THYROIDECTOMY AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL: IS ROUTINE ADMISSION TO INTENSIVE CARE UNIT JUSTIFIED?

Introduction: Thyroidectomy is the commonest endocrine operation performed often in healthy patient at elective setting. Patients are discharged early and the post-operative course is mainly uneventful. The need for intensive care is not essential in most cases. This article reviews the cases of thyroidectomy at CHBAH that are sent to intensive care routinely to assess the relevance of this practice. Objectives: To establish the profile, the outcome of thyroidectomy patients admitted in intensive care and the incidence of uneventful ICU stay. Method: Review of all thyroidectomy admitted in intensive care from January 2013 to July 2017 Results: In 88.42% of cases, intensive care admission was not justified. Of the 11.57% that needed ICU, 90.90% was predicted pre-operatively by the underlying comorbidity and the surgical approach. Altogether only 1.06% of cases had unpredicted ICU admission. Conclusion: Routine intensive care admission was unnecessary in most cases.

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The Epidemiology of Vancomycin-Resistant Enterococcus Colonization in a Medical Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/502199 ◽

2003 ◽

Vol 24 (4) ◽

pp. 257-263 ◽

Cited By ~ 35

Author(s):

David K. Warren ◽

Marin H. Kollef ◽

Sondra M. Seiler ◽

Scott K. Fridkin ◽

Victoria J. Fraser

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multiple Logistic Regression Analysis ◽

Control Measures ◽

Icu Patients ◽

Icu Admission ◽

Contact Precautions ◽

Icu Stay ◽

Vancomycin Resistant

AbstractObjective:To determine the epidemiology of colonization with vancomycin-resistant Enterococcus (VRE) among intensive care unit (ICU) patients.Design:Ten-month prospective cohort study.Setting:A 19-bed medical ICU of a 1,440-bed teaching hospital.Methods:Patients admitted to the ICU had rectal swab cultures for VRE on admission and weekly thereafter. VRE-positive patients were cared for using contact precautions. Clinical data, including microbiology reports, were collected prospectively during the ICU stay.Results:Of 519 patients who had admission stool cultures, 127 (25%) had cultures that were positive for VRE. Risk factors for VRE colonization identified by multiple logistic regression analysis were hospital stay greater than 3 days prior to ICU admission (adjusted odds ratio [AOR], 3.6; 95% confidence interval [CI95], 2.3 to 5.7), chronic dialysis (AOR, 2.4; CI95, 1.2 to 4.5), and having been admitted to the study hospital one to two times (AOR, 2.3; CI95,1.4 to 3.8) or more than two times (AOR, 6.5; CI95, 3.7 to 11.6) within the past 12 months. Of the 352 VRE-negative patients who had one or more follow-up cultures, 74 (21%) became VRE positive during their ICU stay (27 cases per 1,000 patient-ICU days).Conclusion:The prevalence of VRE culture positivity on ICU admission was high and a sizable fraction of ICU patients became VRE positive during their ICU stay despite contact precautions for VRE-positive patients. This was likely due in large part to prior VRE exposures in the rest of the hospital where these control measures were not being used.

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Prevalence of Delirium and Its Clinical Outcome in Adult Filipino Patients Admitted in The Intensive Care Unit

Journal Of Medicine & Health ◽

10.28932/jmh.v2i4.1106 ◽

2019 ◽

Vol 2 (4) ◽

Author(s):

Abram P Tanuatmadja ◽

Jacqueline R Vea

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Scoring Method ◽

Icu Admission ◽

Icu Stay ◽

Manpower Requirement ◽

Tertiary Teaching ◽

Metro Manila ◽

Tertiary Teaching Hospital ◽

Dsm Iv

Delirium is common in the ICU setting and is associated with increased morbidity, manpower requirement, and costs. This study aims to investigate the prevalence of delirium and its outcome in terms of 14-days mortality and length of ICU stay in ICU patients. The study was done at a 150-bed tertiary teaching hospital, located in Quezon City, Metro Manila, February to September 2016. This is a prospective studyinvolving 136 adults. Screening for delirium was done within 24 hours of ICU admission using both CAM-ICU scoring method and DSM-IV-TR criteria for delirium. Delirium prevalence was found to be 5.15%. The average age was higher in the subjects positive for delirium (70.14 + 21.15 years versus 60.43 + 16.10 years, p=0.1286). At the time of ICU admission, 11.54% of sedated patients were positive for delirium compared to 3.64% of non-sedated patients, p=0.1513 ;OR 3.457. Delirium was associated with higher 14 days mortality (OR 16.8, p=0.0212). Subjects positive for delirium had 2.74 longer days average ICU stay compared to the other group, with p=0.026. We concluded delirium was associated with higher 14-days mortality and longer ICU stay. Keywords : delirium, prevalence, Intensive Care Unit

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Factors Associated with Intensive Care Unit (ICU) Admission Among Inpatients with and without Diabetes in South Western Sydney Public Hospitals Using the New South Wales Admission Patient Data Collection (2014 and 2017).

