Admission Characteristics Research Articles

Trends in Inpatient Dermatology and The Impact of the COVID-19 Pandemic at A Tertiary Care Facility in Western India

Background: Little is known regarding the effect of the coronavirus pandemic on the characteristics of dermatology admissions, particularly in the Indian context. Objectives: To conduct a retrospective analysis of the discharge records of all patients admitted to a tertiary care centre in Western India from 1 January 2019 to 31 December 2022. Methods: Patient records were reviewed and compiled. Diagnoses were grouped to achieve consistency with international studies. Finally, the effect of COVID on admissions was determined. Data samples were assessed using descriptive statistics. Continuous variables were expressed as median or mean. The student’s t-test and chi-square test were utilised to investigate wherever appropriate. Results: Inpatient care was required for 1,817 patients. Males (1000, 55.04%) were significantly more likely to be admitted than females (817, 44.96%). The leading causes of hospitalisation were bacterial infections (26.42%), vesiculobullous disorders (17.45%), and psoriasiform disorders (11.34%). The greatest number of admissions occurred in 2019, followed by a substantial decline in 2020. Admission rates for vesiculobullous disorders, psoriasiform disorders, and malignancies were significantly higher during the pandemic period. Conclusions: Our study offers an analysis of the impact of the coronavirus pandemic on the patient profiles of patients admitted to a dermatology ward.

Characteristics of Patients Hospitalized in Rural and Urban ICUs From 2010 to 2019.

Rural hospitals are threatened by workforce shortages and financial strain. To optimize regional critical care delivery, it is essential to understand what types of patients receive intensive care in rural and urban hospitals. A retrospective cohort study. All fee-for-service Medicare beneficiaries in the United States who were 65 years old or older hospitalized in an ICU between 2010 and 2019 were included. Rural and urban hospitals were classified according to the 2013 National Center For Health Statistics Urban-Rural Classification Scheme for Counties. Patient comorbidities, primary diagnoses, organ dysfunction, and procedures were measured using the International Classification of Diseases , 9th and 10th revisions diagnosis and procedure codes. Standardized differences were used to compare rural and urban patient admission characteristics. None. There were 12,224,097 ICU admissions between 2010 and 2019, and 1,488,347 admissions (12.2%) were to rural hospitals. The most common diagnoses in rural hospitals were cardiac (30.3%), infectious (24.6%), and respiratory (10.9%). Patients in rural ICUs had similar organ dysfunction compared with urban hospitals (mean organ failures in rural ICUs 0.5, sd 0.8; mean organ failures in urban ICUs 0.6, sd 0.9, absolute standardized mean difference 0.096). Organ dysfunction among rural ICU admissions increased over time (0.4 mean organ failures in 2010 to 0.7 in 2019, p < 0.001). Rural hospitals care for an increasingly complex critically ill patient population with similar organ dysfunction as urban hospitals. There is a pressing need to develop policies at federal and regional healthcare system levels to support the continued provision of high-quality ICU care within rural hospitals.

