scholarly journals Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

2018 ◽  
Vol 12 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Aroldo Bacellar ◽  
Telma Assis ◽  
Bruno B. Pedreira ◽  
Gersonita Costa ◽  
Osvaldo J.M. Nascimento
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Low Socioeconomic Status ◽  
Neurological Disorders ◽  
Risk Model ◽  
Medical Center ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Neurological Complications ◽  
Low Socioeconomic

Background: Neurological disorders (NDs) are associated with high hospital mortality. We aimed to identify predictors of hospital mortality among elderly inpatients with NDs. Methods: Patients aged ≥60 years admitted to the hospital between January 1, 2009 and December 31, 2010 with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic data, NDs, and comorbidities as independent predictors of hospital mortality. Logistic regression was performed for multivariable analysis. Results: Overall, 1540 NDs and 2679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8±9.1). Of these, 54.5% were female. Diagnostic frequency of NDs ranged between 0.3% and 50.8%. Diagnostic frequency of comorbidities ranged from 5.6% to 84.5%. Comorbidities varied from 0 to 9 per patient (90% of patients had ≥2 comorbidities), mean 3.2±1.47(CI, 3.1-3.3). Patients with multimorbidities presented with a mean of 4.7±1.7 morbidities per patient. Each ND and comorbidity were associated with high hospital mortality, producing narrow ranges between the lowest and highest incidences of death (hospital mortality = 18%) (95% CI, 15%-21%). After multivariable analysis, advanced age (P<0.001) and low socioeconomic status (P=0.003) were recognized as predictors of mortality, totaling 9% of the variables associated with hospital mortality. Conclusion: Neither a particular ND nor an individual comorbidity predicted hospital mortality. Age and low socioeconomic class accounted for 9% of predictors. We suggest evaluating whether functional, cognitive, or comorbidity scores will improve the risk model of hospital mortality in elderly patients admitted with ND.

scholarly journals Predictors of readmission and long length of stay in elders admitted with neurological disorders in a tertiary center: a real-world investigation

2019 ◽  
Vol 77 (5) ◽  
pp. 321-329 ◽  
Author(s):  
Aroldo Bacellar ◽  
Bruno B. Pedreira ◽  
Gersonita Costa ◽  
Telma Assis ◽  
Camila Lobo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neurological Disorders ◽  
Hospital Readmission ◽  
Risk Model ◽  
Neurological Complications ◽  
Respiratory Disorder ◽  
Socioeconomic Class ◽  
Low Socioeconomic ◽  
Tertiary Center ◽  
Patient Readmissions

ABSTRACT Hospital readmission and long length of stay (LOS) increase morbidity and hospital mortality and are associated with excessive costs to health systems. Objective: This study aimed to identify predictors of hospital readmission and long LOS among elders with neurological disorders (NDs). Methods: Patients ≥ 60 years of age admitted to the hospital between January 1, 2009, and December 31, 2010, with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic factors, NDs, and comorbidities as independent predictors of readmission and long LOS (≥ 9 days). Logistic regression was performed for multivariate analysis. Results: Overall, 1,154 NDs and 2,679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8 ± 9.1). Of the patients, 54.5% were female. Patient readmissions were 251(31%) and 409 patients (51%) had an LOS ≥ 9 days (95% confidence interval 48%–55%). We found no predictors for readmission. Low socioeconomic class (p = 0.001), respiratory disorder (p < 0.001), infection (p < 0.001), genitourinary disorder (p < 0.033), and arterial hypertension (p = 0.002) were predictors of long LOS. Identified risks of long LOS explained 22% of predictors. Conclusions: Identifying risk factors for patient readmission are challenges for neurology teams and health system stakeholders. As low socioeconomic class and four comorbidities, but no NDs, were identified as predictors for long LOS, we recommend studying patient multimorbidity as well as functional and cognitive scores to determine whether they improve the risk model of long LOS in this population.

scholarly journals Multimorbidity and associated outcomes among older adult inpatients with neurological disorders

2021 ◽  
Vol 79 (1) ◽  
pp. 30-37
Author(s):  
Aroldo BACELLAR ◽  
Telma ASSIS ◽  
Bruno Bacellar PEDREIRA ◽  
Luan CÔRTES ◽  
Silas SANTANA ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Mortality ◽  
Neurological Disorders ◽  
Medical Center ◽  
Demographic Data ◽  
Neuromuscular Disorders ◽  
Length Of Hospital Stay ◽  
Poor Quality ◽  
Patients With Epilepsy ◽  
Chronic Comorbidities

