Admission Of Patients Research Articles

Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics.

During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical. We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations. Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively). We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.

Etiological and epidemiological analysis of patella fractures: evaluation of COVID-19 pandemic and lockdown era effects

Background: Patella fractures are relatively rare, but significant public health burden with consequences ranging from skin problems to extensor mechanism deficiencies and patellofemoral arthrosis due to their significant effects on pain, functionality, and quality of life. It was aimed to present basic etiological, and epidemiological information about patella fractures and to evaluate the impact of the COVID-19 Pandemic and lockdown era period. Methods: All patellar fractures admitted to a stage-1 trauma center between 2016 and 2022 were collected retrospectively. Patient's gender, age, side, fracture classification, trauma mechanism, treatment method, admission day and season, accompanying extremity, and non-musculoskeletal/visceral pathologies were recorded and analyzed. Results: A retrospective evaluation was conducted on 304 patients, with 181 (59.5%) males and 123 (40.5%) females, with an average age of 46±19 years. Most patients were between 30-65 (51.4%) and the most common cause was simple falls (74%). Fractures mostly occurred in the winter (35.2%) and on Sundays (19.7%). 9.9% of the patients were accompanied by extremity traumas and 6.9% by non-musculoskeletal injuries. Regarding the descriptive classification, transverse, distal pole, and proximal pole; and according to the AO/OTA classification, C1 was the most common. Conclusion: The incidence of patella fractures is increasing. Non-surgical treatment is a priority, and the complication rates of surgical treatment are considerable. The study, which presents etiological and epidemiological data of level-1 trauma center patients, is a suitable sample for Türkiye. The study is unique in showing the potential effects of COVID-19 on the patient profile and treatment management of patella fractures.

Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves

BackgroundThe clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves. Methods The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500mg of intravenous sotrovimab (SOT) or 600mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI.Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixedeffects logistic model. These trials are registred with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021-004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2) Findings Between March 2022 and February 2023, 991 patients (SOT=332, TGM/CGM =327, NMV/r=332) were enrolled in 15 Italian centersThe overall mean age was 66 years; 482 participants (48.80%) were male and 856 vaccinated with at least a primary course ( 86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35-1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p=0.015) and 2.42 (95% CI 0.19 to infinity; p=0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032-1.83; p=0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the other two groups at the 21-day follow-up (P=0.039) and a higher prevalence of nausea at the 7-day follow-up in the NMV/r group compared to the mAbs group (p=0.036). Interpretation NMV/r was superior to TGM/CGM in reducing hospital admission or death in clinical vulnerable patients with SARS-CoV-2 infection treated within 5 days of symptoms’ onset. No significant difference in symptom prevalence over time across the arms was found. Funding: The trials were funded by the Italian Agency of Drugs (AIFA) in 2021.

Hospital Re-Admission Prediction Using Named Entity Recognition and Explainable Machine Learning.

Early hospital readmission refers to unplanned emergency admission of patients within 30 days of discharge. Predicting early readmission risk before discharge can help to reduce the cost of readmissions for hospitals and decrease the death rate for Intensive Care Unit patients. In this paper, we propose a novel approach for prediction of unplanned hospital readmissions using discharge notes from the MIMIC-III database. This approach is based on first extracting relevant information from clinical reports using a pretrained Named Entity Recognition model called BioMedical-NER, which is built on Bidirectional Encoder Representations from Transformers architecture, with the extracted features then used to train machine learning models to predict unplanned readmissions. Our proposed approach achieves better results on clinical reports compared to the state-of-the-art methods, with an average precision of 88.4% achieved by the Gradient Boosting algorithm. In addition, explainable Artificial Intelligence techniques are applied to provide deeper comprehension of the predictive results.

Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules.

