scholarly journals Forty-eight-hour hospital mortality: an emergency department perspective studying the relationship between suboptimal care and mortality

2021 ◽  
Vol 5 ◽  
pp. 14-14
Author(s):  
Farhat Mushtaq ◽  
Talat Mushtaq ◽  
Nadia Amin
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Suboptimal Care ◽  
The Relationship

scholarly journals Association between Shock Index and Emergency Department Cardiac Arrest

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Chao-Tung Chen ◽  
Pei-Ming Wang ◽  
Chao-Hsin Wu ◽  
Chih-Wei Wei ◽  
Tai-Lin Huang
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Screening Tool ◽  
Vital Signs ◽  
Shock Index ◽  
Patients At Risk ◽  
Injured Patients ◽  
The Relationship

Background. In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED. Methods. Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems. Results. In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5–1.8). The aOR (CI) in the five etiologies was 1.3 (1.1–1.6) for hypoxia, 1.8 (1.6–2.1) for cardiac cause, 1.3 (0.98–1.7) for bleeding, 1.3 (1.03–1.6) for sepsis, and 1.9 (1.5–2.1) for other metabolic problems. Conclusion. More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.

scholarly journals Covid-19 and acute conjunctivitis: Controversial data from a tertiary refferral Italian center

2021 ◽  
pp. 112067212199104
Author(s):  
Giuseppe D’Amico Ricci ◽  
Claudia Del Turco ◽  
Elena Belcastro ◽  
Marco Palisi ◽  
Mario R Romano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Odds Ratio ◽  
Signs And Symptoms ◽  
Time Span ◽  
Nasopharyngeal Swab ◽  
Eye Disorders ◽  
Eye Examination ◽  
The Relationship ◽  
Acute Conjunctivitis ◽  
Piedmont Region

Purpose: Although acute conjunctivitis has been listed from the beginning as a possible sign of COVID-19, the likelihood of this association remains unclear. The aim of this study was to investigate the relationship between COVID-19 and conjunctivitis. Methods: In this retrospective, observational study, we recruited all patients with signs and symptoms of acute conjunctivitis seen at the Eye Emergency Department (ED), Turin Eye Hospital, between 01/01/2020 and 12/05/2020 and cross-checked our data with the Piedmont Region online COVID-19 registry in the same period. Results: Among 10,065 patients seen at our ED during the timespan considered, 88 underwent a nasopharyngeal swab (NS) for SARS-CoV-2 detection within 4 weeks before/after our examination. On average, NS was performed −0.72 ± 1.8 weeks before/after eye examination. Of the 77 patients with a negative NS, 26 (33.8%) had a diagnosis of acute conjunctivitis, whereas the remaining 51 (66.2%) had other eye disorders. Among the 11 patients with COVID-19, 7 (63,6%) had a diagnosis of acute conjunctivitis. We found a non-statistically significant increase in NS positivity rate (21.2%) among cases examined at our ED for acute conjunctivitis, compared to the NS positivity rate (7.3%) in patients examined for all other eye conditions ( p = 0.092). The Odds Ratio of having a positive NS in patients with acute conjunctivitis was 3.43 (95% I.C. = 0.9–12.8, p = 0.06). Considering online-registry data of Turin population during the same time-span, among 2441 positive NS cases only 27 (1.1%) presented with acute conjunctivitis. Conclusion: Our results do not reveal a statistically significant correlation between COVID-19 and acute conjunctivitis. Synopsis The present study analyzes retrospectively data from a tertiary eye referral center to investigate the relationship between COVID-19 infection and conjunctivitis.

scholarly journals Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoling Zhang ◽  
Jingjing Zhang ◽  
Jiamei Li ◽  
Ya Gao ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Venous Blood ◽  
Sensitivity Analyses ◽  
Icu Mortality ◽  
Logistic Regression Models ◽  
The Mean ◽  
The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

Infection management processes in intensive care and their association with mortality

2021 ◽  
Author(s):  
Leigh P. Fitzpatrick ◽  
Bianca Levkovich ◽  
Steve McGloughlin ◽  
Edward Litton ◽  
Allen C. Cheng ◽  
...  
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Hospital Mortality ◽  
Process Of Care ◽  
Infection Management ◽  
Hierarchical Logistic Regression ◽  
Management Processes ◽  
Patient Database ◽  
Improving Patient Care ◽  
The Relationship

Abstract Background ICU-specific tables of antimicrobial susceptibility for key microbial species (‘antibiograms’), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain. Objectives To measure the association of these processes in ICU with in-hospital mortality. Methods The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and Critical Care Resources registry were used to extract patient-level factors, ICU-level factors and the year in which each process took place. Descriptive statistics and hierarchical logistic regression were used to determine the relationship between each process and in-hospital mortality. Results The study included 799 901 adults admitted to 173 ICUs from July 2009 to June 2016. The proportion of patients exposed to each process of care was 38.7% (antibiograms), 77.5% (AMS programmes) and 74.0% (ID rounds). After adjusting for confounders, patients admitted to ICUs that used ICU-specific antibiograms had a lower risk of in-hospital mortality [OR 0.95 (99% CI 0.92–0.99), P = 0.001]. There was no association between the use of AMS programmes [OR 0.98 (99% CI 0.94–1.02), P = 0.16] or routine rounds with ID physicians [OR 0.96 (99% CI 0.09–1.02), P = 0.09] and in-hospital mortality. Conclusions Use of ICU-specific antibiograms was associated with lower in-hospital mortality for patients admitted to ICU. For hospitals that do not perform ICU-specific antibiograms, their implementation presents a low-risk infection management process that might improve patient outcomes.

scholarly journals Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051237
Author(s):  
Emilio Ortega ◽  
Rosa Corcoy ◽  
Mònica Gratacòs ◽  
Francesc Xavier Cos Claramunt ◽  
Manel Mata-Cases ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Male Sex ◽  
Poor Outcomes ◽  
The Relationship

AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.

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