scholarly journals Evaluation of clinical outcomes of patients with mild symptoms of coronavirus disease 2019 (COVID-19) discharged from the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258697
Author(s):  
Hamidreza Morteza Bagi ◽  
Maryam Soleimanpour ◽  
Fariba Abdollahi ◽  
Hassan Soleimanpour
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Emergency Departments ◽  
Demographic Data ◽  
Family Members ◽  
Risk Of Death ◽  
Phone Calls ◽  
History Of Disease ◽  
History Of ◽  
Underlying Diseases

Introduction This study was performed to determine the clinical outcomes of patients with mild symptoms of COVID-19 discharged from the emergency department. Methods The present descriptive-analytical cross-sectional study was performed on 400 patients discharged with a diagnosis of COVID-19 from the emergency departments of hospitals affiliated to Tabriz University of Medical Sciences in the time period of 21 March-21 June, 2020. The disease characteristics and demographic data were collected by phone calls during the first, third, and fourth weeks using a researcher-made questionnaire. Finally, the data were analyzed by univariate logistic regression and cross-tabulation using the IBM SPSS Statistics for Windows, version 20. Results In the first week of follow-up, 23(5.8%) patients died, of whom seven patients were female and 16 were male (mean age of death: 70.73±3.27). Out of 41 (10.3%) patients with underlying diseases, 7 (17.1%) died; but out of 359 (89.8%) cases with no history of disease only 16 (4.5%) died. The risk of death in subjects with a history of underlying diseases was 3.27 times higher than those without a history of disease (P = 0.02) (OR = 3.27, 95% CI, 1.20–8.87); and this risk was 1.41 times higher in patients with more family members (P = 0.04) (OR = 1.41, 95% CI, 1.01–1.97). Furthermore, 81 (20.3%) patients had spread the virus to others in their households and disregarded hygiene guidelines such as washing hands, keeping social distancing, and wearing face masks after discharge. In addition, family members of these patients were 16.37 times more likely to be infected than patients who followed the protocols (P ≤ 0.001) (OR = 16.37, 95% CI, 9.10–29.45). Conclusion Since our findings showed that mortality rate is high in the first week after patients’ referral to the emergency departments, the health status of infected people should be carefully monitored daily in this period.

scholarly journals P.064 Delays in the emergency department for stroke patients, medical complications and predictors of outcomes: the McGill experience

2016 ◽  
Vol 43 (S2) ◽  
pp. S36-S36
Author(s):  
C Legault ◽  
B Chen ◽  
L Vieira ◽  
B Lo (Montreal) ◽  
L Wadup ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Stroke Unit ◽  
Best Practice ◽  
Brain Oedema ◽  
Medical Complications ◽  
Significant Delay ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Increased Risk

Background: The Canadian Stroke Best Practice recommends admission of patients to a specialised stroke unit within three hours. We aimed at assessing delays in our emergency department (ED) and correlating these with medical complications and clinical outcomes. Methods: Predictors and outcomes This is a retrospective review of patients (n=353) admitted with ischemic strokes (January 2011-March 2014). We assessed the length of stay in ED, medical complications in ED and in the stroke unit, functional status (modified Rankin Scale) at discharge and survival. Results: The median delay in ED was 13.8 hours. The rate of medical complications in the ED was 14% (most common being delirium), compared to the stroke unit with 46.7% (most common being pneumonia). Worse functional outcome was correlated with diagnosis of pneumonia (standardised β coefficient=0.2, p=0.001) and presence of brain oedema in the stroke unit (standardised β coefficient=0.2, p<0.01). Increased risk of death was correlated with brain oedema (OR=649.2, 95%CI=19-2184, p<0.01) and sepsis in the stroke unit (OR=26.8, 95%CI=2.1-339, p<0.01). Conclusions: We found a significant delay in the admission of our patients from the ED to the stroke unit, which is not in keeping with the present guidelines. Medical complications were correlated with worse outcomes. Future analyses will correlate ED delays with clinical outcomes.

