Specialty-related differences in diagnosing hip-spine syndrome: a multi-center retrospective cohort study.

The relationship between platelet count and sepsis outcomes in intensive care units (ICUs) requires comprehensive investigation through large-scale multicenter studies. In this multicenter retrospective cohort study, we analyzed 17,977 sepsis patients from 208 U.S. hospitals (2014-2015) using the eICU Collaborative Research Database v2.0. Analyses were adjusted for demographics, clinical parameters, comorbidities, and treatments. Generalized additive models and two-piecewise linear regression were used to assess the relationship between platelet count and mortality. A U-shaped relationship was identified with an inflection point at 176 × 10⁹/L. Below this threshold, each 10 × 10⁹/L increase in platelet count was associated with a 6% decrease in mortality risk (adjusted OR 0.94, 95% CI 0.93-0.95, p < 0.0001), while above it, each 10 × 10⁹/L increase was associated with a 1% increase in mortality risk (adjusted OR 1.01, 95% CI 1.00-1.01, p = 0.0153). This large-scale, multicenter retrospective study has made a significant contribution to understanding the association between platelet count and mortality in patients with sepsis in intensive care units. We identified a critical threshold of 176 × 109/L for platelet count and demonstrated a distinct U-shaped relationship with 30-day in-hospital mortality, providing valuable reference criteria for clinical risk stratification.

Introduction: Endoscopic ultrasound (EUS) is widely used in the adult population for a wide range of diagnostic and therapeutic purposes. In the pediatric population, the use of EUS has been historically diagnostic, however, EUS-guided therapy is increasing. In this retrospective study, we aim to describe the safety and efficacy profiles of EUS in pediatric patients across a spectrum of EUS procedures. Methods: This is a retrospective multi-center cohort study of pediatric patients who underwent EUS procedures for diagnostic or therapeutic purposes between January 2011 and March 2022. Data including demographics, procedural details, and adverse events (AE) were collected. Outcomes were diagnostic success, defined as successful diagnosis using only EUS without any additional diagnostic tools, and therapeutic success, defined as using only EUS without additional therapeutic interventions. Results: 61 pediatric patients between the age of 0 to 18 years underwent 77 EUS procedures, of which 35 were females (56.5%). The mean age at the procedure was 16.2 ± 4.2 years and the median weight was 70.2 kg (IQR 49.7-91.2). The indications for EUS were gastrointestinal lumen evaluation ± fine needle biopsy/aspiration (FNB/A), pancreaticobiliary tree evaluation ±FNB/A, surveillance for tumor syndrome, suspected lymph node (LN), or gastrointestinal (GI) mass, celiac plexus block and cyst gastrostomy creation (Table). The median procedure time was 35 minutes (IQR 18 – 49). The diagnostic success rate was 98.7% and the therapeutic success rate was 100%. The complication rate was 2.6% which included 2 cases of pancreatitis after fine-needle aspiration of the pancreas. No case had any anesthesia-related complications. Conclusion: In this multicenter retrospective cohort study, the use of EUS in pediatrics has shown to be safe and effective in a wide range of diagnostic and therapeutic intents. Table 1. - Baseline characteristics, procedural and clinical outcomes of pediatric patient EUS procedures N=77 (%) Females 35 (56.5) Weight (n=66) 70.2 [49.7 – 91.2] Age at procedure (years) 16.2 ± 4.2 Indication Diagnostic GI lumen Evaluation 9 (11.7) GI lumen Evaluation with FNB/A 5 (6.5) Pancreaticobiliary tree evaluation 37 (48.1) Pancreaticobiliary tree evaluation with FNB/A 6 (7.8) Surveillance for tumor syndrome 7 (9.1) Suspected LN or mass 8 (10.4) Therapeutic Celiac Plexus Block 1 (1.3) Cystgastrostomy 4 (5.2) Anesthesia Type Monitored Anesthesia Care (MAC) 48 (62.3) General Anesthesia 29 (37.7) Mean procedure Time in minutes (N= 59) 35.0 [18.0 - 49.0] Diagnostic Success 76 (98.7) Therapeutic Success (n=5) 5 (100) EUS related complications 2 (2.6) Anesthesia complications 0 (0) EUS = endoscopic ultrasound, FNA/B = fine needle aspiration/biopsy, LN = lymph node.Continuous variables presented as mean ± SD or median (IQR).Categorical variables presented as n (%).

