scholarly journals Mortality Risk Factors Among Hospitalized Children with Severe Pertussis.

2021 ◽  
Author(s):  
Tingting Shi ◽  
Ling Wang ◽  
Shuling Du ◽  
Huifeng Fan ◽  
Minhua Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Mortality Risk ◽  
Medical Records ◽  
Odds Ratio ◽  
Medical Center ◽  
Hospitalized Children ◽  
Prognostic Variables ◽  
Pertussis Infection ◽  
Independent Risk Factors

Abstract Background: Some children hospitalized for severe pertussis infection require intensive care; moreover, some children die because of disease deterioration alone or in combination with other complications. The purpose of this study was to identify mortality risk factors among hospitalized children with severe pertussis.Methods: This study evaluated the medical records of 144 hospitalized children with severepertussis at the Guangzhou Women and Children’s Medical Center between January 2016 and December 2019.Results: The median age of patients was 2 months (IQR, 1–4 months), with 90.1% of the patients aged <6 months and 56.9% of the patients aged <3 months. A total of 13 patients died, and the mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for 76.9% of the deaths. On multivariate analysis, the independent risk factors for death were WBC >70.0×109/L (odds ratio [OR], 230.66; 95% confidence interval [CI], 5.16–10319.09 P = 0.005) and pulmonary hypertension (PH) (OR, 323.29; 95% CI, 16.01–6529.42; P<0.001).Conclusion: Severe pertussis mainly occurred in children aged <3 months. The mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for the majority of the deaths. We recommend the first dose of diphtheria-tetanus-pertussis (DTP) should be advanced to the age of 2 months or even 6 weeks. The presence of a WBC >70.0×109/L and PH were the prognostic variables independently associated with death.

scholarly journals Mortality risk factors among hospitalized children with severe pertussis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tingting Shi ◽  
Ling Wang ◽  
Shuling Du ◽  
Huifeng Fan ◽  
Minghua Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Pulmonary Hypertension ◽  
Intensive Care ◽  
Mortality Risk ◽  
Medical Records ◽  
Odds Ratio ◽  
Hospitalized Children ◽  
Independent Variables ◽  
Independent Risk Factors

Abstract Background Some children hospitalized for severe pertussis need intensive care; moreover, some children die because of deterioration alone or in combination with other complications. The purpose of this study was to identify the mortality risk factors among hospitalized children with severe pertussis. Methods This study evaluated the medical records of 144 hospitalized children with severe pertussis at the Guangzhou Women and Children’s Medical Centre between January 2016 and December 2019. Results The median age of patients was 2 months (IQR 1–4 months), with 90.3% of the patients aged < 6 months and 56.9% of the patients aged < 3 months. A total of 38 patients were admitted to intensive care unit (ICU), 13 patients died, and the mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for 76.9% of the deaths. On the multivariate analysis, the independent risk factors for death were WBC > 70.0 × 109/L (odds ratio [OR], 230.66; 95% confidence interval [CI], 5.16–10,319.09 P = 0.005) and pulmonary hypertension (PH) (OR 323.29; 95% CI 16.01–6529.42; P < 0.001). Conclusion Severe pertussis mainly occurred in children aged < 3 months. The mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for the majority of the deaths. We recommend the first dose of diphtheria-tetanus-pertussis (DTP) should be advanced to the age of 2 months or even 6 weeks. The presence of a WBC > 70.0 × 109/L and PH were the prognostic independent variables associated with death.

scholarly journals Risk Factors and Outcomes of Recurrent Candidemia in Children: Relapse or Re-Infection?

2019 ◽  
Vol 8 (1) ◽  
pp. 99 ◽  
Author(s):  
Mei-Yin Lai ◽  
Jen-Fu Hsu ◽  
Shih-Ming Chu ◽  
I-Hsyuan Wu ◽  
Hsuan-Rong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Medical Center ◽  
Late Recurrence ◽  
Gastrointestinal Diseases ◽  
Early Recurrence ◽  
Neurological Sequelae ◽  
Independent Risk Factors ◽  
Different Strains

In this paper, our aim was to investigate the incidence, clinical characteristics, risk factors, and outcomes of recurrent candidemia in children. We retrospectively reviewed all children with candidemia from a medical center in Taiwan between 2004 and 2015. Two episodes of candidemia ≥30 days apart with clinical and microbiological resolution in the interim were defined as “late recurrence”, and those that had 8–29 days apart from previous episodes were defined as “early recurrence”. 45 patients (17.2%) had 57 episodes of recurrent candidemia, and 24 had 28 episodes of late recurrent candidemia. The median time between recurrences was 1.8 months (range: <1 month to 13 months). Of those, 29 had relapsed candidemia and 28 were re-infected by different Candida species (n = 24) or by different strains (n = 4). Recurrent candidemia patients were more likely to require echinocandins treatment, had a longer duration of candidemia, and higher rate of treatment failure (p = 0.001, 0.014, and 0.012, respectively). Underlying gastrointestinal diseases (Odds ratio (OR) 3.84; 95% Confidence interval (CI) 1.81–8.12) and neurological sequelae (OR 2.32; 95% CI 1.15–4.69) were independently associated with the development of recurrent candidemia. 17.2% of pediatric patients with candidemia developed recurrent candidemia, and approximately half were re-infected. Underlying gastrointestinal diseases and neurological sequelae were the independent risk factors for recurrent candidemia.