Pediatric Respiratory Syncytial Virus Hospitalizations, 2017-2023

Respiratory syncytial virus (RSV) transmission was disrupted worldwide following the COVID-19 pandemic, and further study is required to better understand these changes. To compare observed and expected RSV hospital and intensive care unit (ICU) admission rates and characteristics of admitted children during the 2021-2022 and 2022-2023 seasons. A population-based cohort study of all children aged younger than 5 years in Ontario, Canada, July 1, 2017, through March 31, 2023, was conducted. Individual and neighborhood-level sociodemographic and clinical characteristics were identified from administrative data, including age, palivizumab eligibility, complex medical conditions, rurality, and living in a marginalized neighborhood. The main outcome was RSV-associated hospitalization. Secondary outcomes included ICU admissions, mechanical ventilation, extracorporeal membrane oxygenation, and in-hospital death. Poisson generalized estimating equations were used to model weekly age- and sex-specific hospitalization rates and estimate expected rates in the postpandemic era; adjusted rate ratios (RRs) and 95% CIs are reported. This cohort study included approximately 700 000 children per study year. Compared with prepandemic years (2017-2018, 2018-2019, and 2019-2020), the 2021-2022 RSV season peaked slightly earlier, but overall admission rates were comparable (289.1 vs 281.4-334.6 per 100 000, or approximately 2000 admissions). The 2022-2023 season peaked a month earlier and resulted in more than twice as many hospitalizations (770.0 per 100 000; n = 4977 admissions). The proportion of children admitted to an ICU in 2022-2023 (13.9%) was slightly higher than prepandemic (9.6%-11.4%); however, the population-based rate was triple the prepandemic levels (106.9 vs 27.6-36.6 per 100 000 children in Ontario). With the exception of palivizumab-eligible children, all sociodemographic and health status characteristics were associated with lower-than-expected RSV hospitalization rates in 2021-2022. In contrast, older age of patients was associated with higher-than-expected rates in 2022-2023 (ie, 24-59 months: RR, 1.90; 95% CI, 1.35-2.66). There were notable differences in RSV epidemiologic characteristics in Ontario following the COVID-19 pandemic. It is not yet clear whether and how long atypical RSV epidemics may persist. Clinicians and program planners should consider the potential for ongoing impacts to health care capacity and RSV immunization programs.

Private and Public Sector Differences in Adverse Incidents and Restrictive Practices: Factors That Predicted Service Sector in a National Sample of Forensic Psychiatric Inpatients

Forensic mental health services play a key role in the diversion, treatment, rehabilitation, and supervision of offenders with mental health problems in Europe. Private sector providers are increasingly commissioned to provide secure care for service users. Questions have been raised about the effectiveness of the private sector providers. A sample of 229 patients from low, and medium secure psychiatric services in the United Kingdom was analyzed to determine differences in restrictive practices, adverse service user incidents, and service user characteristics between service users admitted to private sector or publicly funded hospitals. Service users with a diagnosis of a personality disorder, and those who had multiple psychiatric diagnoses were disproportionately placed in the private sector. Greater prevalence of seclusion, physical restraint, verbal aggression toward staff, physical violence toward staff and other service users, property damage, and self-harm were observed in private sector service users. Further attention is warranted around the decision-making processes that allocate people to private versus publicly funded care, potential sources of bias in admission characteristics should be taken into account when interpreting poorer clinical outcomes in the private sector.

Characteristics and preventability of medication-related admissions for acute kidney injury and dehydration in elderly patients

PurposePatients with impaired renal function using medication that affects glomerular filtration rate are at increased risk of developing acute kidney injury (AKI) leading to hospital admissions. The risk increases during periods of dehydration due to diarrhoea, vomiting or fever (so-called “sick days”), or high environmental temperatures (heat wave). This study aims to gain insight into the characteristics and preventability of medication-related admissions for AKI and dehydration in elderly patients.MethodsRetrospective case series study in patients aged ≥ 65 years with admission for acute kidney injury, dehydration or electrolyte imbalance related to dehydration that was defined as medication-related. General practitioner’s (GP) patient records including medication history and hospital discharge letters were available. For each admission, patient and admission characteristics were collected to review the patient journey. A case-by-case assessment of preventability of hospital admissions was performed.ResultsIn total, 75 admissions were included. Most prevalent comorbidities were hypertension, diabetes, and known impaired renal function. Diuretics and RAS-inhibitors were the most prevalent medication combination. Eighty percent of patients experienced non-acute onset of symptoms and 60% had contacted their GP within 2 weeks prior to admission. Around 40% (n = 29) of admissions were considered potentially preventable if pharmacotherapy had been timely and adequately adjusted.ConclusionA substantial proportion of patients admitted with AKI or dehydration experience non-acute onset of symptoms and had contacted their GP within 2 weeks prior to admission. Timely adjusting of medication in these patients could have potentially prevented a considerable number of admissions.