10.21203/rs.3.rs-966041/v1 ◽

2021 ◽

Author(s):

Uchechukwu L Osuagwu ◽

Matthew Xu ◽

Milan K Piya ◽

Kingsley E Agho ◽

David Simmons

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

New South ◽

Public Hospitals ◽

Admission Diagnosis ◽

Icu Admission ◽

Icu Stay ◽

System Disease ◽

South Wales

Abstract Background South Western Sydney (SWS) is a hotspot for diabetes in Australia. We compared intensive care unit (ICU) admission risk between people with and without diabetes admitted to public hospitals in this metropolitan health district. Methods Retrospective study of all admissions to ICU in the New South Wales Admitted Patient Data Collection (APDC) over three years. Data on demographic and health insurance status, primary admission diagnosis, comorbidities including death in admission for public hospital inpatients aged ≥18 years residing in South Western Sydney were analysed. The ICU length of stay was the main outcome variable classified into short stay (≤48hrs) and long stay (>48 hrs) were analysed. Potential predictors were analysed for possible association with long ICU stay among people with and without diabetes admitted to the hospital. Results Of the 187660 inpatients from SWS in the three years, 3.5% spent at least one hour in ICU [5.0% with diabetes versus 3.3% without diabetes, P<0.001]. The median length of ICU stay was similar between people with and without diabetes [40hrs IQR 16-88 hrs versus 43hrs IQR 19-79hrs] as well as the prevalence of long ICU stay [44.9%, 95%CI 42.1, 47.7% versus 43.6%, 95%CI 42.2, 44.9%], respectively. A primary admission diagnosis of circulatory system disease was associated with long ICU stay in both groups, while male sex and a primary diagnosis of nervous system disease was associated with long ICU stay in the non-diabetes group only. Long ICU stay was associated with 1.6 times higher in-hospital mortality in people with diabetes. Conclusions ICU admission was more common in people with diabetes. One in every two admissions to ICU had a long stay, thereby increasing the resource utilization and was associated with higher in-hospital mortality. The predictors identified in the study can target this group to improve resource utilization and efficiency of ICU care. Additional population-based approaches to diabetes care are needed to reduce the risks of acute hospital admission.

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Methicillin-resistant Staphylococcus aureus nasal colonization and infection in an intensive care unit of a university hospital in China

Journal of International Medical Research ◽

10.1177/0300060518777812 ◽

2018 ◽

Vol 46 (9) ◽

pp. 3698-3708 ◽

Cited By ~ 2

Author(s):

Fu Qiao ◽

Wenzhi Huang ◽

Lin Cai ◽

Zhiyong Zong ◽

Weijia Yin

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Methicillin Resistant Staphylococcus Aureus ◽

Mainland China ◽

Methicillin Resistant ◽

Icu Admission ◽

Icu Stay ◽

Nasal Swabs ◽

Mrsa Colonization

Objective This study was performed to determine the prevalence and risk factors associated with nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization upon intensive care unit (ICU) admission and during the ICU stay in mainland China. Methods A prospective observational study was performed in a 50-bed general ICU of a 4300-bed teaching hospital in China from 2011 to 2013. Nasal swabs for MRSA detection were obtained upon ICU admission and at discharge for patients having stayed in the ICU for longer than 3 days. Results In total, 115 patients (4.1%; 95% confidence interval [CI], 3.4–4.9) were already colonized with MRSA on ICU admission, and another 185 patients (10.7%; 95% CI, 9.3–12.2) acquired MRSA during their ICU stay. Development of an MRSA infection was significantly more likely in patients with than without MRSA colonization on ICU admission (odds ratio [OR], 2.8; 95% CI, 1.1–7.3). Patients who acquired MRSA had significantly prolonged lengths of stay in the ICU (23.3 days) and higher hospital bills (135,171 RMB; about 19,590 USD) than those who tested negative for MRSA. Conclusion The MRSA colonization rate among ICU patients in mainland China is high. Patients with MRSA-positive nasal swabs are more likely to develop MRSA infections.

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Correlation of PeradeniyaOrganophosphorus Poisoning Scale (POP) and outcome of Organophosphorus poisoning

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29702 ◽

2020 ◽

Vol 5 (1) ◽

pp. 986-989

Author(s):

Gunjan Regmi ◽

Batsalya Arjyal ◽

Kanak Khanal ◽

Kumud Pyakurel ◽

Rejina Shahi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Assessment Tool ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Intensive Care Admission ◽