ABSTRACT Background: Multimorbidity is common among adults and associated with socioeconomic deprivation, polypharmacy, poor quality of life, functional impairment, and mortality. Objectives: To identify the frequency of multimorbidity among older adults inpatients with neurological disorders (NDs), stratify clusters of chronic comorbidities associated with NDs in degrees, and verify whether multimorbidity was associated with demographic data, readmission, long length of hospital stay (LOS), and hospital mortality in this population. Methods: We enrolled patients aged ≥60 years successively admitted to a tertiary medical center with NDs between January 1, 2009, and December 31, 2010. Results: Overall, 1,154 NDs and 2,679 comorbidities were identified among 798 inpatients aged ≥60 years (mean: 75.76±9.12). Women comprised 435 (54.51%) of patients. Multimorbidity was detected in 92.61% (739) of patients, with a mean of 3.88±1.67 (median: 4.0), ranging from 2 to 10 chronic diseases. Patients with epilepsy, dementia, and movement disorders had the highest degrees of clusters of chronic morbidities (>50% of them with ≥5 chronic disorders), followed by those with cerebrovascular and neuromuscular disorders. Multimorbidity was associated with long LOS (p<0.001) and readmission (p=0.039), but not with hospital mortality (p=0.999). Conclusions: Multimorbidity was preponderant among older adults inpatients with NDs, and NDs had a high degree of associated chronic comorbidities. Multimorbidity, but not isolated NDs, was associated with readmission and long LOS. These results support ward-based, neurohospitalist-directed, interdisciplinary care for older adults inpatients with NDs to face multimorbidity.

scholarly journals Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wonjin Choi ◽  
Seon Hee Woo ◽  
Dae Hee Kim ◽  
June Young Lee ◽  
Woon Jeong Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
Prolonged Length ◽  
History Of

Background. This study aimed at investigating whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU may be associated with adverse clinical outcomes in elderly patients with infections. Methods. This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results, and ED LOS. Outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was applied to identify factors predictive of mortality. Results. A total of 439 patients admitted to the ICU via the ED were included in this study, 132 (30.1%) of whom died in the hospital. The median (IQR) age was 78 (73, 83) years. In multivariable analysis, a history of malignancy (OR: 3.76; 95% CI: 1.88–7.52; p < 0.001 ), high lactate level (OR: 1.13; 95% CI: 1.01–1.27; p = 0.039 ), and ED LOS (OR: 1.01; 95% CI: 1.00–1.02; p = 0.039 ) were independent risk factors for all-cause in-hospital admission. Elderly patients with an ED LOS >12 hours had a longer hospital LOS ( p = 0.018 ), and those with an ED LOS > 24 hours had a longer hospital LOS and higher mortality rate ( p = 0.044 ,   p = 0.008 ). Conclusions. This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections who visit the ED.

Promoting physical activity compliance in a low socioeconomic Latina population with chronic neurological disorders: A Proof-of-Concept Study (Preprint)

2021 ◽  
Author(s):  
Alexander Garbin ◽  
Jesús Díaz ◽  
Vy Bui ◽  
Janina Morrison ◽  
Beth E Fisher ◽  
...  
Keyword(s):  
Physical Activity ◽  
Effect Size ◽  
Neurological Disorders ◽  
Medical Center ◽  
Vigorous Physical Activity ◽  
Community Based ◽  
Self Monitoring ◽  
Low Socioeconomic ◽  
Behavioral Coaching

BACKGROUND Physical activity is known to improve quality of life as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latinas are less likely to participate in recommended levels of physical activity due to common socioeconomic barriers including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity-monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting physical activity. OBJECTIVE To determine the feasibility and efficacy of a community-based intervention to promote physical activity (PA) through self-monitoring via a Fitbit and behavioral coaching in Latina participants with chronic neurological disorders. METHODS We conducted a proof-of-concept study in 21 Spanish-speaking Latina participants recruited from the Los Angeles County/ University of Southern California (LAC/USC) neurology clinic and enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital. Demographic data was assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. Physical activity promotion was determined by examining change in time spent performing moderate-vigorous physical activity (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days coaching occurred vs. days without coaching. Change in psychometric measures (baseline vs. post-intervention) and medical center visits (16-weeks pre-intervention vs. during intervention) were also examined. RESULTS Participants were of low socioeconomic status and acculturation. 19 participants completed the study (attrition 9.5%) with high Fitbit wear adherence (90.31%). Time performing moderate-vigorous physical activity (MVPA) significantly increased throughout the study (P<0.001). Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent in MVPA on days coaching occurred. Participants’ illness perception (Effect Size g=.30), self-rated quality-of-life (Effect Size g=.32), and medical center visit frequency (Effect Size r =.44) improved. CONCLUSIONS Self-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion in low socioeconomic Latinas with chronic neurological conditions. PA is known to be important in brain health in neurological conditions but remains relatively unexplored in minority populations. CLINICALTRIAL Clinicaltrials.gov; NCT04820153

scholarly journals Relationship of Socioeconomic Status to Arterial Stiffness: Comparison Between Medical Aid Beneficiaries and National Health Insurance Beneficiaries