Acute Myelogenous Leukemia in the Elderly. Intensive Induction Chemotherapy Improves Survival

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4002-4002
Author(s):  
Anant Sharma ◽  
Runhua Shi ◽  
Francesco Turturro
Keyword(s):  
Clinical Outcomes ◽  
Induction Chemotherapy ◽  
Median Survival ◽  
The Elderly ◽  
Older Age ◽  
Myelogenous Leukemia ◽  
Risk Of Death ◽  
Elderly Aml ◽  
History Of ◽  
Wbc Count

Abstract Acute Myeloid Leukemia (AML) in the elderly has poor prognoses and carries inferior results with therapy. The purpose of this study was to determine the incidence of elderly AML, examine clinical outcomes with treatment and investigate the impact of intensive induction chemotherapy and other variables such as such as age, leucocytoses, cytogenetics and presence of antecedent hematologic disorder (AHD) on survival, in a cohort of elderly patients with AML treated at our institution. Patients and Methods: The retrospective review included all patients (age&gt;59) treated between January 1999 and February 2008. Patients diagnosed with acute promyelocytic leukemia were excluded. Records were reviewed from time of diagnoses till death or last follow-up. Statistical analyses: Median survival was calculated using Kaplan Meier method and differences in survival between patients treated with intensive chemotherapy and those receiving supportive care were compared using the logrank test which was also used to determine the association between survival and variables such as older age (&lt;69 vs. ≥ 69), leucocytoses (WBC &gt;10k), cytogenetics and history of AHD. Results: Study cohort included 51 patients with age&gt;59. This represented 29% of all AML cases (n=176) treated at our institution. 31(60.78%) were males. Mean age was 68.42 years, range (60–82) with 23 (45.10%) being &gt;69 years of age. History of AHD was observed in 15 (29.41%). Results of cytogenetic studies were available for 29(56.86%) patients of which 11(37.93%) had poor risk cytogenetics with the remainder falling in the intermediate risk group. Elevated WBC count was seen in 25(49.02%). Intensive induction chemotherapy was administered with an anthracycline and cytarabine regimen to 42(82.35%) patients with an induction mortality of 26%. Total of 23 (54.76%) patients achieved first complete remission (CR1). Of those who achieved CR1, 19(82.60%) underwent consolidation. Median survival was 120 days, range (1–2035). By univariate analyses, survival was not affected by older age (p=0.98), poor cytogenetics (p=0.23) or history of AHD (p=0.59), but was affected by induction chemotherapy (p=0.0001), ability to achieve CR1 (p=0.0001) and elevated WBC (p=0.05). In multivariate analyses after adjusting for other variables risk of death was influenced by ability to achieve CR1 (HR 0.146), AHD (HR=2.66) and elevated WBC count (HR=2.48). Conclusion: Elderly AML has poor clinical outcomes. Risk of death is reduced by intensive induction chemotherapy and achievement of CR1. It is increased by history of AHD and elevated WBC at presentation.

scholarly journals Clinical profile of patients of poisoning admitted in emergency department in a teaching hospital, MAMC, Agroha, Haryana, India

2017 ◽  
Vol 5 (8) ◽  
pp. 3767
Author(s):  
Mohd Y. Shah ◽  
Mohd M. Naqash ◽  
Faisal Y. Shah ◽  
Faizan Y. Shah
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Agricultural Land ◽  
Suicide Attempts ◽  
Family Members ◽  
Clinical Profile ◽  
Precipitating Factors ◽  
Number Of Patients ◽  
Catchment Areas ◽  
History Of

3 Million Serious poisoning (1 million accidentals and 2 million suicide attempts) occur each year worldwide.1 India ranks second in Asia in annual pesticide consumption.2 A study was conducted (1 year) wherein patients with history of poisoning were admitted from different catchment areas of hospital (30 Km radius). The total number of patients admitted during study period was 61. Patients had consumed these agents to attempt suicide. Out of 61 patients 26 were male and rest 37 were females. 18 patients died and rest survived. The precipitating factors in the suicide attempts were stranded relations with husband/wife, failure in examination and confrontation with parents. The availability of these poisonous substances in the household make people to consume these agents on slight provocation.3 All our patients, though majority were literate, were from families who had agricultural land and majority of their family members were farmers. Table 1 and Table 2 depict the characteristics and clinical profile of 61 patients admitted during the study period.

