Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, p < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, p < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, p < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, p < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.

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P9 Novel use of CHA2DS2VASC score to select patients to undergo repeat atrial fibrillation screening

European Heart Journal ◽

10.1093/ehjci/ehz872.015 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

W Sun ◽

B P Y Yan

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Clinical Outcomes ◽

Cross Validation ◽

Risk Group ◽

Curve Analysis ◽

Low Risk ◽

Decision Curve Analysis ◽

Risk Patients

Abstract Background We have previously demonstrated unselected screening for atrial fibrillation (AF) in patients ≥65 years old in an out-patient setting yielded 1-2% new AF each time screen-negative patients underwent repeated screening at 12 to 18 month interval. Selection criteria to identify high-risk patients for repeated AF screening may be more efficient than repeat screening on all patients. Aims This study aimed to validate CHA2DS2VASC score as a predictive model to select target population for repeat AF screening. Methods 17,745 consecutive patients underwent 24,363 index AF screening (26.9% patients underwent repeated screening) using a handheld single-lead ECG (AliveCor) from Dec 2014 to Dec 2017 (NCT02409654). Adverse clinical outcomes to be predicted included (i) new AF detection by repeated screening; (ii) new AF clinically diagnosed during follow-up and (ii) ischemic stroke/transient ischemic attack (TIA) during follow-up. Performance evaluation and validation of CHA2DS2VASC score as a prediction model was based on 15,732 subjects, 35,643 person-years of follow-up and 765 outcomes. Internal validation was conducted by method of k-fold cross-validation (k = n = 15,732, i.e., Leave-One-Out cross-validation). Performance measures included c-index for discriminatory ability and decision curve analysis for clinical utility. Risk groups were defined as ≤1, 2-3, or ≥4 for CHA2DS2VASC scores. Calibration was assessed by comparing proportions of actual observed events. Results CHA2DS2VASC scores achieved acceptable discrimination with c-index of 0.762 (95%CI: 0.746-0.777) for derivation and 0.703 for cross-validation. Decision curve analysis showed the use of CHA2DS2VASC to select patients for rescreening was superior to rescreening all or no patients in terms of net benefit across all reasonable threshold probability (Figure 1, left). Predicted and observed probabilities of adverse clinical outcomes progressively increased with increasing CHA2DS2VASC score (Figure 1, right): 0.7% outcome events in low-risk group (CHA2DS2VASC ≤1, predicted prob. ≤0.86%), 3.5% intermediate-risk group (CHA2DS2VASC 2-3, predicted prob. 2.62%-4.43%) and 11.3% in high-risk group (CHA2DS2VASC ≥4, predicted prob. ≥8.50%). The odds ratio for outcome events were 4.88 (95%CI: 3.43-6.96) for intermediate-versus-low risk group, and 17.37 (95%CI: 12.36-24.42) for high-versus-low risk group. Conclusion Repeat AF screening on high-risk population may be more efficient than rescreening all screen-negative individuals. CHA2DS2VASC scores may be used as a selection tool to identify high-risk patients to undergo repeat AF screening. Abstract P9 Figure 1

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Milk drinking and risk of hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

British Journal Of Nutrition ◽

10.1017/s0007114518003823 ◽

2019 ◽

Vol 121 (6) ◽

pp. 709-718 ◽

Cited By ~ 3

Author(s):

Kristin Holvik ◽

Haakon E. Meyer ◽

Ida Laake ◽

Diane Feskanich ◽

Tone K. Omsland ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Cox Regression ◽

