Maternal intensive care unit admission as an indicator of severe acute maternal morbidity: A population-based study

2020 ◽  
Author(s):  
Charlotte Godeberge ◽  
Catherine Deneux-Tharaux ◽  
Aurélien Séco ◽  
Mathias Rossignol ◽  
Anne Alice Chantry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Odds Ratio ◽  
Maternal Morbidity ◽  
Adjusted Odds Ratio ◽  
Population Based ◽  
Population Based Study ◽  
Icu Admission ◽  
Severe Acute Maternal Morbidity

Abstract Background Severe acute maternal morbidity, accounting for any life-threatening complication during pregnancy or after delivery, is a major issue in maternal health. Measuring and monitoring it seems critical for assessing the quality of maternal health care. We explored the relevance of maternal ICU admission as an indicator of severe acute maternal morbidity by characterizing, among maternal ICU admissions, the profile of women with severe acute maternal morbidity and their ICU stay, according to the association with other criterion of severe acute maternal morbidity. Methods Secondary analysis of a multiregional prospective population-based study of 2,540 women with severe acute maternal morbidity according to a multicriteria definition based on national experts’ consensus and including ICU admission. Results 511 women were admitted to an ICU during or up to 42 days after pregnancy (2.8 per 1,000 deliveries; 20.1% of women with severe acute maternal morbidity); 15.5% had no other severe acute maternal morbidity criterion. Among women with severe acute maternal morbidity, on multivariable multinomial analysis and adjusting for cause, the odd of intensive care unit admission with another morbidity criterion was increased for migrant from outside of Europe or Africa (adjusted odds ratio = 2.1 [95% CI 1.3-3.4]), with multiple gestation (adjusted odds ratio =1.5 [1.0-2.2]), and intrapartum cesarean (adjusted odds ratio =1.5 [1.1-2.2]). The odd of intensive care unit admission with no other morbidity criterion was increased with pre-existing medical conditions (adjusted odds ratio =2.2 [1.2-4.0]) and cesarean before labor (adjusted odds ratio =3.0 [1.4-6.1]). Women admitted to an ICU with no other morbidity criterion had no interventions for organ support. Conclusions Among women with severe acute maternal morbidity, one in five is admitted to an ICU; 15.5% of these have no other severe acute maternal morbidity criterion and their admission appears mostly indicated for continuous monitoring. The use of ICU admission alone as a single criterion morbidity is misleading to define severe acute maternal morbidity; this criterion needs to be refined to be included in the definition of severe acute maternal morbidity. These results also challenge the current organization of acute care for women with severe maternal morbidity.

scholarly journals Comorbidity and survival after admission to the intensive care unit: A population-based study of 41,230 patients

2020 ◽  
pp. 175114372091422
Author(s):  
Alasdair Simpson ◽  
Kathryn Puxty ◽  
Philip McLoone ◽  
Tara Quasim ◽  
Billy Sloan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Intensive Care Units ◽  
Odds Ratio ◽  
Intensive Care Unit Mortality ◽  
Population Based ◽  
Logistic Regression Models ◽  
Rheumatological Disease ◽  
The Relationship

Purpose To describe the relationship between comorbidities and survival following admission to the intensive care unit. Methods Retrospective observational study using several linked routinely collected databases from 16 general intensive care units between 2002 and 2011. Comorbidities identified from hospitalisation in the five years prior to intensive care unit admission. Odds ratios for survival in intensive care unit, hospital and at 30 days, 180 days and 12 months after intensive care unit admission derived from multiple logistic regression models. Results There were 41,230 admissions to intensive care units between 2002 and 2011. Forty-one percent had at least one comorbidity – 24% had one, 17% had more than one. Patients with comorbidities were significantly older, had higher Acute Physiology and Chronic Health Evaluation II scores and were more likely to have received elective rather than emergency surgery compared with those without comorbidities. After excluding elective hospitalisations, intensive care unit and hospital mortality for the cohort were 24% and 29%, respectively. Asthma (odds ratio 0.79, 95% confidence interval 0.63–0.99) and solid tumours (odds ratio 0.74, 0.67–0.83) were associated with lower odds of intensive care unit mortality than no comorbidity. Intensive care unit mortality was raised for liver disease (odds ratio 2.98, 2.43–3.65), cirrhosis (odds ratio 2.61, 1.9–3.61), haematological malignancy (odds ratio 2.29, 1.85–2.83), chronic ischaemic heart disease (odds ratio 1.53, 1.19–1.98), heart failure (odds ratio 1.79, 1.35–2.39) and rheumatological disease (odds ratio 1.53, 1.18–1.98). Conclusions Comorbidities affect two-fifths of intensive care unit admission and have highly variable effects on subsequent outcomes. Information on the differential effects of comorbidities will be helpful in making better decisions about intensive care unit support and understanding outcomes beyond surviving intensive care unit.