scholarly journals Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

2021 ◽  
Vol 10 (5) ◽  
pp. 928
Author(s):  
Takuya Okugawa ◽  
Tadayuki Oshima ◽  
Keisuke Nakai ◽  
Hirotsugu Eda ◽  
Akio Tamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Colorectal Polyp ◽  
Control Group ◽  
Single Center ◽  
Antithrombotic Agents ◽  
Delayed Bleeding ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Continuous Use

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

scholarly journals Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

2016 ◽  
Vol 31 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Manuel C. Vallejo ◽  
Ahmed F. Attaallah ◽  
Robert E. Shapiro ◽  
Osama M. Elzamzamy ◽  
Michael G. Mueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Medical Center ◽  
Tertiary Care ◽  
Site Infection ◽  
Tertiary Care Medical Center ◽  
Independent Risk Factors

scholarly journals Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

2020 ◽  
Author(s):  
Ruo-Yi Huang ◽  
Szu-Jen Chen ◽  
Yen-Chang Hsiao ◽  
Ling-Wei Kuo ◽  
Chien-Hung Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endotracheal Tube ◽  
Odds Ratio ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Shortness Of Breath ◽  
Airway Protection ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Facial Burn

Abstract BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

scholarly journals Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

2020 ◽  
Vol 73 (6) ◽  
pp. 542-549
Author(s):  
Taeha Ryu ◽  
Baek Jin Kim ◽  
Seong Jun Woo ◽  
So Young Lee ◽  
Jung A Lim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Odds Ratio ◽  
Arthroscopic Surgery ◽  
Sitting Position ◽  
Past Medical History ◽  
Frequent Adverse Event ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Independent Risk Factors

Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position. Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB. Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB. Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

Venous Thromboembolism in Patients With Thrombocytopenia: Risk Factors, Treatment, and Outcome

2015 ◽  
Vol 23 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Jens Kristian Baelum ◽  
Espen Ellingsen Moe ◽  
Mads Nybo ◽  
Pernille Just Vinholt
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Venous Thromboembolism ◽  
Blood Cells ◽  
Medical Records ◽  
Odds Ratio ◽  
Conditional Logistic Regression ◽  
University Hospital ◽  
Hospital Department ◽  
Bleeding Episodes

Background: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. Objectives: To identify VTE risk factors and describe treatment and outcome (bleeding episodes and mortality) in patients with thrombocytopenia. Patients/Methods: Patients with thrombocytopenia (platelet count <100 × 109/L) admitted to Odense University Hospital, Denmark, between April 2000 and April 2012 were included. Fifty cases had experienced VTE. Controls without VTE were matched 3:1 with cases on sex and hospital department. Medical records were examined, and data were analyzed using conditional logistic regression. Results: In multivariate analysis, platelet count <50 × 109/L (odds ratio [OR] 0.22, P < .05) and chronic liver disease (OR 0.05, 95% confidence interval [CI] 0.01-0.58) reduced the risk of VTE. Surgery (OR 6.44, 95% CI 1.37-30.20) and previous thromboembolism (OR 6.16, 95% CI 1.21-31.41) were associated with an increased VTE risk. Ninety-two percent of cases were treated with anticoagulants. There was no difference in bleeding incidence between cases and controls. Conclusions: Several known VTE risk factors also seems to apply in patients with thrombocytopenia. Also, patients with thrombocytopenia may be VTE risk stratified based on platelet count and comorbidities. Finally, patients having thrombocytopenia with VTE seem to be safely treated with anticoagulants without increased occurrence of bleeding.

Outcomes of Multidetector Computed Tomography Pulmonary Angiography in Pregnant and Postpartum Women With Suspected Pulmonary Embolism

2020 ◽  
pp. 084653711989955
Author(s):  
Simon Sun ◽  
Marius Diaconescu ◽  
Tian Zhe ◽  
Benoit Mesurolle ◽  
Alexandre Semionov
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Odds Ratio ◽  
Pulmonary Angiography ◽  
Reproductive Age ◽  
P Value ◽  
Postpartum Women ◽  
Computed Tomography Pulmonary Angiography ◽  
Early Postpartum ◽  
Independent Risk Factors

