Average Number Of Admissions Research Articles

A RETROSPECTIVE STUDY ON PATIENTS HOSPITALIZED FROM THE EMERGENCY DEPARTMENT BEFORE AND DURING THE COVID-19 PANDEMIC PERIOD

This study aims to evaluate patients hospitalized from the emergency department before and during the pandemic. The research was designed as a retrospective study. All patients (32,544 patients) who came to the emergency department of a training and research hospital for a total duration of two years, consisting of one year before the pandemic and one year during the pandemic, and subsequently required admission, were included in the study. The study compared the monthly average number of admissions, age, gender, diagnosis, discharge status, and mortality rate variables of the patients included. There was a decrease in the number of patients during the pandemic compared to the pre-pandemic period. The rate of change (decrease) ranged from 12.6% to 34%. The decrease in the number of patients in the early months of the pandemic (March, April, May, June) exceeded 25%. The mean age, average length of stay and mortality rates of patients admitted from the emergency department increased during the pandemic, and this change was statistically significant (p

Safety culture survey among medical residents in Japan: a nationwide cross-sectional study

PurposeThis study aimed to examine safety culture among Japanese medical residents through a comparative analysis of university and community hospitals and an investigation of the factors related to safety culture.MethodThis...

Global Initiative for Asthma (GINA) guideline: achieving optimal asthma control in children aged 6-11 years.

The Global Initiative for Asthma (GINA) 2021 guidelines for asthma have been set forth with some alterations in Step 3, for children from 6-11-year-old age group. The low dose LABA-ICS, very low dose formoterol-ICS, medium dose ICS and ICS-LTRA combination were recommended in the guideline. We organized this study to draw an effective comparison between these three combinations of controller therapies in pediatric population. A retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan which enrolled 114 children aged 6-11 years old, from July 2021 to December 2022. These children were admitted with asthma exacerbations and were discharged on controller medications as per GINA guidelines on step 3 for control of asthma for 3 months. They were then followed for re-admission within 30 days of discharge, number of ER visits with asthma exacerbations for 1 year, number of admissions with asthma including HDU and PICU admissions, length of stay per admission for all admissions in subsequent one year. The pulmonary function test was done at 1 week follow-up in clinic after discharge and at 3 months visit post discharge. A total of 114 pediatric patients from age 6-11-year-old, were enrolled in the study period out of which 36 (31.57%), 33(28.9%) and 34 (29.82%) patients were categorized into ICS-LABA, ICS and ICS-LTRA groups respectively. ER visits were significantly low in ICS-LABA group followed by ICS-LRTA group and then ICS group (1.75±0.96 vs 2.93±1.412 vs 3.11±1.21, p<0.001). Similar statistically significant results were observed on average number of admissions per year (1.52±1.02 vs 1.96±0.84 vs 2.06±1.07, p=0.047) and number of patients needing PICU (13.88% vs 26.47% vs 39.39%, p=0.034) in these groups respectively. ICS- LABA group patients had the best values of FEV1 and FEV1/FVC ratio after pulmonary function tests at 3 months follow-up followed by ICS-LTRA and ICS group. Amongst the three options regimens for children managed at step 3 on GINA 2021 guidelines, ICS-LABA therapy helps attain optimal patient outcomes and lung functions in children with asthma followed by ICS-LTRA and ICS group respectively.

Hospitalizations Among Adults With CKD in Public Renal Specialty Practices: A Retrospective Study From Queensland, Australia

