, P = .44), discharged dead or to a skilled nursing facility (8% vs 13%, P = .59), or direct patient costs (US$7100 vs US$6200, P = .33). Median length of stay was significantly longer in the ICU group (5 vs 4 days, P = .01). Conclusions: This study revealed a shorter length of stay but no large differences in functional outcome, safety, or cost among patients with minor ICH admitted to a dedicated SU compared to an ICU.

Predictors of hospital length of stay and cost in patients with intracerebral hemorrhage

Neurology ◽  
2006 ◽  
Vol 67 (7) ◽  
pp. 1279-1281 ◽  
Author(s):  
M. W. Russell ◽  
A. V. Joshi ◽  
P. J. Neumann ◽  
L. Boulanger ◽  
J. Menzin
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Clinical characteristics, risk factors, prognosis and immune status of secondary infection of sepsis: a retrospective observational study

2019 ◽  
Author(s):  
Yao Chen ◽  
Yanyan Hu ◽  
Jin Zhang ◽  
Yue Shen ◽  
Junling Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Immune Status ◽  
Secondary Infection ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Group ◽  
Hla Dr

Abstract Background: Secondary infection in hospital was found to have a higher incidence in septic patients and affect clinical outcomes. This study aimed to investigate the clinical characteristics, risk factors, prognosis and immune status of secondary infection of sepsis. Methods: A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between 2014 January and 2018 January. Data were acquired from medical records. The flow cytometry was performed to measure the CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression. Serum cytokines levels were measured by enzyme-linked immunosorbent assay (ELISA) method. Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 38, 32%). Urinary and deep venous catheterization increased the risk of developing secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital length of stay owing to secondary infection was 4.63 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival curves and Log-rank test revealed secondary infection group had a worse survival between day 15 and day 90. Conclusions: Urinary and deep venous catheter indwelling increased the risk of developing secondary infection. Secondary infection influenced outcomes of septic patients and prolonged in-hospital length of stay. Immunosuppression led to a higher tendency to developing secondary infection. Keywords: Sepsis, Secondary infection, Immunosuppression, HLA-DR, Cytokine

scholarly journals Hospital Outcomes of Adult Diabetic Patients by Glycated Hemoglobin Level in Nonsurgical Pathology in a High-Complexity Institution

2019 ◽  
Vol 12 ◽  
pp. 117955141988267
Author(s):  
German Camilo Giraldo-Gonzalez ◽  
Cristian Giraldo-Guzman ◽  
Abelardo Montenegro-Cantillo ◽  
Angie Carolina Andrade-García ◽  
Duvan Snaider Duran-Ardila ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Glycated Hemoglobin ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Diabetic Patients ◽  
Hospital Stays ◽  
The Relationship ◽  
Hba1c Levels

Recent evidence supports the relationship between in-hospital hyperglycemia and inpatient complications. Besides, glycated hemoglobin (HbA1c) can predict the clinical course of patients with type 2 diabetes mellitus (DM2) during hospital stays. This study aimed to assess the relationship between HbA1c levels and inpatient outcomes. Type 2 diabetes mellitus patients with age greater than 18 years, hospital length of stay greater than 24 hours, and one HbA1c report during their in-hospital management were included. All the electronic care records of patients admitted at the Clinical Versalles, a high-volume institution, in Manizales-Colombia were revised. The following variables were considered: hospital length of stay, diagnoses at the arrival, complications, capillary glucose levels, and treatment at discharge. Variables were categorized by HbA1c levels: group 1 = ⩽ 7%, group 2 = 7.01% to 8.5%, group 3 = 8.51% to ⩽10% and group 4 = >10%. There were a total of 232 patients. Average age was 69.7 years, mean HbA1c was 7.19 ± 2.03, average body mass index (BMI) was 28.8 ± 5.6. About HbA1c, 146 (62.9%) had ⩽7.5%. The most frequent admission diagnosis was by cardiovascular diseases. Average hospitalization was 7.5 ± 5.7 days. There was no relationship between the levels of HbA1c with hospital stays, inpatient complications, or readmissions. Infections and respiratory diseases were more common conditions related to higher HbA1c levels, especially when these were 8.5%. In diabetic patients with nonsurgical diseases and high HbA1c levels, there was no association with clinical complications, length of stay, readmissions, or in-hospital mortality, but changes in treatment at discharge were observed.

556 Hospital Length of Stay for Patients with Small and Medium Burns Impacted by Distance to Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S118-S119
Author(s):  
Stephen Sibbett ◽  
Jamie Oh ◽  
Saman Arbabi ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Location ◽  
Chi Square ◽  
Hispanic Males ◽  
Burn Care ◽  
Burn Center ◽  
Significant Difference ◽  
Hospital Stays

