scholarly journals Higher In-Hospital Mortality in Patients with Nonspecific Complaints Presenting to the Emergency Department

2019 ◽  
Vol 18 (4) ◽  
pp. 232-238
Author(s):  
JJH Wachelder ◽  
◽  
Patricia M. Stassen ◽  
RS Fourmanov ◽  
CH Nickel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Patients ◽  
Orange Yellow ◽  
Number Of Patients

Background: Nonspecific complaints (NSC) at the Emergency Department (ED) are not well researched yet. Objective: To investigate the number of patients who could be classified as having NSC early after arrival in the ED using an algorithm. Method: Retrospective cohort study was conducted among all hemodynamically stable non-trauma adult patients with MTS category orange/yellow visiting the ED. Patients who had no specific complaints/signs, predefined on a list, were categorized as NSC. Results: In total, 2419 patients, of whom 102 (4.2%) presented with NSC. Hospitalization was more prevalent (85.3% vs. 69.0%, p<0.001) and in-hospital mortality was higher in the NSC-group (11.8% vs. 3.5%, adjusted OR 2.0, 95% CI 1.0-3.9, p=0.04). Conclusion: Using an algorithm it is possible to identify NSC patients who have (worse) outcomes than those classified as SC.

scholarly journals Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Occupancy Rate ◽  
Number Of Patients ◽  
Ed Overcrowding

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

The Predictive Applicability of Liberal vs Restrictive Intubation Criteria in Adult Patients With Suspected Inhalation Injury—A Retrospective Cohort Study

2020 ◽  
Vol 41 (6) ◽  
pp. 1290-1296
Author(s):  
Minesh Chotalia ◽  
Christine Pirrone ◽  
Thomas Mangham ◽  
Barbara Torlinska ◽  
Randeep Mullhi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Inhalation Injury ◽  
Adult Patients ◽  
Queen Elizabeth Hospital ◽  
Burn Patients ◽  
Prolonged Intubation ◽  
Number Of Patients ◽  
Highly Sensitive

Abstract This study compares the ability of liberal vs restrictive intubation criteria to detect prolonged intubation and inhalation injury in burn patients with suspected inhalation injury. Emerging evidence suggests that using liberal criteria may lead to unnecessary intubation in some patients. A single-center retrospective cohort study was conducted in adult patients with suspected inhalation injury admitted to intensive care at Queen Elizabeth Hospital, Birmingham between April 2016 and July 2019. Liberal intubation criteria, as reflected in local guidelines, were compared to restrictive intubation criteria, as outlined in the American Burn Association guidelines. The number of patients displaying positive characteristics from either guideline was compared to the number of patients who had prolonged intubation (more than 48 hours) and inhalation injury. In detecting a need for prolonged intubation (n = 85), the liberal criteria had greater sensitivity (liberal = 0.98 [0.94–1.00] vs restrictive = 0.84 [0.75–0.93]; P = .013). However, the restrictive criteria had greater specificity (restrictive = 0.96 [0.89–1.00] vs liberal = 0.48 [0.29–0.67]; P &lt; .001). In detecting inhalation injury (n = 72), the restrictive criteria were equally sensitive (restrictive = 0.94 [0.87–1.00] vs liberal = 0.98 [0.84–1.00]; P = .48) and had greater specificity (restrictive = 0.86 [0.72–1.00] vs liberal = 0.04 [0.00–0.13]; P &lt; .001). In patients who met liberal but not restrictive criteria, 65% were extubated within 48 hours and 90% did not have inhalation injury. Liberal intubation criteria were more sensitive at detecting a need for prolonged intubation, while restrictive criteria were more specific. Most patients intubated based on liberal criteria alone were extubated within 48 hours. Restrictive criteria were highly sensitive and specific at detecting inhalation injury.

scholarly journals In-hospital mortality due to breakthrough COVID-19 among recipients of COVISHIELD (ChAdOx nCoV-19) and COVAXIN (BBV152)