Little is known about hospital admissions in nondialysis patients with chronic kidney disease (CKD) before death or starting kidney replacement therapy (KRT). Retrospective observational cohort study. Hospitalizations among 7,201 patients with CKD from 10 public renal clinics in Queensland (QLD), enrolled in the CKD.QLD registry starting in May 2011, were followed for 25,496.34 person-years until they started receiving KRT or died, or until June 30,2018. Demographic and clinical characteristics of patients with CKD. Hospital admissions. We evaluated the association of demographic and clinical features with hospitalizations, length of hospital stay, and cost. Approximately 81.5% of the patients were admitted at least once, with 42,283 admissions, costing Australian dollars (AUD) 231 million. The average number of admissions per person-year was 1.7, and the cost was AUD 9,060, 10 times and 2 times their Australian averages, respectively. Single (1-day) admissions constituted 59.2% of all the hospital episodes, led by neoplasms (largely chemotherapy), anemia, CKD-related conditions and eye conditions (largely cataract extractions), but only 14.8% of the total costs. Approximately 41% of admissions were>1-day admissions, constituting 85.2% of the total costs, with cardiovascular conditions, respiratory conditions, CKD-related conditions, and injuries, fractures, or poisoning being the dominant causes. Readmission within 30 days of discharge constituted>42% of the admissions and 46.8% costs. Admissions not directly related to CKD constituted 90% of the admissions and costs. More than 40% of the admissions and costs were through the emergency department. Approximately 19% of the hospitalized patients and 27% of the admissions did not have kidney disease mentioned as either principal or associate causes. Variable follow-up times because of different dates of consent. The hospital burden of patients with CKD is mainly driven by complex multiday admissions and readmissions involving comorbid conditions, which may not be directly related to their CKD. Strategies to prevent these complex admissions and readmissions should minimize hospital costs and outcomes. We analyzed primary causes, types, and costs of hospitalizations among 7,201 patients with chronic kidney disease (CKD) from renal speciality clinics across Queensland, Australia, over an average follow-up of 3.54 years. The average annual cost per person was $9,060, and was the highest in those with more advanced CKD, higher age, and with diabetes. More than 85% of costs were driven by more complex hospitalizations with longer length of stay. Cardiovascular disease was the single largest contributor for hospitalizations, length of hospital stay, and total costs. Readmission within 30 days of discharge, particularly for the same disorder, and multiday admissions should be the main targets for mitigation of hospital costs in this population.

Is the incident of once chronic obstructive pulmonary disease related admission a high risk for readmission in the future?

Although it is known that a history of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most important predictor of future risk of AECOPD and readmission to hospitals, there is no scientific evidence that an event of only one chronic obstructive pulmonary disease (COPD)-related admission is a high risk of future readmission. We retrospectively analyzed the association of an incident of one COPD-related admission with future readmission risk. This is a retrospective study. The data of AECOPD-related admissions and readmissions during 5 years were obtained and analyzed for the admission frequencies of patients with AECOPD and an association of the admission history with a future readmission risk. The admission frequency of patients with frequent admission (3 or more admissions within 5 years) was 4.1 times that of those with non-frequent admission (0.95 vs. 0.23 times per person per year). In each calendar year during the 5-year study period, most patients (88.2%) were hospitalized only once, and 11.8% had two or more admissions. Nevertheless, their average number of admissions in each calendar year was 3.3 times that of those who only had one admission each year (3.33 vs. 1.00 times per person per year). More importantly, the positive predictive value for future readmission due to AECOPD was only 14.8% in those who had one admission in the previous year. The patients with the greater readmission risk were those with two or more admissions due to AECOPD in the previous year [crude odds ratio (OR): 4.10, 95% confidence interval (CI): 1.24-13.58 and 7.51, 95% CI: 3.81-16.68]. There is a subtype of frequent admission due to AECOPD, and it can be distinguished by having three or more admissions in the past 5 years or two or more admissions in the previous year. Nevertheless, an incident of admission once a year is not a good predictor of future readmission.

