Cause Of Hospital Admission Research Articles

The use of machine learning based models to predict the severity of community acquired pneumonia in hospitalised patients: A systematic review

Background: Community acquired pneumonia (CAP) is a common cause of hospital admission. CAP carries significant risk of adverse outcomes including organ dysfunction, intensive care unit (ICU) admission and death. Earlier admission to ICU for those with severe CAP is associated with better outcomes. Traditional prediction models are used in clinical practice to predict the severity of CAP. However, accuracy of predicting severity may be improved by using machine learning (ML) based models with added advantages of automation and speed. This systematic review evaluates the evidence base of ML-prediction tools in predicting CAP severity. Methods: MEDLINE, EMBASE and PubMed were systematically searched for studies that used ML-based models to predict mortality and/or ICU admission in CAP patients, where a performance metric was reported. Results: 11 papers including a total of 351,365 CAP patients were included. All papers predicted severity and four predicted ICU admission. Most papers applied multiple ML algorithms to datasets and derived area under the receiver operator characteristic curve (AUROC) of 0.98 at best performance and 0.57 at worst, with a mixed performance against traditional prediction tools. Conclusion: Although ML models showed good performance at predicting CAP severity, the variables selected for inclusion in each model varied significantly which limited comparisons between models and there was a lack of reproducible data, limiting validity. Future research should focus on validating ML predication models in multiple cohorts to derive robust, reproducible performance measures, and to demonstrate a benefit in terms of patient outcomes and resource use.

Digital twin driven electrode optimization for wearable bladder monitoring via bioimpedance

Monitoring fluid intake and output for congestive heart failure (CHF) patients is an essential tool to prevent fluid overload, a principal cause of hospital admissions. Addressing this, bladder volume measurement systems utilizing bioimpedance and electrical impedance tomography have been proposed, with limited exploration of continuous monitoring within a wearable design. Advancing this format, we developed a conductivity digital twin from radiological data, where we performed exhaustive simulations to optimize electrode sensitivity on an individual basis. Our optimized placement demonstrated an efficient proof-of-concept volume estimation that required as few as seven measurement frames while maintaining low errors (CI 95% −1.11% to 1.00%) for volumes ≥100 mL. Additionally, we quantify the impact of ascites, a common confounding condition in CHF, on the bioimpedance signal. By improving monitoring technology, we aim to reduce CHF mortality by empowering patients and clinicians with a more thorough understanding of fluid status.

P-1704. Impact of an Empiric Antibiotic Pocket Guide on Rates of Guideline-concordant Empiric Regimens for Inpatient Community-acquired Pneumonia at a Community Hospital

Abstract Background Community-acquired pneumonia (CAP) is a common cause of hospital admissions and studies have shown concordance with guideline recommendations improves outcomes. Antibiotic pocket guides (PG) have been shown to increase use of preferred agents in urinary tract and intra-abdominal infections, but their impact on inpatient CAP treatment has not yet been evaluated. This study sought to evaluate the impact of a newly introduced empiric antibiotic PG (introduced May 2023) on rates of guideline-concordant empiric CAP regimens within 24 hours of admission. Methods This retrospective, pre-post, quasi-experimental study conducted at a 300-bed community hospital included adult inpatients initiated on antibiotics with order indication of pneumonia (+/- sepsis) within 24 hours. Patients were excluded if other indications were selected, if they had severe β-lactam allergies precluding use of all recommended agents, or if initiated on azithromycin or doxycycline alone. Included patients were randomly stratified 1:1 from pre-PG (Jul–Sep 2022) and post-PG (Jul–Sep 2023). The primary outcome was the rate of guideline-concordant empiric antibiotic selection for CAP between the two time periods. Secondary outcomes included total duration of therapy and C. difficile rate within 60 days of admission. Length of stay and all-cause mortality within 30 days of discharge were exploratory safety outcomes. Results 300 patients were included,150 per group. Baseline demographics and risk factors were similar between groups except for higher rates of ICU-admission and recent hospitalization with IV antibiotics in the pre-PG group (Table 1). Patients received a guideline-concordant regimen more frequently post-PG than pre-PG, but this did not reach statistical significance (44.7% vs 35.3%, p = 0.099). No difference in appropriate duration was observed. 30-day all-cause mortality was significantly higher in the pre-PG group (p = 0.015). Other details on management and outcomes can be seen in Table 2 and Figures 1-2. Conclusion Introduction of an antibiotic pocket-guide did not result in a significant change in guideline-concordant empiric CAP treatment in this study. Though no evidence of harm was observed, other interventions may be needed to improve guideline-concordant inpatient CAP treatment.Figure 2.Hospital Length of Stay Disclosures Martin Brenneman, PharmD, BCIDP, Cardinal Health, Inc.: Stocks/Bonds (Public Company)|Dexcom, Inc: Stocks/Bonds (Public Company)|Insulet Corp.: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)|Medtronic Plc: Stocks/Bonds (Public Company)