Orthogeriatric comanagement of older patients with hip fractures has been proven to provide significant benefits concerning functional status, readmissions, nursing home placement, in-hospital complications and mortality. Medication management in older individuals is acornerstone in orthogeriatric comanagement. The aim of the study was to analyze the extent of overprescription and undertreatment in older trauma patients. Personal and medical data of consecutively admitted older trauma patients were analyzed. Evaluation of medication was conducted according to the Fit fOR The Aged (FORTA) criteria. Data were retrieved from an ongoing observational study on the incidence of delirium in surgical patients. Atotal of 492 patients were enrolled. There were 374 cases of overprescription and 575 cases of undertreatment. Only 78(16%) patients had neither overprescription nor undertreatment on admission. Overprescription and undertreatment were most prevalent in cardiovascular disease. Undertreatment was most prevalent concerning osteoporosis. The number of prescribed drugs correlated with the Charlson Comorbidity Index (r = 0.478, p < 0.001), age (r = 0.122; p < 0.01), anticholinergic burden (r = 0.528, p < 0.001), FORTA score (r = 0.352, p < 0.001), and overtreatment (r = 0.492, p < 0.001), but not with undertreatment. Undertreatment also correlated with age (r = 0.172, p < 0.001) and overtreatment (r = 0.364, p < 0.01). The FORTA score correlated significantly with age (r = 0.159, p < 0.001), anticholinergic burden (ACB) score (r = 0.496, p < 0.001), Katz index (r = -0.119, p < 0.01), IADL score (r = -0.243, p < 0.001), and clinical frailty scale (CFS, r = 0.23, p < 0.001). The high numbers of overprescription and undertreatment in older trauma patients underlines the need for orthogeriatric comanagement. Besides the evaluation of multimorbidity and geriatric problems, drug management is acore topic. Future studies should investigate the impact of medication management on outcome parameters such as quality of life, functional status, and mortality. Abenefit can be expected.

Data quality in hospital information systems: Lessons learned from analyzing 30 years of patient data in a regional German hospital

Background: The integration of Hospital Information Systems (HIS) into healthcare delivery has significantly enhanced patient care and operational efficiency. Nonetheless, the rapid acceleration of digital transformation has led to a substantial increase in the volume of data managed by these systems. This emphasizes the need for robust mechanisms for data management and quality assurance.Objective: This study addresses data quality issues related to patient identifiers within the Hospital Information System (HIS) of a regional German hospital, focusing on improving the accuracy and consistency of these administrative data entries.Methods: Employing a combination of data analysis and expert interviews, this study reviews and programmatically cleanses a dataset with over 2,000,000 patient data entries extracted from the HIS. The areas of investigation are patient admissions, discharges, and geographical data.Results: The analysis revealed that roughly 25% of the dataset was rendered unusable by errors and inconsistencies. By implementing a thorough data cleansing process, we significantly enhanced the utility of the dataset. In doing so, we identified the primary issues affecting data quality, including ambiguities among similar variables and a gap between the intended and actual use of the system.Conclusion: The findings highlight the critical importance of enhancing data quality in healthcare information systems. This study shows the necessity of a careful review of data extracted from the HIS before it can be reliably utilized for machine learning tasks, thereby rendering the data more usable for both clinical and analytical purposes.

Pattern of admission and outcome at a newly established sickle cell center in Nigeria

Background: Sickle cell disease (SCD) encompasses a group of autosomal recessive haemoglobinopathies whose genetic mutation leads to the replacement of glutamic acid by valine in position 6 of the beta-globin chain. Most of the world’s SCD burden is in Africa, where it is a major contributor to childhood morbidity and mortality. The study is aimed at determining the pattern of admission and outcome of patients seen at the sickle cell center Asaba, over a two-year period January 2022 to December 2023. Methods: This was a retrospective descriptive study of children with SCD admitted into the sickle cell center of the Asaba specialist hospital. Information obtained included age, gender, diagnosis, month and year of admission, and outcome. Descriptive statistics was used to describe the demographic characteristics and chi-square to assess their association. Results: A total of 338 children were seen, 34.5% of the patients were less than 5 years of age; males were 52.6% while 61.6% of the admission occurred during the rainy season. Vaso-occlusive crisis (80.6%) was the most common crisis seen; malaria (51.9%) was the prominent diagnosis made. Case fatality rate was 1.7%. Conclusions: SCD s remains a major source of admission and mortality in our environment. A comprehensive SCD care plan is needed to reduce the adverse consequences associated with this disease.