705: NATIONAL TRENDS IN PEDIATRIC CRITICAL ASTHMA SEVERITY DURING THE COVID-19 PANDEMIC

Introduction: Asthma exacerbations in children have historically been attributed to a combination of viral infection, environmental exposures, and individual patient attributes. The COVID-19 pandemic has provided a unique opportunity to evaluate variations in asthma severity during a time of changing viral exposure patterns and patient behaviors. This study describes the trends in pediatric critical asthma severity during the COVID-19 pandemic. Methods: We performed a retrospective analysis of the Virtual Pediatric Systems (VPS) database. Inclusion criteria were: patients admitted to a pediatric intensive care unit in the United States from 2014-2021 with a discharge diagnosis of “asthma with acute exacerbation” or “asthma with status asthmaticus.” Asthma severity was determined by the maximum level of respiratory support required during the admission, from lowest to highest: 1-Heated high flow nasal cannula; 2-Non-invasive positive pressure; 3-Endotracheal intubation; 4-Inhaled anesthetics or ECMO. Patients were divided into Pre-COVID, Pandemic Era 2020, and 2021 groups based on the date of admission, with the start of the COVID-19 pandemic defined as April 1, 2020. Subgroup analysis was performed based on race/ethnic group. Results: A total of 51,746 patients were identified in the VPS database that met the stated criteria. The average number of admissions per month was 713 and 206 in the Pre-COVID and Pandemic groups, respectively. Patients categorized as “Severe” (severity levels 3 & 4) represented 3.8% and 4.7% of admissions, respectively (p< 0.05). Patients categorized as “Moderate” (severity level 2) represented 16.9% and 21.7% of admissions, respectively (p< 0.05). Asthma mortality rates were found to be 0.3% and 0.7%, respectively (p< 0.05). Subgroup analysis by race/ethnic group found that asthma severity by race/ethnicity was unchanged from the pre-COVID baseline. Conclusions: During the COVID-19 pandemic, the number of critical asthma admissions decreased while the average severity and mortality rate in those patients increased. Further study is needed to determine whether these findings are due to delayed presentation to healthcare, changes in viral exposure patterns, or other factors.

THE USE OF METARAMINOL AS A VASOPRESSOR IN CRITICALLY UNWELL PATIENTS: A NARRATIVE REVIEW AND A SURVEY OF UK PRACTICE

<h3>Background</h3> Major international guidelines state that norepinephrine should be used as the first-line vasopressor to achieve adequate blood pressure in patients with hypotension or shock. However, recent observational studies report that in the United Kingdom and Australia, metaraminol is often used as a first-line medication for cardiovascular support. <h3>Aim of the study</h3> The aim of this study was to carry out a systematic review of metaraminol use for the management of shock in critically unwell patients and carry out a survey evaluating whether UK critical care units use metaraminol and under which circumstances. <h3>Methods</h3> A systematic review literature search was conducted. We investigated 30 departments, representing small (< 10 beds), medium (10-20 beds), and large (> 20 beds) units, and both teaching and non-teaching hospitals, using a semi-structured narrative interview and a pre-defined list of questions. <h3>Results</h3> We received 26 responses from the 30 hospitals we contacted, representing 10% of UK adult critical care units. Of these 4 were small, 10 were medium, and 12 were large units. The surveyed units had a collective total of 34206 annual admissions, representing 17% of the UK total. The average number of admissions per small unit was 419/year, medium unit 757/year and larger unit 2080/year. In total, 88% of the units (23/26 hospitals) used metaraminol prior to critical care admission. In 70% of the hospitals, metaraminol was used on the wards or in the emergency departments. In 70% of the cases, metaraminol was used to manage hypotension due to any cause. Most hospitals (67%, 15/23) continued metaraminol infusion in the critical care unit. Almost half of the respondents explained that infusion was time-limited (usually 12–24 hours) with a subsequent change to norepinephrine. Approximately 2/3 of hospitals used metaraminol as the first-line vasopressor in critical care. The systematic literature review revealed several case reports and only two studies conducted in the last 20 years investigating the effect of metaraminol as a stand-alone vasopressor. Both studies focused on different aspects of metaraminol use, therefore it was not feasible to carry out a full systematic review. The narrative review has demonstrated the lack of robust evidence to support the use of metaraminol in critically ill patients. Even though the pharmacodynamic properties of metaraminol provide a rationale for its use but there is no evidence to evaluate its impact on important patient outcomes, such as the length of vasopressor support, complications associated with its use, morbidity, and mortality. <h3>Conclusions</h3> Metaraminol was the first-line vasopressor in a representative sample of UK critical care units. We identified no randomised trials describing clinical outcomes of metaraminol use, meaning the benefits and risks of this treatment are uncertain. Further observational studies and prospective randomised controlled trials are warranted to inform evidence-based practice for patient benefit.

