scholarly journals The Safety of Non-Transport Decisions Made by Ambulance Personnel: A Retrospective Study of Subsequent Hospital Admission and 30-Day Mortality

2021 ◽  
Author(s):  
Kjersti Amundsen ◽  
Marie Svanes Elden ◽  
Lars Myrmel ◽  
Jörg Assmus ◽  
Audun Lange ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Information Age ◽  
Time Of Day ◽  
Ambulance Personnel ◽  
Icd 10 ◽  
Health Trust ◽  
Reason For Admission ◽  
Mental And Behavioral Disorders

Abstract BackgroundAmbulance missions do not always result in the patient being transported to a doctor or hospital after evaluation at the scene by ambulance personnel. Sometimes a patient is discharged at the scene but should have been transported for further examination and treatment. In this study, we aimed to identify and describe this group, and to investigate subsequent hospital admission within 72 hours and 30-day mortality, which may indicate the safety of leaving a patient at the scene after examination. MethodThis retrospective study was carried out in the Bergen health trust in western Norway and included ambulance missions from 2018. For each mission, we recorded the patient’s demographic information (age, gender, time of day), initial reason for contacting the emergency medical service (EMS), hospital admissions after non-transport, and time of death if within 30 days, in addition to some other variables. ResultsAmong 33,183 included acute and urgent ambulance missions, 7.3% of the patients were discharged at the scene after evaluation by ambulance personnel. The median age in this group was 47 years (IQR 28–70 years), compared to 64 years (IQR 39–80 years) for all included missions. Following a non-transport decision, 4.8% of the patients were admitted to a public hospital within 72 hours (median age, 59 years; IQR 35–76 years), with mental and behavioral disorders (ICD-10 chapter V) being the most common reason for admission (24.8%). The 30-day mortality rate following non-transport mission was 2.4%. In this group, the median age was 83 years (IQR 73–90 years), and the most common reasons for contacting EMS were breathing difficulties or lung diseases (25.4%), and injuries or fractures (18.6%). ConclusionOur present analysis revealed low rates of hospital admission within 72 hours, and 30-day mortality, among patients left at the scene following evaluation by ambulance personnel. These findings do not suggest an unsafe rate of non-transport in the Bergen EMS. There remains a need for further evaluation of the factors involved in the decision not to transport a patient, and the safety of these decisions.

scholarly journals Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Laszlo Trefan ◽  
Ashley Akbari ◽  
Jennifer Siân Morgan ◽  
Daniel Mark Farewell ◽  
David Fone ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Accurate Determination ◽  
Rate Sensitivity ◽  
Misclassification Rate ◽  
Care Utilization ◽  
Diagnostic Codes ◽  
Cohort Data ◽  
Icd 10 ◽  
Excessive Consumption

IntroductionThe excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. ObjectivesTo compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. MethodsRoutine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. ResultsThere was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. ConclusionWith the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.

RCVS: Symptoms, Incidence, and Resource Utilization in a Population-Based US Cohort

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012223
Author(s):  
Jessica Magid-Bernstein ◽  
Setareh Salehi Omran ◽  
Neal S. Parikh ◽  
Alexander E. Merkler ◽  
Babak Navi ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Administrative Data ◽  
Census Data ◽  
Hospital Admissions ◽  
Population Based ◽  
Cerebrovascular Diseases ◽  
Cerebral Vasoconstriction ◽  
Icd 10 ◽  
Incidence Of Hospitalization ◽  
Age And Sex