Purpose: Verify whether there is a difference in likelihood of developing pulmonary embolism (PE) between pregnant women, nonpregnant women of reproductive age, and postpartum (up to 6 weeks) women, by comparing their outcomes on computed tomography pulmonary angiography (CTPA) done for suspicion of PE. Materials and Methods: Retrospective cohort study of 1463 CTPA done for suspicion of PE in females of reproductive age (18-40 years), nonpregnant, pregnant (antepartum), and postpartum, from 2 tertiary-care academic hospitals between October 2006 and September 2015. Primary outcome was diagnosis of PE on imaging. Additional assessment was made of technical adequacy of the studies and method of delivery for the postpartum cohort (vaginal vs caesarean birth). Twenty-nine technically nondiagnostic studies were excluded. The effect of any potential variable on PE status was tested using univariate logistic regression. Subgroup analysis was performed after excluding patients with independent risk factors for PE. Results: The rate of CTPA positive for PE was less among pregnant patients compared to early postpartum and nonpregnant women of similar age, 2.9% vs 11.5% and 10.3%, respectively. Pregnancy was associated with statistically significant decreased odds ratio of developing a PE on CTPA, 0.23 (0.09-0.89), P value = .004. After excluding patients with additional independent risk factors for PE, there was no statistically significant odds ratio association between presence of PE on CTPA and pregnancy 0.41 (0.13-1.34), P value = .14. Conclusion: Rate of CTPA positive for PE in pregnant women was lower than in nonpregnant and early postpartum women. Pregnancy was statistically significantly less likely to be associated with positive PE on a CTPA study. The common perception that pregnancy (antepartum state) is associated with an increased risk of PE may require a thorough critical reappraisal.

Preventing Healthcare Workers From Acquiring Influenza

2009 ◽  
Vol 30 (3) ◽  
pp. 292-295 ◽  
Author(s):  
Tak Ching Ng ◽  
Nelson Lee ◽  
Shu-Cheong David Hui ◽  
Raymond Lai ◽  
Margaret Ip
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Odds Ratio ◽  
Healthcare Workers ◽  
Influenza Season ◽  
Standard Precautions ◽  
Household Contacts ◽  
Suboptimal Adherence ◽  
Independent Risk Factors ◽  
To Receive

Our survey of 133 on-duty medical ward nurses showed that, during peak influenza season, 30 (23%) developed an influenza-like illness, despite wearing a mask at work. Suboptimal adherence to standard precautions, such as the use of a face shield (odds ratio, 3.56) during high-risk procedures, and failure to receive influenza vaccination (odds ratio, 4.82) were independent risk factors, adjusted for household contacts.

Incidence and Risk Factors for Community and Hospital Acquisition of Clostridium difficile Infection in the Tel Aviv Sourasky Medical Center

2017 ◽  
Vol 38 (8) ◽  
pp. 912-920 ◽  
Author(s):  
Wasef Na’amnih ◽  
Amos Adler ◽  
Tamar Miller-Roll ◽  
Dani Cohen ◽  
Yehuda Carmeli
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Confidence Interval ◽  
Family Member ◽  
Incidence Rate ◽  
Odds Ratio ◽  
Close Contact ◽  
Medical Center ◽  
Tel Aviv ◽  
Hospital Acquired

OBJECTIVESTo estimate the incidence and identified risk factors for community-acquired (CA) and hospital-acquired (HA) Clostridium difficile infection (CDI)METHODSWe conducted 2 parallel case-control studies at Tel Aviv Sourasky Medical Center from January 1, 2011, to December 31, 2014. We identified persons with CDI, determined whether infection was community or hospital acquired, and calculated incidence rates from 2007 to 2014. We collected demographic, clinical, and epidemiological information for CDI cases and hospitalized control cases and estimated the odds ratio with 95% confidence interval using conditional logistic regression.RESULTSIn total, 1,563 CDI cases were identified in the study. The incidence rate of CA-CDI and HA-CDI increased by 1.6-fold and 1.2-fold, respectively, during 2012–2014. However, the incidence rate of CA-CDI was 0.84 per 100,000 (95% CI, 0.52–1.30), the rate for HA-CDI was 4.7 per 10,000 patient days (95% CI, 4.08–5.38), respectively, in 2014. We identified several factors as independent variables significantly associated with HA-CDI: functional disability, presence of nasogastric tube, antibiotic use, chemotherapy, infection by extended-spectrum β-lactamases, and mean of albumin values. Risk factors independently associated with CA-CDI were close contact with a family member who had been hospitalized in the previous 6 months, inflammatory bowel disease, and home density index (adjusted odds ratio, 25.7; 95% confidence interval, 3.99–165.54; P=.001).CONCLUSIONSThe identification of the main modifiable risk factors for HA-CDI (antibiotic exposure and hypoalbuminemia) and for CA-CDI (close contact with a family member who had been hospitalized in the previous 6 months) is likely to optimize prevention efforts; these factors are critical in preventing the spread of CDI.Infect Control Hosp Epidemiol 2017;38:912–920

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