2020 ◽  
Vol 33 (8) ◽  
pp. 718-725
Author(s):  
Hack-Lyoung Kim ◽  
Jin Yong Lee ◽  
Woo-Hyun Lim ◽  
Jae-Bin Seo ◽  
Sang-Hyun Kim ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Arterial Stiffness ◽  
National Health Insurance ◽  
National Health ◽  
Low Socioeconomic Status ◽  
Multivariable Analysis ◽  
Laboratory Findings ◽  
Low Socioeconomic ◽  
Medical Aid

Abstract Background There is no general agreement on underlying pathophysiology explaining the high burden of cardiovascular disease on people at low socioeconomic status (SES). This study was conducted to investigate the association between healthcare systems and arterial stiffness. Methods A total of 8,929 subjects (60 years old and 55% were male) who underwent brachial-ankle pulse wave velocity (baPWV) measurement were retrospectively analyzed. There were 8,237 National Health Insurance (NHI) beneficiaries (92.2%) and 692 medical aid (MA) beneficiaries (7.8%). The median value of baPWV was 1,540 cm/s. Results Subjects with higher baPWV values (≥1,540 cm/s) were older, and more frequently had cardiovascular risk factors and unfavorable laboratory findings than those with lower values baPWV (&lt;1,540 cm/s). The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries (1,966 ± 495 vs. 1,582 ± 346 cm/s, P &lt; 0.001). The proportion of MA beneficiaries was significantly higher in subjects with higher baPWV than those with lower baPWV (13.1% vs. 2.3%, P &lt; 0.001). In multivariable analysis, MA beneficiaries were significantly associated with higher baPWV values even after controlling for potential confounders (odds ratio, 5.41; 95% confidence intervals, 4.02–7.27; P &lt; 0.001). Conclusions The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries. The result of this study provides additional evidence on the association between low SES and arterial stiffening.

scholarly journals Development and validation of a predictive model of in-hospital mortality in COVID-19 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247676
Author(s):  
Diego Velasco-Rodríguez ◽  
Juan-Manuel Alonso-Dominguez ◽  
Rosa Vidal Laso ◽  
Daniel Lainez-González ◽  
Aránzazu García-Raso ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Predictive Model ◽  
Predictive Value ◽  
Demographic Data ◽  
Smoking Habit ◽  
Fatal Outcome ◽  
Multivariable Analysis ◽  
Male Gender ◽  
Correlated Factors ◽  
D Dimer

We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.

scholarly journals Assessing and coping with the financial burden of computed tomography utilization in Limbe, Cameroon: a sequential explanatory mixed-methods study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Joshua Tambe ◽  
Lawrence Mbuagbaw ◽  
Pierre Ongolo-Zogo ◽  
Georges Nguefack-Tsague ◽  
Andrew Edjua ◽  
...  
Keyword(s):  
Health Insurance ◽  
Low Socioeconomic Status ◽  
Financial Burden ◽  
Multivariable Analysis ◽  
Mixed Methods Study ◽  
Financial Hardship ◽  
Low Socioeconomic ◽  
Ct Utilization ◽  
Explanatory Mixed Methods ◽  
Depth Interviews

Abstract Background There has been a significant increase in computed tomography (CT) utilization over the past two decades with the major challenges being a high exposure to ionizing radiation and rising cost. In this study we assess the risk of financial hardship after CT utilization and elaborate on how users adapt and cope in a sub-Saharan context with user fee for services and no national health insurance policy. Methods We carried out a sequential explanatory mixed methods study with a quantitative hospital-based survey of CT users followed by in-depth interviews of some purposively selected participants who reported risk of financial hardship after CT utilization. Data was summarized using frequencies, percentages and 95% confidence intervals. Logistic regression was used in multivariable analysis to determine predictors of risk of financial hardship. Identified themes from in-depth interviews were categorized. Quantitative and qualitative findings were integrated. Results A total of 372 participants were surveyed with a male to female sex ratio of 1:1.2. The mean age (standard deviation) was 52(17) years. CT scans of the head and facial bones accounted for 63% (95%CI: 59–68%) and the top three indications were suspected stroke (27% [95%CI: 22–32%]), trauma (14% [95%CI: 10–18%]) and persistent headaches (14% [95%CI: 10–18%]). Seventy-two percent (95%CI: 67–76%) of the respondents reported being at risk of financial hardship after CT utilization and predictors in the multivariable analysis were a low socioeconomic status (aOR: 0.19 [95%CI: 0.10–0.38]; p < 0.001), being unemployed or retired (aOR: 11.75 [95%CI: 2.59–53.18]; p = 0.001) and not having any form of health insurance (aOR: 3.59 [95%CI: 1.31–9.85]; p = 0.013). Coping strategies included getting financial support from family and friends, borrowing money and obtaining discounts from the hospital administration and staff. Conclusion No health insurance ownership, being unemployed or retired and a low socioeconomic status are associated with financial hardship after CT utilization. Diverse coping strategies are utilized to lessen the financial burden, some with negative consequences. Minimizing out-of-pocket payments and/or the direct cost of CT can reduce this financial burden and improve CT access.

