Risk Factors and Cost of Nosocomial Infections in Pediatric Patients With Traumatic Brain Injury

Mapping Intimacies ◽

10.21203/rs.3.rs-96061/v1 ◽

2020 ◽

Author(s):

Feyza Incekoy Girgin ◽

Makbule Nilufer Ozturk

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Nosocomial Infections ◽

Pediatric Patients ◽

Cost Benefit ◽

Pediatric Intensive Care ◽

Bloodstream Infections ◽

Cost Benefit Ratio ◽

The Cost

Abstract Aim: This study aimed to determine the factors that increase and decrease the presence of the nosocomial infections in pediatric patients with traumatic brain injury, and the effects on both treatment cost and length of hospital stay.Methods: We performed a case-control study on patients admitted to the pediatric intensive care unit (PICU) with (n=66) or without (n=120) traumatic brain injury (TBI) between 2012 and 2014. The risk factors, length of stay, and costs of nosocomial infections, were determined. Results: Data for 186 patients were analyzed. Hundred and twenty patients were controls (54 males vs. 66 females), while 66 were cases (27 males vs. 39 females). Seventeen out of the 186 PICU patients had nosocomial infections. The most isolated microbial agent was Acinetobacter baumannii (four cases). Thirteen (76.5%) out of the 17 infections were catheter-related bloodstream infections. The mean expenses per PICU patient were $762, with an additional cost of $2081 for patients with nosocomial contamination. Conclusion: The use of catheters was the most critical risk factor for nosocomial infections in our study. The cost was probably underestimated for several reasons. Nevertheless, the findings supported our hypothesis about the additional burden of nosocomial spread on PICU patients. The results of this study should help to provide evidence on cost-effectiveness or calculating the cost-benefit ratio of reducing nosocomial infections in children.

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A Prospective Analysis of Derangement of Coagulation Profile in Adult and Pediatric Age Group in Moderate-to-Severe Traumatic Brain Injury

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1676556 ◽

2018 ◽

Vol 15 (02/03) ◽

pp. 087-093

Author(s):

Swarup Sohan Gandhi ◽

Manish Mann ◽

Shashikant Jain ◽

Ugan Singh Meena ◽

Virendra Deo Sinha

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Pediatric Patients ◽

Age Groups ◽

Age Group ◽

Pediatric Age ◽

Coagulation Profile ◽

Pediatric Age Group ◽

Severe Tbi

Abstract Background and Aim of Study Coagulopathy is a common occurrence following traumatic brain injury (TBI). Various studies have reported the incidence and risk factors of coagulopathy and their correlation with poor outcome in adult as well as pediatric age group. In our study, we aim to analyze trauma-induced coagulopathy in adult and pediatric patients. Methods Adult (> 18 years) and pediatric (< 18 years) patients of TBI admitted in the intensive care unit of a trauma center of a tertiary care center had been studied from August 2015 to March 2018. Patients were further subdivided into moderate and severe TBI based on Glasgow Coma Scale (GCS) of 9 to 12 and < 9, respectively. Coagulation profile (prothrombin time [PT], activated partial thromboplastin time [APTT], thrombin time, fibrinogen, and D-dimer) and arterial blood gas (ABG) analysis were done on day of admission and on days 3 and 7. Coagulation profiles were analyzed in both the age groups, and risk factors were studied and correlated with the mortality and morbidity based on the Glasgow outcome score. Results Two hundred patients including 143 adults and 57 pediatric patients were included. Mean age among the adult and pediatric population was 31.51 ± 16.83 and 11.5 ± 5.90 years, respectively. In adults, 96 (83.62%) out of 116 in severe TBI group and 20 (74.07%) out of 27 in moderate TBI group developed coagulopathy, and in pediatric age group, 14 (70%) out of 20 in moderate TBI and 30 (81.08%) out of 37 in severe TBI developed coagulopathy. Midline shift was significantly associated with coagulopathy in both the age groups (p value < 0.039). Mortality was not significantly different in patients with coagulopathy between the age groups, but improved status as per the Glasgow outcome score was more in pediatric age group. Conclusion The development of coagulopathy is a frequent complication in patients with moderate to severe TBI in both age groups. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.