Complications and Hospital Admissions among Pregnant Women with Substance Abuse

In recent times, there has been an increase in drug abuse in not only the general population, but in women of reproductive age. Our objectives were to identify, classify, and describe the spectrum of complications, the average number of admissions, and length of hospital stay that occur among pregnant women with substance abuse. The aim was to obtain better understanding of complication prevalence to improve management in this ever-growing population. A retrospective chart review was conducted of pregnant women ages 18-45 with a history of substance abuse from 2013-2018 in the tri-state area of West Virginia, Ohio, and Kentucky. We collected the following data: demographics, medical history, specific substances abused, inpatient admission dates and diagnoses, and delivery information. A total of 411 patients met the inclusion criteria, with a total of 525 pregnancies. Out of 525 pregnancies, 71.6 % used buprenorphine (i.e., Subutex), 43.4% used opiates, excluding heroin, and 35% of patients used heroin. Out of the 525 pregnancies, there were 714 inpatient antepartum admissions. Of these, 376 were admissions due to withdrawal symptoms (52.7%). A total of 263 pregnancies had at least one admission for withdrawal, drug abuse, overdose, or buprenorphine/methadone conversion (50%). The average length of hospital stay for withdrawal admissions was 3.4 days (SD). There were 62 admissions for infectious causes, 24 of these being due to pyelonephritis (38.7%). The findings highlight multiple areas for future studies as well as areas for quality improvement in the management of this population.

Trends in Lower Extremity Injuries Presenting to Emergency Departments During the COVID-19 Pandemic

BackgroundDuring the emergence of the SARS-CoV-2 (COVID-19) pandemic, there were substantial changes in U.S. emergency department (ED) volumes and acuity of patient presentation compared with more recent years. Objectives: The purpose of this study was to characterize the incidence of specific lower extremity (LE) injuries presenting to U.S. EDs during the COVID-19 pandemic and to analyze trends across age groups and rates of hospital admission compared with previous years. MethodsThe National Electronic Injury Surveillance System database was queried to identify patients who presented to U.S. EDs for a LE orthopedic injury between 2016 and 2020. ResultsThese queries returned 252,656 cases, representing a total estimate of 9,740,514 injuries presenting to EDs across the United States. The mean incidence of LE orthopedic injuries was 596.8 injuries per 100,000 person-years (95% confidence interval [CI] 594.9–598.7), with the greatest annual decrease in incidence occurring between 2019 and 2020 (24.96%). The largest number of estimated hospital admissions occurred in 2020, with a total 181,671 admissions (95% CI 178,032–185,311), a 25.74% increase from the average number of admissions between 2016 and 2019. ConclusionThe COVID-19 pandemic has placed immense stress on both emergency medical services and hospital systems around the United States. While there were decreased rates of ED utilization for LE orthopedic complaints during the first year of the pandemic, there was a concomitant increase in both the number and proportion of these injuries admitted to the hospital from the ED. This places an additional burden on already stressed emergency medicine services and overall hospital systems that could slow down the management of medical emergencies.

Sanitary measures to contain COVID-19 spread decreased pediatric hospitalizations due to other respiratory infections in São Paulo, Brazil

ObjectiveAfter the Covid-19 pandemics hit Brazil and sanitary measures were adopted to contain its dissemination, pediatric hospital admissions were apparently fewer than usual. The authors aimed to describe the time trends of public hospital admissions of children and adolescents due to respiratory infections (RIs) in São Paulo State, Brazil, before and after the adoption of sanitary measures to contain the dissemination of Covid-19. MethodsEcological, time-series study on the monthly average number of admissions per day of children and adolescents (< 16 years) admitted to public hospitals of São Paulo due to acute RIs between January 2008 and March 2021. Data from 2008 to 2019 were used to adjust the statistical model, while data from 2020 and 2021 were compared to the values predicted by the model. ResultsIn 2020 and 2021, the number of hospital admissions was significantly lower than predicted by the time series. However, lethality was three times higher in these years, compared to the previous, and six times higher in patients with Covid-19, compared to those without the disease. Hospitalization costs in 2020 and 2021 were lower than in previous years. ConclusionsThese findings suggest that the sanitary measures adopted to contain the dissemination of Covid-19 also effectively reduce the transmission of other respiratory viruses. Policymakers and administrators can use this knowledge as a guide to planning preventative interventions that could decrease the number and severity of RIs and related hospital admissions in children and adolescents, decreasing the burden on the public health system.

