On-admission laboratory predictors for developing critical COVID-19 during hospitalization – a multivariable logistic regression model

Abstract Background The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN. Methods This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model. Results A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%. Conclusion AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN. Disclosures All authors: No reported disclosures.

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Surgical Thoracoabdominal Aortic Aneurysm Repair in a Non-High-Volume Institution

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1708470 ◽

2020 ◽

Author(s):

Takashi Kunihara ◽

Claudia Vukic ◽

Fumihiro Sata ◽

Hans-Jaochim Schäfers

Keyword(s):

Spinal Cord ◽

Logistic Regression ◽

Aortic Aneurysm ◽

Regression Model ◽

Logistic Regression Model ◽

Thoracoabdominal Aortic Aneurysm ◽

Left Ventricular ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression ◽

Cord Injury

Abstract Background Surgical thoracoabdominal aortic aneurysm (TAAA) repair remains challenging. Apart from mortality, spinal cord injury (SCI) is a dreaded complication. We analyzed our experience to identify predictors for SCI in a nonhigh-volume institution. Patients and Methods All patients who underwent TAAA repair between February 1996 and November 2016 (n = 182) were enrolled. Most were male (n = 121; 66.4%), median age was 68 years (range: 21–84). Elective operations were performed in 153 instances (84.1%). Our approach to minimize SCI includes distal aortic perfusion, mild hypothermia, identification of the Adamkiewicz artery, and sequential aortic clamping. Cerebrospinal fluid drainage was introduced in 2001 and liberal use of selective visceral perfusion in 2006. Results Early mortality was 12.1%; it was 8.5% after elective procedures. Reduced left ventricular function, nonelective setting, older age, and longer bypass time were identified as independent predictors for mortality in multivariable logistic regression model. Permanent SCI was observed in nine patients (4.9%), of whom seven (3.8%) developed paraplegia. In a multivariable logistic regression model for paraplegia, peripheral arterial disease (PAD), Crawford type II repair, smaller body surface area, and era before 2001 were identified as independent predictors, whereas only PAD was significant for SCI. The incidence of paraplegia was 13.8% in extensive repair out of the first 91 cases, whereas it was improved up to 2.7% thereafter. Conclusion Using an integrated approach, acceptable outcome of TAAA repair can be achieved, even in a nonhigh-volume center. PAD and extensive involvement of the aorta are strong independent predictors for spinal cord deficit after TAAA repair.

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Beyond TILs: Predictors of pathologic complete response (pCR) in triple-negative breast cancer (TNBC) patients with moderate tumor-infiltrating lymphocytes (TIL) receiving neoadjuvant therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.572 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 572-572

Author(s):

Nour Abuhadra ◽

Kenneth R. Hess ◽

Jennifer Keating Litton ◽

Gaiane M Rauch ◽

Alastair Mark Thompson ◽

...

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Neoadjuvant Therapy ◽

Logistic Regression Model ◽

Stage I ◽

Multivariable Logistic Regression Model ◽

Ki 67 ◽

Early Stage Disease ◽

Cut Points ◽

Multivariable Logistic Regression

572 Background: Increased TIL in TNBC is associated with higher rates of pCR. High TIL is also associated with improved disease free survival and overall survival. The aim of this study is to identify data cut-points of pre-treatment low, moderate and high TIL count based on pCR and to identify clinical and pathological predictors of pCR in patients with moderate TIL. Methods: We evaluated the relationship between pCR and TIL in 180 patients with stage I-III TNBC enrolled in the ARTEMIS trial (NCT02276443). Recursive portioning was used to identify cut-points. Clinical and pathological variables such as age at diagnosis, stage, race, histology as well as Ki-67, vimentin, and androgen receptor (AR) by immunohistochemistry, were evaluated in pts with moderate TIL. A multivariable logistic regression model identified variables independently, significantly associated with pCR. Results: Four TIL groups were identified with pCR rates of 23%, 31%, 48% and 78% respectively (p < 0.0001) (Table A). In the two combined moderate TIL groups, 90 (97%) pts were evaluable for the multivariate model. Stage I-II disease, high Ki-67 and low AR were associated with increased probability of pCR (Table B). The multivariable logistic regression model area under the ROC curve was 0.78 (95% CI=0.68-0.88; p<0.0001). A model of computed risk score [ Stage I-II (score 2)+Ki-67≥ 50% (score 1)+AR<10% (score 1)] predicted a probability of 67% for pCR when all three variables were favorable (Table). Conclusions: Four TIL groups were identified. In pts with moderate TIL levels, early stage disease, high Ki-67 and low AR were associated with increased probability of pCR with neoadjuvant therapy. [Table: see text]

