Common Cause Of Admission Research Articles

Impact of COVID-19 on Hospital Admissions for Children With Developmental Disadvantages: A Western Sydney Metropolitan Hospital Experience on Health Inequity.

To investigate the impact of Sydney's COVID-19 lockdown on children with developmental disadvantages and reflect on current clinical practice. Retrospective data was collected from a western Sydney metropolitan hospital's electronic database and patients. We reviewed all children with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP) or Intellectual Disability (ID) admitted 36 months prior to and after lockdown policy being implemented. The prevalence of hospital presentation was reduced during the lockdown period. The average length of stay (LoS) increased by approximately 1.5 folds. Comparatively, the average LoS of the general paediatric population increased minimally. Seizures, asthma, and upper respiratory tract infections were the three commonest issues for hospital admissions in both periods. COVID-19 infection accounted for 4% of admissions in the lockdown period. Around 20.8% of patients with disadvantages were admitted with more than two major issues. None of these patients had concurrent COVID-19 infection. Children with developmental disabilities experience greater disadvantages during lockdown. The likely reasons include inequity caused by increased barriers to healthcare service. The indirect benefit of reducing infection transmission during lockdown was not reflected in our patient group, contributing to the disease burden. Chronic diseases remain the most common causes of admissions in all periods, suggesting the essentiality of improving chronic disease management in future clinical practice.

P-1122. Impact of an Antimicrobial and Diagnostic Stewardship Program in Children with Lower Respiratory Tract Infection admitted to Intensive Care Unit in Argentina

Abstract Background Lower respiratory tract infection (LRTI) is a common cause of admission and antibiotic (ATB) overuse in children. Adequate use of diagnostic methods and ATB prescription in intensive care units (ICU) remain a challenge for antimicrobial stewardship programs. Aims to evaluate the impact of a multilevel intervention to improve diagnostic testing and ATB use in children with LRTI admitted to ICU. Methods Quasi-experimental, before-after study. Patients admitted to ICU from April to June 2023 (Pre Intervention period: PreI) and July to October 2023 (Post Intervention: PostI) with community acquired LRTI were included. Intervention consisted in educational activities, daily review and feedback of ATB prescription, development and dissemination of an institutional Guideline of ATB use in LTRI, including a Clinical Score to distinguish viral from bacterial pneumonia. Results 95 patients were included. Median age was 11 months (IQR 4-19).Fifty eight (61%) had any underlying condition, including: previous bronchiolitis N:16 (17%), Asthma N:8(8%) and Neurological Disorders N:7 (7%). Clinical diagnosis upon ICU admission was: bronchiolitis (N:42, 44%), asthmatic crisis (N: 33, 35%) and Pneumonia (N: 11, 12%). A viral etiology was documented in 76 patients (80%). The most common was RSV (N: 52, 55%) followed by Rhinovirus (N: 19, 20%). Viral coinfection was detected in 15 patients (16%). Sixty-three patients were admitted during PreI and 32 during PostI. Children admitted to ICU during PreI were more frequently healthy (PreI: 48% vs PostIn 22%, p 0.015), with bronchiolitis as admission diagnosis (PreI 56% vs PostI 23%, p 0.002) and confirmed respiratory infection (PreI 87% vs PostI 66%, p 0.01). In PreI more Blood cultures (PreI 61% vs PostI 51%, p 0.06) and tracheal aspirate cultures (PreI 48% vs PostI 22%, p 0.04) were performed. Empirical ATB were started on admission in 39 patients (62%) during PreI, and in 13 patients (41%) in PostI (p: 0.04). Adequate ATB prescription increased from 14% in the PreI to 37% in the PostI (p 0.01). Patients in PostI had shorter hospital length of stay (8 vs 14 days, p 0.02) Conclusion A multilevel intervention in children with LRTI on admission to ICU improved the use of blood and tracheal aspirate cultures and ATB prescription. Length of stay decreased in PostI. Disclosures All Authors: No reported disclosures

Morbidity and mortality pattern of neonates admitted into a newly established special care baby unit at Asaba specialist hospital, Asaba, Nigeria

