Enzymatic Parameters at Admission and the Risk of Death in Politrauma Patientrs with Associated Thoracic Trauma

Abstract Polytrauma patients represent one of the most challenging medical conditions. Developing methods of assessing the risk of death in these patients is a continous effort for the medical field. In this study we evaluate the creatine kinaze isoenzyme MB (CK-MB) and troponin as markers of increased risk of death in the first 24 hours after admission in polytrauma patients with associated thoracic trauma. The study was conducted on 33 patients treated in the emergency department of County Clinical Emergency Hospital Constanta between 2014 and 2017. The results of the study suggest that CK-MB does not offer additional information related to the risk of death in these patients, while in the case of troponin, higher values were observed in the patients that didn’t survive after 24 hours of followup.

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P.064 Delays in the emergency department for stroke patients, medical complications and predictors of outcomes: the McGill experience

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.168 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S36-S36

Author(s):

C Legault ◽

B Chen ◽

L Vieira ◽

B Lo (Montreal) ◽

L Wadup ◽

...

Keyword(s):

Emergency Department ◽

Clinical Outcomes ◽

Stroke Unit ◽

Best Practice ◽

Brain Oedema ◽

Medical Complications ◽

Significant Delay ◽

Stroke Patients ◽

Risk Of Death ◽

Increased Risk

Background: The Canadian Stroke Best Practice recommends admission of patients to a specialised stroke unit within three hours. We aimed at assessing delays in our emergency department (ED) and correlating these with medical complications and clinical outcomes. Methods: Predictors and outcomes This is a retrospective review of patients (n=353) admitted with ischemic strokes (January 2011-March 2014). We assessed the length of stay in ED, medical complications in ED and in the stroke unit, functional status (modified Rankin Scale) at discharge and survival. Results: The median delay in ED was 13.8 hours. The rate of medical complications in the ED was 14% (most common being delirium), compared to the stroke unit with 46.7% (most common being pneumonia). Worse functional outcome was correlated with diagnosis of pneumonia (standardised β coefficient=0.2, p=0.001) and presence of brain oedema in the stroke unit (standardised β coefficient=0.2, p<0.01). Increased risk of death was correlated with brain oedema (OR=649.2, 95%CI=19-2184, p<0.01) and sepsis in the stroke unit (OR=26.8, 95%CI=2.1-339, p<0.01). Conclusions: We found a significant delay in the admission of our patients from the ED to the stroke unit, which is not in keeping with the present guidelines. Medical complications were correlated with worse outcomes. Future analyses will correlate ED delays with clinical outcomes.

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Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

BMC Pediatrics ◽

10.1186/s12887-019-1706-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Prosper J. Bashaka ◽

Hendry R. Sawe ◽

Victor Mwafongo ◽

Juma A. Mfinanga ◽

Michael S. Runyon ◽

...

Keyword(s):

Emergency Department ◽

Case Fatality ◽

Descriptive Study ◽

High Rate ◽

World Health ◽

Mortality Data ◽

Children Under Five ◽

Under Five ◽

Risk Of Death ◽

Increased Risk

Abstract Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania. Methods This was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR). Results A total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively. Conclusions In an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

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Markers of increased risk of death in polytrauma patients with associated chest trauma

Archives of the Balkan Medical Union ◽

10.31688/abmu.2018.53.3.14 ◽

2018 ◽

Vol 53 (3) ◽

pp. 401-407

Author(s):

Cristina TASE GHINGULEAC ◽

◽

Rodica O. TUDORAN ◽

Sergiu CHIRILA ◽

Leonard GURGAS ◽

...

Keyword(s):

Chest Trauma ◽

Risk Of Death ◽

Increased Risk ◽

Polytrauma Patients

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Low-impact pelvic fractures in the emergency department

CJEM ◽

10.1017/s1481803500012732 ◽

2010 ◽

Vol 12 (06) ◽

pp. 509-513 ◽

Cited By ~ 12

Author(s):

Greg Dodge ◽

Rob Brison

Keyword(s):