Epidemiological characterization of congenital heart disease at different altitudes in Ecuador: a four-year retrospective study in a pediatric referral hospital

BackgroundCongenital heart disease (CHD) is one of the main causes of hospital admissions and infant mortality, especially in developing regions.ObjectivesThis study aims to describe the epidemiological and clinical features of CHD in pediatric patients, from one of the largest tertiary-level national referral pediatric hospitals in Ecuador.Materials and methodsAn epidemiological, retrospective cohort study was conducted among patients with CHD who were hospitalized at “Hospital Baca Ortiz” between January 2019 to December 2022 in Quito, Ecuador.ResultsA total of 1,000 pediatric patient medical records were reviewed from 2019 to 2022. Among these patients, 56.0% were female, and 65.2% resided at high altitudes (2,500–3,500 m). Most cases (71.4%) were acyanotic CHD, with patent ductus arteriosus being the most prevalent (48.7%). Among cyanotic CHD, Tetralogy of Fallot was predominant (28.1%). Mortality was observed in 5.3% of patients, with a higher rate among acyanotic CHD (p < 0.001).ConclusionMost cases of CHD were of the acyanotic type, predominantly affecting female patients. Although most cases occurred in children living above 2,500 meters, no clear influence of altitude on specific types of CHD was found. While mortality related to CHD was low, the burden of disability from these conditions was significant among patients with acyanotic CHD.

Prevalence of Respiratory Syncytial Virus Infection in Hospitalized COPD Patients in Spain Between 2018-2022.

Respiratory syncytial virus (RSV) infection is a common cause of hospital admission. The association between chronic obstructive pulmonary disease (COPD) exacerbation and RSV infection is not well studied. To analyze the hospitalizations of patients with COPD and RSV infection in Spain between 2018 and 2022. The data used were obtained from the Spanish Hospital Discharge Database. We selected subjects aged ≥40 years diagnosed with COPD, admitted to the hospital from 1 January 2018 to 31 December 2022. The COPD population that met the selection criteria was subdivided based on the presence of an ICD-10 code for RSV infection. To obtain comparable populations, for each subject with COPD and RSV infection, a subject without an RSV code was selected, with the COPD code in the same diagnostic position (1 to 20), as well as the same year of admission, sex, and age. Among subjects aged ≥40 years, 1,429,288 were identified as having COPD, of whom 5673 also had RSV infection. The number of hospitalizations with COPD and RSV infection increased during the study period. The proportion of RSV infection among patients admitted for COPD increased significantly over time, from 0.32% in 2018 to 0.65% in 2022, p < 0.001. In-hospital mortality (IHM) increased over time, but the differences were not significant (6.23% in 2018 vs. 6.79% in 2022). Patients with COPD and RSV infection had, compared with those without RSV infection, a higher use of mechanical ventilation, both invasive (3.44% vs. 1.34%, p < 0.001) and noninvasive (8.09% vs. 4.51%, p < 0.001) and a higher proportion of intensive care unit (ICU) admission (7.21% vs. 3.9%, p < 0.001). After multivariate adjustment, a significant increase in IHM was found from 2018 to 2022 in subjects with and without RSV infection. The presence of RSV infection was associated with a higher mortality (OR 1.22; 95% CI 1.01-1.46). The proportion of RSV infection among patients admitted for COPD increased significantly over time. Patients with COPD and RSV infection had, compared with those without RSV infection, a higher severity, a higher use of mechanical ventilation, and a higher proportion of ICU admission. The presence of RSV infection was associated with IHM. These results can help to identify patients at higher risk and make decisions to avoid the increased risk of hospitalization and mortality in this population.

Will controlled monitoring of biochemical profile help in better prognosis of diabetic foot ulcer?