Background: Neonatal morbidity and mortality has remained high in Nigerian and other low and middle-income countries (LMIC) despite numerous advances in newborn care. A periodic review of the common causes of morbidity and mortality will aid in evaluating the practices and improving service delivery. aimed at reducing neonatal morbidity and mortality pattern of neonates admitted into the special care baby unit (SCBU) of Asaba specialist hospital, Delta state, Nigeria. Methods: This was a 3-year retrospective study, carried out at the SCBU of Asaba specialist Hospital, Asaba, between January 2021 and December 2023. Factors including age, sex, weight, diagnosis and outcome were studied. Results: A total of 1,604 neonates were admitted and managed in the SCBU during the period under review with a female to male ratio of 1.3:1. The commonest cause of admission was perinatal asphyxia (23.0%), prematurity (21.4%) and neonatal sepsis (18.5%). The mortality rate was 13.2% were the commonest causes of death been prematurity (26.2%), perinatal asphyxia (17.8%) and neonatal sepsis (7.8%). Discharge against medical advice (DAMA) rate of is 6.7%. Conclusions: The study showed that prematurity, perinatal asphyxia and neonatal sepsis remain the commonest cause of admissions and death in our SCBU.

Characteristics of Unplanned Hospital Admissions Among Patients With Cancer Treated at a Comprehensive Cancer Center in Jordan.

This study describes the characteristics of unplanned hospital admissions of patients with cancer. This prospective study was conducted at King Hussein Cancer Center in Amman, Jordan, from March 2023 to August 2023. The study included adult cancer patients who had unplanned hospital admissions, defined as any admission through the emergency department. The follow-up period concluded upon patient discharge, transfer to palliative service, or death. Patients' medical charts were reviewed to collect baseline characteristics and data related to the admission, including the cause of admission, length of stay (LOS), and hospitalization outcomes. During the study period, a total of 2435 admissions were included. The mean age of the admitted patients was 56.9 years ± 14.7 SD, with 49.8% (n = 1212) being male. The most common cancer types were gastrointestinal, hematological, and breast cancers, accounting for 20.9% (n = 508), 20.5% (n = 499), and 20.0% (n = 488) of the admissions, respectively. Among the included admissions, 84.4% were directed to the Medical Oncology service. The most common causes of admission were infection (31.5%), followed by complications from cancer treatment (10.4%). Among the included patients, 87% (n = 2118) were discharged home after a median LOS of five days (range 1-66), 3.3% (n = 81) were transferred to palliative care, and 9.7% (n = 235) died. Infection was associated with the longest LOS compared to other causes of admission. Among the unplanned hospital admissions of cancer patients, infections and complications from cancer treatment were the most common causes. Further studies are warranted to assess the preventability of these admissions.

Outcome Assessment of Perinatal Asphyxia in Neonates: Study in a district hospitalMd

Perinatal asphyxia (also known as neonatal asphyxia or Perinatal Asphyxia in children) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the delivery process to cause physical harm, usually to the brain. Perinatal Asphyxia in children is defined by the World Health Organization (WHO) "the failure to initiate and sustain breathing at birth". There were 102 live births asphyxia neonates whose were clinically diagnosed and admitted in several private clinics in Jamalpur, Bangladesh during January 2017 to December 2017 were selected as study subjects. The aim of this study was to assess the outcome of perinatal asphyxia in neonates. Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications. The NICU records provided additional information about new born infant.The outcome of treatment in babies with Perinatal Asphyxia in children showing in (Table 3) Recovery rate in group one (HIE I) was 14(13.78%) , in group two (HIE II) was 75(73.52) and in group three (HIE III) was 05(4.9%) and Death ratio was in group one (HIE I)was 1(0.98%) , in group two (HIE II) was 2(1.96%) and in group three (HIE III) was 05(4.90%). The morbidity and mortality in cases of Perinatal Asphyxia in children the highest causes of death in stage 3(HIE III). Preterm with Hyaline membrane disease was 4(3.92%) and then the higher causes of death in stage II was Neonatal sepsis 3(2.94%). Perinatal Asphyxia in children was one of the commonest causes of admission and mortality in NICU and others beds. Babies with HIE Stage III had a very poor prognosis. Perinatal Asphyxia in children combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of Perinatal Asphyxia in children. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergencycaesarean section, preterm and in addition male sex were the risk factors for Perinatal Asphyxia in neonates.