Emergency Department ◽

Elderly Women ◽

Pelvic Fractures ◽

Risk Of Death ◽

Ambulatory Ability ◽

Increased Risk ◽

Injury Mechanisms ◽

Injury Event ◽

Record Review ◽

Impact Injury

ABSTRACT Objective: We examined the records of patients presenting to the emergency department (ED) with low-impact pelvic fractures. We describe frequency, demographics, management and patient outcomes in terms of ambulatory ability, living independence and mortality. Methods: Patients treated for a pelvic fracture over a 2-year period in Kingston, Ont., were identified. We performed a retrospective hospital record review to distinguish high- versus low-impact injury mechanisms, and to characterize the injury event, ED management and outcomes for patients with low-impact fractures. Results: Of 132 pelvic fractures identified, 77 were low-impact fractures. Patients were predominantly women (82%) with a mean age of 81 years; 96% had some pre-existing medical comorbidity. The pubic rami were most commonly involved (86%). The median length of stay in the ED was 9.4 hours. Twenty-five patients (32%) were admitted to hospital. Ten patients had surgical stabilization, mostly of the acetabulum. Five patients died in hospital, 4 from pneumonia and 1 from myocardial infarction. Eight additional patients died within 1 year of injury. At discharge, only 18% lived independently and 16% walked without aids versus 42% and 38%, respectively, before injury. Conclusion: Low-impact pelvic fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of time and resources in the ED are used during the workup of these patients and while awaiting their disposition from the ED. These injuries are important because they affect independence and seem associated with an increased risk of death.

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Rurality, Death, and Healthcare Utilization in Heart Failure in the Community

Journal of the American Heart Association ◽

10.1161/jaha.120.018026 ◽

2021 ◽

Vol 10 (4) ◽

Author(s):

Sheila M. Manemann ◽

Jennifer St. Sauver ◽

Carrie Henning‐Smith ◽

Lila J. Finney Rutten ◽

Alanna M. Chamberlain ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Rural Area ◽

Healthcare Utilization ◽

International Classification Of Diseases ◽

Emergency Department Visits ◽

Risk Of Death ◽

Increased Risk ◽

Classification Of Diseases

Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first‐ever code for HF ( International Classification of Diseases, Ninth Revision [ ICD‐9 ], code 428, and International Classification of Diseases, Tenth Revision [ ICD‐10 ] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural‐urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen‐Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas ( P <0.001). After a mean (SD) follow‐up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09–1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82–0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73–0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health.

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N-Terminal Pro-B-Type Natriuretic Peptide – Prognstic Value for Death Within 24 Hours in Severe Polytrauma Patients with Chest Trauma

ARS Medica Tomitana ◽

10.2478/arsm-2018-0022 ◽

2018 ◽

Vol 24 (3) ◽

pp. 119-123

Author(s):

Tase Ghinguleac Cristina ◽

Tudoran Rodica ◽

Chirila Sergiu ◽

Gurgas Leonard ◽

Ion Ileana

Keyword(s):

Multiple Trauma ◽

Natriuretic Peptide ◽

Thoracic Trauma ◽

Chest Trauma ◽

Cardiac Injury ◽

Trauma Patients ◽

Death Rates ◽

Risk Of Death ◽

Polytrauma Patients ◽

Multiple Trauma Patients

Abstract Patients with multiple trauma with thoracic trauma have higher death rates compared to multiple trauma patients without thoracic trauma, mainly because of cardiac injury. We investigated the 24 hours prognostic value of NT-proB-type Natriuretic Peptide (Nt-ProBNP) in polytraumatised patients with thoracic trauma. The study group was composed of 33 patients, 25 males and 8 females. During the study, the endpoint, which was death in the first 24 hours after admission was observed in 33% of the patients (11 patients). Using a cut-off point of 125 pg/ml, the sensitivity of the test was 100% and the specificity was 59.09%. Accoring to the results of the study, NT-ProBNP proves that it might be useful in detecting patients with a bad prognosis, the analyzed enzyme having the capacity of identifying polytrauma patients with thoracic trauma that have high risk of death in the first 24 hours after admission.

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Abstract P117: Frailty and Outcomes among Heart Failure Patients in the Community

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap117 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Sheila M McNallan ◽

Shannon M Dunlay ◽

Mandeep Singh ◽

Alanna M Chamberlain ◽

Margaret M Redfield ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Emergency Department Visits ◽