Diabetes Mellitus affects more than 400 million people worldwide and that number is growing rapidly. India is the country with largest number of diabetic patients in the world. Diabetic foot ulcer is one of the common causes of hospital admissions among diabetics in India.This study was aimed at creating a database on biochemical profile of diabetic foot ulcer patients and to see if they can be used to detect and prevent progressing complications and also to monitor treatment progress. A cross sectional study was conducted amongst 50 diabetic foot ulcer patients, biochemical parameters such as HbA1c, S. urea, S. creatinine, S. electrolytes, S. protein, S. albumin, S. SGPT, S. acetone, S. cholesterol, S. triglycerides and S. HDL were estimated from the time of hospital admission and in successive follow up. The population study group age was between 40 to 65 years with 60 percent being males. Among 50 patients there was a relative and gradual increase in values of HbA1c, Creatinine, Cholesterol and Triglycerides. whereas there is a decrease in values observed in parameters like Protein, Albumin and Sodium. Novel diagnostics are able to rapidly detect some of the most dangerous consequences of diabetic foot ulcer and can help to guide therapy. Therefore, preventive and evidence -based guidelines should be followed for diabetic wound management. Diabetic foot ulceration is a major health problem along with wound healing. Its management must also focus on identifying and correction of these biochemical changes and other contributing factors.

Factors Affecting Influenza and Pneumococcal Vaccination Rates in Hemodialysis Patients: A Multicenter Study.

In patients with end-stage renal disease (ESRD), infections, particularly pneumonias, are the most common cause of hospital admissions and death after cardiovascular diseases. It is recommended that dialysis patients receive the pneumococcal vaccine every five years and the influenza vaccine annually. Our study aims to determine the awareness and factors affecting influenza and pneumococcal vaccination rates in hemodialysis patients. This cross-sectional study was conducted on patients undergoing regular hemodialysis treatment in 10 different hemodialysis centers across 4 cities. After excluding patients with less than one year of hemodialysis duration and those under 18 years of age, 548 patients were included in the study. Patients were administered a 20-item survey via face-to-face interview and electronic medical records. Out of the 548 patients, only 19 (3.5%) had knowledge about the pneumococcal vaccine, while 238 (43.4%) had knowledge about the influenza vaccine. There were 220 patients (20.1%) who had knowledge about both vaccines. Among the patients, 95 (17.3%) had received the pneumococcal vaccine, with 41.1% of them having received it five years ago or more. A significant proportion (33.7%) of the patients could not recall the timing of their vaccination. While 183 (33.4%) patients had not received the influenza vaccine, only 140 (25.5%) had been vaccinated regularly every year. The reasons for not receiving the influenza and pneumococcal vaccines were stated as "I do not feel the need because I do not get the flu"(25%) and"I do not know about the pneumonia vaccine" (36.7%), respectively. The ROC curve analysis for the influenza questionnaire score showed an AUC of 0.822 (95% CI 0.787-0.856), with a p-value of <0.001. The statistically significant cutoff value for predicting influenza vaccination was determined to be 2.5. In the univariate analysis, dialysis duration (HD duration), diabetes mellitus (DM), and vascular access type were found to be statistically significant. In the multivariate logistic regression analysis, dialysis duration and DM were identified as independent factors predicting a higher level of knowledge about the influenza vaccine (p=0.009, 0.003, and p=0.041). The ROC curve analysis for the pneumococcal questionnaire score showed an AUC of 0.920 (95% CI 0.886-0.955), with a p-value of <0.001. The statistically significant cutoff value for predicting pneumococcal vaccination was determined to be 3.5. In the univariate analysis, residence, dialysis duration, and education level were found to be statistically significant. In the multivariate logistic regression analysis, dialysis duration and education level were identified as independent factors predicting a higher level of knowledge about the pneumococcal vaccine (p=0.038, 0.040, and p=0.010). It was observed that awareness and vaccination rates regarding influenza and pneumococcal vaccines were lower in our patients than recommended. We believe that educating patients about vaccines and increasing the sensitivity of hemodialysis physicians, nurses and nephrologists on this issue will increase vaccination rates.