Characteristics of hospital admission during checkpoint-inhibition therapy.

e14510 Background: Immune checkpoint inhibitors (ICI) have enriched the therapeutic armamentarium in outpatient oncology care; however, data on necessity of hospitalizations associated with immune-related adverse event (irAEs) are scarce. Here, we retrospectively characterize hospitalizations of patients (pts) undergoing ICI. Methods: Between 12/2019 and 06/2022, 237 pts were included. Clinical data and characteristics of ICI were collected during a 6-month observation period after the initiation of therapy. Descriptive Statistics and Kaplan-Meier statistics were administered. Results: 30 out of 237 pts were hospitalized (HA+). Most common underlying tumor entities in the overall cohort were malignant melanoma (59.5%), renal cell carcinoma (13.1%), and non-small cell lung carcinoma (12.7%). Hospitalized pts exhibited an increased rate of pulmonary and cerebral metastases. We observed a significantly higher hospitalization rate during dual ICI with Nivolumab and Ipilimumab. The predominant irAEs for hospitalization were colitis (26.7), followed by hypophysitis (13.3%), leading to a median hospitalization of 7 days (range 1-34). Most pts were treated on the general ward (76.7%). Interdisciplinary consultations were frequent, especially to gastroenterology (46.7%) and neurology (26.7%). Although a trend towards an overall survival in the HA+ subgroup was identified, no statistically significant difference was found among the subgroups. Conclusions: The hospitalization rate of 12.6% is comparable to the literature. There was a disproportionate admission of patients with immune-related colitis and hypophysitis compared to the prevalence described under ICI. We observed a high need for interdisciplinary consults in line with the heterogeneity of immune-mediated side effects. When compared to non-hospitalized pts, there was no survival disadvantage in the cohort of hospitalized patients.

Comparative Sero-Analysis between Copper Levels and the Risk of Acute Myocardial Infarction in District Nowshera

There is an increasing evidence pointing to a possible correlation between AMI and copper levels. Serum copper levels serve as a valuable biomarker for assessing the body's copper status. Objective: To find the changes in serum copper level in patients with Acute Myocardial Infarction (AMI). Methods: This observational study was conducted in District Headquarter Hospital, Nowshera in duration of two years. A total of 240 patients were recruited in this study. Upon admission, demographic information, medical history, and clinical characteristics were collected. Blood samples were obtained for measurement of serum copper levels using established laboratory methods. All data were analyzed through SPSS version 29.0. Results: Among total, 65% males and 35% females and the prevalence of cardiovascular risk factors was notable, with 70% of patients having hypertension, 40% with diabetes mellitus, 60% with dyslipidemia, and 45% identified as smokers. Baseline serum copper levels averaged 110 ± 5.2 µg/dL, within 24 hours of admission, the peak serum copper level significantly increased to 125 ± 18.6 µg/dL. Subsequently, levels decreased gradually over the following days, with mean values of 120 ± 17.1 µg/dL on Day 2, 115 ± 16.4 µg/dL on Day 3, 112 ± 15.9 µg/dL on Day 4, and returning to baseline levels by Day 5, 110 ± 15.2 µg/dL. Conclusions: Serum copper levels exhibit significant changes during the acute phase of AMI, with a peak observed within 24 hours of admission. While patients with anterior infractions showed higher peak copper levels, no significant associations were found between copper levels and traditional cardiovascular risk factors or inflammatory markers

Long-term prescribed opioid use after hospitalization or emergency department presentation among opioid naïve adults (2014-2020)-A population-based descriptive cohort study.