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Rapid screening for influenza using a multivariable logistic regression model to save labor at a clinic in Iwaki, Fukushima, Japan

American Journal of Infection Control ◽

10.1016/j.ajic.2014.01.019 ◽

2014 ◽

Vol 42 (5) ◽

pp. 551-553 ◽

Cited By ~ 2

Author(s):

Vinh Quang Nguyen ◽

Shigeto Abe ◽

Guanghao Sun ◽

Ayumu Matsuoka ◽

Hidekazu Nishimura ◽

...

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Logistic Regression Model ◽

Rapid Screening ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression

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The risk of flax versus straw bedding on ileal impaction in colic horses: Retrospective analysis of 2336 cases (2008-2017)

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v87i5.16058 ◽

2018 ◽

Vol 87 (5) ◽

pp. 255-262 ◽

Cited By ~ 1

Author(s):

A. Dufourni ◽

A. Decloedt ◽

L. Lefère ◽

D. De Clercq ◽

P. Deprez ◽

...

Keyword(s):

Logistic Regression ◽

Body Weight ◽

Regression Model ◽

Logistic Regression Model ◽

Cox Regression ◽

Conditional Logistic Regression ◽

Large Animal ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression ◽

Flax Shives

While mature coastal bermudagrass hay is strongly associated with ileal impaction in the Southeastern United States, stabling on flax bedding has anecdotally been associated with this condition in Europe. The aim of this retrospective study was to investigate the association between ileal impaction and the use of flax shives compared to straw as bedding in horses with colic. Medical records of 2336 referral cases evaluated for abdominal pain between January 2008 and May 2017 at the Department of Large Animal Internal Medicine, Ghent University were reviewed. Diagnosis, date of admission, age, breed, gender, body weight and stable bedding were recorded. Conditional logistic regression analysis was used to assess the association between ileal impaction and each individual variable. Odds ratios (OR) and 95% confidence intervals (CI) were determined. Predictors with a value of P < 0.2 were included in a multivariable Cox regression model and Wald’s test was used to assess parameter estimate significance. Further, the association between survival to discharge and type of bedding or type of treatment (medical versus surgical) was analyzed for horses with ileal impactions. The proportion of colic cases stabled on flax bedding at home was 11.3%. The overall prevalence of ileal impaction was 4.2%. In the flax group, the prevalence of ileal impaction was 9.4% as opposed to 3.6% within the straw group. The OR of 2.8 (95% CI 1.7-4.7; P < 0.001) in the multivariable logistic regression model indicated that horses stabled on flax shives were approximately three times more likely to have ileal impactions than horses stabled on straw. There was no significant association found between ileal impaction and the period of admission, age, gender or body weight in a multivariable logistic regression model. The odds for having ileal impaction is approximately six times (OR 6.3; 95% CI 2.4-16.4; P < 0.001) higher in draft horses than in warmbloods in the multivariable logistic regression model. No significant association was found between survival to discharge and type of bedding or treatment. These results suggest that horses with colic that were housed on flax bedding are more likely to present ileal impactions than horses housed on straw.

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Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Hematologic Patients: Experience at the Hospital Attending More Patients in Spain

Blood ◽

10.1182/blood-2020-141991 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 30-31

Author(s):

Alba Cabirta ◽

Macarena Izuzquiza ◽

Isabel Ruiz-Camps ◽

David Valcarcel ◽

Eva Catala ◽

...