Trends in upper extremity injuries presenting to emergency departments during the COVID-19 pandemic

IntroductionDuring the emergence of the SARS-CoV-2 (COVID-19) pandemic, there were substantial changes in United States (U.S.) emergency department (ED) volumes and acuity of patient presentation compared to more recent years. Thus, the purpose of this study was to characterize the incidence of specific upper extremity (UE) injuries presenting to U.S. EDs during the COVID-19 pandemic and analyze trends across age groups and rates of hospital admission compared to years prior. MethodsThe National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to U.S. EDs for an UE orthopaedic injury between 2016 and 2020. Chi-square analysis and logistic regression were used to assess for differences in ED presentation volume and hospital admissions between pre-pandemic (2016 through 2019) and during-pandemic (2020) times. ResultsThese queries returned 285,583 cases, representing a total estimate of 10,452,166 injuries presenting to EDs across the U.S. The mean incidence of UE orthopaedic injuries was 640.2 (95% CI, 638.2–642.3) injuries per 100,000 person-years, with the greatest year to year decrease in incidence occurring between 2019 and 2020 (20.1%). The largest number of estimated admissions occurred in 2020, with a total 135,018 admissions (95% CI, 131,518–138,517), a 41.6% increase from the average number of admissions between 2016 and 2019. ConclusionThere was a 20.1% decrease in the incidence of UE orthopaedic injuries presenting to EDs after the start of the COVID-19 pandemic with a concomitant 41.2% increase in the number of hospital admissions from the ED in 2020 compared to recent pre-pandemic years. We speculate that at least some elective, semi-elective or urgent ambulatory surgeries were canceled or delayed due to the pandemic and were subsequently directed to the ED for admission. Regardless of the cause of increased UE orthopaedic admissions, policy planners and administrators should be aware of the additional stresses placed on already burdened ED and inpatient services. Level of evidenceLevel III – Retrospective Cohort Study.

Non-COVID-19 In-Hospital Admission in a Large Academic Center in Belgium During the First Two Waves of the COVID-19 Pandemic.

BackgroundPreliminary reports described a reduction in non-COVID admissions during the first wave of the pandemic including some of critical diseases such as cancer, myocardial and cerebral infarction.ObjectiveThe aim of our study was to evaluate the impact of the COVID-19 pandemic on non-COVID in-hospital admissions in a large academic center in Belgium.Materials and MethodsWe performed a retrospective study of non-COVID-19 in-hospital admissions during the first two waves of the COVID-19 pandemic. The average number of admissions per week in 2020 has been compared to that of the same period in 2019 and 2018. Comparisons were made first for all admissions, then by disease groups, using the classification of APRDRG, and then by diagnoses using ICD-10-CM classification.ResultsOverall in-hospital admissions were reduced by around 39% and 29% during the first and the second waves of the COVID-19 pandemic respectively compared to 2018 and 2019. No significant difference was found between the average number of admissions in the early-COVID and the pre-COVID baseline period during the two waves. The average number of admissions was significantly reduced in the peak-COVID period compared to the baseline (first wave: 332 versus 763 admissions/week, p<0.01, −57%; second wave: 496 versus 788 admissions/week, p<0.01, −37%), as well as in the late-COVID period compared to the baseline (first wave: 412 versus 763 admissions/week, p<0.01, −46%; second wave: 470 versus 788 admissions/week, p<0.01, −40%). Cancer, myocardial and cerebral infarction admissions were not statistically reduced during the the two waves of COVID pandemic compared to the pre-COVID period.ConclusionOur study shows that non-COVID in-hospital admissions rates were substantially reduced during the first two waves of COVID-19 pandemic. In our study, cancer, myocardial and cerebral infarction admissions were not statistically reduced, which was not in accordance to what was described in the literature.