Abstract TP334: Clinical Impact of Hematoma Expansion in LVAD Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kara Melmed ◽  
David Roh ◽  
Josh Willey
Keyword(s):  
Hospital Mortality ◽  
Medical Center ◽  
Demographic Data ◽  
Similar Rate ◽  
Left Ventricular ◽  
Hematoma Expansion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ich Score ◽  
The Impact

Background: Intracerebral hemorrhage (ICH) in left ventricular assist device (LVAD) patients is a devastating complication. Hematoma expansion (HE) is associated with poor outcomes in ICH patients, but the impact of HE on LVAD patients is not known. Prevention of HE includes rapid and complete coagulopathy reversal, adding further potential complications in LVAD patients given the inherent risk of hardware thrombosis. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality in this population. Methods: We performed a retrospective cohort study of ICH patients with preceding LVAD implantation admitted to Columbia University Irving Medical Center between Jan 2008 and April 2019. Intentionally matched ICH controls without LVADs were identified to compare rate of HE in LVAD and non LVAD patients. ICH volume was measured using ABC/2 method.We defined HE as an increase in hematoma volume of 6 ml or 33% comparing the first and last scan in 24 hours. Demographic data was compared using Pearson’s χ2 test for categorical variables and students T test and Wilcoxon rank sum test for normal and non-parametric continuous variables. The association between HE and hospital mortality in LVAD patients was examined using regression modeling after adjusting for Glasgow coma scale, age, hematoma size and location and admission INR. Results: Of605 LVAD patients, we identified 40 patients with ICH. Of these, 28 patients met the inclusion criteria. Mean (SD) age of LVAD patients was 56 (10), 29% of patients were female and the majority (81%) of LVAD patients were supported by Heartmate II. The median (interquartile range [IQR]) baseline hematoma size was 20.1 ml (8.6-46.9), median (IQR) ICH score was 1 (1-2). HE occurred in 16 (57%) patients supported by LVAD, and in 50% of patients without LVAD with no difference (p=0.6).There was an association between HE and in-hospital mortality in LVAD patients after adjusting for admission ICH score and INR (OR of 20.5, 95% CI: 1.8-232.8). Conclusions: HE is a potentially modifiable risk factor for mortality. We demonstrate that LVAD patients experience HE at a similar rate to matched controls. We show that prevention of HE with anticoagulation reversal does not increase mortality.

Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Song-I Lee ◽  
Younsuck Koh ◽  
Jin Won Huh ◽  
Sang-Bum Hong ◽  
Chae-Man Lim
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Medical Reason ◽  
Chronic Heart Disease

<b><i>Introduction:</i></b> An increase in age has been observed among patients admitted to the intensive care unit (ICU). Age is a well-known risk factor for ICU readmission and mortality. However, clinical characteristics and risk factors of ICU readmission of elderly patients (≥65 years) have not been studied. <b><i>Methods:</i></b> This retrospective single-center cohort study was conducted in a total of 122-bed ICU of a tertiary care hospital in Seoul, Korea. A total of 85,413 patients were enrolled in this hospital between January 1, 2007, and December 31, 2017. The odds ratio of readmission and in-hospital mortality was calculated by logistic regression analysis. <b><i>Results:</i></b> Totally, 29,503 patients were included in the study group, of which 2,711 (9.2%) had ICU readmissions. Of the 2,711 readmitted patients, 472 patients were readmitted more than once (readmitted 2 or more times to the ICU, 17.4%). In the readmitted patient group, there were more males, higher sequential organ failure assessment (SOFA) scores, and hospitalized for medical reasons. Length of stay (LOS) in ICU and in-hospital were longer, and 28-day and in-hospital mortality was higher in readmitted patients than in nonreadmitted patients. Risk factors of ICU readmission included the ICU admission due to medical reason, SOFA score, presence of chronic heart disease, diabetes mellitus, chronic kidney disease, transplantation, use of mechanical ventilation, and initial ICU LOS. ICU readmission and age (over 85 years) were independent predictors of in-hospital mortality on multivariable analysis. The delayed ICU readmission group (&#x3e;72 h) had higher in-hospital mortality than the early readmission group (≤72 h) (20.6 vs. 16.2%, <i>p</i> = 0.005). <b><i>Conclusions:</i></b> ICU readmissions occurred in 9.2% of elderly patients and were associated with poor prognosis and higher mortality.

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