LARGE-SCALE, MULTICENTER, RETROSPECTIVE STUDY ON NEPHROTOXICITY ASSOCIATED WITH EMPIRIC, BROAD-SPECTRUM ANTIBIOTICS IN CRITICALLY ILL PATIENTS

605 A four-year population based analysis of emergency department syncope: predictors of admission/readmission, and regional variations in practice patterns

ObjectiveIntracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) is a prevalent stroke subtype among Asian populations. Characterized by dynamic intraprocedural reocclusion and underlying stenotic pathology, this condition poses distinct challenges for acute endovascular management. Contemporary guidelines universally recommend mechanical thrombectomy (MT) as first-line recanalization therapy for large vessel occlusion (LVO); however such recommendations derive predominantly from studies without etiological stratification. Consequently, optimal initial endovascular strategies for ICAD-LVO remain undefined despite its epidemiological significance in Asian cohorts.MethodsIn this multicenter retrospective cohort study, 161 patients with underlying ICAD-LVO who underwent endovascular therapy (June 2022–December 2024) were stratified by initial strategy: angioplasty/stenting (AS group, n = 94) or mechanical thrombectomy (MT group, n = 67). The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] score 0–2). Secondary outcomes included successful recanalization (mTICI 2b–3), symptomatic intracranial hemorrhage (SICH), and mortality.ResultsAmong 161 included patients (94 AS vs. 67 MT), baseline characteristics were balanced except for a higher prevalence of hyperlipidemia (p = 0.041), progressive stroke (p < 0.001), and tirofiban administration (p = 0.043) in the AS group. The initial AS approach achieved significantly higher rates of functional independence (63.8% vs. 47.8%; adjusted OR = 2.886, 95% CI: 1.290–6.736, p = 0.011) and reduced the need for rescue therapy (24.5% vs. 55.2%). Rates of successful recanalization (96.8% vs. 91.0%, p = 0.155), SICH (13.8% vs. 13.4%, p = 0.985), and 90-day mortality (14.9% vs. 13.4%, p = 0.784) did not differ significantly.ConclusionIn this multicenter retrospective cohort study, primary angioplasty/stenting was associated with superior clinical efficacy compared to mechanical thrombectomy as the initial approach for underlying ICAD-LVO. This approach showed higher rates of 90-day functional independence while maintaining a comparable safety profile. These findings support the concept of etiology-specific endovascular strategies; however, this approach requires confirmation in prospective randomized controlled trials.

BackgroundMechanical ventilation (MV) is an important lifesaving method in intensive care unit (ICU). Prolonged MV is associated with ventilator associated pneumonia (VAP) and other complications. However, premature weaning from MV may lead to higher risk of reintubation or mortality. Therefore, timely and safe weaning from MV is important. In addition, identification of the right patient and performing a suitable weaning process is necessary. Although several guidelines about weaning have been reported, compliance with these guidelines is unknown. Therefore, the aim of this study is to explore the variation of weaning in China, associations between initial MV reason and clinical outcomes, and factors associated with weaning strategies using a multicenter cohort.MethodsThis multicenter retrospective cohort study will be conducted at 17 adult ICUs in China, that included patients who were admitted in this 17 ICUs between October 2020 and February 2021. Patients under 18 years of age and patients without the possibility for weaning will be excluded. The questionnaire information will be registered by a specific clinician in each center who has been evaluated and qualified to carry out the study.DiscussionIn a previous observational study of weaning in 17 ICUs in China, weaning practices varies nationally. Therefore, a multicenter retrospective cohort study is necessary to be conducted to explore the present weaning methods used in China.Trial RegistrationChinese Clinical Trial Registry (ChiCTR) (No. ChiCTR2100044634).

BackgroundIntracerebral hemorrhage (ICH) is associated with a poor prognosis. The association between the neutrophil-to-albumin ratio (NAR) with mortality in patients with ICH remains underexplored. This study investigated the relationship between the NAR and mortality in patients with ICH.MethodsA multicenter retrospective observational cohort study was conducted from January 2010 to June 2019. Participants were divided into four groups according to NAR quartiles at admission. Univariable and multivariable logistic regression analyses were used to evaluate the relationship between NAR and 90-day mortality. The predictive power of NAR was compared with neutrophil count and albumin levels using receiver operating characteristic (ROC) curve analysis.ResultsPatients in the highest NAR quartile had significantly greater odds of 90-day mortality (adjusted OR 1.74, 95% CI 1.27–2.39, p < 0.001) compared to those in the lowest quartile. The area under the curve (AUC) for NAR was 0.68, demonstrating superior discriminative ability compared to neutrophil count (AUC 0.64) and albumin (AUC 0.60). These findings were consistent across various subgroups, with multivariate analysis confirming the independent predictive value of NAR for mortality in patients with ICH.ConclusionsElevated NAR was independently associated with increased mortality in patients with ICH. NAR is a promising inflammatory marker that could aid in early risk assessment and guide management strategies for patients with ICH.