Racial and Ethnic Disparities in the Outcomes and Treatment of Patients Admitted with Heart Failure: A Nationwide Analysis

Background/Objectives: Heart failure is the leading cause of hospital admission and mortality. Racial disparities have been demonstrated in various cardiovascular disorders; however, the data for in-hospital outcomes, complications, and procedural rates are limited. Methods: Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Coding for race and ethnicity in the NIS combines self-reported race and ethnicity provided by the data source into 1 data element (“RACE”). We compared the outcomes between various racial groups, focusing on mortality, the length of stay (LOS), hospital charges, and complications. Differences in the utilization of advanced therapies, including implantable cardiac defibrillators, cardiac resynchronization therapy (CRT), ventricular assist devices (VADs), and heart transplant, were also analyzed. Results: Out of 1,107,860 patients hospitalized with heart failure, 715,345 (64.57%) patients were White, 244,394 (22.06%) patients were Black, and 97,063 (8.31%) patients were Hispanic. Compared to White people, the odds of in-hospital mortality were lower among Black (aOR 0.74; 95% CI 0.68–0.81; p &lt; 0.001) and Hispanic (aOR 0.78; 95% CI 0.69–0.88; p &lt; 0.001) people. Complication rates including cardiogenic shock were found to be significantly lower in Black people (aOR 0.86; 95% CI 0.77–0.96; p &lt; 0.001) and in Hispanic (aOR 0.72; 95% CI 0.63–0.81; p &lt; 0.001) people. The rates of acute respiratory failure were also lower in Black (aOR 0.72; 95% CI 0.69–0.74; p &lt; 0.001) and Hispanic (aOR 0.77; 95% CI 0.73–0.81; p &lt; 0.001) people as opposed to White people. However, Black people were found to have higher rates of acute kidney injury (aOR 1.11; 95% CI 1.07–1.14; p &lt; 0.001) and cardiac arrest (aOR 1.17; 95% CI 1.03–1.34; p = 0.02) compared to White people. Black people were less likely to receive advanced interventions, including cardiac resynchronization therapy (aOR 0.71; 95% CI 0.60–0.83; p &lt; 0001), a ventricular assist device (aOR 0.45; 95% CI 0.34–0.59; p &lt; 0.001), and heart transplants (aOR 0.57; 95% CI 0.42–0.77; p &lt; 0.001), than White people. Hispanic people were found to have lower rates of ventricular assist device (aOR 0.49; 95% CI 0.33–0.72; p &lt; 0.001) use than White people. Conclusions: These findings highlight significant racial disparities in mortality, secondary outcomes, and advanced therapy utilization in heart failure admissions. Further research is needed to identify the root factors for these disparities in order to guide targeted interventions to reduce this racial gap.

Prescription patterns and drug utilization in respiratory tract infections: implications for antimicrobial stewardship at a tertiary care teaching hospital.

Respiratory tract infections (RTIs) are common causes of hospital admissions and are often treated with multiple medications, including antibiotics, contributing to antimicrobial resistance. Effective drug utilization evaluation (DUE) is essential for ensuring rational drug use in RTI management. This study aimed to assess prescription patterns and drug utilization in RTI patients at a tertiary care hospital, focusing on the rationality of drug use, polypharmacy, adherence to clinical guidelines, and implications for antimicrobial stewardship. A cross-sectional study was conducted at Vivekananda General Hospital, Hubballi, India, from August 2023 to January 2024. Data from 200 RTI inpatients, including demographics, medication types, administration routes, and prescription patterns, were analyzed. Descriptive and inferential statistics were used to evaluate adherence to guidelines and rational drug use. DUE revealed that 50.99% of patients were not prescribed cough syrup. Oral (52%) and intravenous (48%) routes were the most common. Budesonide was the most frequently prescribed bronchodilator (26.49%), and 72.45% of patients received oxygen. Ceftriaxone (12.68%) and azithromycin (11.88%) were the most commonly prescribed antibiotics. A high prevalence of polypharmacy was identified, with 39.50% of patients receiving more than three antibiotics, raising concerns about drug interactions and rationality. The study underscores the need for stricter adherence to clinical guidelines and targeted antimicrobial stewardship in RTI management. Enhanced DUE practices could improve patient outcomes and promote rational drug use.

