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2021 ◽  
Jin Hui Paik ◽  
Jung-Soo Kim ◽  
Man-Jong Lee ◽  
Mi Hwa Park ◽  
Areum Durey ◽  

Abstract Background: The duration of mechanical ventilation (MV) required by patients admitted to the emergency department (ED) is difficult to predict. We investigated the duration of MV in ED-admitted patients, as well as their clinical progress.Methods: We investigated the duration of MV in adult patients (aged ≥18 years) who were attached to ventilators in our ED between January and December 2017. The patients were divided into two groups; MV <7 days and MV ≥7 days. The patients’ demographic characteristics, diagnoses, clinical features, and underlying diseases were compared between two groups.Results: The study comprised 282 patients including 142 in the MV <7 days group and 140 in the MV ≥7 days group. The MV ≥7 days group had more patients diagnosed with metabolic disorder, pneumonia, neurological disease, sepsis, and multiple trauma, and also had a greater proportion of patients with dementia or stroke as the underlying disease. The mean C-reactive protein level in the MV ≥7 days group was 6.4 mg/dL, which was higher than that in the MV <7 days group. The risk factors for requiring ≥7 days of MV were identified as a diagnosis of stroke as well as having the underlying diseases of cancer and stroke or dementia. Among the laboratory test results, pH, HCO3- , and albumin <3.5 g/dL were identified as factors influencing the duration of MV.Conclusions: MV for ≥7 days is predicted to be required for patients admitted for a stroke; those with underlying cancer or stroke; and those with adverse pH, HCO3-, and albumin blood test results.

2021 ◽  
Vol 11 (1) ◽  
Johan Courjon ◽  
Julie Contenti ◽  
Elisa Demonchy ◽  
Jacques Levraut ◽  
Pascal Barbry ◽  

AbstractThe variant 20I/501Y.V1, associated to a higher risk of transmissibility, emerged in Nice city (Southeast of France, French Riviera) during January 2021. The pandemic has resumed late December 2020 in this area. A high incidence rate together with a fast turn-over of the main circulating variants, provided us the opportunity to analyze modifications in clinical profile and outcome traits. We performed an observational study in the University hospital of Nice from December 2020 to February 2021. We analyzed data of sequencing of SARS-CoV-2 from the sewage collector and PCR screening from all positive samples at the hospital. Then, we described the characteristics of all COVID-19 patients admitted in the emergency department (ED) (n = 1247) and those hospitalized in the infectious diseases ward or ICU (n = 232). The UK-variant was absent in this area in December, then increasingly spread in January representing 59% of the PCR screening performed mid-February. The rate of patients over 65 years admitted to the ED decreased from 63 to 50% (p = 0.001). The mean age of hospitalized patients in the infectious diseases ward decreased from 70.7 to 59.2 (p < 0.001) while the proportion of patients without comorbidity increased from 16 to 42% (p = 0.007). Spread of the UK-variant in the Southeast of France affects younger and healthier patients.

10.2196/30022 ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. e30022
Ann Corneille Monahan ◽  
Sue S Feldman

Background Emergency department boarding and hospital exit block are primary causes of emergency department crowding and have been conclusively associated with poor patient outcomes and major threats to patient safety. Boarding occurs when a patient is delayed or blocked from transitioning out of the emergency department because of dysfunctional transition or bed assignment processes. Predictive models for estimating the probability of an occurrence of this type could be useful in reducing or preventing emergency department boarding and hospital exit block, to reduce emergency department crowding. Objective The aim of this study was to identify and appraise the predictive performance, predictor utility, model application, and model utility of hospital admission prediction models that utilized prehospital, adult patient data and aimed to address emergency department crowding. Methods We searched multiple databases for studies, from inception to September 30, 2019, that evaluated models predicting adult patients’ imminent hospital admission, with prehospital patient data and regression analysis. We used PROBAST (Prediction Model Risk of Bias Assessment Tool) and CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) to critically assess studies. Results Potential biases were found in most studies, which suggested that each model’s predictive performance required further investigation. We found that select prehospital patient data contribute to the identification of patients requiring hospital admission. Biomarker predictors may add superior value and advantages to models. It is, however, important to note that no models had been integrated with an information system or workflow, operated independently as electronic devices, or operated in real time within the care environment. Several models could be used at the site-of-care in real time without digital devices, which would make them suitable for low-technology or no-electricity environments. Conclusions There is incredible potential for prehospital admission prediction models to improve patient care and hospital operations. Patient data can be utilized to act as predictors and as data-driven, actionable tools to identify patients likely to require imminent hospital admission and reduce patient boarding and crowding in emergency departments. Prediction models can be used to justify earlier patient admission and care, to lower morbidity and mortality, and models that utilize biomarker predictors offer additional advantages.