108 Emergency Department Crowding Resulting from a Local Health System Cyberattack

Emergency department crowding continues to be a concern in many major urban emergency departments. The causes of ED crowding are complex and multi-factorial, and now cyber attach threats are contributing to this ongoing issue. We analyze the impact of a cyberattack on a large, multi-hospital health system on the already burdensome crowding in our emergency department. This is a retrospective study evaluating the boarding of admitting patients on two EDs from a single healthcare system during an ongoing ransomware cyberattack on a neighboring health system in San Diego. San Diego regional hospitals serve an estimated population of roughly 3.3 million residents across a 4,206-square-mile land mass; approximately 1.4 million reside within the City of San Diego. One ED is in an urban level one trauma center and the other is a suburban academic hospital. They have a combined annual census of ∼80, 000). Census and admitted patients from the two-week period before (April 17 through April 30, 2021) and two weeks after (May 2 through May 15, 2021) the incident started (May 1, 2021). In the study period, the number of admissions, discharges and LWBS statuses increased therefore increasing daily ED census. Between the pre- and post-cyberattack periods, the average number of admissions, discharges, LWBS and overall census increased by 46 (95% CI = 24.32, 67.68), 7 (95% CI = -1.93, 17.93), 25 (95% CI = 13.55, 36.45) and 8 (95% CI = 3.02, 12.98), respectively. The number of EDIPs increased in the post-period. The percent of admissions being held in the ED to ED census were roughly 13% in the pre-period and 14% in the post-period, demonstrating an increased in the percent % of EDIPs within daily ED volume. These results reveal the significant rise in ED visits and boarding as a result of the ransomware cyberattack on a neighboring health system. As these attacks likely become more common in the future, local and regional response strategies to consider the safe management of patients by other unaffected health systems may help reduce the impact on ED crowding and maintain flow in the department so a sustained surge doesn’t impact patient safety.

Impact of an acute geriatric outreach service to residential aged care facilities on hospital admissions.

IntroductionResidential aged care facility (RACF) residents frequently present to the emergency department (ED) and are often admitted to hospital. Some presentations and admissions may be avoidable. In 2013, Bankstown‐Lidcombe Hospital introduced a subacute geriatric outreach service (SGOS), which had little impact on reducing ED presentations. In 2015, Bankstown‐Lidcombe Hospital introduced an acute geriatric outreach service (AGOS), a geriatrician‐led team that assesses and treats acutely unwell patients in RACFs. We aim to determine whether the AGOS reduces the risk of hospital admission for RACF residents.MethodsHospital admissions data from 2010 to 2019 were used to conduct an interrupted time series (ITS) analysis. AGOS activity data were also summarized.ResultsThe average number of admissions from RACF per month declined from 42.8 during the SGOS period to 27.1 during the AGOS period. The difference of 15.7 admissions from RACF per month was statistically significant (95% CI 12.1–19.2; P < .001). After the introduction of the AGOS, the risk of admission to our geriatric department from RACFs was reduced by 36.1% (incidence rate ratio =0.64; 95% CI: 0.58–0.71; P < .001) compared to the SGOS period, adjusting for seasonality.DiscussionThe AGOS probably reduced the risk of hospital admission for RACF residents.

Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic

BackgroundChildren have been less affected by the COVID-19 pandemic, but its repercussions on pediatric illnesses may have been significant. This study examines the indirect impact of the pandemic on a population of critically ill children in the United States.Research QuestionWere there significantly fewer critically ill children admitted to PICUs during the second quarter of 2020, and were there significant changes in the types of diseases admitted?Study Design and MethodsThis retrospective observational cohort study used the Virtual Pediatric Systems database. Participants were 160,295 children admitted to the PICU at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017 to 2019 (pre-COVID-19) and 2020 (COVID-19).ResultsThe average number of admissions was similar between pre-COVID-19 Q1 and COVID-19 Q1 but decreased by 32% from pre-COVID-19 Q2 to COVID-19 Q2 (20,157 to 13,627 admissions per quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID-19 Q2 (6.6% of patients) vs 241 subjects in COVID-19 Q2 (1.8%; P < .001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; P < .001). The percentage of trauma admissions increased, although the raw number of trauma admissions decreased. Admissions for diabetes mellitus and poisoning/ingestion also increased. In the multivariable model, illness severity-adjusted odds of ICU mortality for PICU patients during COVID-19 Q2 increased compared with pre-COVID-19 Q2 (OR, 1.165; 95% CI, 1.00-1.357; P = .049).InterpretationPediatric critical illness admissions decreased substantially during the second quarter of 2020, with significant changes in the types of diseases seen in PICUs in the United States. There was an increase in mortality in children admitted to the PICU during this period.

Readiness of Primary Hospitals in Providing Neonatal Intensive Care Services in Ethiopia.