Epidemiological characteristics of eleven common respiratory viral infections in children

BackgroundLower respiratory tract infections (LRTIs) are one of the leading causes of hospital admissions among children. In this study, we aimed to describe the epidemiological characteristics of viral pathogens associated with LRTIs in hospitalized children in Yan’an; this has yet to be reported in the literature and may guide public health interventions and resource allocation in this region.MethodsBetween June 2021 and May 2023, we conducted a retrospective analysis of the results of viral detection using oral pharyngeal swabs from 4565 children with LRTIs in the Inpatient Department of Yan’an University Affiliated Hospital. Eleven respiratory viruses, including influenza A virus (Flu A), influenza A H1N1 virus (H1N1), seasonal influenza A H3N2 virus (H3N2), influenza B virus (Flu B), parainfluenza virus (HPIV), adenovirus (HADV), bocavirus (HBoV), rhinovirus (HRV), metapneumovirus (HNPV), coronavirus (HCoV), and respiratory syncytial virus (HRSV), were confirmed by applying a multiplex real-time polymerase chain reaction (PCR) kit for respiratory viruses. We evaluated the epidemiological features of infections caused by respiratory pathogens, including aging, gender and the seasonal variations of different pathogens, and explored the high-risk factors associated with virus-caused pneumonia.ResultsAt least one virus was detected in all 4565 cases; the positivity rate was 27.95%. We also detected a total of 1,276 cases with mixed infections (with two or more viruses). Of the positive cases, 59.3% were male and 40.7% were female (x2 = 0.41, P = 0.68). The highest positivity rates for respiratory pathogens were observed for HRSV, HRV, and HADV, at 5.98%, 5.67%, and 4.38%, respectively. We also observed variations in the number and positivity rates of respiratory pathogen infections by season, age and gender. HPIV (x2 = 12.05, P < 0.05) and HADV (x2 = 11.73, P < 0.05) were more common in children under three years-of-age. Notably, with the exception of the 1 to < 3 years age group, males consistently demonstrated elevated infection rates across other age groups.ConclusionsOur analysis revealed that respiratory pathogen infections varied by gender, season, and age in the enrolled population of children.

Admissions Within the First Year After Kidney Transplantation: Evaluation of Risk Factors, Causes, and Outcomes

Objectives: The aim of this study was to evaluate causes of hospital admission within the 1st year after kidney transplantation in a public hospital. Methods: This is a retrospective cohort. Data were collected by medical record review. Inclusion criteria were age older than 18 years and kidney transplant. Exclusion criteria were double transplant, primary graft failure, and in-hospital death after transplant procedure. Outcomes included 4-year patient survival (primary outcome), 1-year graft failure, and graft function in 1 year. Results: A total of 130 patients were evaluated. There was a predominance of male sex, glomerulonephritis, history of hemodialysis, first kidney transplant, and deceased donor kidneys. Hospital admission in the 1st year occurred in 71.5%. There were three deaths at the first admission (two had cardiovascular causes). The most frequent causes of admission were infections, rejection, and surgical complications. Less common causes included elective procedures such as peritoneal dialysis catheter removal. There was no statistically significant association between categorical and continuous variables studied and the occurrence of hospital admission. Also, hospital admission did not influence primary outcome or 1-year graft failure rate. However, it was associated with lower graft function at 1 year (both by serum creatinine and by estimated glomerular filtration rate – p &lt; 0.05). Conclusion: There was a high incidence of hospital admission, and first admissions resulted in death in three patients (noninfectious causes). Considering the contribution of elective procedures to the high incidence of admission, we propose that hospital managers focus on improving the ability to solve such problems in the outpatient setting.

Examine the Neuro Nurse's Understanding of Stroke Warning Signs and Risk Factors in a Chosen Hospital

The study titled "A Study to Assess Neuro Nurses’ Knowledge about Risk Factors and Warning Signs of Stroke in Selected Hospitals of Bengaluru" was conducted with the primary objective of assessing the knowledge level of neuro nurses regarding stroke risk factors and warning signs. Stroke is a significant cause of hospital admissions globally, and the need for early identification of risk factors and symptoms is crucial for timely intervention. Objectives: The study aimed to assess the neuro nurses' knowledge of stroke risk factors, warning signs, and the relationship between knowledge and selected demographic variables. Methodology: A descriptive survey was conducted among 50 neuro nurses working in the Neuro Medical and Surgical wards and ICUs of People Tree Hospital, Bengaluru, using a standardized questionnaire. The sample was selected through convenient sampling, and the data collection spanned from August to November 2022. The Stanford Stroke Center Questionnaire was employed to assess knowledge. The study included both male and female staff nurses with varying educational qualifications and experience. Results: The findings indicated that nurses had more knowledge about the warning signs of stroke (90.4%) than risk factors (78.4%). There was no significant correlation between nurses' knowledge and their demographic variables, including age, gender, and professional qualifications. The study concluded that while neuro nurses possessed above-average knowledge, there is still a need for regular in-service training to enhance their understanding of stroke risk factors and improve patient care outcomes.

