scholarly journals The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Anneloes NJ Huijgens ◽  
Laurens J van Baardewijk ◽  
Carolina JPW Keijsers
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Lateral View ◽  
X Ray ◽  
Hospital Patients ◽  
Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

scholarly journals Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

CMAJ Open ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. E322-E329 ◽  
Author(s):  
Zachary Bouck ◽  
Graham Mecredy ◽  
Noah M. Ivers ◽  
Ciara Pendrith ◽  
Ben Fine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Low Risk ◽  
Health Examination ◽  
Periodic Health Examination ◽  
X Ray ◽  
Risk Patients ◽  
Chest X Ray

scholarly journals Incidence of Bloodstream Infections in Patients with COVID-19: A Retrospective Cohort Study of Risk Factors and Outcomes

2021 ◽  
Author(s):  
Claudia Villatoro Santos ◽  
Elisa Akagi Fukushima ◽  
Wei Zhao ◽  
Mamta Sharma ◽  
Dima Youssef ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Disease ◽  
Bloodstream Infections ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Male Sex

Abstract Objective: To describe the incidence, risk factors, and outcomes of bloodstream infections (BSIs) in patients with coronavirus disease 19 (COVID-19).Methods: This was a single-center retrospective cohort study of adults admitted for COVID-19 with BSIs. Data were collected by electronic medical record review. BSIs were defined as positive blood cultures (BCs) with a known pathogen in one or more BCs or the same commensal organism in two or more BCs. Results: Of 565 eligible patients, 290 (51.3%) had BCs done, with 39 (13.4%) having a positive result. In univariable analysis, male sex, black/African American race, admission from a facility, hemiplegia, altered mental status, and a higher Charlson Comorbidity Index were positively associated with a positive BC, whereas obesity and low systolic blood pressure (SBP) were negatively associated. Patients with positive BCs were more likely to have severe disease, be admitted to the Intensive Care Unit (ICU), require mechanical ventilation, have septic shock, and higher mortality. In multivariable logistic regression, factors that were independent predictors of a positive BC were male sex (OR=2.75, p=0.03), hypoalbuminemia (OR=3.3, p=0.01), ICU admission (OR=5.3, p<0.0001), SBP < 100 (OR=3.7, p=0.03) and having a procedure (OR=10.5, p<0.0001). Patients with an abnormal chest x-ray on admission were less likely to have a positive BC (OR=0.25, p=0.007). Conclusions: We found that independent predictors of BSIs in COVID-19 patients included male sex, abnormal chest x-ray, hypoalbuminemia, admission to ICU, low SBP, and having a procedure during hospital stay.

scholarly journals Is Tocilizumab an effective therapy for Severe COVID-19: a retrospective cohort study

2020 ◽  
Author(s):  
Samreen Sarfaraz ◽  
Quratulain Shaikh ◽  
Sundus Iftikhar ◽  
Fivzia Farooq Herekar ◽  
Syed Ghazanfar Saleem ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Group Analysis ◽  
Length Of Hospital Stay ◽  
Median Length ◽  
X Ray ◽  
Chest X Ray ◽  
Baseline Characteristics ◽  
Critical Patients

Abstract ObjectivesTo compare the outcome of severe COVID-19 patients treated with Tocilizumab (TCZ). Methods: A retrospective cohort study comparing the clinical characteristics and outcomes of patients who received TCZ with those who did not, was conducted at The Indus Hospital, Karachi. A sub-group analysis was conducted on the TCZ group to identify predictors of mortality. Results 88 patients including 41 patients in the TCZ group and 47 in non-TCZ group were recruited. Baseline characteristics were comparable. TCZ group patients presented with worse clinical features including median SpO2 82% vs 88%, p<0.05 and CRP 193 vs 133.9 mg/L, p<0.05. TCZ group showed severe bilateral chest x-ray findings (92% vs 31%, p<0.05) compared to non-TCZ. In the TCZ group 85.4% were admitted in ICU compared to 69.8% in non-TCZ group, p>0.05. Mortality was not different among the groups (46% in TCZ group vs 51.1% in non-TCZ group, p>0.05). Median length of hospital stay, days of intubation, use of inotropic agents, use of invasive ventilation or in-hospital complications were not different between the groups. Sub-group analysis revealed that mortality within TCZ group was associated with high IL-6 levels (173 vs 69.66 pg/ml, p<0.05), ICU admission (100% vs 72%, p<0.05), need for mechanical ventilation (100% vs 13.6%, p<0.05) and higher incidence of in-hospital complications, p<0.05. ConclusionTCZ group had more critical patients and TCZ failed to demonstrate any mortality benefit in these patients. Non-survivors within the TCZ group were more critical compared to survivors and developed higher proportion of in hospital complications

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