Population Based ◽

Third Wave ◽

Hospital Data ◽

High Fracture ◽

Hazard Ratios ◽

Meta Analyses

AbstractMilk provides energy and nutrients considered protective for bone. Meta-analyses of cohort studies have found no clear association between milk drinking and risk of hip fracture, and results of recent studies are contradictory. We studied the association between milk drinking and hip fracture in Norway, which has a population characterised by high fracture incidence and a high Ca intake. Baseline data from two population-based cohorts were used: the third wave of the Norwegian Counties Study (1985–1988) and the Five Counties Study (2000–2002). Diet and lifestyle variables were self-reported through questionnaires. Height and weight were measured. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Of the 35 114 participants in the Norwegian Counties Study, 1865 suffered a hip fracture during 613 018 person-years of follow-up. In multivariable Cox regression, hazard ratios (HR) per daily glass of milk were 0·97 (95 % CI 0·92, 1·03) in men and 1·02 (95 % CI 0·96, 1·07) in women. Of 23 259 participants in the Five Counties Study, 1466 suffered a hip fracture during 252 996 person-years of follow-up. HR for hip fractures per daily glass of milk in multivariable Cox regression was 0·99 (95 % CI 0·92, 1·07) in men and 1·02 (95 % CI 0·97, 1·08) in women. In conclusion, there was no overall association between milk intake and risk of hip fracture in Norwegian men and women.

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Hormonal contraception and the risk of severe asthma exacerbation: 17-year population-based cohort study

Thorax ◽

10.1136/thoraxjnl-2020-215540 ◽

2020 ◽

pp. thoraxjnl-2020-215540

Author(s):

Bright I Nwaru ◽

Holly Tibble ◽

Syed A Shah ◽

Rebecca Pillinger ◽

Susannah McLean ◽

...

Keyword(s):

Clinical Outcomes ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Population Based ◽

Emergency Department Visits ◽

Reproductive Age ◽

Hormonal Contraceptives ◽

Reproductive Age Women ◽

Severe Asthma Exacerbation

BackgroundLongitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma.MethodsWe used the Optimum Patient Care Research Database, a population-based, longitudinal, anonymised primary care database in the UK, to construct a 17-year (1 January 2000–31 December 2016) retrospective cohort of reproductive-age (16–45 years, n=83 084) women with asthma. Using Read codes, we defined use, subtypes and duration of use of hormonal contraceptives. Severe asthma exacerbation was defined according to recommendations of the European Respiratory Society/American Thoracic Society as asthma-related hospitalisation, accident and emergency department visits due to asthma and/or oral corticosteroid prescriptions. Analyses were done using multilevel mixed-effects Poisson regression with QR decomposition.ResultsThe 17-year follow-up resulted in 456 803 person-years of follow-up time. At baseline, 34% of women were using any hormonal contraceptives, 25% combined (oestrogen/progestogen) and 9% progestogen-only contraceptives. Previous (incidence rate ratio (IRR) 0.94, 95% CI 0.92 to 0.97) and current (IRR 0.96, 95% CI 0.94 to 0.98) use of any, previous (IRR 0.92, 95% CI 0.87 to 0.97) and current use of combined (IRR 0.93, 95% CI 0.91 to 0.96) and longer duration of use (3–4 years: IRR 0.94, 95% CI 0.92 to 0.97; 5+ years: IRR 0.91, 95% CI 0.89 to 0.93) of hormonal contraceptives, but not progestogen-only contraceptives, were associated with reduced risk of severe asthma exacerbation compared with non-use.ConclusionsUse of hormonal contraceptives may reduce the risk of severe asthma exacerbation in reproductive-age women. Mechanistic studies investigating the biological basis for the influence of hormonal contraceptives on clinical outcomes of asthma in women are required.Protocol registration numberEuropean Union electronic Register of Post-Authorisation Studies (EUPAS22967).

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Delayed risk stratification system in pT1aN0/Nx DTC patients treated without radioactive iodine

Endocrine Connections ◽

10.1530/ec-17-0135 ◽

2017 ◽

Vol 6 (7) ◽

pp. 522-527 ◽

Cited By ~ 2

Author(s):

Danuta Gąsior-Perczak ◽

Iwona Pałyga ◽

Monika Szymonek ◽

Artur Kowalik ◽

Agnieszka Walczyk ◽

...