The aim of this work is to describe opioid initiation and long-term use after emergency department (ED) visits or hospitalizations in New South Wales, Australia, by patient, admission and clinical characteristics. This is a population-based cohort study, including all hospitalizations and ED visits between 2014 and 2020, linked to medicine dispensings, deaths and cancer registrations (Medicines Intelligence Data Platform), among adults with no opioid dispensings in the previous year. Outcome measures were opioid initiations (dispensed within 7days of discharge) and long-term use (90 days of continuous exposure, 90-270 days after initiation). The cohort included 16 153 096 admissions by 4.2 million opioid-naïve adults; 39.0% were ED presentations without hospital admission, 16.8% hospital admissions via ED and 44.2% direct hospital admissions. Opioids were initiated post-discharge for 6.2% of ED, 8.3% of hospital via ED and 10.0% of direct hospital admissions; of these 1.0%, 2.5% and 0.5% progressed to long-term opioid use, respectively. Initiation was lowest in obstetric admissions without surgery (1.0%), and highest among trauma admissions (25.4%), obstetric admissions with surgical intervention (19.8%) and non-trauma surgical admissions (12.0%). Long-term use was highest among medical admissions via ED (3.5%), trauma admissions (2.3%) and ED alone (1.0%). From 2014 to 2020, overall opioid initiations decreased 16% from 8.7% to 7.2%, and long-term opioid use decreased 33% from 1.3% to 0.8%. Both opioid initiation and long-term use decreased over time; however, the higher rates of long-term use following trauma, and medical admissions via ED, warrant further surveillance. Strategies supporting appropriate prescribing and access to multidisciplinary pain services will facilitate best practice care.

#2125 Endotypes of kidney injury in patients with acute decompensation of heart failure and their impact on long-term mortality

Abstract Background and Aims Renal dysfunction with and without albuminuria is common in patients with heart failure and associated with poorer outcomes. However, the prevalence and long-term influence of increased urine albumin creatinine ratio (uACR) and/or isolated decreased glomerular filtration rate (GFR &amp;lt; 60 ml/min/1,73 m2) have not been well studied in patients with acute decompensation of heart failure (ADHF). The aim was to investigate the prevalence of different variants of kidney injury and their impact on the mortality in patients with ADHF within 1 year of follow-up. Method This prospective, observational study included 140 patients who were discharged after ADHF. We excluded patients with terminal stage of chronic kidney disease, end-stage heart failure, malignancy. Patients were divided according to the kidney function (the maximum level of GFR) and albuminuria level taken at hospitalization into four groups: normal renal function (GFR&amp;gt;60 ml/min/1,73 m2, uACR&amp;lt;30 mg/gCr), isolated decreased GFR (GFR&amp;lt;60 ml/min/1,73 m2, uACR&amp;lt;30 mg/gCr), isolated albuminuria (GFR&amp;gt;60 ml/min/1,73 m2, uACR&amp;gt;30 mg/gCr), combined changes (GFR&amp;lt;60 ml/min/1,73 m2, uACR&amp;gt;30 mg/gCr). The observation period was 365 days. Results During hospitalization 25% (n = 35) patients had GFR&amp;gt;60 ml/min/1,73 m2, uACR&amp;lt;30 mg/gCr, 19.3% (n = 27) patients had isolated decreased GFR, 22.8% (n = 32) patients had isolated uACR&amp;gt;30 mg/gCr, and 32.9% (n = 46) patients had both. The baseline and admission characteristics are presented in the table (Fig. 1). 34 (24,3%) patients died during follow-up. Mortality was remarkably higher in groups with registered albuminuria during hospitalization regardless of GFR level (25% (n = 8) patients with isolated increased uACR, 39.1% (n = 18) patients with combined changes; with non-albuminuria: (11.4% (n = 4) patients with GFR&amp;gt;60 ml/min/1,73 m2, uACR&amp;lt;30 mg/gCr, 14.8% (n = 4) patients with isolated decreased GFR, p = 0.019 for trend). Kaplan-Meier plots revealed worse outcomes for these groups after adjusting for ejection fraction (EF) (Log-Rank p = 0.0057) (Fig. 2). In the multivariate Cox regression, in which age, gender, reduced EF and three categories of kidney damage were included, only combination of decreased GFR and albuminuria was an independent predictor of long-term mortality (hazard ratio: 3.71 95% confidential interval 1.59 to 8.67, p = 0.002). Conclusion Albuminuria is frequently observed in patients with ADHF and, especially with combination with decreased GFR, associated with higher mortality rate during 1 year of follow-up. Albuminuria with decreased GFR during hospitalization with ADHF was an independent risk factor for mortality during one year.