Implementing Telemedicine into Clinical Training Through Pre-recorded Video Consultations

Although the contribution of real patient encounters to medical education is well known, challenges such as a lack of suitable cases, patients not consenting to student involvement, physical space limitations that prevent every student from participating, the inability to replicate the same patient encounter, and reduced patient admissions to healthcare facilities during extraordinary periods are common obstacles that need to be addressed in clinical education. To overcome these challenges, video consultation (VC) recordings, which were made with the consent of patients having a telemedicine consultation, were collected as an archive of medical interview recordings covering a wide spectrum of pulmonary diseases. These recordings were watched by students in a classroom setting during clinical clerkships, with case discussions interspersed. This article, which also discusses the results of clinical clerkship evaluations, indicates that the use of pre-recorded VC sessions can be an effective tool for teaching good clinical practices through the ideal method of medical interviews, diagnostic approaches, evaluation of test results, communication skills with patients and their relatives, and addressing the socio-psychological aspects and social impacts of diseases. As an innovative attempt, sharing this process at an early stage of development may inspire enthusiasm for implementing this approach and open the field for further development.

Development of a Predictive Model for Emergency Department Utilization and Unanticipated Hospital Admission in Patients Receiving Cancer Treatment for Solid Tumor Malignancies

Development of a Predictive Model for Emergency Department Utilization and Unanticipated Hospital Admission in Patients Receiving Cancer Treatment for Solid Tumor Malignancies

The early prognostic value of the 1–4-day BCM/PA trend after admission in neurocritical patients

The purpose of this study was to investigate early stage dynamic changes in relevant indicators in neurocritical patients to identify biomarkers that can predict a poor prognosis at an early stage (1–4 days after admission). This study retrospectively collected clinical data, inflammatory indicators, and nutritional indicators from 77 patients at the neurology intensive care unit. The 3-month modified Rankin scale score was used as the outcome indicator. A linear mixed model was used to analyze changes in inflammatory indicators and nutritional indicators in neurocritical patients over time from 1–4 days after admission. Logistic regression was used to determine the independent risk factors for a poor prognosis in neurocritical patients and to construct a predictive model. The predictive efficacy of the model was verified using leave-one-out cross-validation and decision curve analysis methods. The analysis results showed that 1–4 days after admission, the inflammatory indicators of white blood cell and absolute monocyte counts and the nutritional indicators of body cell mass(BCM), fat-free mass, body cell mass/phase angle (BCM/PA), intracellular water, extracellular water, and skeletal muscle index increased overall, while the nutritional indicators of albumin and visceral fat area decreased overall. The logistic multivariate regression model showed that the Charlson comorbidity index (CCI) (odds ratio (OR) = 2.526, 95% CI [1.202, 5.308]), hemoglobin (Hb)(on admission)-Hb(min) (OR = 1.049, 95% CI [1.015, 1.083), BCM(on admission) (OR = 0.794, 95% CI [0.662, 0.952]), and the change in BCM/PA 1–4 days after admission (OR = 1.157, 95% CI [1.070, 1.252]) were independent risk factors for a poor prognosis in neurocritical patients. The predictive analysis showed that the predictive power of Model 1 with BCM/PA (area under the curve (AUC) = 0.95, 95% CI (0.90, 0.99)) was 93%, 65%, 141%, and 133% higher than that of Model 2 without BCM/PA, the CCI, the APACHE II score, and the NRS2002 score (all P < 0.05), respectively. The CCI, Hb(on admission)-Hb(min), BCM(on admission), and an increase in BCM/PA 1–4 days after admission were independently associated with a poor prognosis in neurocritical patients. Of these variables, BCM/PA may be a valid indicator for early stage prediction of a poor prognosis in neurocritical patients.

Dynamic change of lymphocytes associated with short-term prognosis in anti-MDA5-positive dermatomyositis with interstitial lung disease: a multicenter retrospective study