Keyword(s):

Logistic Regression ◽

Severe Acute Respiratory Syndrome ◽

Regression Model ◽

Logistic Regression Model ◽

Hematologic Malignancies ◽

Active Therapy ◽

Multivariable Logistic Regression Model ◽

Hematopoietic Stem ◽

Multivariable Logistic Regression ◽

The Impact

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic raises many questions about the management of patients with significant comorbidities. Hematologic patients are usually fragile due to an important immunosuppression, so the impact of coronavirus disease (COVID-19) is yet to be determined. MATERIALS AND METHODS: We conducted a single-center retrospective observational study of patients with hematologic malignancies diagnosed with SARS-CoV-2 at Vall d´Hebron University Hospital (HUVH) between March 1st and May 31st 2020 to analyze their clinical characteristics and evolution. Patient's demographic data, underlying pathology, signs and symptoms of COVID-19, treatment received and clinical course were collected. A statistical analysis was performed to identify the possible variables associated with COVID-19 mortality. For this purpose, we used univariate and multivariable logistic regression models. RESULTS: We identified 70 patients with PCR confirmed SARS-CoV-2 infection and hematologic malignancy. The median age was 75 years (range 22-91), and 44% were female. The majority (74%) had evidence of active malignancy and 53% were receiving active therapy. Lymphoid pathology (73%) predominated over myeloid. The median number of previous lines of treatment was 0 (range 0-6), 23% had received at least 2 lines, whereas 10% underwent hematopoietic stem cell transplantation (HSCT) (5 patients allo-HSCT, 2 auto-HSCT). Half of the patients had more than one pre-existing comorbidity (17% obstructive pulmonary disease). At diagnosis the most common symptoms were fever (76%), cough (60%) and dyspnea (31%). We observed that 58% of patients presented a chest X-ray compatible with COVID-19. Regarding laboratory parameters, stood out lymphopenia (65% of patients presented <1200 lymphocytes/mm3) and elevation of inflammation parameters, such as D-dimer (median 365 ng/mL, range 50-5860), ferritin (median 1063 ng/mL, range 73-14191), IL-6 (median 59,6 pg/mL, range 3-4079) and PCR (median 11,2 mg/dL, range 0,3-79,9). Empirical therapy for COVID-19 included antibiotics (78%), anti-virals (50%, 3% remdesivir), and hydroxychloroquine (88%). Only 24% received tocilizumab, 50% heparin (33% prophylactic dose), 12% G-CSF, 9% norepinephrine, 4% corticosteroids and 1% ß-IFN. Most of patients (73%) required oxygen therapy: 36% high-flow, 29% low flow and 8% endotracheal intubation. There were 6 patients who did not receive any treatment. COVID-19 was acquired via nosocomial infection in 23% of patients, 91% of them requiring hospitalization, 14% in the Intensive Care Unit (ICU). The median days of hospitalization since diagnosis was 17 (range 3-55). The case fatality rate (CFR) from COVID-19 was higher in hematologic patients than the one observed in non-hematologic patients at the HUVH (figure 1), being of 41% at 11 days from diagnosis. CFR was higher in patients older than 75 years old (61%), while the mortality among patients receiving active therapy was 42%. The main cause of death was acute respiratory failure (93%). In the univariate logistic regression model, age >75 years (OR 1.07; p=0.008), active malignancy (OR 5; p=0,02), >1 comorbidity (OR 5.3; p=0,049) and high levels of IL-6 (OR 8.2; p= 0.005) were statistically significant. In the multivariable logistic regression model, age ≥75 years (OR 4.4; p=0.01) and IL-6 levels at baseline > 59.6 pg/mL (OR 7.2; p=0.01) were associated with a higher mortality (table 1). The presence of an active malignancy was not a significant variable in the multivariable logistic regression model. CONCLUSIONS: Patients with hematologic malignancies and COVID-19 presented similar symptoms, signs and radiological characteristics to those described in the general population at diagnosis. In our cohort, advanced age and high IL-6 values were associated with higher mortality. Furthermore, it was observed that active hematologic disease is a factor of poor prognosis of COVID-19. Disclosures Salamero: Daichii Sankyo:Honoraria;Celgene:Consultancy, Honoraria;Novartis:Consultancy, Honoraria;Jazz Pharmaceuticals:Consultancy, Honoraria;Pfizer:Consultancy.Abrisqueta:Janssen:Consultancy, Honoraria, Speakers Bureau;AbbVie:Consultancy, Honoraria, Speakers Bureau;Roche:Consultancy, Honoraria, Speakers Bureau;Celgene:Consultancy, Honoraria.Bosch:Hoffmann-La Roche:Research Funding.