Pulmonary Embolism in Patients Admitted With Peripartum Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events.

Introduction Peripartum cardiomyopathy (PPCM) is defined as an idiopathic left ventricular failure with reduced ejection fraction (EF <45%) that affects women in the last month of pregnancy or in the months after giving birth. The pathophysiology remains elusive, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically pulmonary embolism (PE). The purpose of this study was to characterize and evaluate the real-world prevalence, predictors, and outcomes of PE in PPCM. Methods The data were derived from the National Inpatient Sample (NIS) database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with PPCM with or without PE. Outcomes for PPCM patients with PE and predictors of mortality for PPCM were also analyzed. Results PE developed in 105 of 4,582 patients with PPCM (2.3%). Patients with PPCM and PE had longer hospital stays (10.86 days ± 1.4 vs. 5.73 ± 0.2 days, p = 0.001) and total charges ($169,487 ± $39,628 vs. $86,116 ± $3,700, p = 0.001). Patients with PE had a higher burden of coagulopathy (13.3% vs. 3.0%, p = 0.01), intracardiac thrombus (6.7% vs. 1.6%, p = 0.01), and iron deficiency anemia (21.0% vs. 12.6%, p = 0.01). Patients without PE were found to have a higher burden of preeclampsia (14.7% vs. 1.9%, p = 0.01) and obstructive sleep apnea (5.4% vs. 1.0%, p = 0.045). Predictors of mortality in patients with PPCM included cardiogenic shock (aOR 13.42, 95% CI 7.50-24.03, p = 0.05), PE (aOR 6.60, 95% CI 2.506-17.39, p = 0.05), non-ST-elevation myocardial infarction (NSTEMI; aOR 3.57, 95% CI 1.35-9.44, p = 0.05), chronic kidney disease (aOR 3.23, 95% CI 1.68-6.22, p = 0.05), and atrial fibrillation (aOR 2.57; 95% CI 1.25-5.30, p = 0.05). Conclusion Although an uncommon complication, PE in PPCM demonstrates an association with higher mortality and financial burden. Along with PE, we found predictors of mortality in PPCM to include atrial fibrillation, NSTEMI, chronic kidney disease, and cardiogenic shock.

Predicting survival with scales for in-hospital extracorporeal cardiopulmonary resuscitation

Abstract Funding Acknowledgements None. Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, and anecdotal scores are specific to this situation. Purpose Our objective was to analyse the usefulness of different scales used in shock and venoarterial extracorporeal membrane oxygenator (VA-ECMO) support in in-hospital ECPR. Methods Retrospective analysis of consecutive ECPR cases in a referal center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analysed hospital survival based on our own and other literature-based mortality scales calculated prior to VA-ECMO implantation: SCAI, INTERMACS, CardShock, CSS, SAVE-ECMO, RESCUE-IHCA. Results Out of 222 VA-ECMO implanted, we included 66 ECPR cases between 2014-oct 2023. Baseline, admission and ECPR characteristics are collected in the table. Overall in-hospital survival was 16.7% (n=11) (cerebral performance cathegory 1-2). We developed a sumative mortality scale including factors related to survival in our population and the literature (lactate &amp;gt;10.05, &amp;gt;60 minutes CA, peripheral arterial disease (PAD), and on-call time for ECPR alert activation) (figure A). This scale was significantly related to survival to discharge (figure A). Regarding the scales and their association with survival, only RESCUE-IHCA showed a trend towards statistical significance (16 [15] points in survivors vs 19 [15] in died patients, p=0.096). The remaining scores showed no relationship with survival to discharge: SAVE-ECMO -15,73±4.8 in survivors vs -14,07±4.1 in died patients (p= 0.301), CSS 10,09±1.9 vs 10.40±2.7 (p=0.651), CardShock 4.82±1.3 vs 5.27±1.2 (p=0.287). INTERMACS (all patients 1) and SCAI classification (all patients stage E) are not valid for discriminating survival in this situation. We compared the scales using the ROC curve for hospital survival, and we found that our own scale had the best discriminatory ability (Figure B). Conclusions Scales developed for shock or VA-ECMO support were not significantly related to survival in patients undergoing in-hospital ECPR. The specific ECPR scale RESCUE-IHCA, and our own scale developed in this population showed better discriminatory ability in survival to discharge.Table.Baseline, admission and ECPRFigure.A: Own scale. B: ROC curves