Assessment of Mortality and Morbidity in Covid patients with Previous Pulmonary Pathology of SKZH/CMH

2021 ◽  
Vol 15 (11) ◽  
pp. 2954-2955
Author(s):  
Syed Sajid Ali Bukhari ◽  
Munazza Nazir ◽  
Sohail Khan Raja ◽  
Abdur Rehman ◽  
Muhammad Ashraf ul Islam ◽  
...  
Keyword(s):  
Cohort Study ◽  
Data Collection ◽  
Demographic Data ◽  
Laboratory Findings ◽  
Mortality And Morbidity ◽  
Duration Of Illness ◽  
Treatment Measures ◽  
History Of ◽  
Pulmonary Pathology ◽  
Underlying Diseases

Aim: To study the severity of symptoms, rates of mortality and morbidity in COVID patients with and without previous pulmonary pathology. Methodology: The cohort study consisted of 244 patients and nearly all the individuals had underlying diseases. Data collection forms included demographic data, medical history, history of exposure to infection, symptoms, signs, laboratory findings, HRCT results, treatment measures especially history of corticosteroid use, and duration of illness. Results: In 244 patients, 180 patients were having the pulmonary pathology and other 64 were having no pulmonary pathology. 77.2% (139/180) of the patients showed severe symptoms in the previous pulmonary pathology while 21.8% (10/64) showed severe symptoms in the group with no pulmonary pathology. 16.1% (29/180) patients died because of COVID and were also having pulmonary pathology. While 10.9% (7/64) patients died in the group having no pulmonary pathology. Conclusion: In this study, 16.1% patients died of COVID with pulmonary pathology. While 10.9% patients died having no pulmonary pathology. 77.2% of the patients showed severe symptoms with previous pulmonary pathology while 21.8% showed severe symptoms with no pulmonary pathology. Keywords: Covid-19, Mortality, morbidity

scholarly journals What are the needs and preferences of patients and family members discharged from the emergency department within 24 hours? A qualitative study towards a family-centred approach

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e050694
Author(s):  
Christina Østervang ◽  
Annmarie Touborg Lassen ◽  
Charlotte Myhre Jensen ◽  
Elisabeth Coyne ◽  
Karin Brochstedt Dieperink
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Observational Studies ◽  
Participatory Design ◽  
Family Members ◽  
Acute Illness ◽  
Family Presence ◽  
Individual Interviews ◽  
Purposeful Sampling ◽  
Tailored Communication

ObjectiveThere is an increase in patients being discharged after short stays in the emergency department, but there is limited knowledge of their perspectives on treatment and care. This study aims to explore and understand the needs and preferences of emergency care from the perspective of patients and family members discharged from the emergency department within 24 hours of admission.DesignThe study reports from the first phase in an overall participatory design project. Systematic text condensation was used to identify key themes from field observations and interviews with patients and family members.SettingThis study was conducted in two emergency departments in the Region of Southern Denmark.ParticipantsAll adults aged ≥18 years who had been discharged from the emergency department within 24 hours were eligible to take part. Purposeful sampling was used to recruit patients and family members with different sociodemographic features.ResultsField observational studies (n=50 hours), individual interviews with patients (N=19) and family members (N=3), and joint interviews with patients and family members (N=4) were carried out. Four themes were derived from the material: (1) being in a vulnerable place—having emotional concerns; (2) having a need for person-centred information; (3) the atmosphere in the emergency department and (4) implications of family presence.ConclusionThis study demonstrates a gap between patients’ and family members’ needs and preferences and what current emergency departments deliver. The findings highlight the importance of family and person-centred care. Tailored communication and information with genuine involvement of family members is found to be essential needs during acute illness.

scholarly journals Assessment of The Relationship of REMS and MEWS Scores with Prognosis in Patients Diagnosed with Covid-19 Admitted to the Emergency Department