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MO532WHICH UNHEALTHY LIFE-BEHAVIOR IS THE MOST IMPACT FOR THE PRESENCE OF PROTEINURIA?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0052 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jun Muratsu ◽

Masahiko Hara ◽

Atsuyuki Morishima ◽

Katsuhiko Sakaguchi ◽

Takashi Fujimoto

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Odds Ratio ◽

Logistic Regression Model ◽

Multivariable Logistic Regression Model ◽

Current Smoking ◽

Exercise Habits ◽

Multivariable Logistic Regression ◽

Skipping Breakfast ◽

Life Behavior

Abstract Background and Aims Unhealthy life-behaviors such as dietary habits, lack of exercise, drinking large amount of alcohol and smoking cause obesity, hypertension, diabetes, dyslipidemia, cardiovascular disease (CVD). These are also closely associated with chronic kidney disease (CKD). CKD is characterized by proteinuria and low glomerular filtration rate (GFR). Independent of GFR, proteinuria is an important predictor of ESKD. Few studies have assessed which is the most clinical impact among the unhealthy life-behaviors: skipping breakfast, snacking, late-night dinner, smoking, heavy alcohol intake and lack of exercise habits for proteinuria in normal renal function patients. Method This cross-sectional study included 29,780 normal renal function patients: eGFR≥60 mL/min/1.73 m2 and no history of kidney diseases who underwent health checkup at the Physical Checkup Center of Sumitomo Hospital. The endpoint of this investigation is defined as dipstick proteinuria of≥ 1+. To assess the association of life-behaviors and the presence of proteinuria, their odds ratios were calculated in adjusted univariable and multivariable logistic regression model. Multivariable logistic regression model was performed by not selected items, the same with univariable model. We would like to investigate the most impact unhealthy life-behavior for the proteinuria. Results Among 29,780 total study subjects (male: 60.3%; mean age: 49±11 years), 1,118 (3.75%) subjects were shown as urinary protein above 1+. The presence of unhealthy dietary life-behaviors: skipping breakfast, snacking and late-night dinner was 5,293 (17.3%), 3,899 (13.1%) and 11,231 (37.7%), respectively. About sleeping duration, the population of <6 hours, 6-8 hours and >8 hours were 12,027 (40.4%), 17,236 (57.9%) and 517 (1.7%). The population of exercise habits: over 3 days/weeks, 1-2 days/weeks and none were 5,138 (17.3%), 9,375 (31.5%) and 15,237 (51.3%), suggesting half of them did not have exercise habits. About smoking habits, the population of current smoking, past smoking and never smoking were shown 6,445 (21.6%), 8,459 (28.4%) and 14,876 (50.0%). In addition, about alcohol amount per day, the population of over 60g, 40-60g, 20-40g and 0-20g were 1,840 (6.18%), 4,504 (15.1%), 6,727 (22.6%) and 16,709 (56.1%). To investigate the impact of life-behavior for proteinuria, we obtained odds ratio of adjusted multivariable logistic regression model. In multivariable regression, among the life-behavior: skipping breakfast, current smoking, alcohol amount (ethanol over 60 g/day), none of exercise habits and snacking were strongly associated with the prevalence of proteinuria (skipping breakfast, adjusted odds ratio 1.45 [1.26, 1.68]; current smoking, 1.35 [1.14, 1.59]; alcohol amount (ethanol over 60 g/day), 1.35 [1.08, 1.69]; none of exercise habits, 1.29 [1.07, 1.57]; snacking, 1.23 [1.04, 1.46]). In addition, among the history of medical history, diabetes mellitus, hypertension and dyslipidemia were significantly associated with the prevalence of proteinuria (diabetes mellitus, adjusted odds ratio 2.39 [1.93, 2.96]; hypertension, 1.83 [1.53, 2.17]; 1.22 [1.03, 1.45]). Conclusion Among the unhealthy life-behaviors, skipping breakfast is the most impact factor for the presence of proteinuria.