The Ethiopian neonatal mortality has not shown much progress over the years. In light of this, the country has introduced interventions such as the utilization of newborn corners and neonatal intensive care units to avert preventable neonatal deaths. This study was conducted to assess readiness of primary hospitals in providing neonatal intensive care services. A health facility based cross-sectional study design was employed where data were collected using both prospective and retrospective techniques using a format adapted from national documents. SPSS version 25 was used for data entry and analysis using descriptive statistics. Data were collected from 107 of 113 (94.7%) primary hospitals due to inaccessibility of some primary hospitals. The minimum national standard requirement of a level one neonatal intensive care unit for infrastructure was met by 63% (68/107) and 44% (47/107) had fulfilled the requirements for kangaroo mother care units. The average number of neonatal intensive care unit trained nurses per primary hospital was 2.6, 0.8 for general practitioners and 2.9 support staff; all of which is less than the minimum recommended national standard. The minimum national requirement for medical equipment and renewables for primary hospital level was fulfilled by 24% (26/107) of the hospitals, 65% (70/107) for essential laboratory tests, and 87% (93/107) for clinical services and procedures. The average number of admissions during the six months prior to the data collection was 87.2 sick newborns per facility with a 'discharged improved' rate of 71.5%, referral out rate of 18.4% and level one neonatal intensive care unit death rate of 6.6%. The remaining newborns had either left against medical advice or were still undergoing treatment during data collection. The overall readiness of primary hospitals to deliver neonatal intensive care services in terms of infrastructure, human resource, medical equipment, and laboratory tests was found to be low. There is a need to fill gaps in infrastructure, medical equipment, renewables, human resource, laboratory reagents, drugs and other supplies of neonatal intensive care units of primary hospitals to garner better quality of service delivery.

Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh.

With the proposed pathophysiologic mechanism of neurologic injury by SARS CoV-2, the frequency of stroke and henceforth the related hospital admissions were expected to rise. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic. This is a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates can be found before and after 25 March since when there is a surge in COVID-19 infections. A total of 1394 stroke patients took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 1.06:1. From January to March 2020, the mean rate of admission was 302.3 cases per month, which dropped to 162.3 cases per month from April to June, with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done, whereas, in the last three months, there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT-PCR SARS Cov-2 positive based on nasal swab testing. This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.

Evaluation of Intravenous Diphenhydramine Use in Patients with Sickle Cell Vaso-Occlusive Crisis.

Purpose: To compare the incidence of oversedation between oral and parenteral diphenhydramine therapy for treatment of opioid-induced pruritus in patients with sickle cell disease vaso-occlusive crisis (SCD VOC). Methods: This retrospective, single-center, cohort study included patients greater than or equal to 18 years old with sickle cell disease admitted for vaso-occlusive crisis who received either intravenous or oral diphenhydramine for opioid-induced pruritus. Patients were identified through ICD-9 and ICD-10 codes from June 1, 2016 through July 1, 2017. Rates of oversedation were compared between the 2 formulations. Secondary endpoints included length of stay, amount and duration of diphenhydramine, rate of acute chest and indication for IV therapy. Results: Fifty unique patients were included in the analysis representing 121 admissions. Seven patients received both formulations on separate admissions and were included in both groups. Twenty-nine percent of patients in the IV diphenhydramine group experienced oversedation (12/42) versus 13% in the oral diphenhydramine group (2/15, P = .312). The average number of admissions was significantly higher in the IV versus oral group (2.45 vs 1.20; P = .005) with average and median length of stay also significantly higher in the IV versus oral group (30.57, 16.0 vs 10.67, 10.0; P = .003). Conclusion: While there was no statistically significant difference in the rates of oversedation with use of IV versus oral diphenhydramine formulations, patients with SCD VOC who received IV diphenhydramine had more frequent admissions and a longer length of stay. Clinicians may consider oral diphenhydramine preferentially in appropriate patients over IV administration.

A Study of the Pattern of Admissions to the Accident and Emergency (A&E) Department of a Tertiary Care Hospital in Sri Lanka.