Objective:To estimate the incidence of hospitalization for reversible cerebral vasoconstriction syndrome (RCVS), we identified RCVS-related hospital admissions across 11 U.S. states in 2016.Methods:We tested the validity of ICD-10 code I67.841 in 79 patients with hospital admissions for RCVS or other cerebrovascular diseases at one academic and one community hospital. After determining that this code had a sensitivity of 100% (95% CI, 82-100%) and a specificity of 90% (95% CI, 79-96%), we applied it to administrative data from the Healthcare Cost and Utilization Project on all ED visits and hospital admissions. Age- and sex-standardized RCVS incidence was calculated using census data. Descriptive statistics were used to analyze associated diagnoses.Results:Across 5,067,250 hospital admissions in our administrative data, we identified 222 patients with a discharge diagnosis of RCVS in 2016. The estimated annual age- and sex-standardized incidence of RCVS hospitalization was 2.7 (95% CI, 2.4-3.1) cases per million adults. Many patients had concomitant neurologic diagnoses, including subarachnoid hemorrhage (37%), ischemic stroke (16%), and intracerebral hemorrhage (10%). In the 90 days before the index admission, 97 patients had an ED visit and 34 patients a hospital admission, most commonly for neurologic, psychiatric, and pregnancy-related diagnoses. Following discharge from the RCVS hospital admission, 58 patients had an ED visit and 31 had a hospital admission, most commonly for neurologic diagnoses.Conclusions:Using population-wide data, we estimated the age- and sex-standardized incidence of hospitalization for RCVS in U.S. adults as approximately 3 per million per year.

P0783PREVALENCE AND PROGNOSIS OF HYPERKALAEMIA IN PEOPLE HOSPITALISED WITH AND WITHOUT AKI

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Andrew McLean ◽  
Corri Black ◽  
Angharad Marks ◽  
Simon Sawhney
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Kidney Diseases ◽  
Close Observation ◽  
Icd 10 ◽  
Initial Hospital ◽  
Serial Serum ◽  
Definition Of ◽  
The Relationship ◽  
Clinical Emergency

Abstract Background and Aims Hyperkalemia is a clinical emergency associated with kidney diseases and hospital mortality. It may be apparent on initial hospital presentation, or develop during the course of admission, and can occur in the context of AKI. The prevalence of hyperkalemia across these different presentations and contexts is not well described. No work has previously described whether the prognosis of hyperkalemia varies depending on timing of presentation, or on AKI status defined by KDIGO creatinine change biochemical criteria. Method We constructed a cohort of all adult residents in Grampian (North Scotland) admitted to hospital in 2012 (n=28462). We used a validated and replicated KDIGO based definition of AKI to identify AKI using serial serum creatinine values. We determined the presence of hyperkalemia (serum potassium >= 6 mEq/L) both on first blood test on presentation to hospital, and also during the course of hospital admission. We explored the outcome of 30 day mortality within subgroups of AKI status and timing of hyperkalemia. Covariates of interest included age, CKD, medications prescribed in the preceding 90 days and comorbidities (ICD-10 hospital episode codes). The relationship between hyperkalemia and 30 day mortality was determined using multivariable logistic regression. Results Of 28462 hospital admissions, 247 (0.9%) presented with hyperkalemia, whereas 560 (2.0%) had hyperkalemia during the course of hospital admission. Hyperkalemia was common in the presence of AKI (4.2% at hospital presentation, 9.3% during hospital admission and rising to 24.5% during AKI stage 3). Hyperkalemia was uncommon in the absence of AKI (0.3% and 0.7% respectively) (OR AKI vs no AKI 13.9, 11.6-16.6). Other factors associated with hyperkalemia were male gender (OR 1.5, 1.3-1.8), age >70 years (OR 2.4, 2.0-2.9), CKD based on eGFR or proteinuria (5.5, 4.6-6.5), diabetes (OR 3.4, 2.8-4.0), heart failure (OR 3.0, 2.4-3.7), RAAS blockers (OR 2.4, 2.0-2.9), trimethoprim containing antibiotics (OR 2.2, 1.7-2.8)), non-RAAS antihypertensives (OR 1.7, 1.4-2.0), but not NSAIDs (OR 0.9, 0.7-1.1). Hyperkalemia mortality (AKI vs no AKI) was 31% vs 29% when presenting at admission, or 34.3% vs 27.8% when occurring during hospital admission. Although absolute risks were similar irrespective of AKI, the excess relative mortality risk associated with hyperkalemia was lower for those with AKI (OR 2.7, 2.1-3.4) than those without AKI (OR 9.5, 6.8-13.2), which may be explained by a higher mortality for those with AKI even without hyperkalemia. Conclusion Hyperkalemia is associated with a high mortality even in the absence of AKI and irrespective of the timing of presentation. Management protocols should draw attention to this poor prognosis across all clinical contexts. As hyperkalemia usually occurs within the context of AKI, it should prompt clinicians to consider ongoing close observation for emerging AKI even when AKI is not yet evident on blood tests.