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994. Risk for Viral Rebound in the Era of U=U; A CNICS Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1180 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S525-S526

Author(s):

Blake Hansen ◽

Tao Liu ◽

Lauri Bazerman ◽

Mari-Lynn Drainoni ◽

Fizza S Gillani ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Model ◽

Logistic Regression Model ◽

Viral Suppression ◽

Viral Rebound ◽

Research Support ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression

Abstract Background The “Undetectable equals Untransmittable (U=U)” HIV prevention campaign is a cornerstone of HIV prevention. However, there are few recommendations to guide patients and providers in U=U implementation and limited data on risk factors for viral rebound among persons eligible for U=U. Methods We conducted a retrospective multi-center study using data from the CNICS HIV research network to identify risk factors for viral rebound among persons with established viral suppression [two viral loads (VL) and all VLs of < 200 copies/ul within a one-year period (U=U eligible)]. Demographics, patient-reported outcomes, and longitudinal clinical data from 21,359 persons with HIV were analyzed. To include missing data in the analysis, they were treated as a separate category. The primary outcome of viral rebound was defined as any VL > 200 copies/ul within two years after U=U eligibility. A univariable logistic regression model was conducted to identify predictors of viral rebound. Significant variables (p< 0.05) were included in a multivariable logistic regression model. Predictive values of individual variables were captured by adjusted odds ratios (aORs). Results From 2011-2019, 12,150 patients met criteria for U=U eligibility and had two years of follow up data. The median age was 46 (IQR: 38-53); 68% male; 51% were white, 39% black. 1544 (13%) experienced viral rebound during follow-up. Forest plot summaries of univariable and multivariable logistic regression models are in Figures 1&2. In multivariable analysis, Black race (aOR=1.56, p< 0.001); MSM-IDU risk (aOR=1.38, p=0.006); lower QoL score (aOR=1.49, p=0.005); poorer ART adherence (aOR=1.84, p< 0.001); duration of lifetime ART [aOR=1.47 (10+yrs), = 1.37 (5-10 yrs); and = 1.28 (2-5 yrs), p< 0.001]; use of InSTIs after eligibility (aOR=1.60, p< 0.001); current smoker (aOR=1.49, p< 0.001), current amphetamine (aOR=1.83, p< 0.001) or cocaine use (aOR=1.46, p=0.012), were associated with viral rebound. In both analyses, older age was protective against viral rebound. Figure 1. Summary of Univariate Logistic Regression Model Figure 2. Summary of Multivariable Logistic Regression Model Conclusion We identified multiple risk factors for viral rebound among PWH with viral suppression. Further research is needed to identify synergistic risk factors that increase probability of viral rebound to inform optimal implementation of U=U. Disclosures Edward Cachay, MD, MAS, Gilead (Consultant, Grant/Research Support)Merck Sciences (Grant/Research Support) Heidi Crane, MD, MPH, ViiV (Grant/Research Support) Benigno Rodriguez, MD, Gilead (Speaker’s Bureau)ViiV (Speaker’s Bureau)

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Heart Rate n-Variability (HRnV) Measures for Prediction of Mortality in Sepsis Patients Presenting at the Emergency Department

10.1101/2020.12.26.20248866 ◽

2021 ◽

Author(s):

Nan Liu ◽

Marcel Lucas Chee ◽

Mabel Zhi Qi Foo ◽

Jeremy Zhenwen Pong ◽

Dagang Guo ◽

...