2021 ◽  
Author(s):  
Tejas M Suri ◽  
Tamoghna Ghosh ◽  
M Arunachalam ◽  
Rohit Vadala ◽  
Saurabh Vig ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Vaccination Campaign ◽  
Adult Patients ◽  
Hospital Outcomes ◽  
Hospital Outcome ◽  
Second Wave

AbstractBackgroundMultiple vaccines have received emergency-use authorization in different countries in the fight against the COVID-19 pandemic. India had started its vaccination campaign using the COVISHIELD (ChAdOx nCoV-19) and the COVAXIN (BBV152) vaccines. However, there is a lack of head-to-head comparisons of the different vaccines.MethodsWe performed a retrospective cohort study during the second wave of the pandemic in India with predominant circulation of the delta strain of SARS-CoV-2. We enrolled adult patients who were hospitalized with breakthrough COVID-19 infection after vaccination. We compared in-hospital outcomes between patients who had received the COVISHIELD (n=181) or COVAXIN vaccines.ResultsBetween April and June 2021, a total of 353 patients were enrolled, among whom 181 (51.3%) received COVAXIN (156 partially vaccinated and 25 fully vaccinated) and 172 (48.7%) received COVISHIELD (155 partially vaccinated and 17 fully vaccinated). The in-hospital mortality did not differ between the recipients of COVISHIELD or COVAXIN in either the fully vaccinated [2 deaths (11.8%) vs 0 deaths (0%), respectively p=0.08] or the partially vaccinated cohorts [31 deaths (20%) vs 28 deaths (17.9%), respectively, p=0.65].ConclusionsPatients who are hospitalized with breakthrough COVID-19 had similar in-hospital outcome irrespective of whether they received COVISHIELD or COVAXIN.

Comorbidities Associated with In-Hospital Mortality in Adult Patients with COVID-19 in Lima, Peru: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Mirtha Gabriela Soto Cabezas ◽  
Mary F. Reyes ◽  
Luis Ordoñez Ibargüen ◽  
Kevin S. Martel ◽  
Noemi Flores Jaime ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Patients

scholarly journals Sepsis in patients with haematological versus solid cancer: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e038349
Author(s):  
Ralphe Bou Chebl ◽  
Rawan Safa ◽  
Mohammad Sabra ◽  
Ali Chami ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Haematological Malignancy ◽  
Solid Cancer ◽  
Solid Malignancy

ObjectivesThis study aims to examine the outcome of haematological and patients with solid cancer presenting with sepsis to the emergency department (ED).DesignSingle-centred, retrospective cohort study. Setting conducted at an academic emergency department of a tertiary hospital.ParticipantsAll patients >18 years of age admitted with sepsis were included.InterventionsPatients were stratified into two groups: haematological and solid malignancy.Primary and secondary outcomeThe primary outcome of the study was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) mortality, ICU and hospital lengths of stay and mechanical ventilation duration.Results442 sepsis cancer patients were included in the study, of which 305 patients (69%) had solid tumours and 137 patients (31%) had a haematological malignancy. The mean age at presentation was 67.92 (±13.32) and 55.37 (±20.85) (p<0.001) for solid and liquid tumours, respectively. Among patients with solid malignancies, lung cancer was the most common source (15.6%). As for the laboratory workup, septic solid cancer patients were found to have a higher white blood count (12 576.90 vs 9137.23; p=0.026). During their hospital stay, a total of 158 (51.8%) patients with a solid malignancy died compared with 57 (41.6%) patients with a haematological malignancy (p=0.047). There was no statistically significant association between cancer type and hospital mortality (OR 1.15 for liquid cancer p 0.58). There was also no statistically significant difference regarding intravenous fluid administration, vasopressor use, steroid use or intubation.ConclusionSolid tumour patients with sepsis or septic shock are at the same risk of mortality as patients with haematological tumours. However, haematological malignancy patients admitted with sepsis or septic shock have higher rates of bacteraemia.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

scholarly journals Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Stress Ulcer ◽  
Increased Risk ◽  
Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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