2021 ◽  
Author(s):  
Behlul Bas ◽  
Mucahit Senturk ◽  
Tugce Nur Burnaz ◽  
Kubilay Timur ◽  
Asim Kalkan
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Clinical Outcomes ◽  
Demographic Data ◽  
Scoring Systems ◽  
Roc Curves ◽  
Practical Method ◽  
Significant Difference ◽  
Discharged Patients ◽  
Global Increase

ABSTRACTAimWith the rapid and global increase in COVID-19 cases, it is becoming important to identify patients with a risk of mortality and patients that need hospitalization. The aim of this study is to try to predict the mortality rate of COVID patients admitted to the emergency department with rapid scoring systems such as REMS and MEWS and their clinical termination in the emergency department at the end of the first month.MethodWe have designed this study to be a single-centered, prospective and an observational study. A total of 392 patients diagnosed with COVID-19, who were admitted to the emergency department in a 1-month period, were included in the study. REMS and MEWS scores were calculated for each case. Demographic data of patients, clinical outcomes such as discharge, service hospitalization, ICU hospitalization, and first-month mortality were analysed based on these scores. ROC curves were analysed to determine the cut-off value with the help of which REMS and MEWS scores can predict 1-month mortality and hospitalization.ResultsOut of the 392 patients included in the study, the 43.4% (n=170) were female and 56.6% (n=222) were male. The average age of our patients was 48.98±19.49 years. The 1-month mortality rate of our patients was 4.3% (n=17). At the end of the first month, the mortality of patients with a comorbid disease was higher than those who did not (p<0.01). The average of the REMS score was higher in patients with an average mortality of (7.24±3.77) than in patients without it (2.87±3.09), and there was a statistically significant difference between them (p<0.01). Similarly, the average of the MEWS score was higher in patients with an average mortality of (2.76±1.86) than in patients without it (1.65±1.35), and there was a statistically significant difference (p<0.01). The REMS score of patients admitted to the service was higher than that of patients discharged (p<0.01). When the REMS score was determined as 3 cut-off value in ROC analysis, service hospitalization was 5 times higher in patients with a REMS score of 3 and above than in those who were discharged (OR: 1:5.022 95% CI: 3.088-8.168)). REMS and MEWS scores were also higher in ICU patients than in discharged patients (p<0.01).ConclusionIn predicting the 1-month mortality of ER patients diagnosed with COVID-19, REMS and MEWS scoring systems can be useful and guiding in determining the patients who need hospitalization for emergency physicians. The use of these scoring systems in emergency departments can help predict the clinical outcomes of patients at the time of the initial evaluation, and can also be a practical method of predicting the prognosis of the patients.

scholarly journals Retrospective Analysis of Emergency Computed Tomography Imaging Utilization at an Academic Centre: An Analysis of Clinical Indications and Outcomes

2019 ◽  
Vol 70 (1) ◽  
pp. 13-22 ◽  
Author(s):  
Jason Seidel ◽  
Mary Beth Bissell ◽  
Sannihita Vatturi ◽  
Angus Hartery
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
Clinical Outcomes ◽  
Emergency Departments ◽  
Ct Imaging ◽  
Clinical Indication ◽  
Lower Quadrant ◽  
Clinical Indications ◽  
Common Diagnosis

Purpose To explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting. Methods A retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist. Results A total of 4556 CT scans were performed in the emergency department over a 1-year period. A total of 3.6% of all-comers to our emergency departments underwent CT scan as part of their investigation. There were 2107 head CTs (46%), 1296 (28%) abdominal CTs, 468 (10%) CTs of the chest, 408 (9%) CTs of the neck/spine, and 101 (2%) extremity CTs performed. The most common clinical indication for performing a CT head was focal neurological defect comprising 1534 (73%) of all CT heads. Twenty-four percent of abdominal CTs were for investigation of right lower quadrant pain, followed by flank pain (19%). Chest pain and shortness of breath were the most common indications for CTs of the chest (315 [75%]) with 10% of these examinations for this indication positive for pulmonary embolism. Trauma was the most common indication for neck CTs (296 [73%]) and extremities (70 [69%]). Nil acute was the most common final interpretation in all categories (79% CT heads, 75% neck CTs, 38% abdominal CTs, 43% chest CTs). Conclusions Nil acute was the most common diagnosis; however, serious clinical outcomes were identified 40% of the time. Cross-sectional imaging remains an integral tool for triage and diagnosis in this environment as the cost of missing a diagnosis in this setting has a great impact on patient care.