Association of Homelessness with Before Medically Advised Discharge After Surgery

Before medically advised (BMA) discharge, which refers to patients leaving the hospital at their own discretion, is associated with higher rates of readmission and death in other settings. It is not known if housing status is associated with this phenomenon after surgery. We identified all admitted adults who underwent an operation by one of 11 different surgical services at a single tertiary care hospital between January 2013 and June 2022. Chi-square tests and t-tests were used to compare demographic and clinical features between BMA discharges and standard discharges. Multivariable logistic regression was used to evaluate the association between housing status and BMA discharge, adjusting for demographic and admission characteristics. Documented reasons for BMA discharge were also abstracted from the medical record. Of 111,036 patient admissions, 242 resulted in BMA discharge (0.2%). After adjusting for observable confounders, patients experiencing homelessness had substantially higher odds of BMA discharge after surgery (adjusted odds ratio 4.4, 95% confidence interval 3.0-6.4; p < 0.001) when compared to housed. Patients who underwent emergency surgery, patients with a documented substance use disorder, and those insured by Medicaid also had significantly higher odds of BMA discharge. System- or provider-related reasons (including patient frustration with the hospital environment, challenges in managing substance dependence, and perceived inadequacy of paint control) were documented in 96% of BMA discharges for patients experiencing homelessness (vs. 66% in housed patients). BMA discharge is more common in patients experiencing homelessness after surgery even after adjusting for observable confounding characteristics. Deeper understanding of the drivers of BMA discharge in patients experiencing homelessness through qualitative methods are critical to promote more equitable and effective care.

Pulmonary Embolism in Patients Admitted With Takotsubo Cardiomyopathy: Prevalence and Associated In-Hospital Adverse Events.

Introduction Takotsubo cardiomyopathy (TCM) is a poorly understood condition typically characterized by abnormal left ventricular wall motion without causative coronary artery disease and typically presents in post-menopausal women after the experience of a physical or emotional stressor. The pathophysiology of TCM is complex and multifactorial, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically, pulmonary embolism (PE), which is understudied in its relation to TCM.The purpose of this study was to characterize and evaluate the real-world prevalence and outcomes of PE in TCM. Methods Data were derived from the National Inpatient Sample database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with TCM with and without PE. Outcomes for TCM patients with PEand predictors of mortality in TCM were also analyzed. Results PE developed in 788 of 40,120 patients with TCM (1.96%). After multivariate adjustment, PE was found to be independently associated with intracardiac thrombus (adjusted odds ratio (aOR) 2.067; 95% confidence interval (CI): 1.198-3.566; p = 0.009) and right heart catheterization (RHC) (aOR: 1.971; 95% CI: 1.160-3.350; p = 0.012). Mortality in patients with TCM was associated with, among other factors, age in years at admission (aOR: 1.104; 95% CI: 1.010-1.017; p = 0.001), African American race (aOR: 1.191; 95% CI: 1.020-1.391; p = 0.027), Asian or Pacific Islander race (aOR: 1.637; 95% CI: 1.283-2.090; p = 0.001), coagulopathy (aOR: 3.393; 95% CI: 2.889-2.986; p = 0.001), liver disease (aOR: 1.446; 95% CI: 1.147-1.824; p = 0.002), atrial fibrillation (aOR: 1.460; 95% CI: 1.320-1.615; p = 0.001), and pulmonary embolism (aOR: 2.217; 95% CI: 1.781-2.760; p = 0.001). Conclusion In a large cohort of patients admitted with TCM,we found the prevalence of PE to be 1.96%. PE, along with comorbidities such as coagulopathy and atrial fibrillation, was found to be a significant predictorof mortality in this patient cohort.