Keyword(s):

Risk Stratification ◽

Clinical Outcomes ◽

Radioactive Iodine ◽

Initial Therapy ◽

American Thyroid Association ◽

Monitoring Method ◽

Risk Patients ◽

Structural Disease ◽

Stratification System

Purpose Delayed risk stratification (DRS) system by Momesso and coworkers was accepted by the American Thyroid Association as a diagnostic tool for the risk stratification of unfavorable clinical outcomes and to monitor the clinical outcomes of differentiated thyroid cancer (DTC) patients treated without radioactive iodine (RAI). The aim of this study was to evaluate the DRS system in patients with pT1aN0/Nx stage. Methods The study included 304 low-risk patients after thyroidectomy (n = 202) or lobectomy (n = 102) without RAI and were treated at a single center. The median age was 50.5 years, 91.1% were women and the median follow-up was 4 years. DRS of the treatment response was performed based on medical records and according to the criteria of Momesso and coworkers. Disease course (recurrence, death) and status (remission, persistent disease) on December 31, 2016 were evaluated. The relationship between unfavorable outcomes and the DRS system was evaluated. Results Response to initial therapy was excellent in 272 patients (89.5%), indeterminate in 31 (10.2%) and biochemical incomplete (increased TgAb levels) in one (0.3%). Two patients in the excellent response group experienced recurrence at 6 and 7 years of follow-up (after lobectomy). None of the patients with indeterminate and biochemical incomplete response developed structural disease, and none of the patients died during the follow-up. Conclusions The DRS system was not useful for predicting the risk of unfavorable clinical outcomes and cannot be used to personalize the monitoring method of the disease in patients at pT1aN0/Nx stage who are not treated with RAI.

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Clinical outcomes in high-risk patients with a severe aortic stenosis: a seven-year follow-up analysis

Swiss Medical Weekly ◽

10.4414/smw.2019.20013 ◽

2019 ◽

Author(s):

Ren Vollenbroich ◽

Elmaze Sakiri ◽

Eva Roost ◽

Stefan Stortecky ◽

Martina Rothenbhler ◽

...

Keyword(s):

High Risk ◽

Aortic Stenosis ◽

Clinical Outcomes ◽

Severe Aortic Stenosis ◽

High Risk Patients ◽

Risk Patients

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Relationship Between Chelation and Clinical Outcomes in Lower-Risk Patients with Myelodysplastic Syndrome (MDS): Registry Analysis at 5 Years

Blood ◽

10.1182/blood.v124.21.1350.1350 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1350-1350 ◽

Cited By ~ 3

Author(s):

Roger M. Lyons ◽

Billie J. Marek ◽

Carole Paley ◽

Jason Esposito ◽

Katie McNamara ◽

...

Keyword(s):