Icu Stay ◽

Number Of Patients ◽

Organophosphorus Poisoning

Introduction: Organophosphorus poisoning is one of the common causesfor the intensive care admission in the developing countries.This study was conducted to assess the correlation between Peradeniya Organophosphorus Poisoning (POP) scale and the outcomes in poisoningin a tertiary care hospital in Eastern Nepal. Objective: To assess the severity and outcome of OP compound poisoning with the correlation of POP score. Methodology: This was a prospective observational study conducted over 6 months in the intensive care unit at tertiary care hospital in the eastern part of Nepal. The study includedall OP poisoning patients presenting in the emergency department and finally admitted to intensive care unit who fulfilled the inclusion criteria.Correlation was made between POP scores and outcomes in terms of intensive care unit(ICU) stay, need of ventilation and mortality was assessed. Result: Fifty patients with OP poisoning wereincluded in the study. Suicide attempt was the most common reason for poisoning. The incidence of poisoning was more common among males(72%)and significant majority were aged younger than 35 years (84%). On admission, the number of patients in mild, moderate and severepoisoning group were 52%, 30% and 18% respectively. Rates for ICU stay, respiratory failure requiring ventilator and mortality was significantly (p<0.001) higher in severe POP scale. Conclusion: The POP scale is a useful clinical assessment tool to assess and categorize patients with OP poisoning according to severity and in predicting their clinical outcomes.

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Thrombocytopenia in Intensive care units

Journal of Internal Medicine and Emergency Research ◽

10.37191/mapsci-2582-7367-1(1)-001 ◽

2019 ◽

Author(s):

Bahram Alamdary Badlou

Keyword(s):

Intensive Care Unit ◽

Emergency Medicine ◽

Intensive Care ◽

Intensive Care Units ◽

Organ Dysfunction ◽

Illness Severity ◽

Icu Admission ◽

Icu Stay ◽

High Illness Severity

Emergency Medicine Specialists (EMS) are supposed to helping/keeping certain patients alive. Although the Intensive Care Unit (ICU) personnel's priority is just saving life of ICU's patients but their approaches are not always in advantage of treated patients [1-5]. Prevalent thrombocytopenia (on ICU admission) occurred in 8.3% to 67.6% of patients; incident thrombocytopenia (developing during the course of the ICU stay) occurred in 13.0% to 44.1% of patients. High illness severity, sepsis, and organ dysfunction often correlated with thrombocytopenia.

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In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department

Healthcare ◽

10.3390/healthcare9040431 ◽

2021 ◽

Vol 9 (4) ◽

pp. 431

Author(s):

Chun-Fu Lin ◽

Yi-Syun Huang ◽

Ming-Ta Tsai ◽

Kuan-Han Wu ◽

Chien-Fu Lin ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Regression Analysis ◽

Intensive Care ◽

Medical Cost ◽

Total Medical Cost ◽

Hospital Outcomes ◽

Return Visit ◽

Icu Admission ◽

Ed Visits

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

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Development of a machine learning model for predicting pediatric mortality in the early stages of intensive care unit admission

Scientific Reports ◽

10.1038/s41598-020-80474-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Bongjin Lee ◽

Kyunghoon Kim ◽

Hyejin Hwang ◽

You Sun Kim ◽

Eun Hee Chung ◽

...

Keyword(s):

Machine Learning ◽

Intensive Care Unit ◽

Intensive Care ◽

Validation Cohort ◽

External Validation ◽

Learning Model ◽

Derivation Cohort ◽

Icu Admission ◽

Early Stages ◽

Machine Learning Model

AbstractThe aim of this study was to develop a predictive model of pediatric mortality in the early stages of intensive care unit (ICU) admission using machine learning. Patients less than 18 years old who were admitted to ICUs at four tertiary referral hospitals were enrolled. Three hospitals were designated as the derivation cohort for machine learning model development and internal validation, and the other hospital was designated as the validation cohort for external validation. We developed a random forest (RF) model that predicts pediatric mortality within 72 h of ICU admission, evaluated its performance, and compared it with the Pediatric Index of Mortality 3 (PIM 3). The area under the receiver operating characteristic curve (AUROC) of RF model was 0.942 (95% confidence interval [CI] = 0.912–0.972) in the derivation cohort and 0.906 (95% CI = 0.900–0.912) in the validation cohort. In contrast, the AUROC of PIM 3 was 0.892 (95% CI = 0.878–0.906) in the derivation cohort and 0.845 (95% CI = 0.817–0.873) in the validation cohort. The RF model in our study showed improved predictive performance in terms of both internal and external validation and was superior even when compared to PIM 3.

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Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

PLoS ONE ◽

10.1371/journal.pone.0181808 ◽

2017 ◽

Vol 12 (7) ◽

pp. e0181808 ◽

Cited By ~ 5

Author(s):

Laure Doukhan ◽

Magali Bisbal ◽

Laurent Chow-Chine ◽

Antoine Sannini ◽

Jean Paul Brun ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Icu Admission ◽

Respiratory Events

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Early resuscitation orders in hospitalized oldest-old with COVID-19: A multicenter cohort study

Palliative Medicine ◽

10.1177/02692163211018342 ◽

2021 ◽

pp. 026921632110183

Author(s):

Ruth Piers ◽

Eva Van Braeckel ◽

Dominique Benoit ◽

Nele Van Den Noortgate

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Oldest Old ◽

Case Report Form ◽

Resuscitation Orders ◽

Intensive Care Admission ◽

Treatment Limitation ◽

Early Decision

Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty ( p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure ( p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.

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