HPB SO71 - Meta-Anaylsis of Early Endoscopic Retrograde Cholangiopancreatography versus conservative management for gallstone pancreatitis

Abstract Background Acute pancreatitis is one of the most common gastrointestinal causes of hospital admission. The most common cause is transient blockage of the bile or pancreatic duct (or both) by gallstones. Most of the time, pancreatitis responds to conservative management (CM) comprising intravenous fluid hydration and analgesia. ERCP +/_endoscopic sphincterotomy in acute gallstone pancreatitis has been advocated in the past to decrease the number of complications of this condition. However, the role and timing of this procedure are still contentious and an ongoing debate. Method The aim of this study is to compare the clinical outcomes of early urgent ERCP versus conservative management in biliary pancreatitis but not cholangitis. An online search of Medline, Embase, Science citation index, PubMed and Cochrane database of systematic reviews published between 1988 and 2022 was carried out for relevant studies. Statistical analysis was done using Revman 5.4 and Odds ratio with a 95% Confidence interval was used for outcome estimation. There was 14 studies included in the final study consisting a total of 1756 patients with 877 patients in ERCP group while 879 in CM group. Results With random effects model, data showed no significant reduction in mortality in ERCP group as compared to the CM group (OR 0.59, 95% CI 0.30-1.16; p=0.13). However there were overall more local or systemic complications (OR 0.51, 95% CI 0.36-0.71; p&amp;lt;0.002) in the CM group as compared to ERCP group. No statistically significant difference found amongst groups when comparing complications as renal failure(OR-0.99, 95% CI-0.41-2.41, p=0.98), cardiac failure (OR-0.77 95% CI 0.35-1.69, p=0.51) or biliary sepsis (OR-0.56 95%CI 0.15-2.10, p=0.39) but there was more incidence of pseudocyst in CM group patients(OR-0.47, 95% CI 0.25-0.87, p=0.02). Conclusion The above study did show that the mortality rate was not significantly higher in the CM group as compared to the ERCP group however the early ERCP was beneficial in reducing overall complications in the interventional group. Based on this fact, ERCP considered early in the management of acute pancreatitis despite of still being debatable in practice can be considered in severe pancreatitis cases and further high powered randomized controlled trials can be carried out to assess this point.

Abstract 4122677: Reduced Costs and Readmissions With Outpatient Versus Inpatient Diuresis in Heart Failure Patients at UNC Hospital

Background: Heart failure (HF) remains a leading cause of hospital admissions, with high morbidity, mortality, and projected healthcare costs of $70 billion by 2030. Effective management of the patient’s volume status is crucial in managing symptom burden, preventing rehospitalization, and thus reducing healthcare expenses. In 2017, UNC Hospital opened an ambulatory diuresis clinic to address this issue. Aim: This retrospective cohort study evaluates the cost and rehospitalization rates of HF patients treated in the ambulatory diuresis clinic versus those receiving inpatient diuresis at the hospital. Methods: We retrospectively analyzed 2,950 unique HF patients from August 2017 to September 2023, treated with IV diuresis at UNC Hospital or its outpatient clinic. Patients were classified into a clinic cohort, who visited the diuresis clinic at least once, and a non-clinic cohort, who never visited and were defined by a primary HF diagnosis with an ED/observation visit or inpatient stay ≤ two days. The primary outcome measured was average readmissions per cohort; the secondary outcome included total charges from billing records. Rehospitalization and mortality rates were tracked via EHR. Statistical analyses, including descriptive and inferential statistics, were conducted to compare costs and outcomes between the two groups. Results: This study compared 996 patients in the clinic group with 1,954 in the non-clinic group, noting similar baseline characteristics of average ages of 66.80 and 67.24 years, BMIs of 33.95 and 33.73 kg/m^2, and one-year all-cause mortality rates of 21.18% and 22.77%, respectively. Average admissions per cohort were higher for the clinic group one year prior to the index visit—0.159 vs. 0.127—but decreased post-index visit: by six months, admissions were 0.094 for the clinic and 0.161 for the non-clinic; at one year, they were 0.133 and 0.210, respectively. Financially, the clinic group incurred $7,895 less in charges during the index visit and had lower total costs one-year post-index, at $17,785 compared to $23,982 for the non-clinic group. Conclusions: The study demonstrates that outpatient diuresis at UNC Hospital is more cost-effective than inpatient diuresis for HF patients and reduces rehospitalization rates at six months and one-year post-index visit. These results suggest that outpatient diuresis is cost-effective, may enhance patient outcomes, and could alleviate the strain on healthcare resources.