Clinical Outcomes ◽

Cause Of Death ◽

Lower Risk ◽

Multiorgan Failure ◽

Clinical Status ◽

Iron Chelation ◽

Cardiovascular Comorbidity ◽

Time To Death ◽

Risk Patients

Abstract Introduction: We prospectively collected data from lower-risk patients (pts) with MDS in an ongoing US registry in order to assess the association between chelation and clinical outcomes. In addition, we evaluated the association between chelation and overall survival (OS). Here we report outcomes at 5 years. Methods: The registry enrolled 600 pts from 107 US centers. Pts were ≥18 years old with lower-risk MDS (WHO, FAB, and/or IPSS criteria) and transfusional iron overload (serum ferritin ≥1000 µg/L and/or ≥20 packed red blood cell units and/or ≥6 units every 12 weeks). Pts were analyzed by iron chelation status; ie, had never been chelated or had ever used iron chelation, and a subgroup of the latter grouppts with ≥6 mo of chelation. Pts were evaluated every 6 mo for 5 years or until death with respect to characteristics, survival, disease status, comorbidities, cause of death, and MDS therapy. Results: 600 pts (median age, 76 years [range, 21-99], 346 [57.8%] male, 519 [86.6%] Caucasian) were evaluated. IPSS status was similar across chelation groups. Chelated pts (n=271) had a greater median number of lifetime units transfused at the time of enrollment vs nonchelated pts (n=328): 38.5 vs 20.0. At baseline, cardiac and vascular comorbidities (CVC) were significantly higher in nonchelated vs chelated pts (52.4% vs 34.3% [P<0.0001], 59.8% vs 48.0% [P=0.0039], respectively). Endocrine comorbidities (EC) were numerically higher in nonchelated vs ≥6 mo chelated pts (44.2% vs 35.6%). As of May 1, 2014, 61 pts continue in the registry; 538 discontinued (400 died, 66 lost to follow-up, 46 completed study, and 26 discontinued for other reasons). Of the 271 chelated pts, 187 (69.0%) were chelated with deferasirox, 40 (14.8%) with deferasirox and deferoxamine, 32 (11.8%) with deferoxamine, and 1 (0.4%) with an unknown chelator; in 11 (4.1%), the chelator name was not provided. Cumulative duration of chelation was 18.9 mo in pts who had ever used iron chelation and 27.0 mo in pts with ≥6 mo of iron chelation. OS from diagnosis of MDS and time to acute myeloid leukemia (AML) were significantly greater in the chelated vs nonchelated pts (P<0.0001 for both). In pts with CVC, median OS was also significantly greater in chelated vs nonchelated pts (67.66 vs 43.40 mo; P<0.0001). In pts with EC, median OS was also greater in chelated pts (74.98 vs 44.63 mo; P<0.0001) (Table). Patients with ≥6 mo of chelation had numerically fewer deaths in the registry, numerically greater OS, time to death, and time to AML transformation vs pts who had any chelation (Table). Conclusions: Limitations of these analyses include variation in time from diagnosis, duration of chelation, impact of pt clinical status on decision to chelate, and optional conduct of clinical assessments. Nonetheless, the results after 5 years of follow-up of lower-risk pts with MDS suggest iron chelation therapy is associated with improved OS and longer time to AML transformation. Causation has not been established. Abstract 1350. TABLE. Characteristics of Patients Nonchelated, Chelated, and Chelated ≥6 Months Nonchelated n=328 Chelated n=271 Chelated ≥6 Months n=202 Time to death, median (min/max) mo 47.8 (43.4, 53.1) 88.0 (78.4, 103.0) *P<0.0001 100.0 (83.4, 118.2) *P<0.0001 Deaths (n), % 239 (72.9) 161 (59.4) *P=0.0005 115 (56.9) *P=0.0002 Median OS (mo): No CVCMedian OS (mo): With CVC 34.0 (n=42) 43.4 (n=286) 69.3 (n=72) 67.7 (n=199) *P<0.0001 79.3 (n=60) 72.6 (n=142) *P<0.0001 Median OS (mo): No ECMedian OS (mo): With EC 38.5 (n=162) 44.6 (n=166) 67.1 (n=149) 75.0 (n=122) *P<0.0001 69.6 (n=114) 81.8 (n=88) *P<0.0001 Time to AML transformation from diagnosis, median (min, max) mo 46.4 (6.9, 82.5) 72.1 (16.4, 176.6) *P<0.0001 78.8 (16.4, 176.6) *P<0.0001 AML transformation, n (%) 34 (10.4) 17 (6.3) 14 (6.9) Cause of death, n (%) MDS/AML 103 (31.4) 73 (26.9) 53 (26.2) Cardiac 36 (11.0) 21 (7.7) 15 (7.4) Infection 27 (8.2) 14 (5.2) 14 (6.9) Other 16 (4.9) 16 (5.9) 10 (5.0) Unknown 29 (8.8) 18 (6.6) 12 (5.9) Malignancy 14 (4.3) 2 (0.7) 0 (0.0) Respiratory 7 (2.1) 7 (2.6) 4 (2.0) Multiorgan failure 3 (0.9) 3 (1.1) 3 (1.5) CVA 1 (0.3) 5 (1.8) 3 (1.5) GvHD/transplant 3 (0.9) 2 (0.7) 1 (0.5) CVC, cardiovascular comorbidity; EC, endocrine comorbidity; CVA, cerebrovascular accident; GvHD, graft-vs-host disease *Versus nonchelated. Disclosures Paley: Novartis Pharma: Employment. Esposito:Novartis Pharma: Employment. McNamara:Novartis Pharmaceuticals Corporation: Employment. Garcia-Manero:Novartis Pharma: Research Funding.

