Are All MET Calls Required? Patient Characteristics Who Have MET Calls in General Medical Wards

Abstract Background Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock. Methods Patients with candidemia hospitalized in internal medicine wards of 5 tertiary care centers were included in the study (December 2012–December 2014). Patient characteristics, therapeutic interventions, and outcome were reviewed. Propensity score (PS) was used as a covariate of the multivariate analysis to perform a stratified analysis according to PS quartiles and to match patients receiving “echinocandins” or “azoles.” Results Overall, 439 patients with candidemia were included in the study. A total of 172 (39.2%) patients had septic shock. Thirty-day mortality was significantly higher in patients with septic shock (45.3%) compared with those without septic shock (31.5%; P = .003). Among patients with septic shock, the use of echinocandins in the first 48 hours, compared with azoles, did not affect 30-day mortality in the PS-adjusted Cox regression analysis (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.37–1.59; P = .48), the PS-stratified analysis, or the logistic regression model in matched cohorts (adjusted HR, 0.92; 95% CI, 0.51–1.63; P = .77). Conclusions Echinocandin therapy seems not to improve the outcome of non–intensive care unit patients with septic shock due to candidemia. These findings support the urgent need of further studies in this patient population.

Download Full-text

Presenting Characteristics, Treatment Patterns, and Outcomes among Patients with Venous Thromboembolism during Hospitalization for COVID-19

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1718402 ◽

2020 ◽

Cited By ~ 1

Author(s):

Carmen Fernández-Capitán ◽

Raquel Barba ◽

María del Carmen Díaz-Pedroche ◽

Patricia Sigüenza ◽

Pablo Demelo-Rodriguez ◽

...

Keyword(s):

Venous Thromboembolism ◽

Major Bleeding ◽

Optimal Strategies ◽

Patient Characteristics ◽

Treatment Patterns ◽

Adverse Outcomes ◽

Vein Thrombosis ◽

Medical Wards ◽

Deep Vein ◽

Hospital Wards

AbstractVenous thromboembolism (VTE) is common in patients with coronavirus disease-2019 (COVID-19). However, limited data exist on patient characteristics, treatments, and outcomes. To describe the clinical characteristics, treatment patterns, and short-term outcomes of patients diagnosed with VTE during hospitalization for COVID-19. This is a prospective multinational study of patients with incident VTE during the course of hospitalization for COVID-19. Data were obtained from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry. All-cause mortality, VTE recurrences, and major bleeding during the first 10 days were separately investigated for patients in hospital wards versus those in intensive care units (ICUs). As of May 03, 2020, a total number of 455 patients were diagnosed with VTE (83% pulmonary embolism, 17% isolated deep vein thrombosis) during their hospital stay; 71% were male, the median age was 65 (interquartile range, 55–74) years. Most patients (68%) were hospitalized in medical wards, and 145 in ICUs. Three hundred and seventeen (88%; 95% confidence interval [CI]: 84–91%) patients were receiving thromboprophylaxis at the time of VTE diagnosis. Most patients (88%) received therapeutic low-molecular-weight heparin, and 15 (3.6%) received reperfusion therapies. Among 420 patients with complete 10-day follow-up, 51 (12%; 95% CI: 9.3–15%) died, no patient recurred, and 12 (2.9%; 95% CI: 1.6–4.8%) experienced major bleeding. The 10-day mortality rate was 9.1% (95% CI: 6.1–13%) among patients in hospital wards and 19% (95% CI: 13–26%) among those in ICUs. This study provides characteristics and early outcomes of patients diagnosed with acute VTE during hospitalization for COVID-19. Additional studies are needed to identify the optimal strategies to prevent VTE and to mitigate adverse outcomes associated.

Download Full-text

Abstract TP320: Different Response Times to Intrahospital Stroke Between Medical and Surgical Infirmaries: A Dunning-Kruger Effect?