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Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.1.peds12483 ◽

2013 ◽

Vol 11 (5) ◽

pp. 526-532 ◽

Cited By ~ 74

Author(s):

Christian A. Bowers ◽

Jay Riva-Cambrin ◽

Dean A. Hertzler ◽

Marion L. Walker

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Multivariate Analysis ◽

Brain Injury ◽

Decompressive Craniectomy ◽

Pediatric Patients ◽

Skull Fracture ◽

Bone Flap ◽

Bone Flap Resorption ◽

Independent Risk Factors

Object Decompressive craniectomy with subsequent autologous cranioplasty, or the replacement of the native bone flap, is often used for pediatric patients with traumatic brain injury (TBI) who have a mass lesion and intractable intracranial hypertension. Bone flap resorption is common after bone flap replacement, necessitating additional surgery. The authors reviewed their large database of pediatric patients with TBI who underwent decompressive craniectomy followed by bone flap replacement to determine the rate of bone flap resorption and identify associated risk factors. Methods A retrospective cohort chart review was performed to identify long-term survivors who underwent decompressive craniectomy for severe TBI with bone flap replacement from January 1, 1996, to December 31, 2011. The risk factors investigated in a univariate statistical analysis were age, sex, underlying parenchymal contusion, Glasgow Coma Scale score on arrival, comminuted skull fracture, posttraumatic hydrocephalus, bone flap wound infection, and freezer time (the amount of time the bone flap was stored in the freezer before replacement). A multivariate logistic regression model was then used to determine which of these were independent risk factors for bone flap resorption. Results Bone flap replacement was performed at an average of 2.1 months after decompressive craniectomy. Of the 54 patients identified (35 boys, 19 girls; mean age 6.2 years), 27 (50.0%) experienced bone flap resorption after an average of 4.8 months. Underlying parenchymal contusion, comminuted skull fracture, age ≤ 2.5 years, and posttraumatic hydrocephalus were significant, or nearly significant, on univariate analysis. Multivariate analysis identified underlying contusion (p = 0.004, OR 34.4, 95% CI 3.0–392.7), comminuted skull fractures (p = 0.046, OR 8.5, 95% CI 1.0–69.6), posttraumatic hydrocephalus (p = 0.005, OR 35.9, 95% CI 2.9–436.6), and age ≤ 2.5 years old (p = 0.01, OR 23.1, 95% CI 2.1–257.7) as independent risk factors for bone flap resorption. Conclusions After decompressive craniectomy for pediatric TBI, half of the patients (50%) who underwent bone flap replacement experienced resorption. Multivariate analysis indicated young age (≤ 2.5 years), hydrocephalus, underlying contusion as opposed to a hemispheric acute subdural hematoma, and a comminuted skull fracture were all independent risk factors for bone flap resorption. Freezer time was not found to be associated with bone flap resorption.

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Advances in Rapid Molecular Blood Culture Diagnostics: Healthcare Impact, Laboratory Implications, and Multiplex Technologies

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.027409 ◽

2019 ◽

Vol 3 (4) ◽

pp. 617-630 ◽

Cited By ~ 12

Author(s):

Rosemary C She ◽

Jeffrey M Bender

Keyword(s):

Blood Culture ◽

Cost Benefit ◽

Bloodstream Infections ◽

Rapid Identification ◽

Resistance Marker ◽

Stewardship Program ◽

Cost Benefit Ratio ◽

The Cost ◽

Organism Identification ◽

Marker Detection

Abstract Background For far too long, the diagnosis of bloodstream infections has relied on time-consuming blood cultures coupled with traditional organism identification and susceptibility testing. Technologies to define the culprit in bloodstream infections have gained sophistication in recent years, notably by application of molecular methods. Content In this review, we summarize the tests available to clinical laboratories for molecular rapid identification and resistance marker detection in blood culture bottles that have flagged positive. We explore the cost–benefit ratio of such assays, covering aspects that include performance characteristics, effect on patient care, and relevance to antibiotic stewardship initiatives. Summary Rapid blood culture diagnostics represent an advance in the care of patients with bloodstream infections, particularly those infected with resistant organisms. These diagnostics are relatively easy to implement and appear to have a positive cost–benefit balance, particularly when fully incorporated into a hospital's antimicrobial stewardship program.

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Clinical and Economic Impact of Pharmacists’ Intervention on Care of Pediatric Hematology and Oncology Patients

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211068139 ◽

2021 ◽

pp. 107815522110681

Author(s):

Hyun Jee Kim ◽

Sunghee Lee ◽

Yu Jin Lee ◽

Sunghwan Kim ◽

Yun Hee Jo ◽

...