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Racial disparities in treatment patterns and clinical outcomes in patients (pts) with HER2+ metastatic breast cancer (MBC).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.1526 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 1526-1526

Author(s):

Adam Brufsky ◽

Denise Aysel Yardley ◽

Marianne Ulcickas Yood ◽

Debu Tripathy ◽

Peter Andrew Kaufman ◽

...

Keyword(s):

Clinical Outcomes ◽

Metastatic Breast ◽

Stage Iv ◽

Progression Free Survival ◽

Population Based ◽

Treatment Patterns ◽

History Of ◽

Observational Cohort ◽

Grade 3

1526 Background: Data examining prognosis and treatment outcomes for black pts with HER2+ MBC are limited. Methods: registHER is a large, observational cohort of pts (N=1,001) with HER2+ MBC diagnosed w/in 6 mos of enrollment and followed until death, disenrollment, or 6/09 (median follow-up 27 mos). Demographics, treatment patterns, and clinical outcomes were described for black (n=126) and white pts (n=793). Progression Free Survival (PFS) and Overall Survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Results: Black pts were more likely to be obese (BMI ≥ 30), have diabetes, and a history of cardiovascular disease (CVD) than white pts (Table). Black pts were less likely to have estrogen receptor (ER)/progesterone receptor (PR)+ disease and more likely to present with stage IV MBC. In trastuzumab (T)-treated pts, incidence of cardiac safety events (grade ≥3) was higher in black (13/119 [10.9%]) than white pts (59/746 [7.9%]). Unadjusted median OS (mos) was significantly lower (blacks: 27.1, 95%CI 23.2-32.1; whites: 37.3, 95%CI 34.6-41.1) and median PFS (mos) was lower (blacks: 7.0, 95%CI 5.7-9.7; whites: 10.2, 95%CI 9.3-11.2) in black than white pts. The adjusted OS hazard ratio (HR) for black vs. white was 1.32 (95%CI 1.04, 1.69); the adjusted PFS HR was 1.31 (95% CI 1.07, 1.61). Conclusions: These population-based data show poorer prognostic factors and independently worse clinical outcomes in black vs. white pts, and represent the largest database to date with black pts with HER2+ MBC. Further research is needed to explore the basis for the differences noted in this hypothesis-generating analysis. [Table: see text]

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Trends and Characteristics of Emergency Medical Services in Italy: A 5-Years Population-Based Registry Analysis

Healthcare ◽

10.3390/healthcare8040551 ◽

2020 ◽

Vol 8 (4) ◽

pp. 551

Author(s):

Sara Campagna ◽

Alessio Conti ◽

Valerio Dimonte ◽

Marco Dalmasso ◽

Michele Starnini ◽

...

Keyword(s):

Emergency Medical Services ◽

Emergency Departments ◽

Healthcare Services ◽

Population Based ◽

Medical Services ◽

Chi Square ◽

Quality Healthcare ◽

Emergency Calls ◽

Emergency Medical ◽

Private Citizens

Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data were extracted from the emergency registry for the period 2013–2017. This included call and rescue vehicle dispatch information. All relationships in analyses and differences in events proportion between 2013 and 2017 were tested against the Pearson’s Chi-Square with a 99% level of confidence. Results: Among the 2,120,838 emergency calls, operators dispatched at least one rescue vehicle for 1,494,855. There was an estimated overall incidence of 96 emergency calls and 75 rescue vehicles dispatched per 1000 inhabitants per year. Most calls were made by private citizens, during the daytime, and were made from home (63.8%); 31% of rescue vehicle dispatches were advanced emergency medical vehicles. The highest number of rescue vehicle dispatches ended at the emergency department (74.7%). Conclusions: Our data showed that, with some exception due to environmental differences, the highest proportion of incoming emergency calls is not acute or urgent and could be more effectively managed in other settings than in an Emergency Departments (ED). Better management of dispatch can reduce crowding and save hospital emergency departments time, personnel, and health system costs.