Acute respiratory failure due to pulmonary exacerbation in children with cystic fibrosis admitted in a pediatric intensive care unit: outcomes and factors associated with mortality

BackgroundChildren with advanced pulmonary disease due to cystic fibrosis (CF) are at risk of acute respiratory failure due to pulmonary exacerbations leading to their admission to pediatric intensive care units (PICU). The objectives of this study were to determine short and medium-term outcomes of children with CF admitted to PICU for acute respiratory failure due to pulmonary exacerbation and to identify prognosis factors.MethodsThis retrospective monocentric study included patients less than 18 years old admitted to the PICU of a French university hospital between 2000 and 2020. Cox proportional hazard regression methods were used to determine prognosis factors of mortality or lung transplant.ResultsPrior to PICU admission, the 29 patients included (median age 13.5 years) had a severe lung disease (median Forced Expiratory Volume in 1 s percentage predicted at 29%). Mortality rates were respectively 17%, 31%, 34%, 41% at discharge and at 3, 12 and 36 months post-discharge. Survival rates free of lung transplant were 34%, 32%, 24% and 17% respectively. Risk factors associated with mortality or lung transplant using the univariate analysis were female sex and higher pCO2 and chloride levels at PICU admission, and following pre admission characteristics: home respiratory and nutritional support, registration on lung transplant list and Stenotrophomonas Maltophilia bronchial colonization.ConclusionChildren with CF admitted to PICU for acute respiratory failure secondary to pulmonary exacerbations are at high risk of death, both in the short and medium terms. Lung transplant is their main chance of survival and should be considered early.

Prevalence and predictors of medication for opioid use disorder among reproductive-aged women

BackgroundWomen of reproductive age would benefit from treatment of opioid use disorder (OUD) prior to pregnancy to improve maternal and infant outcomes. In this study, we aimed to identify the prevalence of medication for OUD (MOUD) and characterize correlates of MOUD receipt among 12–49-year-old women with OUD seeking treatment in publicly funded substance use disorder treatment programs at the time of their first treatment episode. MethodsThis cross-sectional study explores the demographic and clinical characteristics of women of reproductive age with OUD receiving publicly funded substance use treatment services. We used data from the concatenated 2015–2021 Treatment Episode Data Set–Admissions (TEDS-A), which documents demographic and clinical characteristics of patient admissions to publicly funded substance use treatment services in the United States. ResultsIn the sample of females aged 12–49 with no prior treatment admissions and primary OUD (n=325,512), 40.53% received MOUD (n=131,930), including 39.40% of non-pregnant women (n=115,315) and 52.79% of pregnant women (n=8423). Pregnant women had significantly higher odds of receiving MOUD (aOR = 2.42, 95%CI: 2.30, 2.54) compared to non-pregnant women. Non-white race, treatment setting, and treatment self-referral were also associated with higher levels of MOUD. ConclusionsWe identified a significant unmet need among both pregnant and non-pregnant women with OUD seeking care in publicly funded treatment clinics. While women who are pregnant are significantly more likely to receive evidence-based treatment with MOUD, still 47.21% of pregnant women did not receive MOUD. All reproductive-aged women with OUD should be offered evidence-based treatment options, including MOUD.