The feasibility of laparoscopic surgery for primary appendiceal tumors compared to that of open surgery has not been demonstrated to date because primary appendiceal tumors are rare. This study aimed to compare the long-term outcomes between laparoscopic and open surgeries for primary appendiceal tumors. In this multicenter retrospective cohort study, the data of patients who had been histologically diagnosed with primary appendiceal tumors at 43 tertiary hospitals in Japan between 2000 and 2017 were analyzed. In total, 922 patients were assessed, and 679 cases were eligible for analysis. Using propensity scores, the baseline characteristics were matched for 114 open surgery cases and 114 laparoscopic surgery cases. The primary endpoints were recurrence-free survival (excluding patients with stage IV disease with distant metastasis) and overall survival. The rate of conversion from laparoscopic to open surgery was 1.5%. The 5-year recurrence-free survival rates were 80.4% (95% confidence interval: 71.0-89.7) and 78.2% (95% confidence interval: 69.0-87.3) in the laparoscopic and open surgery groups, respectively, with no significant difference (p = 0.57). No significant difference was observed in the 5-year overall survival rates between the laparoscopic [83.5% (95% confidence interval: 74.4-92.7)] and open surgery [72.7% (95% confidence interval: 62.3-83.0); p = 0.09] groups. In multivariate analysis, laparoscopic surgery was not identified as an independent prognostic factor for overall survival [hazard ratio: 0.49 (95% confidence interval: 0.23-1.06), p = 0.0707]. Laparoscopic surgery is comparable to open surgery and can be considered a treatment option for primary appendiceal tumors.

This study aimed to determine the maximum daily insulin dose (MDI) and associated factors in critically ill patients with coronavirus disease 2019 (COVID-19) receiving insulin therapy, under ventilator and/or extracorporeal membrane oxygenation (ECMO) management. This cross-sectional analysis used the Cross ICU Searchable Information System data from a Japanese multicenter retrospective observational cohort study of critically ill patients with COVID-19 receiving ventilation and/or ECMO, from February 2020 to March 2022. Maximum daily insulin dose was determined, and factors associated with it and maximum daily insulin dose per body weight were assessed using linear regression analysis. The analysis included 788 patients. Their mean age, glycated hemoglobin level, maximum daily insulin dose, and time from admission to the maximum daily insulin dose were 65.2 ± 13.0 years, 7.0 ± 1.5% (53.0 ± 7.1 mmol/mol), 46.0 ± 43.6 U/day, and 7.3 ± 7.0 days, respectively. Male sex (β = 6.902, P = 0.034), body mass index (β = 1.020, P = 0.001), glycated hemoglobin (β = 12.272, P < 0.001), and having renal failure (β = 20.637, P = 0.003) were independent determinants of maximum daily insulin dose. Age (β = 0.004, P = 0.035), glycated hemoglobin (β = 0.154, P < 0.001), and having renal failure (β = 0.282, P = 0.004) were independent determinants of maximum daily insulin dose per body weight. In patients with COVID-19 on ventilator and/or ECMO management, the maximum daily insulin dose reached after about 1 week of hospitalization was approximately 46.0 U/day. Glycated hemoglobin and renal failure were both associated with the maximum daily insulin dose and maximum daily insulin dose per body weight.

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) are alternative minimally invasive procedures for the treatment of symptomatic lumbar disc herniation (LDH). However, insufficient literature exists to highlight the differences between the procedures. OBJECTIVES: This study intended to clarify whether PTED results in better clinical outcomes compared with MED in the surgical management of single-level LDH. STUDY DESIGN: A multicenter retrospective cohort study. SETTING: This study took place in 2 spinal minimally invasive centers in Beijing, China. METHODS: A multicenter retrospective study was conducted in consecutive patients diagnosed with symptomatic LDH receiving PTED or MED in 2 spinal minimally invasive centers from April 2009 to July 2016. A total of 1,053 patients were recruited, of which 632 underwent PTED and 421 underwent MED. All patients were followed with a minimum of 2 years; a set of clinical outcomes were extracted and analyzed. RESULTS: The operation time was similar between groups (71.2 ± 15.1 minutes in the PTED group and 69.4 ± 12.5 minutes in the MED group; P = 0.518); length of incision was significantly shorter; intraoperative blood loss was less in the PTED group (P &lt; 0.001); hospital stay was 3.6 ± 1.5 days in the PTED group and 5.4 ± 2.8 days in the MED group with significant differences detected (P = 0.018); however, intraoperative fluoroscopy was longer with significantly higher cost with the PTED group (P &lt; 0.001). Transient dysesthesia and wound complications were more common in the MED group (P = 0.039 and P = 0.026, respectively); however, no significant differences were found with total complications (P = 0.139). Significant lower Visual Analog Scale pain score (back and leg) were detected on day 1 postoperatively (P = 0.007 and P = 0.018, respectively). No significant differences were found at all other time points (P &gt; 0.05). Significantly better Oswestry Disability Index (ODI) score was detected postoperatively at 1 month in the PTED group (19.6 ± 9.8 vs. 27.2 ± 9.3; P = 0.016); ODI score at other time points did not differ significantly between groups (P &gt; 0.05). Modified MacNab criteria showed that most patients experienced excellent and good results with no significant differences between groups (P = 0.511). LIMITATION: This was a multicenter retrospective study wherein the surgeons may have introduced bias to the study. CONCLUSIONS: Both PTED and MED present to be an acceptable long-term efficacy for the treatment of LDH. Although PTED is associated with longer intraoperative fluoroscopy and a little more cost, it should still be considered superior to MED considering the benefits of lesser invasion, shorter hospital stays, quicker pain relief, and functional recovery. KEY WORDS: Percutaneous transforaminal endoscopic discectomy, microendoscopic discectomy, lumbar disc herniation, VAS score, ODI score