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Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results

Psychological Medicine ◽

10.1017/s0033291711002911 ◽

2012 ◽

Vol 42 (11) ◽

pp. 2239-2253 ◽

Cited By ~ 213

Author(s):

N. Kaymaz ◽

M. Drukker ◽

R. Lieb ◽

H.-U. Wittchen ◽

N. Werbeloff ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Psychotic Disorder ◽

Help Seeking ◽

Meta Analysis ◽

Population Based ◽

Baseline Assessment ◽

Psychotic Experiences ◽

Ultra High Risk

BackgroundThe base rate of transition from subthreshold psychotic experiences (the exposure) to clinical psychotic disorder (the outcome) in unselected, representative and non-help-seeking population-based samples is unknown.MethodA systematic review and meta-analysis was conducted of representative, longitudinal population-based cohorts with baseline assessment of subthreshold psychotic experiences and follow-up assessment of psychotic and non-psychotic clinical outcomes.ResultsSix cohorts were identified with a 3–24-year follow-up of baseline subthreshold self-reported psychotic experiences. The yearly risk of conversion to a clinical psychotic outcome in exposed individuals (0.56%) was 3.5 times higher than for individuals without psychotic experiences (0.16%) and there was meta-analytic evidence of dose–response with severity/persistence of psychotic experiences. Individual studies also suggest a role for motivational impairment and social dysfunction. The evidence for conversion to non-psychotic outcome was weaker, although findings were similar in direction.ConclusionsSubthreshold self-reported psychotic experiences in epidemiological non-help-seeking samples index psychometric risk for psychotic disorder, with strong modifier effects of severity/persistence. These data can serve as the population reference for selected and variable samples of help-seeking individuals at ultra-high risk, for whom much higher transition rates have been indicated.

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Association of patient safety indicator 03 and clinical outcome in a surgery hospital

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-02-2020-0025 ◽

2020 ◽

Vol 33 (6) ◽

pp. 403-412

Author(s):

Mahi Mahmoud Al-Tehewy ◽

Sara Ebraheem Abd Al-Razak ◽

Tamer Shahat Hikal ◽

Maha Magdy Wahdan

Keyword(s):

Patient Safety ◽

Clinical Outcomes ◽

Patient Outcomes ◽

Improve Patient Safety ◽

Cardiothoracic Surgery ◽

Hospital Data ◽

Content Type ◽

Patient Safety Indicators ◽

Risk Of Death

PurposePatient safety indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. The study aimed at measuring the incidence of the Agency for Healthcare Research and Quality (AHRQ) PSI03 (pressure ulcer [PU] rate) and to identify the association between PSI03 and clinical outcomes including death, readmission within 30 days and length of stay (LOS) at the cardiothoracic surgery hospital at Ain Shams University, Cairo, Egypt.Design/methodology/approachAn exploratory prospective cohort study was conducted to follow up patients, who fulfilled the inclusion criteria, from admission until one month after discharge at the cardiothoracic surgery hospital. Data were collected through basic information and follow-up sheets. The total number of included participants in the study was 330.FindingsPSI03 incidence rate was 67.7 per 1,000 discharges. Patients aged 60 years and above had the highest risk among all age groups. In patients who developed PSI03, the risk ratio (RR) of death was 8.8 [95% CI (3.79–20.24)], RR of staying more than 30 days at the hospital was 1.5 [95% CI (1.249–1.872)] and of readmission within 30 days in patients who developed PSI03 was 1.5 [95% CI (0.38–6.15)]. In the study’s hospital, the patients who developed PSI03 were at higher risk of death and stayed longer at the hospital than patients without PSI03. This study demonstrated a clear association between PSI03 and patient outcomes such as LOS and mortality. Early detection, prevention and proper management of PSI03 are recommended to decrease unfavorable clinical outcomes.Originality/valueThe importance of PSIs lies in the fact that they facilitate the recognition of the adverse events and complications which occurred during hospitalization and give the hospitals a chance to improve the possible clinical outcomes. Therefore, the current study aimed at measuring the association between AHRQ PSI03 ( PU rate) and the clinical outcomes including death, readmission within 30 days and the LOS at the cardiothoracic surgery hospital at Ain Shams University. This study will provide the hospital management with baseline data for this type of adverse event and guide them to develop a system for identifying the high-risk group of patients and to upgrade relevant hospital policies and guidelines that lead to improved patient outcomes.

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