Mo1250 Increased Risk of Intensive Care Unit (ICU) Admission in Inflammatory Bowel Disease (IBD): A Population-Based Study

2013 ◽  
Vol 144 (5) ◽  
pp. S-618
Author(s):  
Charles N. Bernstein ◽  
Allan Garland ◽  
Christine Peschken ◽  
Carol Hitchon ◽  
Randy Fransoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Inflammatory Bowel Disease ◽  
Intensive Care ◽  
Bowel Disease ◽  
Population Based ◽  
Population Based Study ◽  
Icu Admission ◽  
Increased Risk ◽  
Inflammatory Bowel

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

2021 ◽  
pp. 0310057X2198971
Author(s):  
M Atif Mohd Slim ◽  
Hamish M Lala ◽  
Nicholas Barnes ◽  
Robert A Martynoga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
One Year ◽  
Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study

2021 ◽  
pp. 1-7
Author(s):  
Antoine Gbessemehlan ◽  
Gilles Kehoua ◽  
Catherine Helmer ◽  
Cécile Delcourt ◽  
Achille Tchalla ◽  
...  
Keyword(s):  
Older People ◽  
Cognitive Performance ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Central Africa ◽  
Population Based ◽  
Vision Impairment ◽  
Sub Saharan Africa ◽  
Population Based Study ◽  
The Impact

<b><i>Introduction:</i></b> Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. <b><i>Methods:</i></b> It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. <b><i>Results:</i></b> Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). <b><i>Conclusion:</i></b> In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

scholarly journals A prospective study of foetomaternal outcome in placenta praevia

2019 ◽  
Vol 8 (10) ◽  
pp. 4028
Author(s):  
Somika Kaul ◽  
Bijal Rami
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Neonatal Death ◽  
Maternal Morbidity ◽  
Neonatal Intensive Care ◽  
Placenta Praevia ◽  
Bladder Injury ◽  
Control Group ◽  
A Prospective Study

Background: Placenta praevia is one of the serious obstetric problems with far reaching effects and a major cause of antepartum haemorrhage. The aim of the study was to evaluate the foetomaternal outcome of pregnancies with placenta praevia.Methods: The present study was a prospective case control study conducted in the Department of Obstetrics and Gynaecology, Lal Ded Hospital, Srinagar from August 2009 to October 2010.Results: Among the 100 cases of placenta praevia studied bleeding per vaginum was the most common presenting symptom. Major placenta praevia was more common (53%) than minor placenta praevia. 43% of the cases of placenta praevia delivered before 37 completed weeks as compared to only 6% in the control group. All cases of placenta praevia delivered by caesarean section. Maternal morbidity in terms of postpartum haemorrhage (32%), intraoperative bowel and bladder injury (2%) and intensive care unit admission (1%) was more in cases of placenta praevia. Foetal complications in terms of neonatal intensive care unit admission (19%), neonatal death (10%) and stillbirth (5%) were more in pregnancies with placenta praevia as compared to controls. 48% of patients with placenta praevia required transfusion of blood and blood products as compared to 4.5% among controls.Conclusions: There is a significant increase in maternal morbidity in pregnancies complicated with placenta praevia. Also, there is a higher incidence of foetal complications and neonatal death. Managing a case of placenta praevia is a challenge in present day obstetrics and it creates a huge burden on the health care system.

A population-based study on epidemiology of intensive care unit treated traumatic brain injury in Iceland

2017 ◽  
Vol 61 (4) ◽  
pp. 408-417 ◽  
Author(s):  
G. M. Jonsdottir ◽  
S. H. Lund ◽  
B. Snorradottir ◽  
S. Karason ◽  
I. H. Olafsson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Population Based ◽  
Population Based Study

scholarly journals Oseltamivir Use Among Children and Adults Hospitalized With Community-Acquired Pneumonia

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Ikwo K. Oboho ◽  
Anna Bramley ◽  
Lyn Finelli ◽  
Alicia Fry ◽  
Krow Ampofo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Differential Diagnosis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Influenza Season ◽  
Community Acquired Pneumonia ◽  
Severe Illness ◽  
Factors Associated ◽  
Icu Admission ◽  
Clinician Education

Abstract Background Data on oseltamivir treatment among hospitalized community-acquired pneumonia (CAP) patients are limited. Methods Patients hospitalized with CAP at 6 hospitals during the 2010−2012 influenza seasons were included. We assessed factors associated with oseltamivir treatment using logistic regression. Results Oseltamivir treatment was provided to 89 of 1627 (5%) children (&lt;18 years) and 143 of 1051 (14%) adults. Among those with positive clinician-ordered influenza tests, 39 of 61 (64%) children and 37 of 48 (77%) adults received oseltamivir. Among children, oseltamivir treatment was associated with hospital A (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.36−4.88), clinician-ordered testing performed (aOR, 2.44; 95% CI, 1.47−5.19), intensive care unit (ICU) admission (aOR, 2.09; 95% CI, 1.27−3.45), and age ≥2 years (aOR, 1.43; 95% CI, 1.16−1.76). Among adults, oseltamivir treatment was associated with clinician-ordered testing performed (aOR, 8.38; 95% CI, 4.64−15.12), hospitals D and E (aOR, 3.46−5.11; 95% CI, 1.75−11.01), Hispanic ethnicity (aOR, 2.06; 95% CI, 1.18−3.59), and ICU admission (aOR, 2.05; 95% CI, 1.34−3.13). Conclusions Among patients hospitalized with CAP during influenza season, oseltamivir treatment was moderate overall and associated with clinician-ordered testing, severe illness, and specific hospitals. Increased clinician education is needed to include influenza in the differential diagnosis for hospitalized CAP patients and to test and treat patients empirically if influenza is suspected.

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