scholarly journals The epidemiology of primary and secondary adrenal malignancies and associated adrenal insufficiency in hospitalised patients: an analysis of hospital admission data, NSW, Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Lubomski ◽  
Henrik Falhammar ◽  
David J. Torpy ◽  
R. Louise Rushworth
Keyword(s):  
Retrospective Study ◽  
Hospital Admission ◽  
Adrenal Insufficiency ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Population Data ◽  
Comorbid Diagnosis ◽  
Admission Data ◽  
Hospitalised Patients ◽  
Considerable Morbidity

Abstract Background Adrenal insufficiency (AI) causes considerable morbidity but may remain undiagnosed in patients with adrenal malignancy (AM). The epidemiology of AI and adrenal crises (AC) in AM is uncertain. Methods This was a retrospective study examining hospital admission data from 2006 to 2017. All admissions to all hospitals in NSW, Australia over this period with a principal or comorbid diagnosis of an adrenal malignancy were selected. Data were examined for trends in admissions for AM and associated AI/AC using population data from the corresponding years. Results There were 15,376 hospital admissions with a diagnosis of AM in NSW over the study period, corresponding to 1281 admissions/year. The AM admission rate increased significantly over the study period from 129.9/million to 215.7/million (p < 0.01). An AI diagnosis was recorded in 182 (1.2%) admissions, corresponding to an average of 2.1/million/year. This rate increased significantly over the years of the study from 1.2/million in 2006 to 3.4/million in 2017 (p < 0.01). An AC was identified in 24 (13.2%) admissions with an AI diagnosis. Four patients (16.7%) with an AC died during the hospitalisation. Conclusion Admission with a diagnosis of AM has increased over recent years and has been accompanied by an increase in AI diagnoses. While AI is diagnosed in a small proportion of patients with AM, ACs do occur in affected patients.

scholarly journals Causes of hospitalization and characteristics of Algerian chronic obstructive pulmonary disease patients in Tizi-Ouzou: a retrospective study

2020 ◽  
Vol 90 (3) ◽  
Author(s):  
Idir Ramdani ◽  
Karen A. Pescatore ◽  
Belaid Bouazza
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Pulmonary Disease ◽  
Low Income ◽  
Hospital Admissions ◽  
Occupational Exposures ◽  
Low Income Countries ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive chronic inflammatory disease and the third cause of death worldwide in 2016. COPD epidemiology is well documented in high-income countries where the disease is well managed. However, the disease is neglected in low-income countries and there is lack of data. Our study aims to identify COPD patients’ characteristics and hospital admission causes, and to determine disease etiologies and associated factors. A retrospective study was conducted in COPD Algerian patients using medical record data collected from January 2007 to May 2017 at the pulmonology department of the Belloua Hospital of Tizi-Ouzou city. Out of 133 hospital admissions for COPD during the study period, only 120 records were found and analyzed. Most of the admitted patients were men (96%) and the mean age was 74.29±9.56 years. Among them, 78.7% were in the GOLD stage III or IV and 9 deaths (7.5%) were recorded during the study period. Interestingly, disease severity is associated with increasing age of the patients and mortality (p=0.01 and p=0.02, respectively). Risk factors include cigarette smoking (93%), history of medical conditions (36.66%) with the most prevalent conditions being emphysema (38.63%) and asthma (27.27%), the cold season (47%), and occupational exposures (58%). Most of the admissions (64.16%) were due to acute dyspnea and 21.66 % to respiratory infections, however, 34.16 % of patients were readmitted at least one time. Comorbidities were observed in 57.5% of the patients, including cardiovascular diseases (63.76%) and diabetes (18.84%). These results show that COPD severity is associated with age and mortality. Better understanding of the COPD etiologies and the causes of hospital admission will lead to more effective management of the disease.