Spectrum of Disease and Outcome in Neonates admitted in NICU in Federal Government Polyclinic (FGPC), Islamabad According to ICD-11

Objective: To determine the spectrum of diseases and outcome of neonates admitted in NICU of Federal Government Polyclinic (PGMI), according to ICD-11. Methodology: This cross-sectional retrospective study was conducted in neonatal intensive care unit of Federal Government Polyclinic (FGPC), Islamabad for a period of 12 months from 1st January 2022 to 31st December 2022 and included 894 neonates inborn and outpatient admitted in the study period. Demographic and clinical data about neonates (age, gender, weight, disease and outcome) was collected from hospital records and was analyzed by SPSS version 23 and tabulated according to the international classification of diseases 11(ICD-11) of WHO. Results: During the study period 894 neonates were admitted.795(88.9%) were discharged, 83(9.3%) neonates expired.538(60.2%) were males and 354(39.6%) were females. The common causes of admission in NICU were disorders related to length of gestation or fetal growth263(29.4%), respiratory disorders 243(27.2%), infections of newborn231(25.8%) and hemorrhagic or hematological disorders 59(6.65). The common causes of mortality in NICU were disorders related to length of gestation or fetal growth48(5.4%), respiratory disorders 16(1.8%), infections of newborn 11(1.2%) and developmental anomalies5(0.6%). Conclusion: Disorders related to length of gestation or fetal growth, respiratory disorders and infections of new born are the common causes of admission and mortality in the NICU. The morbidity and mortality data should be presented by International classification of diseases so that there is a uniform language internationally, helping in identifying and analyzing health trends and in turn reducing morbidity and mortality of neonates.

Streamlining the Non-operative Management of Adhesive Small Bowel Obstruction: A Closed-Loop Audit Evaluating the Introduction of a Standardised Gastrografin Protocol in a District General Hospital.

Introduction Adhesive small bowel obstruction (ASBO) is a common cause of admissions to general surgery services. Water-soluble contrast (WSC), such as Gastrografin® (GGF), can be utilised in the conservative management of patients with ASBO, with predictive and possible therapeutic value. We audited the non-operative management of ASBO in the general surgery department of East and North Hertfordshire NHS Trust, a district general hospital. Following the introduction of a hospital-wide protocol standardising the use of GGF in patients with ASBO, a re-audit was conducted to assess its impact. Methods A retrospective audit of ASBO patients who received GGF was conducted in two cycles: before and after the implementation of the protocol. Data were collected between February and June 2022 for group 1 (pre-protocol) and between August and November 2023 for group 2 (post-protocol). Results Forty-eight patients were included in the analysis across both groups: 31 in group 1 (pre-protocol) and 17 in group 2 (post-protocol). The success rate of this non-operative trial with GGF increased from 77%(24/31) in group 1 to 88% (15/17) in group 2. The median duration of conservative management was two days in both groups. The median time from CT scan to GGF administration decreased from 24 hours in group 1 to 19 hours 22 minutes in group 2, and the interval between GGF administration and first abdominal radiograph decreased from 9 hours in group 1 to 6 hours 25 minutes in group 2. Conclusion Our closed-loop audit suggests that by streamlining the non-operative management pathway of adhesive small bowel obstruction, our standardised protocol is safe and possibly improves efficiency within a district general hospital setting.

Systematic review and network meta-analysis of non-invasive respiratory support in paediatric patients with acute hypoxaemic respiratory failure: a protocol

IntroductionAcute hypoxic respiratory failure (AHRF) is one of the most common causes of admission to paediatric intensive care units (PICUs) around the world, posing a serious health concern for the...

Disease Burden and Outcome of Neonatal Admissions at the Tamale Teaching Hospital, Ghana: A Prospective Study