A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center

Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization cost with the national health insurance system (Phil-Health) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, and assess mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost > 20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (at peso-dollar rate of 56) for service patients was at $ 75.89 compared to private service patients at $ 285.71. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of ≥ $ 357. Accommodation cost and professional fees accounted for majority or 61.6% of the overall cost for private patients, while medications and diagnostic tests were the major or 76.01% contributor to the overall cost for charity patients. Despite existence of Phil-health, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the out-patient setting could potentially reduce total cost for this disease.

Characteristics of Non-diagnostic Admissions to the Epilepsy Monitoring Unit (P6-1.013)

Characteristics of Non-diagnostic Admissions to the Epilepsy Monitoring Unit (P6-1.013)

Distinguishing Characteristics of Admissions to Various Types of Posthospital Brain Injury Rehabilitation Programs.

Describe and compare the demographic characteristics and disability profiles of individuals admitted to 6 types of posthospital brain injury rehabilitation (PHBIR) programs. Data from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and Supported Living programs serving individuals with acquired brain injury (ABI). Two thousand twenty-eight individuals with traumatic brain injury (TBI), stroke, or other ABI. Sex, age, time since injury, and Mayo-Portland Adaptability Inventory, 4th edition (MPAI-4). Retrospective analyses of demographic variables and MPAI-4 Total, Index, and subscale Rasch-derived T-scores on admission comparing diagnostic categories and program types within diagnostic categories. Participants with TBI were predominantly male, and those with stroke were generally older. Admissions to more intensive and supervised programs (residential neurobehavioral and residential neurorehabilitation) generally showed greater disability than admissions to home and community programs who were more disabled than participants in day treatment and outpatient programs. Residential neurobehavioral and supported living program participants generally were male and had TBI. Home and community admissions tended to be more delayed than residential neurorehabilitation admissions. The majority of those with other ABI were admitted to outpatient rather than more intensive programs. Additional analyses demonstrated significant differences in MPAI-4 profiles among the various program types. Admissions with TBI, stroke, and other ABI to PHBIR differ in demographic factors and disability profiles. When examined within each diagnostic category, demographic features and disability profiles also distinguish among admissions to the various program types. Results provide insights about decision-making in referral patterns to various types of PHBIR programs, although other factors not available for analysis (eg, participant/family preference, program, and funding availability) likely also contribute to admission patterns.

Prognostic accuracy of early warning scores for predicting serious illness and in-hospital mortality in patients with COVID-19.

A simple bedside triage tool is essential to stratify COVID-19 patients in the emergency department (ED). This study aimed to identify an early warning score (EWS) that could best predict the clinical outcomes in COVID-19 patients. Data were obtained from medical records of 219 laboratory-confirmed COVID-19 positive patients. We calculated 13 EWSs based on the admission characteristics of the patients. Receiver operating characteristic (ROC) curve analysis was used to assess the performance of the scores in predicting serious illness and in-hospital mortality. The median patient age was 51 (38, 60) years, and 25 (11.4%) patients died. Among patients admitted with mild to moderate illness (n = 175), 61 (34.9%) developed serious illness. Modified National Early Warning Score (m-NEWS) (AUROC 0.766; 95% CI: 0.693, 0.839) and Rapid Emergency Medicine Score (REMS) (AUROC 0.890; 95% CI: 0.818, 0.962) demonstrated the highest AUROC point estimates in predicting serious illness and in-hospital mortality, respectively. Both m-NEWS and REMS demonstrated good accuracy in predicting both the outcomes. However, no significant difference was found between m-NEWS (p = 0.983) and REMS (p = 0.428) as well as some other EWSs regarding the AUROCs in predicting serious illness and in-hospital mortality. We propose m-NEWS could be used as a triage score to identify COVID-19 patients at risk of disease progression and death especially in resource-poor settings because it has been explicitly developed for risk stratification of COVID-19 patients in some countries like China and Italy. However, this tool needs to be validated by further large-scale prospective studies.

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

BackgroundFew ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries.MethodsA retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008–2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05.ResultsOf 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity.ConclusionsMortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.