Keyword(s):

Heart Rate ◽

Logistic Regression ◽

Risk Stratification ◽

Regression Model ◽

Logistic Regression Model ◽

Primary Outcome ◽

Univariable Analysis ◽

Sepsis Mortality ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression

AbstractBackgroundSepsis is a potentially life threatening condition that requires prompt recognition and treatment for optimal outcomes. There is little consensus on an objective way to assess for sepsis severity and risk for mortality. In recent years, heart rate variability (HRV), a measure of the cardiac autonomic regulation derived from short electrocardiogram tracings, has been found to correlate with sepsis mortality, and its use as a prognostic variable and for risk stratification has been promising. In this paper, we present using novel heart rate n-variability (HRnV) measures for sepsis mortality risk prediction and compare against current mortality prediction scores.MethodsThis study was a retrospective cohort study on a convenience sample of patients presenting to the emergency department (ED) of Singapore General Hospital between September 2014 to April 2017. Patients were included in the study if they were above 21 years old, were suspected to have sepsis by their attending physician, triaged as emergency or urgent cases, and if they met two or more of the Systemic Inflammatory Response Syndrome (SIRS) criteria. Demographic and clinical variables were obtained from the electronic medical records, and HRV and novel HRnV parameters were calculated from five minute ECG tracings. Univariable analysis was conducted on variables obtained, with the primary outcome being 30-day in-hospital mortality (IHM). Variables selected through univariable analysis and stepwise selection were included in a multivariable logistic regression model, the results of which were presented using receiver operating curve (ROC) analysis.ResultsOf 342 patients included for final analysis, 66 (19%) met with the primary outcome. On univariable analysis, 85 out of 142 analysed HRV and HRnV parameters showed statistical difference between groups. The final multivariable logistic regression model comprised of 21 variables including four vital signs, two HRV parameters, and 15 HRnV parameters. The area under the curve (AUC) of the model was 0.86 (95% confidence interval 0.81-0.90), outperforming several established clinical scores.ConclusionThe use of novel HRnV measures can provide adequate power to predictive models in the risk stratification of patients presenting to the ED with sepsis. When included in a multivariable logistic regression model, the HRnV-based model outperformed traditional risk stratification scoring systems. The HRnV measures may have potential to allow for a rapid, objective, and accurate means of patient risk stratification for sepsis severity and mortality.

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Abstract 290: Association Between Hourly Call Volume in Emergency Medical Dispatch Center and Dispatcher -Assisted Cardiopulmonary Resuscitation Instruction Time in Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.290 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Jong Hwan Kim ◽

Tae Han Kim ◽

Sang Do Shin ◽

Ki Jeong Hong ◽

Jeong Ho Park ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Regression Model ◽

Logistic Regression Model ◽

Multivariable Logistic Regression Model ◽

Emergency Medical Dispatch ◽

Emergency Calls ◽

Multivariable Logistic Regression ◽

Emergency Medical ◽

Hospital Cardiac Arrest

Objectives: cardiac arrest recognition, ambulance dispatch and dispatcher assisted CPR by emergency medical dispatch (EMD) is crucial for good outcome of out-of-hospital cardiac arrest (OHCA).In EMD, crowding is caused by mismatch between numerous emergency calls and dispatchers per duty available Crowding in emergency department has been shown to decrease the performance and outcome, however little is known about effect of crowding in EMD. We aimed to evaluate incidence of crowding in emergency medical dispatch center and effect of emergency call crowding on dispatcher assisted CPR instruction performance in OHCA calls. Methods: We used nationwide OHCA database from 2013 to 2016, consisted of patients with presumed cardiac origin and dispatched by Seoul EMD. Main exposure was hourly number of total incoming emergency calls to EMD. Number of hourly calls were categorized into quartile (~4o calls, 41~51 calls, 52 ~61 calls and ~62 calls). Primary outcome was successful DA-CPR instruction provision within 120 seconds. Adjusted ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate association between EMD crowding and outcome in multivariable logistic regression model. Results: Of a total of 12,722 patients, proportion of successful DA instruction were highest in least crowded quartile and lowest in the most crowded quartile (22.7% vs. 15.o% , p<0.01). The adjusted odds ratios is 0.85 (95% CI 0.74 - 0.98) in most crowded EMD quartile with lesser proportion of DA instruction within 120 seconds. Crowding quartile 4 and quartile 3 was associated lesser favorable neurological outcome in multivariable logistic regression model.(adjusted OR(95% CI) 0.78 (0.60-0.99) and 0.70 (0.54- 0.91) respectively) . Conclusion: Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed dispatcher assisted CPR instruction provision. Medical directors might consider strategy approach to solve crowding in EMD according to crowding distribution.

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