2021 ◽  
Sohyun Eun ◽  
Hye Eun Kwon ◽  
Heoung Jin Kim ◽  
Seo Hee Yoon ◽  
Moon Kyu Kim ◽  

Abstract Background: Uncontrolled status epilepticus (SE) causes damage to all organs, especially the brain. Although there are guidelines regarding the management of convulsive SE, the timing for administering first-line rescue medications (RMeds) remains unclear. Therefore, we analyzed patients with persistent SE lasting for >30 min, who visited the pediatric emergency department (pED), to determine clinical features and risk factors and provide directions for management on arrival to the pED. Methods: This study was conducted by retrospectively reviewing medical charts of patients aged 0–19 years diagnosed with SE and accompanying motor seizures, who visited the pED between January 2010 and December 2019. After arrival at the pED, patients were divided into two groups, namely ≥30 min (n = 12) and <30 min (n = 13), according to the additional seizure time and administration of the first dose of RMeds before and after 5 min. Results: Seizures lasting for <30 min were mainly belonged to idiopathic SE in the pED. Among four SE patients who needed intensive care unit (ICU) management, three had delayed administration of RMeds of >5 min, which was statistically significant; hence, more hospitalizations in the ICU were observed when RMed administration was delayed (p = 0.047). In acute symptomatic SE such as encephalitis, more than three doses of RMeds were needed to control seizures. Conclusions: Patients with convulsive SE should arrive at the pED as soon as possible and immediately receive RMeds after arrival at the pED for good outcomes.

2021 ◽  
Vol 126 (1) ◽  
Per Wändell ◽  
Axel C. Carlsson ◽  
Anders Larsson ◽  
Olle Melander ◽  
Torgny Wessman ◽  

Background: The impact of body mass index (BMI) on mortality varies with age and disease states. The aim of this research study was to analyse the associations between BMI categories and short- and long-term mortality in patients with or without diabetes seeking care at the emergency department (ED) with acute dyspnoea. Population and methods: Patients aged ≥18 years at ED during daytime on weekdays from March 2013 to July 2018 were included. Participants were triaged according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A), and blood samples were collected. Totally, 1,710 patients were enrolled, with missing values in 113, leaving 1,597 patients, 291 with diabetes and 1,306 without diabetes. The association between BMI and short-term (90-day) and long-term (mean follow-up time 2.1 years) mortality was estimated by Cox regression with normal BMI (18.5–24.9) as referent category, with adjustment for age, sex, METTS-A scoring, glomerular filtration rate, smoking habits and cardiovascular comorbidity in a fully adjusted model. The Bonferroni correction was also used. Results: Regarding long-term mortality, patients with diabetes and BMI category ≥30 kg/m2 had a fully adjusted Hazard Ratio (HR) of 0.40 (95% confidence interval [CI]: 0.23–0.69), significant after the Bonferroni correction. Amongst patients without diabetes, those with underweight had an increased risk but only of borderline significance, whilst risks in those with overweight or obesity did not differ from reference. Regarding short-term mortality, risks did not differ from reference amongst patients with or without diabetes. Conclusions: We found divergent long-term mortality risks in patients with and without diabetes, with lower risk in obese patients (BMI ≥ 30 kg/m2) with diabetes, but no increased risk for patients without diabetes and overweight (BMI: 25–29.9 kg/m2) and obesity.

2021 ◽  
Vol 15 (1) ◽  
Mohamed Eltayeb Abdelrahman Naiem ◽  
Nassir Alhaboob Arabi

Abstract Background Pancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries. Case presentation A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications. Conclusions Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.

2021 ◽  
Vol 12 (10) ◽  
pp. 101198
Anna O. Lukina ◽  
Aubrey Maquiling ◽  
Brett Burstein ◽  
Mieczysław Szyszkowicz

2021 ◽  
Haley Lehman ◽  
Jeffrey Turnbull ◽  
Janice Prescod ◽  
Trevor Gohl ◽  
Peter Lopez ◽  

Abstract Background: The SARS-CoV-2 virus has caused patient aversion to health care facilities for fear of contracting the virus. It has been shown that there has been a decreased amount of emergency department visits since the pandemic started1, with an increased presentation of conditions with progressed pathology. At our community hospital, it was anecdotally noted that there was an increase in the number of patients presenting with perforated appendicitis during this time. Our hypothesis is that more patients presented with the progressed finding of perforated appendicitis during rather than prior to the pandemic because of fear of exposure to COVID-19 in the health care setting. Methods: Retrospective chart review of cases of perforated appendicitis at a local community hospital during March 10-December 31, 2019 (cohort A) and March 10-December 31, 2020 (cohort B).Results: A total of three hundred and fifty-two eligible patients received treatment for acute appendicitis at our community hospital. In Cohort A (prior to the pandemic), there were 53 perforations out of 188 patients (53/188) - 28.2%. In cohort B (during the pandemic), there was 61 perforations out of 164 patients (61/164) – 37.2%. Statistically, there was no difference in the rate of perforation between Cohort A and Cohort B, approaching significance (p-value = 0.072). The median age of patients in Cohort A was 38 and in Cohort B it was 43.5 years of age. There was no statistically significant differences between cohorts regarding age (p < 0.23) and sex (p < 0.8). Conclusion: This study found that the number of patients who presented with perforated appendicitis during the pandemic did increase compared to pre-pandemic (37.2% vs 28.2%) but this did not meet statistical significance (p=0.072).

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