Lymphopenia is a unique manifestation of anti-MDA5 positive dermatomyositis with interstitial lung disease (MDA5 + DM-ILD). This study aimed to investigate the relationship between dynamic changes in peripheral lymphocytes and short-term prognosis in patients of MDA5 + DM-ILD. Two hundred sixty-three MDA5 + DM-ILD patients were divided into different groups according to lymphocyte count and death or survival within 1 month, then the differences in clinical features and outcomes were compared. Associations between lymphocytes and risk of death within 1 month were also investigated in different lymphocyte groups using Cox proportional hazard models. A generalized additive mixed model (GAMM) was established to analyze the dynamic changes of lymphocytes in the death 1-month group. Lymphocytes of the patients who died within 1 month were significantly lower than survivors by different lymphocyte grouping methods, and the total lymphocytes showed a gradually decreasing trend in non-survivors. And the difference between survivors and non-survivors was more obvious over time. The lowest tertile of baseline lymphocytes as a reference, the hazard ratios for death within 1 month in the highest tertile were 0.497 (95% CI 0.26–0.949, P for trend = 0.033) after adjustment for potential confounders. GAMM analysis found a mean daily decrease of lymphocytes (0.034 × 10^9/L) after admission in death 1-month patients. Low baseline lymphocytes and gradually declined lymphocytes are both associated with a high risk of death within 1 month. However dynamic changes in lymphocytes can better reflect the disease status and better predict the short-term prognosis than baseline lymphocytes in MDA5 + DM-ILD patients.Key points•Low baseline lymphocytes and gradually decreased trend along time correlated with poor short-term prognosis in MDA5 + DM-ILD patients.•Dynamic changes of lymphocytes can better reflect the disease status and better predict the 1-month prognosis than baseline lymphocytes in MDA5 + DM-ILD patients.•Generalized additive mixed model (GAMM) analysis found that in 1-month non-survivors, peripheral blood lymphocytes decreased by 0.034 × 10^9/L per day, while the lymphocytes in survivors gradually increased.

Prevalence Characteristics of Osteoporosis Fractures in the Elderly in Two Regions of China and Analysis of the Lag Effect of Air Pollutants on them.

Air pollution is increasing and threatening human health. The objective of this study is to investigate the population distribution characteristics of elderly osteoporosis fractures in Hebei Province and Xinjiang Uygur Autonomous Region and to analyze the effects of air pollutants on the number of elderly osteoporosis fracture inpatients in the two regions. A retrospective collection of elderly osteoporosis fracture cases was conducted in selected hospitals in Hebei Province and Xinjiang Uygur Autonomous Region from January 1, 2018 to December 31, 2022. The chi-square test was used to compare the distributional characteristics of the population in the two regions. Additionally, we used a distributed lag nonlinear model (DLNM) in order to assess the effect of air pollutants on the number of daily hospital admissions of elderly osteoporosis fracture patients in different regions. A total of 19,203 elderly osteoporosis fracture patients were included in the study. The average age of these patients was 76.66 ± 7.55 years, and the majority of them were female (13,514 instances, 70.37%). The disparities in age distribution (χ2 = 133.9 p < 0.001), fracture site (χ2 = 62.0 p < 0.001), and hospitalization cost (Z = -15.635 p < 0.001) between the two regions were statistically significant. The lag effect curves of PM2.5, PM10, and NO2 on the number of elderly osteoporosis fracture hospitalizations in Xinjiang Uygur Autonomous Region exhibited a similar pattern resembling a "W"-shaped curve. All three pollutants reached their highest values after a lag time of 14 days (PM2.5: RR = 1.053, 95% CI: 1.031, 1.074; PM10: RR = 1.031, 95% CI: 1.018, 1.043; NO2: RR = 1.125, 95% CI: 1.070, 1.182). In Hebei Province, the largest impacts of PM2.5 and PM10 were observed after a lag of 14 days (PM2.5: RR = 1.022, 95% CI: 1.013, 1.028; PM10: RR = 1.013, 95% CI: 1.008, 1.018). Similarly, the maximum effect of NO2 was observed after a lag of 11 days (RR = 1.020, 95% CI: 1.010, 1.028). There were differences in the epidemiological characteristics of hospitalized patients with osteoporosis fractures between the two regions, PM2.5, PM10, and NO2 increased the number of hospitalizations for osteoporosis fractures. Exposure to air pollutants such as PM2.5 increases the risk of osteoporosis fractures in the elderly population.