Keyword(s):

Economic Impact ◽

Patient Perspective ◽

Pediatric Patients ◽

Cost Benefit ◽

Hospital Perspective ◽

Pediatric Hematology ◽

Patients With Cancer ◽

Cost Benefit Ratio ◽

Clinically Significant ◽

The Cost

Introduction Children with cancer may be one of the most vulnerable groups to drug-related adverse events because they possess characteristics of patients with cancer as well as pediatric patients. To evaluate the clinical and economic impact of pharmacists’ intervention on the care of pediatric hematology and oncology patients in the inpatient and outpatient settings of a children's hospital. Methods The pharmacist-intervention records from 2017 were retrospectively reviewed. Intervention rate, type of drug-related problems, acceptance rate, and frequently involved drugs in pharmacist interventions were analyzed. One physician and one pharmacist evaluated the clinical significance of each intervention. A cost-benefit analysis was conducted from hospital and patient perspective. The benefit from cost savings by reducing the number of prescribed drugs that are disposed was estimated as the benefit from hospital perspective. The benefit from cost avoidance based on the potential to avoid an adverse drug event (ADE) was estimated as the benefit from patient perspective. The cost of reviewing prescriptions was estimated based on the pharmacists’ salary and the time involved. Results In 2017, 2361 interventions were performed in 381 pediatric patients with cancer. The acceptance rate was 97.2%. More than half of the interventions were regarded as clinically “significant” (58.8%) and “very significant” (14.6%). The cost-benefit of US$28,705 was determined from hospital perspective, with a cost-benefit ratio of 1.45:1. The cost-benefit of US$35,611 was calculated from patient perspective, with a cost-benefit ratio of 1.55:1. Conclusions Pharmacists’ intervention in the care of hematology and oncology pediatric patients was effective in preventing clinically significant ADEs and had a positive economic impact on the health-care budget from both hospital and patient perspective.

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A-126 Clinical Utility of Risk Factors to Predict Self-reported Neurobehavioral Outcome Following Traumatic Brain Injury: PTSD, Sleep, Resilience, and Lifetime Blast Exposure

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.126 ◽

2020 ◽

Vol 35 (6) ◽

pp. 919-919

Author(s):

Lange R ◽

Lippa S ◽

Hungerford L ◽

Bailie J ◽

French L ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Risk Factor ◽

Brain Injury ◽

Clinical Utility ◽

Poor Sleep ◽

Post Injury ◽

Poor Outcome ◽

Blast Exposure ◽

Neurobehavioral Outcome

Abstract Objective To examine the clinical utility of PTSD, Sleep, Resilience, and Lifetime Blast Exposure as ‘Risk Factors’ for predicting poor neurobehavioral outcome following traumatic brain injury (TBI). Methods Participants were 993 service members/veterans evaluated following an uncomplicated mild TBI (MTBI), moderate–severe TBI (ModSevTBI), or injury without TBI (Injured Controls; IC); divided into three cohorts: (1) < 12 months post-injury, n = 237 [107 MTBI, 71 ModSevTBI, 59 IC]; (2) 3-years post-injury, n = 370 [162 MTBI, 80 ModSevTBI, 128 IC]; and (3) 10-years post-injury, n = 386 [182 MTBI, 85 ModSevTBI, 119 IC]. Participants completed a 2-hour neurobehavioral test battery. Odds Ratios (OR) were calculated to determine whether the ‘Risk Factors’ could predict ‘Poor Outcome’ in each cohort separately. Sixteen Risk Factors were examined using all possible combinations of the four risk factor variables. Poor Outcome was defined as three or more low scores (< 1SD) on five TBI-QOL scales (e.g., Fatigue, Depression). Results In all cohorts, the vast majority of risk factor combinations resulted in ORs that were ‘clinically meaningful’ (ORs > 3.00; range = 3.15 to 32.63, all p’s < .001). Risk factor combinations with the highest ORs in each cohort were PTSD (Cohort 1 & 2, ORs = 17.76 and 25.31), PTSD+Sleep (Cohort 1 & 2, ORs = 18.44 and 21.18), PTSD+Sleep+Resilience (Cohort 1, 2, & 3, ORs = 13.56, 14.04, and 20.08), Resilience (Cohort 3, OR = 32.63), and PTSD+Resilience (Cohort 3, OR = 24.74). Conclusions Singularly, or in combination, PTSD, Poor Sleep, and Low Resilience were strong predictors of poor outcome following TBI of all severities and injury without TBI. These variables may be valuable risk factors for targeted early interventions following injury.

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