scholarly journals Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wonjin Choi ◽  
Seon Hee Woo ◽  
Dae Hee Kim ◽  
June Young Lee ◽  
Woon Jeong Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
Prolonged Length ◽  
History Of

Background. This study aimed at investigating whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU may be associated with adverse clinical outcomes in elderly patients with infections. Methods. This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results, and ED LOS. Outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was applied to identify factors predictive of mortality. Results. A total of 439 patients admitted to the ICU via the ED were included in this study, 132 (30.1%) of whom died in the hospital. The median (IQR) age was 78 (73, 83) years. In multivariable analysis, a history of malignancy (OR: 3.76; 95% CI: 1.88–7.52; p < 0.001 ), high lactate level (OR: 1.13; 95% CI: 1.01–1.27; p = 0.039 ), and ED LOS (OR: 1.01; 95% CI: 1.00–1.02; p = 0.039 ) were independent risk factors for all-cause in-hospital admission. Elderly patients with an ED LOS >12 hours had a longer hospital LOS ( p = 0.018 ), and those with an ED LOS > 24 hours had a longer hospital LOS and higher mortality rate ( p = 0.044 ,   p = 0.008 ). Conclusions. This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections who visit the ED.

Family health evaluated by family members of older patients and nurses in emergency departments

2017 ◽  
Vol 38 (1) ◽  
pp. 38-47
Author(s):  
Jekaterina Demidenko ◽  
Pirkko Routasalo ◽  
Mika Helminen ◽  
Päivi Åstedt-Kurki ◽  
Eija Paavilainen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Family Member ◽  
Emergency Departments ◽  
Older Patients ◽  
Family Members ◽  
Family Health ◽  
Moderate Level ◽  
The Family ◽  
Health Related ◽  
Over Time

Older patients quite often arrive in an emergency department (ED) with a family member, but little is known about the family member’s health evaluated in ED. The aim of this study was to describe family health in EDs evaluated by family members and nurses. Data were collected from Estonian hospital EDs from 111 family members of older patients and from 93 nurses. Family health in EDs was evaluated as being at a moderate level. Family members reported that family health was better when older patients lived with the family. The more time the family spent in the ED, the worse the health-related activities were. Nurses reported that cardiovascular problems in older patients who presented in EDs disturbed the values of family health. We conclude that ED nurses should recognize the level of family health, in order to ensure that the family will be able to cope at home. Family health in EDs should be reviewed over time to help nurses meet the required needs of the family.

New Families with Hereditary Hemorrhagic Trait due to Deficiency of Fibrin Stabilizing Factor (F. XIII)

1968 ◽  
Vol 20 (03/04) ◽  
pp. 534-541 ◽  
Author(s):  
O Egeberg
Keyword(s):  
Factor Xiii ◽  
Family Members ◽  
Recessive Inheritance ◽  
Factor Xiii Deficiency ◽  
History Of ◽  
Congenital Factor

SummarySevere hemorrhagic disorder due to congenital factor XIII deficiency is described in two unrelated Norwegian girls.Plasma cephalin time was for both patients extraordinarily short during episodes of bleeding and hematomas. No such hyperactivity reaction was demonstrable in unaffected condition some months later.Estimations of blood factor XIII levels revealed a partial defect in the parents of both children, and also in some other family members, consistent with an autosomal incompletely recessive inheritance of the defect. Some of the presumptive heterozygotes had a history of light bleeding phenomenons; whether this was related to their partial lack of factor XIII is so far uncertain.

Sign in / Sign up

Export Citation Format

Share Document