The Role of Troponin Measured on Admission to the Emergency Department in Patients with Acute Ischemic Stroke to Predict Stroke Severity and Neurological Outcome

Objective: This study aims to investigate the prognostic value of cardiac troponin levels measured at admission to the emergency department (ED) for stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS) and neurological outcomes determined by Modified Rankin Scale (mRS) scores in patients diagnosed with acute ischemic stroke (AIS). Materials and Methods: Patients presenting to ED with a diagnosis of AIS confirmed by neuroimaging findings were included. Patients were divided into 2 groups based on troponin-I levels: elevated and normal. NIHSS during admission, 30-day all-cause mortality data, and 30-day mRS were examined. In comparisons between groups, categorical variables were evaluated with Chi-square and continuous variables were evaluated with the Mann-Whitney-U test. To determine the prognostic value of troponin with poor outcomes in stroke patients, diagnostic 2x2 tables were made. Results: The study was conducted with 200 patients. Troponin elevation was detected in 37, and mortality was significantly higher in this group. The sensitivity of troponin to predict mortality was 88.89%, and PLR (positive likelihood ratio) was 5.85 (3.89–8.79). The 30-day mRS scores were significantly higher in the elevated troponin group. NIHSS scores didn’t show a significant difference between groups. Conclusions: Troponin levels assessed at admission in AIS patients may be a prognostic marker for mortality and adverse neurological outcomes.

The effect of vibroacoustic therapy on the structural integrity of erythrocytes and platelets in patients with acute exogenous poisoning

Background. Vibroacoustic therapy is used as a non-drug method of correcting respiratory disorders in various diseases, including acute poisoning. The effect of vibroacoustic therapy on blood cells currently remains unexplored.Objective. To evaluate the impact of vibroacoustic therapy on the morphofunctional rate of erythrocytes and platelets in patients with acute poisoning in patients with acute poisoning.Material and methods. Thirty eight patients with complicated acute poisoning transferred to the Toxicology Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine were examined. In 19 patients, along with the standard therapy, a vibroacoustic therapy was performed using a VibroLUNG device (the main study group); the other 19 patients received only standard therapy (the comparison group). Vibroacoustic therapy began on the 2nd day after the patient admission to the Toxicology Department. The course of vibroacoustic therapy consisted of 2–9 procedures. Morphofunctional analysis of erythrocytes and platelets in all cases was performed before the start of the vibroacoustic therapy (before treatment) and before discharge from the hospital (1–2 days after completing the vibroacoustic therapy course).Results. In both groups, before treatment, we noted normal morphofunctional rate of erythrocytes and normal level of platelets with granules in the circulating blood. The level of severely damaged or altered platelets was only slightly higher than normal and did not differ between the groups. Meanwhile, in 50% of patients, platelets had a tendency to spontaneous activation and hyperactivation. Before discharge, the morph functional parameters of erythrocytes and platelets did not significantly change in both groups, while treatment with vibroacoustic therapy allowed to eliminate or reduce spontaneous platelet activation in 7 of 9 patients in the main study group. In the comparison group spontaneous platelet activation was absent in only 3 of 10 patients. In parallel, the time till pneumonia resolution turned statistically significantly reduced, by 1.5 times.Conclusions. In acute exogenous poisoning with complicated course, the risk of spontaneous platelet activation and hyperactivation increases. Vibroacoustic therapy does not violate the structural integrity of circulating erythrocytes and platelets. Vibroacoustic therapy, using the VibroLUNG device, reduces the tendency of platelets to spontaneous activation and hyperactivation, reduces the time for resolving pneumonia.

Hospital overcrowding and care of stroke patients: Irish national audit of stroke

IntroductionHospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome.MethodsData on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) ‘Trolley Count’ database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay.Results579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389–27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9-14.0%). Median Quarterly Length of stay was 9 days (8–11 days). Median quarterly door to needle was 65 min (45–80 min). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p = 0.005 t-test) and for Q3 (mean 14542 (sd 4753) p = 0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r = 0.084, p = 0.63), median length of stay r=-0.15, p = 0.37) or thrombolysis rate (r = 0.089 p = 0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p = 0.03).ConclusionDespite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care.

Clinical evaluation of a machine learning-based early warning system for patient deterioration.