Stroke ◽

10.1161/str.51.suppl_1.tp320 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Iago N Perissinotti ◽

Fernanda A Salvadori ◽

Barbara S Fonseca ◽

Marcelo Calderaro

Keyword(s):

Statistical Power ◽

Response Times ◽

Intravenous Thrombolysis ◽

Patient Characteristics ◽

Stroke Care ◽

Tertiary Hospital ◽

Surgical Teams ◽

Medical Wards ◽

Different Response

Rapid response teams (RRT) improve speed and quality of urgent inpatient care. Nonetheless, its effectiveness depends on adequate problem identification and fast triggering of institutional procedures. Differences in patient profiles and team experience between medical (Me) or surgical (Su) wards may influence the response times to suspected intrahospital strokes. From January/2016 through April/2019, we retrospectively analyzed data in a large tertiary hospital in Brazil. There were proportionally more callings for suspected strokes in medical wards (36/281 [13%] Me vs. 16/619 [2%] Su, p<0.001) in relation to the total of calls for any reason, while the ratio of diagnostic confirmation was similar (19/36 [52%] Me vs. 10/16 [62%] Su, p=0.495). Ischemic strokes were more prevalent in both infirmaries (17/19 [89%] Me vs. 8/10 [80%] Su, p=0.43). While not statistically significant, there were numerical differences between time to symptom recognition and the interval between recognition and triggering of the RRT. Medical ward teams recognized symptoms on average 108 minutes after the presumed onset versus 164 minutes in surgical wards. Paradoxically, surgical teams more promptly called RRT after recognition, on average 93 versus 172 minutes. There were no statistical differences in the ratio of ischemic strokes submitted to intravenous thrombolysis (11/17 [35,3%] Me vs. 1/8 [12,5%] Su, p=0.25) or mechanical thrombectomy (2/17 [11,8%] Me vs. 0/8 Su, p=0.45), however it is possible that the small number of events (52 calls in 40 months) led to low statistical power. This study suggests there may be differences in initial responses to suspected intrahospital strokes between different ward profiles. These might be secondary to variations in patient characteristics and team education, but also be caused by a Dunning-Kruger phenomenon (i.e. a higher perception of knowledge on stroke care leading to delays in triggering institutional workflows). Identifying these divergences in further larger, prospective trials can help develop individualized interventions to improve the quality of care in these medical emergencies.

Download Full-text

Clinical characteristics and factors associated with admission to intensive care units in hospitalized COVID-19 patients in Lyon University Hospitals, France

10.1101/2020.06.09.20125286 ◽

2020 ◽

Author(s):

Philippe Vanhems ◽

Marie-Paule Gustin ◽

Christelle Elias ◽

Laetitia Henaff ◽

Cédric Dananché ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Time Window ◽

Patient Characteristics ◽

University Hospitals ◽

Total Hospital ◽

Total Hospital Stay ◽

Direct Admission ◽

Multivariable Regression ◽

Medical Wards

AbstractIntroductionA new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analyzing clinical presentation on admission and the determinants associated with direct admission or transfer to intensive care units (ICUs) in hospitalized COVID-19 patients.Patients and MethodsIn this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients were prospectively collected and analyzed. The outcome was admission/transfer to intensive care units compared with total hospital stay in medical wards according to patient characteristics.ResultsOf the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of admission/transfer to ICUs with male gender (OR, 1.99 [95%CI, 1.07-3.73]), temperature (OR, 1.37 [95% CI, 1.01-1.88] per degree Celsius increase), abnormal lung auscultation on admission (OR, 2.62 [95% CI, 1.40-4.90]), elevated level of CRP (OR, 6.96 [95% CI, 1.45-33.35 for CRP>100mg/L vs CRP<10mg/L). Increased time was observed between symptom onset and hospital admission (OR, 4.82 [95% CI, 1.61-14.43] for time >10 days vs time <3 days) and monocytopenia (OR, 2.49 [95% CI, 1.29-4.82]). Monocytosis was associated with lower risk of admission/transfer to ICUs (OR, 0.25 [95% CI, 0.05-1.13]).ConclusionsClinical and biological features on admission and time until admission were associated with admission to ICUs. Signs to predict worsening on admission could be partially associated with the time until admission. This finding reinforces the need for appropriate guidelines to manage COVID-19 patients in this time window.

Download Full-text