Abstract 4140198: Impact of Non-ST-segment elevation Myocardial Infarction on outcomes of Diabetic Ketoacidosis in Hospitalized Patients: A National Inpatient Sample Analysis

Introduction: Diabetes Mellitus (DM) has a broad spectrum of complications and is one of the leading 5 causes of hospital admissions in the US. Decompensated DM is associated with high mortality in hospitalized patients. Cardiac ischemia and related events are proposed to be increasingly prevalent in hospitalized patients with decompensated diabetes. Numerous studies and reports have suggested that elevation in troponin levels is associated with high mortality in such patients. Notably, there have only been a few studies that assessed the prevalence of NSTEMI (Non-ST segment elevation myocardial infarction) and its effect on outcomes in patients hospitalized with Diabetes ketoacidosis (DKA). Methods: We aimed to compare the outcomes of DKA in hospitalized adults (age &gt;18 years) with NSTMI with those without NSTEMI using the National Inpatient Sample (NIS) database from 2018 to 2020. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays. Results: There were a total of 1113295 hospitalizations identified with a diagnosis of DKA. Of these, 9860 (0.88%) patients had NSTEMI. The mean age of this subpopulation was 38.71 years. Among these patients, 48.59% were female, and 58.40% were male. We attempted to assess the impact of NSTEMI on the occurrence of complications such as cardiac arrest, acute renal failure (ARF), Acute liver failure (ALF), Acute heart failure (Acute HF), and acute respiratory failure in patients admitted with DKA. The results of this analysis are depicted in the table below. The cost of hospitalization for DKA with NSTEMI was $35878 higher and the length of stay was 50% longer compared to the patients with DKA without NSTEMI. The Odds ratio for mortality was 2.84 for patients with NSTEMI. Conclusions: Our analysis suggests that the occurrence of NSTEMI negatively impacts outcomes in DKA patients. The occurrence of primary outcomes assessed in this study (Cardiac arrest, ARF, ALF, Acute HF, and Acute respiratory failure) was significantly higher in DKA patients with concomitant diagnosis of NSTEMI. NSTEMI also increased the cost burden on hospitalizations for DKA.

Correlation Between Feeding Pattern and Duration of Hospital Stay in Pneumonia of Infants Below 6 Months of Age

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Pneumonia is the most common respiratory disorder among infants and one of the leading causes of hospital admission. Various feeding patterns have multiple impacts on pneumonia and recovery from it. Breast milk provides some protective properties against respiratory tract and gastrointestinal illness to protect infants during the first year of life. This study aimed to find an association between feeding patterns and duration of hospital stay due to pneumonia in infants below 6 months of age. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: This cross-sectional study was conducted in the Department of Paediatrics, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from February, 2019 to August, 2020. In our study, 200 infants below 6 months of age admitted with pneumonia in the Department of Paediatrics in Shaheed Suhrawardy Medical College Hospital, Dhaka were enrolled according to selection criteria. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: Maximum incidence was seen in the 3 to 4 months of age, e.g.40.0% &amp; 36.30% in girls and boys respectively, mean age of the pneumonia patient was 2.9±1.5 months. Out of 200 cases, 55.0% cases were male and 45.0% were female. Among all infants 93.75% of exclusively breastfed infants needed ≤10 days, and 27.88% of non-exclusive breastfed infants needed&amp;gt;10 days in the hospital for recovery from pneumonia. In both cases, the p-value was 0.001. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Exclusive breastfed infants have shorter and non-exclusive breastfed infants have longer hospital stays due to pneumonia below 6 months of age.

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary

BackgroundSevere acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.MethodsWe collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.ResultsOur results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4–7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43–7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14–6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29–8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35–4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.ConclusionsOur research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.

Sarcopenia is associated with new-onset acute biliary infection within 1 year in patients with hepatitis B virus-related decompensated cirrhosis.