The implementation and clinical impact of machine learning-based early warning systems for patient deterioration in hospitals have not been well described. We sought to describe the implementation and evaluation of a multifaceted, real-time, machine learning-based early warning system for patient deterioration used in the general internal medicine (GIM) unit of an academic medical centre. In this nonrandomized, controlled study, we evaluated the association between the implementation of a machine learning-based early warning system and clinical outcomes. We used propensity score-based overlap weighting to compare patients in the GIM unit during the intervention period (Nov. 1, 2020, to June 1, 2022) to those admitted during the pre-intervention period (Nov. 1, 2016, to June 1, 2020). In a difference-indifferences analysis, we compared patients in the GIM unit with those in the cardiology, respirology, and nephrology units who did not receive the intervention. We retrospectively calculated system predictions for each patient in the control cohorts, although alerts were sent to clinicians only during the intervention period for patients in GIM. The primary outcome was non-palliative in-hospital death. The study included 13 649 patient admissions in GIM and 8470 patient admissions in subspecialty units. Non-palliative deaths were significantly lower in the intervention period than the pre-intervention period among patients in GIM (1.6% v. 2.1%; adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.55-1.00) but not in the subspecialty cohorts (1.9% v. 2.1%; adjusted RR 0.89, 95% CI 0.63-1.28). Among high-risk patients in GIM for whom the system triggered at least 1 alert, the proportion of non-palliative deaths was 7.1% in the intervention period, compared with 10.3% in the pre-intervention period (adjusted RR 0.69, 95% CI 0.46-1.02), with no meaningful difference in subspecialty cohorts (10.4% v. 10.6%; adjusted RR 0.98, 95% CI 0.60-1.59). In the difference-indifferences analysis, the adjusted relative risk reduction for non-palliative death in GIM was 0.79 (95% CI 0.50-1.24). Implementing a machine learning-based early warning system in the GIM unit was associated with lower risk of non-palliative death than in the pre-intervention period. Machine learning-based early warning systems are promising technologies for improving clinical outcomes.

Intensive care unit caseload and workload and their association with outcomes in critically unwell patients: a large registry-based cohort analysis

BackgroundToo high or too low patient volumes and work amounts may overwhelm health care professionals and obstruct processes or lead to inadequate personnel routine and process flow. We sought to evaluate, whether an association between current caseload, current workload, and outcomes exists in intensive care units (ICU).MethodsRetrospective cohort analysis of data from an Austrian ICU registry. Data on patients aged ≥ 18 years admitted to 144 Austrian ICUs between 2013 and 2022 were included. A Cox proportional hazards model with ICU mortality as the outcome of interest adjusted with patients’ respective SAPS 3, current ICU caseload (measured by ICU occupancy rates), and current ICU workload (measured by median TISS-28 per ICU) as time-dependent covariables was constructed. Subgroup analyses were performed for types of ICUs, hospital care level, and pre-COVID or intra-COVID period.Results415 584 patient admissions to 144 ICUs were analysed. Compared to ICU caseloads of 76 to 100%, there was no significant relationship between overuse of ICU capacity and risk of death [HR (95% CI) 1.06 (0.99–1.15), p = 0.110 for > 100%], but for lower utilisation [1.09 (1.02–1.16), p = 0.008 for ≤ 50% and 1.10 (1.05–1.15), p < 0.0001 for 51–75%]. Exceptions were significant associations for caseloads > 100% between 2020 and 2022 [1.18 (1.06–1.30), p = 0.001], i.e., the intra-COVID period. Compared to the reference category of median TISS-28 21–30, lower [0.88 (0.78–0.99), p = 0.049 for ≤ 20], but not higher workloads were significantly associated with risk of death. High workload may be associated with higher mortality in local hospitals [1.09 (1.01–1.19), p = 0.035 for 31–40, 1.28 (1.02–1.60), p = 0.033 for > 40].ConclusionsIn a system with comparably high intensive care resources and mandatory staffing levels, patients’ survival chances are generally not affected by high intensive care unit caseload and workload. However, extraordinary circumstances, such as the COVID-19 pandemic, may lead to higher risk of death, if planned capacities are exceeded. High workload in ICUs in smaller hospitals with lower staffing levels may be associated with increased risk of death.