Introduction Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area. Methods A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022. Results Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72–0.74). Conclusion About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.

Curcumin and QingDai (QD, Indigo) were shown effective for treating active ulcerative colitis (UC). We aimed to evaluate the real-world experience with the Curcumin-QingDai (CurQD) herbal combination to induce remission in active UC. A retrospective multicentre adult cohort study from five tertiary academic centres (2018-2022). Active UC was defined as a Simple Clinical Colitis Activity Index (SCCAI) ≥ 3. Patients were induced by CurQD. The primary outcome was clinical remission at weeks 8-12, defined as SCCAI ≤2 and a decrease ≥3 points from baseline. clinical response (SCCAI decrease ≥3 points), corticosteroid-free remission, faecal calprotectin (FC) response (reduction ≥50%), FC normalisation (FC ≤100 μg/g for patients with FC ≥300 μg/g at baseline) and safety. All outcomes were analysed for patients who were maintaining stable treatment. Eighty-eight patients were included; 50% were biologics/small molecules experienced, and 36.5% received ≥2 biologics/small molecules. Clinical remission was achieved by 41/88 (46.5%), and clinical response by 53/88 (60.2%). The median SCCAI decreased from 7 (IQR:5-9) to 2 (IQR:1-3), p < 0.0001. Of the 26 patients on corticosteroids at baseline, seven (26.9%) patients achieved corticosteroid-free remission. Among 43 biologics/small molecules experienced patients, clinical remission was achieved in 39.5% and clinical response by 58.1%. FC normalisation and response were achieved in 17/29 (58.6%) and 27/33 (81.8%) respectively. Median FC decreased from 1000 μg/g (IQR:392-2772) at baseline to 75 μg/g (IQR:12-136) at the end of inductions (n = 30 patients with paired samples), p < 0.0001. No overt safety signals emerged. In this real-world cohort, CurQD effectively induced clinical and biomarker remission in patients with active UC, including the biologics/small molecules experienced patients.

Anticoagulation and Major Bleeding or Recurrent Thrombosis in Patients with Isolated Cancer-Associated Splanchnic Vein Thrombosis: A Multi-Center Cohort Study

BackgroundTraumatic acute subdural haematoma is a debilitating condition. Laterality intuitively influences management and outcome. However, in contrast to stroke, this research area is rarely studied. The aim is to investigate whether the hemisphere location of the ASDH influences patient outcome.MethodsFor this multicentre observational retrospective cohort study, patients were considered eligible when they were treated by a neurosurgeon for traumatic brain injury between 2008 and 2012, were > 16 years of age, had sustained brain injury with direct presentation to the emergency room and showed a hyperdense, crescent shaped lesion on the computed tomography scan. Patients were followed for a duration of 3-9 months post-trauma for functional outcome and 2-6 years for health-related quality of life. Main outcomes and measures included mortality, Glasgow Outcome Scale and the Quality of Life after Brain Injury score. The hypothesis was formulated after data collection.ResultsOf the 187 patients included, 90 had a left-sided ASDH and 97 had a right-sided haematoma. Both groups were comparable at baseline and with respect to the executed treatment. Furthermore, both groups showed no significant difference in mortality and Glasgow Outcome Scale score. Health-related quality of life, assessed 59 months (IQR 43-66) post-injury, was higher for patients with a right-sided haematoma (Quality of Life after Brain Injury score: 80 vs 61, P = 0.07).ConclusionsThis study suggests patients with a right-sided acute subdural haematoma have a better long-term health-related quality of life compared to patients with a left-sided acute subdural haematoma.

Little guidance exists for the treatment of pseudoaneurysm (PA) following pediatric blunt liver and/or spleen injuries (BLSIs). We aimed to describe the incidence of delayed PA development and the subsequent clinical course of PA in pediatric BLSIs. This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs. A total of 1,407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1,056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions. Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies. Therapeutic/Care Management; Level IV.