Introduction The latest national healthcare reform policies of Sri Lanka include the development of accident and emergency (A&E) departments in all major hospitals. Provincial General Hospital Kurunegala (PGHK) is a home to the first established A&E department in Sri Lanka. PGHK provides services to a population of 2.4 million spread out in the North Western Province and part of the Sabaragamuwa Province. This study was carried out to identify the pattern of all admissions to the A&E department of PGHK. Methods The prospective observational study was carried out from July 1, 2016, to June 30, 2017 (one year) to identify the pattern of admissions to the A&E department. Results There were 49,213 admissions to PGHK's A&E department during the study period. The average number of admissions was 135 (±17.9) per day. The percentage of deaths in the A&E department was 0.21%. The mean age of admitted patients was 46.7 (±21.7) years. A further 62% of admitted patients were males. The number of medical, surgical, paediatric, and gynaecological and obstetrical admissions was 55%, 42%, 3.5%, and 0.22%, respectively. Among the common emergency medical presentations, 34% were chest pain, 11% patients presented with unilateral weakness and/or slurring of speech, 10% covered dyspnoea, and 9% complained of dizziness/giddiness. Among emergency surgical presentations, 83% were trauma due to accidents, of which 27% were road-traffic-related accidents (RTAs). Discussion. The A&E department of PGHK provides services to a significantly high number of health emergencies every day. The majority of these admissions was due to chest pain and trauma related to accidents. The lower recorded number of paediatric and gynaecological and obstetrical emergencies presented to the A&E department is a result of a government policy mandating the admission of these types of patients directly to their respective wards. Further infrastructure development, staff recruitment, and training have to be planned and implemented to address the significantly high number of admissions to the A&E Department of PGHK.

Machine Learning Algorithms in Predicting Hospital Readmissions in Sickle Cell Disease

Background: Sickle cell disease (SCD) is the most common inherited hemoglobinopathy worldwide. The pathophysiology of the disease results in end organ damage which leads to morbidity and mortality. In a subset of patients, SCD-related complications have resulted in prolonged hospitalizations and increased frequency of 30-day hospital readmissions. In the era of value-based health care, hospital quality metrics and reimbursements are generated based on strategic health care utilization. Therefore, being able to identify early unplanned hospital readmissions is critical in managing health care expenditure. Objective: To develop machine learning algorithms for predicting the 30-day unplanned readmission risk of SCD patients and to compare the predictive power of machine learning models against standard hospital readmission scoring systems. Methods: We analyzed retrospective real-world electronic health records (EHR) data for patients with SCD at our institution from January 1, 2013- November 1, 2018. The raw data set contained 2824 unique SCD patients from across 5 hospitals within the University of Pittsburgh Medical Center. After preprocessing using our inclusion criteria, our cohort included 3299 admissions comprising of 446 adult SCD patients. Features extracted from the EHR data were reduced and regrouped using both data-driven methods and clinical knowledge, resulting in 486 unique features. Logistic Regression (LR), Support Vector Machine (SVM), and Random Forest (RF) were applied to predict for 30-day unplanned hospital readmissions in SCD. Prediction performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. We compared our results against standard hospital readmission prediction tools such as LACE and HOSPITAL indices. Results: We randomly selected the inpatient admissions incurred by 30 percent of the 195 return patients and 251 nonreturn patients to be included in the testing set (n = 134); the training set contained the inpatient admissions incurred by the remaining 211 patients. Thus, our training and testing sets contained similar demographic information, predictors, and outcomes. The average number of admissions was 7.40 (12.90) for the 446 patients, and 14.47 (16.97) for the 195 patients who had 30-day readmissions. Since the number of samples in our study is comparatively small, our results might be sensitive to the training and testing splits. To address this problem, we performed 100 different training and testing splits and averaged the resulting 100 AUCs. Figure 1 summarizes the two performance metrics of each model. The two benchmark prediction tools, LACE and HOSPITAL, have AUCs of 0.56 (95%CI 0.52-0.60) and 0.63 (95%CI 0.59-0.67), respectively. Notably, all three machine learning algorithms outperformed both benchmarks. The RF was the best machine learning model in prediction of hospital readmissions, as reported in similar machine learning studies (Deschepper et al. 2019), with an AUC of 0.73 (95%CI 0.69-0.76). Table 1 summarizes the sensitivity and specificity of our RF model. Conclusion: Machine learning algorithms outperformed the standard hospital readmission risk scoring systems, LACE and HOSPITAL, by a large margin in a real world data set of SCD patients at a single institution. In particular, machine learning algorithms were able to identify important variables that are underrepresented in the traditional risk scoring systems (Figure 2). The use of machine learning algorithms can be a powerful tool in providing valuable insight towards health care expenditure and resource allocation in high risk patient groups. Disclosures No relevant conflicts of interest to declare.