Malnutrition and sarcopenia are prevalent complications in cirrhosis. The relationship between sarcopenia and biliary infection in cirrhotic patients is not well understood. Our study aims to clarify this association. In this study, we leveraged data from a tertiary care hospital, enrolling patients with hepatitis B virus (HBV)-induced cirrhosis from 2022. An acute biliary tract infection was defined as the onset of acute cholecystitis or cholangitis within a year. Sarcopenia was identified based on established criteria and assessed using the L3 skeletal muscle index (SMI). A multivariate logistic regression model was constructed to analyze the relationship between sarcopenia and acute biliary tract infection. Receiver operating characteristic (ROC) curve analysis and smooth curve fitting were also conducted. This study enrolled a total of 262 patients with HBV-related cirrhosis, with an average age of 60 years and including 173 males. The primary causes for hospital admission were ascites and hepatic encephalopathy. Within the group with biliary infection, patients typically presented with higher white blood cell counts, lower platelet levels, and poorer indicators of liver and kidney function. In the multivariate analysis, after adjusting for various confounding factors, sarcopenia was associated with an odds ratio of 1.55 ( P = 0.002) for acute biliary infection. Smooth curve fitting revealed an approximately linear positive relationship between L3 SMI and acute biliary infection, with the area under the ROC curve for L3 SMI reaching 0.89, indicating a strong predictive value. Sarcopenia is associated with acute biliary infection in patients with HBV-related cirrhosis.

The Treatment Outcomes of Tuberculosis Patients at Adare General Hospital, Southern Ethiopia (A Five-Year Retrospective Study).

Ethiopia is among the countries most heavily affected by tuberculosis, where it is the leading cause of morbidity, the third cause of hospital admission and the second cause of death. To improve tuberculosis management and control, the early detection of cases, effective treatment and the persistent evaluation of treatment outcomes are vital issues that should be taken into consideration. This study was designed to determine the treatment outcomes and associated risk factors among TB patients registered at Adare General Hospital in Southern Ethiopia. A five-year retrospective study was conducted by reviewing the files of the TB patients registered from September 2013 to August 2017. The data were coded, cleaned, entered and analyzed using SPSS version 20 statistical software. Bivariate and multivariable logistic regression with odds ratios (OR) along with a 95% confidence interval was computed and interpreted. A p-value < 0.05 was declared as statistically significant. Among the 1122 cases, 620 (55.3%) were male, 748 (66.7%) were from urban areas, 319 (28.4%) were smear positive, 352 (31.4%) were smear negative and 451 (40.2%) were extra-pulmonary patients. Among the treated patients, 284 were declared cured, 753 completed their treatment, 29 were defaulters, 3 failed to follow up, and 53 died. The overall treatment success rate was 92.4%. The TB patients from urban areas (AOR = 1.44, 95% CI: 0.28, 0.67), and the HIV-negative TB patients (AOR = 5.48, 95% CI; 3.474, 8.64) were significantly associated with successful treatment outcomes. The treatment success rates of tuberculosis at Adare General Hospital were comparable to the national health facility-level coverage, but they should be maintained and strengthened further to attain tuberculosis-related national and millennium goals.

Administrative data for public health: a regional data warehouse applied to dementia epidemiology

Abstract Administrative data can represent valuable sources of information for researchers seeking to advise policymakers. Several countries have established population-based data warehouses (DWH), integrating multiple data sources in single repositories through data linkage techniques. In Lombardy (Italy), a regional population-based DWH was established in the 1980s. It collects data about citizens from multiple sources in the social and health sectors, anonymising them immediately after their acquisition. Lombardy Region signed a specific agreement with the University of Pavia to investigate the epidemiology and access to care among people living with dementia (PLWD), using the DWH. A retrospective cohort study was conducted on hospitalised PLWD, including people aged ≥ 65 years with diagnoses of dementia at discharge from 2002 to 2020. The aim was to study the trends of hospitalisations among PLWD, computing these by calendar year, age, sex and cause of hospitalisation. A total of 340,144 hospital discharges were registered, of which 211,709 (63.0%) were women and 124,195 (37.0%) were men. The rate of hospitalisation decreased over the study period, ranging from 100.6/10,000 in 2002 to 65.1/10,000 in 2020. The average age at hospitalisation increased for men and women from 78.9 and 81.8 years in 2002 to 82.0 years and 84.2 years, respectively, in 2020. Respiratory diseases caused 10.4% of all hospitalisations in 2002 and grew steadily to 26.8% in 2020, becoming the leading cause of hospital admissions since 2017. Results allowed us to elaborate epidemiological measures and to characterise our population in a wide temporal trend, quantifying access to acute care by leading causes of hospitalisation. However, the analysis of administrative data comes along with several challenges, such as data incompleteness and biases. Researchers should take advantage of these data sources while keeping in mind the limitations and constraints related to data quality.