Physical Component Score ◽

Risk Of Death ◽

Increased Risk ◽

Ed Visits

Objective: To determine among community heart failure (HF) patients whether frailty is associated with an increased risk of hospitalization, emergency department (ED) visits and death, independently of comorbidities. Background: Frailty is associated with adverse outcomes in some populations; however the prognostic value of frailty among HF patients is not fully documented, particularly for healthcare utilization. Methods: Olmsted, Dodge and Fillmore County residents with HF between 10/2007 and 12/2010 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss >10 lbs. in 1 year, physical exhaustion, weak grip strength, and slowness and low activity measured by the SF-12 physical component score. Intermediate frailty was defined as having 1-2 components. To account for repeated events, Anderson-Gill modeling was used to determine if frailty predicted hospitalization or ED visits. Cox proportional hazards regression examined associations between frailty and death. Results: Among 409 patients (mean age 73±13, 58% male), 19% were frail and 55% had intermediate frailty. Within one year, 449 hospitalizations, 523 ED visits and 34 deaths occurred. There was a positive graded association between frailty and hospitalization and ED visits (Table). After adjustment for age, sex, ejection fraction and comorbidity, frailty was associated with an 80% increased risk of hospitalization and a 60% increased risk of ED visits. Frailty was also associated with more than a 2-fold increased risk of death after adjustment. Conclusion: In the community, frailty is prevalent and is a strong and independent predictor of hospitalizations, ED visits and death among HF patients. As it is independent from coexisting comorbidities, frailty defines new avenues for intervention and should be formally assessed clinically. Hazard Ratios (95% CI) for Hospitalizations, Emergency Department Visits and Death by Frailty Status Not Frail Intermediate Frail Frail P for trend Hospitalization Crude 1.00 1.46 (1.05-2.02) 2.15 (1.45-3.19) <0.001 Fully-adjusted 1.00 1.29 (0.94-1.77) 1.82 (1.22-2.73) 0.005 Emergency Department Visits Crude 1.00 1.59 (1.14-2.21) 1.88 (1.22-2.90) 0.002 Fully-adjusted 1.00 1.46 (1.05-2.05) 1.58 (1.01-2.48) 0.034 Death Crude 1.00 1.40 (0.73-2.69) 3.98 (2.01-7.90) <0.001 Fully-adjusted 1.00 0.87 (0.44-1.73) 2.42 (1.19-4.95) 0.003

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COVID Outcome Prediction in the Emergency Department (COPE)

10.1101/2020.12.30.20249023 ◽

2021 ◽

Author(s):

David van Klaveren ◽

Alexandros Rekkas ◽

Jelmer Alsma ◽

Rob JCG Verdonschot ◽

Dick TJJ Koning ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Outcome Prediction ◽

Model Performance ◽

Hospital Death ◽

Icu Admission ◽

Risk Of Death ◽

Increased Risk ◽

Temporal Validation ◽

Second Wave

ABSTRACTBackground and aimThe COVID-19 pandemic is putting extraordinary pressure on emergency departments (EDs). To support decision making about hospital admission, we aimed to develop a simple and valid model for predicting mortality and need for admission to an intensive care unit (ICU) in suspected-COVID-19 patients presenting at the ED.MethodsFor model development, we included patients that presented at the ED and were admitted to 4 large Dutch hospitals with suspected COVID-19 between March and August 2020, the first wave of the pandemic in the Netherlands. Based on prior literature we included patient characteristics, vital parameters and blood test values, all measured at ED admission, as potential predictors. Logistic regression analyses with post-hoc uniform shrinkage was used to obtain predicted probabilities of in-hospital death and of being admitted to the ICU, both within 28 days after admission. Model performance (AUC; calibration plots, intercepts and slopes) was assessed with temporal validation in patients who presented between September and December 2020 (second wave). We used multiple imputation to account for missing predictor values.ResultsThe development data included 5,831 patients who presented at the ED and were hospitalized, of whom 629 (10.8%) died and 5,070 (86.9%) were discharged within 28 days after admission. A simple model – named COVID Outcome Prediction in the Emergency Department (COPE) – with linear age and logarithmic transforms of respiratory rate, CRP, LDH, albumin and urea captured most of the ability to predict death within 28 days. Patients who were admitted in the first month of the pandemic had substantially increased risk of death (odds ratio 1.99; 95% CI 1.61-2.47). COPE was well-calibrated and showed good discrimination for predicting death in 3,252 patients of the second wave (AUC in 4 hospitals: 0.82; 0.82; 0.79; 0.83). COPE was also able to identify patients at high risk of needing IC in second wave patients below the age of 70 (AUC 0.84; 0.81), but overestimated ICU admission for low-risk patients. The models are implemented as a web-based application.ConclusionCOPE is a simple tool that is well able to predict mortality and ICU admission for patients who present to the ED with suspected COVID-19 and may help to inform patients and doctors when deciding on hospital admission.