scholarly journals Changing patterns of hospital admission for asthma, 1981–97

Thorax ◽  
2001 ◽  
Vol 56 (9) ◽  
pp. 687-690
Author(s):  
D S Morrison ◽  
P McLoone
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Hospital Admission Rate ◽  
Admission Rates ◽  
Lengths Of Stay ◽  
Icd 10 ◽  
Changing Patterns ◽  
Bed Days ◽  
Age And Sex

BACKGROUNDHospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland.METHODSLinked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45–6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex.RESULTSThere were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children.CONCLUSIONSAfter a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

Poisoning due to Insect and Scorpion Stings/Bites

1993 ◽  
Vol 12 (2) ◽  
pp. 123-125 ◽  
Author(s):  
Charles F.B. Nhachi ◽  
Ossy M.J. Kasilo
Keyword(s):  
Retrospective Study ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Average Duration ◽  
Age Groups ◽  
Age Group ◽  
Duration Of Hospitalization ◽  
Scorpion Stings ◽  
Insect Stings

1 A retrospective study, 1980 to 1989 inclusive, of hospital admission cases due to insect and scorpion stings or bites was carried out in the six main central hospitals of Zimbabwe's four main cities. 2 A total of 92 cases were recorded and analysed. This constituted 1.5% of all hospital admissions for poisoning which were analysed during that time. 3 Of the 92 cases the highest number of victims were seen in the 2-to-5-year age group (29.3%), followed by the 6-to-10-year age group (23.9%). In other age groups the incidence of poisoning was distributed approximately evenly with the 41 to 50 and the over 60-year age groups having the least number of victims, (2.2%). 4 The main groups of insects associated with poisoning were bees, 44.6%; wasps, 8.7%; and spiders 8.7%. A further 32.6% of the insect stings were not specified. Scorpion stings accounted for 5.4% of incidences. 5 No fatalities occurred. 6 Treatment consisted mainly of the administration of promethazine, as an antihistamine in 35% of the cases, steroids (16.5% of the cases), perhaps for their anti-allergic effects, and paracetamol, a mild analgesic, (14.7% of the cases). Interestingly, 22.6% of the cases were given an antibiotic (14.1 % of which were penicillins). Adrenaline was administered in only 1.7% of the cases. 7 The majority of the recorded cases, 49.4%, were hospitalized for at least a day and the average duration of hospitalization was 6.4 days.

scholarly journals Validating coding for a chronic condition (Cerebral Palsy) in routinely collected hospital admissions data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Bethan Carter ◽  
Hywel Jones ◽  
Jackie Bethell ◽  
Alison Kemp ◽  
Ting Wang
Keyword(s):  
Cerebral Palsy ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Hospital Data ◽  
Case Identification ◽  
Healthcare Data ◽  
Routinely Collected Data ◽  
Admission Data ◽  
Icd 10