Abstract Introduction Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay. Methods Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn center from 2011 to 2018. Inclusion was limited to patients from the burn center state. Patients were grouped by distance from the home zip code to the burn center (≤100 and &gt;100 miles) according to what might be ground or air transport. Chi-square and Mann-Whitney tests were used to determine differences between groups by race, burn size (TBSA), hospital length of stay (LOS), LOS/TBSA, mortality, and disposition to home. Burn size was categorized by TBSA into small (0–20%), medium (21–50%) and large (51–100%) burns. Results Our study population was predominantly white, non-Hispanic males. Mean burn size was significantly higher in patients who traveled more than the &gt;100 miles to the burn center (Table). Mean LOS/TBSA was not significant between the two groups. However, controlling for burn size, patients with small and medium burns that lived farther from the burn center had significantly longer hospital stays. There was no significant difference in length of stay for patients with large burns, mortality or disposition to home between the two distance groups. Conclusions At a burn center with a large catchment area, patients with burn size &lt; 50%TBSA who lived more than 100 miles from the burn center had significantly longer hospital stays than those who lived closer to the burn center. This may indicate that patients who are referred to a regional burn center for care of smaller burns may require care beyond the level of their local hospitals. It is worth noting that using burn size as an indication of complexity of care may be misleading as body site location of the burn (e.g. hand, face or feet) impacts the recovery. Applicability of Research to Practice For a burn center that serves patients across a vast region, this investigation might be useful in identifying opportunities to provide care for patients who live far from tertiary burn care.

scholarly journals Clinical characteristics and durations of hospitalized patients with COVID-19 in Beijing: a retrospective cohort study

2020 ◽  
Author(s):  
Wen Zhao ◽  
Shikai Yu ◽  
Xiangyi Zha ◽  
Ning Wang ◽  
Qiumei Pang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Ct Scan ◽  
Clinical Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Endpoint ◽  
Cumulative Probability ◽  
Illness Onset ◽  
Severity Of Disease

AbstractBackgroundCOVID-19 is still becoming an increasing global threat to public health. More detailed and specific characteristics of COVID-19 are needed to better understand this disease. Additionally, durations of COVID-19, e.g., the average time from exposure to recovery, which is of great value in understanding this disease, has not been reported so far.AimsTo give the information on clinical characteristics and different durations of COVID-19 and to identify the potential risk factors for longer hospitalization duration.MethodsIn this retrospective study, we enrolled 77 patients (mean age: 52±20 years; 44.2% males) with laboratory-confirmed COVID-19 admitted to Beijing YouAn Hospital during 21st Jan and 8th February 2020. Epidemiological, clinical and radiological data on admission were collected; complications and outcomes were followed up until 29th February 2020. The study’s endpoint was the discharge within two weeks. Cox proportional-hazards regression was performed to identify risk factors for longer hospitalization duration.ResultsOf 77 patients, there are 34 (44.2%) males, 24 (31.2%) with comorbidities, 22 (28.6%) lymphopenia, 20 (26.0%) categorized as severe patients, and 28 (36.4%) occurred complications. By the end of follow-up, 64 (83.1%) patients were discharged home after being tested negative for SARS-CoV-2 infections, 8 remained in hospital and 5 died. 36 (46.8%) patients were discharged within 14 days and thus reached the study endpoint, including 34 (59.6%) of 57 non-severe patients and 2 (10%) of 20 severe patients. The overall cumulative probability of the endpoint was 48.3%. Hospital length of stay and duration of exposure to discharge for 64 discharged patients were 13 (10-16.5) and 23 (18-24.5) days, respectively. Multivariable stepwise Cox regression model showed bilateral pneumonia on CT scan, shorter time from the illness onset to admission, severity of disease and lymphopenia were independently associated with longer hospitalized duration.ConclusionsCOVID-19 has significantly shorter duration of disease and hospital length of stay than SARS. Bilateral pneumonia on CT scan, shorter period of illness onset to admission, lymphopenia, severity of disease are the risk factors for longer hospitalization duration of COVID-19.

scholarly journals COVID Oximetry @home: evaluation of patient outcomes

2021 ◽  
Author(s):  
Michael Boniface ◽  
Dan Burns ◽  
Christopher Duckworth ◽  
Franklin Duruiheoma ◽  
Htwe Armitage ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Remote Monitoring ◽  
Odds Ratio ◽  
Service Evaluation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Deterioration ◽  
The North ◽  
Hospital Stays

Background: COVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care. Methods: We conducted a retrospective service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to March 2021 in the North Hampshire (UK) community led service (a collaboration of 15 GP practices, covering a population of 230,000 people). We have compared outcomes for patients admitted to Basingstoke & North Hampshire Hospital who were CO@h patients (COVID-19 patients with monitoring of SpO2 (n=137)), with non CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Odds Ratio analysis was performed to contrast the likelihood of patient outcomes resulting in 30 day mortality, ICU admission and length of stay greater than 3, 7, 14, and 28 days. Results: Hospital length of stay was reduced by an average of 6.3 days for CO@h patients (6.9 95% CI [5.6 - 8.1]) in comparison to Non-CO@h (13.2 95% CI [12.2 - 14.1]). The most significant odds ratio effect was on mortality (0.23 95%CI [0.11 - 0.49]), followed by length of stay > 14 days (OR 0.23 95%CI [0.13 - 0.42]), length of stay > 28 days (OR 0.23 95%CI [0.08 - 0.65]), length of stay > 7 days (OR 0.35 95%CI [0.24 - 0.52]), and length of stay > 3 days (OR 0.52 95%CI [0.35 - 0.78]). Mortality and length of stay outcomes were statistically significant. Only 5/137 (3.6%) where admitted to ICU compared with 52/633 (8.2%) for Non-CO@h. Conclusions: CO@h has demonstrated considerably improved patient outcomes reducing the odds of longer length hospital stays and mortality.

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