The Correlation Between CT Findings and Neurosurgical Intervention in Mild Traumatic Brain Injury Patients with Isolated Subdural Hematomas

Abstract Objective In patients with mild traumatic brain injuries (mTBIs), with Glasgow Coma Scale (GCS) scores of 13 to 15, isolated subdural hematomas (iSDHs) are identified as a prevalent category of intracranial hemorrhage. The primary objective of our research was to investigate the relationship between the characteristics of iSDHs, as revealed through computed tomography (CT) scans on patient admission, and the consequent necessity for neurosurgical intervention. Materials and Methods This was a 1-year study, employing a prospective observational design at our institution. We enrolled adult trauma patients diagnosed with mTBIs and concurrent iSDHs, intent on documenting the hemorrhages' quantitative parameters such as maximum length and thickness, among other related variables. The eventual execution of neurosurgical procedures constituted our primary outcome, aiming to establish a decisive correlation between CT scan metrics of iSDHs upon admission and the imperative for subsequent surgical intervention. Results A total of 50 patients were included in our study: 14 patients received a neurosurgical intervention and 36 patients did not. The neurosurgical intervention group had a mean maximum SDH length and thickness that were 38 mm longer and 9.6 mm thicker than those of the non-neurosurgical intervention group (p &lt; 0.001 for both). Conclusion In this study, we evaluated the odds of a neurosurgical intervention based on hemorrhage characteristics on CT, in patients with an iSDH and mTBI. Once validated in a second population, these data can be used to evaluate the necessity of interhospital transfers and to better inform patients and families of the risk of future neurosurgical intervention and prognosis.

Impact of Capacity Strain on the Health Status of Patients Discharged From an Intensive Care Unit

Intensive care units (ICUs) play a vital role in hospitals and often experience capacity strain. Using data from a large teaching hospital, we empirically examine the effect of ICU capacity strain on patient discharge. We find that capacity strain has no effect on the health status of discharged patients and that capacity strain leads to a shorter length-of-stay in the ICU, but the magnitude of the effect is less than half a day in the most extreme scenarios. In post-hoc analyses, we find evidence the discharge process is expedited by starting discharges earlier in the day when capacity is strained, demonstrating that more efficient discharges can free up space without compromising patient health. In addition, we find a decrease in patient admissions during periods of capacity strain. To our knowledge, this is the first study to examine the direct relationship between ICU capacity strain and patient health at discharge, and it builds on the existing literature that has examined the effects of ICU capacity strain on proxies for patient health at discharge. We advocate that hospitals use outcome measures based on patient status at discharge to accurately assess the impact of capacity strain on quality of care. In addition, our work highlights the need for tailored research approaches and management practices for different types of ICUs, as generalizing the impact of ICU capacity strain across different settings may lead to inaccuracies.

ThP6.14 - The Diagnostic Utility of C-Reactive Protein in Acute Appendicitis

Abstract Aim This study sought to determine the value of C-Reactive Protein (CRP) as a diagnostic marker in acute appendicitis. Methods All patients &amp;gt; 18 years presenting to the surgical assessment unit with acute appendicitis in 2022 were retrospectively identified. Data including patient demographics, admission CRP, CT results and operative findings were analysed. Results This study identified 130 patients with a median age of 35 years. Operative management was undertaken in 85% of patients (n=110) and conservative in 15% (n=20). Of these, four required conversion to operative management. No significant difference in CRP was identified between conservative and operative management. CT was performed in 84% of patients. Of these, 98% (n=107) were suggestive of acute appendicitis - 85% uncomplicated (n=91) and 15% (n=16) complicated. CRP was significantly higher in patients with CT- diagnosed complicated appendicitis (p&amp;lt;0.001). Operative assessment demonstrated 76 patients (58%) with uncomplicated and 38 (29%) with complicated appendicitis, with CRP significantly elevated in complicated appendicitis (median 119.5 vs 21, p&amp;lt;0.001). A CRP cut-off of 96mg/L showed reasonable predictive value of complicated appendicitis (sensitivity=61%, specificity=88%) with AUC value of 0.76 (95%CI: 0.66-0.87). CRP also showed value as a predictor of perforation and abscess (AUC=0.79 (95%CI: 0.67-0.90) and 0.76 (95%CI: 0.63-0.89) respectively. Optimal CRP cut off for perforation was 84mg/L (sensitivity=73%, specificity=88%) and 96mg/L (sensitivity=73%, specificity=81%) for abscess. CRP was not significantly elevated in necrotic or gangrenous appendicitis. Conclusions CRP levels correlate with appendicitis severity in both CT and operative assessment and may be a useful predictor of perforation and abscess formation.