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P785Unplanned readmissions after discharge increases risk of death in acute dyspnoea patients: non-cardiac is as severe as cardiac causes

European Heart Journal ◽

10.1093/eurheartj/ehz747.0384 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Cerlinskaite ◽

A Mebazaa ◽

R Cinotti ◽

D N Wussler ◽

E Gayat ◽

...

Keyword(s):

Emergency Department ◽

Cox Regression ◽

Validation Cohort ◽

P Value ◽

Unplanned Readmission ◽

Cox Regression Analysis ◽

Derivation Cohort ◽

Risk Of Death ◽

Acute Dyspnoea ◽

Increased Risk

Abstract Introduction Acute dyspnoea is a major reason for admission to the emergency department and has been associated with high rates of readmission and mortality. However, the association of readmission with mortality risk has not been widely studied in patients with acute dyspnoea. Purpose To determine whether unplanned readmission during first 6 months after discharge is associated with greater risk of death within 1 year in patients with acute dyspnoea. Methods Derivation cohort consisted of 1371 patients from the prospective observational study, which enrolled acute dyspnoea patients admitted to emergency departments of two university centres from 2015 to 2017 and discharged alive from the hospital. Cox regression analysis compared 1-year risk of death between readmitted vs. non-readmitted patients in the first 6 months after discharge. In addition, we studied this association in 1986 patients from a multicentre validation cohort, which included acute dyspnoea patients from 2006 to 2014. Sensitivity analysis was done in the subgroups divided by cause of index admission (acute heart failure [AHF] and non-AHF) and cause of the first readmission (cardiovascular [CV] or non-CV). The statistical analyses were performed using R statistical software. P value of <0.05 was considered statistically significant. Results In the derivation cohort 666 (49%) of patients were readmitted at 6 months and 282 (21%) died in 1 year. Readmitted patients died more frequently than non-readmitted patients (211 [32%] vs. 71 [10%], respectively, p<0.001). All-cause 6-month readmission was associated with an increased 1-year risk of death in a multivariate analysis in both the derivation cohort (adjusted hazard ratio (aHR) 3 [95% confidence interval (CI) 2.2–4], p<0.001) and the validation cohort (aHR 1.8 [95% CI 1.4–2.2], p<0.001). Moreover, deleterious effect of readmission on 1-year survival was equally observed in AHF and non-AHF patients, independent of whether the reason of first readmission was cardiovascular or non-CV, in both study cohorts. The results are displayed in Figure 1. Figure 1. Main results of the study Conclusions Our data demonstrates that readmission is associated with a markedly increased risk of death within 1 year in patients presenting to the emergency department with acute dyspnoea. Furthermore, the detrimental relationship between outcomes is similar in non-cardiac and cardiac causes. Acknowledgement/Funding The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.

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Disparities in outcomes among patients diagnosed with cancer associated with emergency department visits

10.1101/2021.03.03.21252826 ◽

2021 ◽

Author(s):

Nicholas Pettit ◽

Elisa Sarmiento ◽

Jeffrey Kline

Keyword(s):

Emergency Department ◽

Low Income ◽

Emergency Department Visits ◽

Transitions Of Care ◽

Control Analysis ◽

Chi Square ◽

Entire Study ◽

Risk Of Death ◽

Increased Risk ◽

First Time

Importance: Diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to socioeconomic (SES) disparities, however data are limited. Objective: To examine the morality and associated disparities for cancer diagnoses made less than six months after an ED visit. Design: This study is case-control analysis of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time diagnoses of ICD-cancer appearing in the registry between January 2013 and December 2017 were included. Cases were patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no recent ED visits. Main Outcome(s) and Measure(s): Primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. Secondary outcomes include SES and demographic disparities. Results: 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. In cases and controls, the mean age was same at 65 and the Charlson Comorbidity Index (CCI) was the same at 2.0 in both groups. More of the ED cohort were Black than the non-ED cohort (12.4% vs 7.4%, P<.0001, Chi Square) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancer (8.9%), vs. the non-ED cohort were breast (17%), lung (14.9%), and prostate cancer (10.1%). Regardless of type, all ED-associated cancers had an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P<.0001) over the entire study period. Regression analysis predicting mortality, clustering by city, controlling for age, gender, race, SES, drug/alcohol/tobacco use, and CCI score, produced an odds ratio of 4.12 (95% CI 3.72-4.56 for ED associated cancers). Conclusion and Relevance: This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed in order to reduce disparities among ED-associated cancer diagnoses, including increased surveillance and improved transitions of care.

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