IntroductionData-linkage provides an opportunity to evaluate healthcare utilisation of patients with chronic health conditions. However the consistency and accuracy of recording chronic conditions in routinely collected healthcare data is unclear and we aim to explore this in children and young people (CYP) with a cerebral palsy (CP). Objectives and ApproachThe study aims to validate CP case identification in routinely collected data by data-linking cases from The Northern Ireland Cerebral Palsy Register (NICPR) born 1981-2011 with routinely collected hospital admission data and cross-referencing cases between the two datasets. CP cases were identified in the administrative data using ICD-10 codes G80 (cerebral palsy), G81 (hemiplegia), G82 (paraplegia and tetraplegia) and G83.0-83.3 (diplegia and monoplegias). ResultsThere were 1,693 cases in the NICPR cohort and 1,733 cases of CP identified in the hospital admissions data, 915 of which were on the NICPR giving a positive predictive value for identifying a CP case within routinely collected data of 52.8%. Specificity was high (99.8%) however sensitivity was low (54.1%). 1,157 (68.3%) patients on the NICPR had at least one hospital admission. 914 (79.0 %) cases were coded at some time point with G80-83.3 (829 (71.7%) G80, 328 (28.3%)  G81-83.3). NICPR cases had a total 11,844 hospital admissions and a CP code was recorded during 6,397 (54.0%). The type of CP was recorded in NICPR for 1,673 (98.8%) cases whereas in the hospital admissions, data the majority (70.6%) were coded as other/unspecified CP (G80.8-9). Conclusion/ImplicationsThis study adds to understanding of CP coding practices within routinely collected hospital data, further supporting claims that coding of CP within such datasets is poor. Coding must be accurate and consistent if data are to be meaningful, comparable and useful to inform health outcome reviews and patient care.

scholarly journals National Temporal Trend Analysis of Infective Endocarditis among Patients Infected with HIV in Spain (1997–2014): A Retrospective Study

2019 ◽  
Vol 8 (8) ◽  
pp. 1167 ◽  
Author(s):  
Maria Fe Muñoz-Moreno ◽  
Pablo Ryan ◽  
Alejandro Alvaro-Meca ◽  
Jorge Valencia ◽  
Eduardo Tamayo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Infective Endocarditis ◽  
Hospital Admissions ◽  
Downward Trend ◽  
Coagulase Negative Staphylococci ◽  
Data Set ◽  
Gram Negative ◽  
Epidemiological Trend ◽  
Incidence And Mortality ◽  
Significant Downward Trend

Background: People living with human immunodeficiency virus (HIV) (PLWH) form a vulnerable population for the onset of infective endocarditis (IE). We aimed to analyze the epidemiological trend of IE, as well as its microbiological characteristics, in PLWH during the combined antiretroviral therapy era in Spain. Methods: We performed a retrospective study (1997–2014) in PLWH with data obtained from the Spanish Minimum Basic Data Set. We selected 1800 hospital admissions with an IE diagnosis, which corresponded to 1439 patients. Results: We found significant downward trends in the periods 1997–1999 and 2008–2014 in the rate of hospital admissions with an IE diagnosis (from 21.8 to 3.8 events per 10,000 patients/year; p < 0.001), IE incidence (from 18.2 to 2.9 events per 10,000 patients/year; p < 0.001), and IE mortality (from 23.9 to 5.5 deaths per 100,000 patient-years; p < 0.001). The most frequent microorganisms involved were staphylococci (50%; 42.7% Staphylococcus aureus and 7.3% coagulase-negative staphylococci (CoNS)), followed by streptococci (9.3%), Gram-negative bacilli (8.3%), enterococci (3%), and fungus (1.4%). During the study period, we found a downward trend in the rates of CoNS (p < 0.001) and an upward trends in streptococci (p = 0.001), Gram-negative bacilli (p < 0.001), enterococci (p = 0.003), and fungus (p < 0.001) related to IE, mainly in 2008–2014. The rate of community-acquired IE showed a significant upward trend (p = 0.001), while the rate of health care-associated IE showed a significant downward trend (p < 0.001). Conclusions: The rates of hospital admissions, incidence, and mortality related to IE diagnosis in PLWH in Spain decreased from 1997 to 2014, while other changes in clinical characteristics, mode of acquisition, and pathogens occurred over this time.

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