Objective: To determine the pattern of diseases and factors affecting the outcome of neonates admitted at the Tamale Teaching Hospital Neonatal Intensive Care Unit (TTH NICU) over three months. Methodology: A hospital-based prospective cohort design was used to collect data from participants. A sample size of 399 neonates (participants) admitted into the NICU from 1st March 2021 to 10th June 2021. Data was obtained using KoboCollect, exported into Excel for cleaning, coding and analysed using SPSS version 20. Results: This study screened a total of 450 neonates under 28 days admitted in the NICU of Tamale Teaching Hospital, Ghana, over three months. Fifty-one of them were rejected, and 399 were included in the final analysis. The mean birth weight was 2600 g (±810g), with 33.1% of the neonates having low birth weight. Three hundred and forty-one (341) (85.5%) neonates survived, while 58 (14.5%) died during hospitalisation. The pattern of diseases showed that neonatal sepsis (37.3%, n=149/399), small for gestational age or low birth weight (SGA/LBW) (33.1%, n=132/399), neonatal jaundice (28.1%, n=112/399), prematurity (23.6%, n=94/399), birth asphyxia (13.5%, n=54/399) and congenital anomalies (7.8%, n=31/399) were the most common causes of admissions. All variables which had an association with neonatal mortality (p <0.05) were entered into a binomial logistic model, prematurity (AOR=6.974, 95% CI: 1.766-27.537; p=0.006) was the main predictor of mortality. Conclusion: The common causes of admission and deaths in the TTH NICU during the study were neonatal sepsis, prematurity, birth asphyxia, LBW/SGA and neonatal jaundice. This highlights the need for interventions to address these conditions as we strive to reduce institutional neonatal mortality.

Evaluation of hospital quality of care outcomes in a teaching hospital in Ethiopia: a retrospective database study

ObjectivesWe aimed to evaluate hospital mortality rates, readmission rates and length of hospital stay (LOS) among adult medical patients admitted to a teaching hospital in Ethiopia.DesignWe performed a retrospective study...

Intercambio de plasma y enfermedades autoinmunes críticas

Introduction: Renal replacement therapy (RRT) has evolved significantly since its introduction; initially used to treat acute renal failure, it is applied in various clinical scenarios due to improved membranes and equipment. Other techniques have emerged, such as therapeutic apheresis and hemoadsorption, which allow specific components to be removed from the blood. These therapies have shown promise in the treatment of various diseases. Important points: Sepsis and septic shock are the most common causes of admission to intensive care units (ICU), and extracorporeal therapies (ECT) have shown promise in their management. Sepsis is characterized by a dysregulated inflammatory response, which can lead to multiorgan damage. ECT can help modulate this response, eliminating inflammatory mediators and restoring immune balance. Although clinical evidence is inconclusive for all indications, studies have shown improvements in clinical parameters, such as decreased need for vasopressors and improved oxygenation. The response to ECT may be variable between patients due to genetic, epigenetic, and sociodemographic factors. Conclusion: extracorporeal therapies are presented as a promising tool in the management of critically ill patients, and their use is expanding beyond sepsis. As more scientific evidence accumulates, it is expected that these techniques will become consolidated as part of the standard treatment in various pathologies.

Correlation of Clinical Assessment of Jaundice with Total Serum Bilirubin in Neonates: Hospital-Based Cross-Sectional Study

Introduction: Neonatal jaundice is a common cause of admission in the neonatal period. Early diagnosis and treatment of neonatal jaundice prevent the bilirubin encephalopathy. There are various methods for the estimation of neonatal jaundice. Clinical assessment of neonatal jaundice can aid in the diagnosis of neonatal jaundice in low-resource settings and refer to the higher center for those who require treatment. This study aims to understand the relation between clinical assessment of jaundice and total serum bilirubin in neonates and to know the risk factors of neonatal jaundice.  Methods: The Clinical assessment of jaundice by Kramers scale can be used to assess the level of jaundice and know the progression of jaundice.  Results: This shows a significant positive relation between clinical assessment of jaundice and serum bilirubin level.  Conclusions: The study findings showed that clinical assessment of jaundice was comparable with the serum bilirubin. Clinical assessment of jaundice by Kramer‟ 's scale can be used to assess the level of jaundice and know the progression of jaundice.

Clinical audit of cases and outcomes of patients admitted to the intensive care unit at Kamuzu Central Hospital, Lilongwe, Malawi

In 2016, a new, improved and modern intensive care unit was constructed at Kamuzu Central Hospital in Lilongwe, Malawi. Having been operational for about 4 years, there has not been a systematic audit to gauge its performance. Therefore, this quantitative retrospective cohort study aimed at investigating the performance of the intensive care unit at Kamuzu Central Hospital in Lilongwe, Malawi. We analysed the patterns of admission through 250 clinical cases and their respective outcomes spanning from 1st January 2019 to 31st December 2019 using STATA. Descriptive and inferential statistics were computed. We also had a follow-up discussion with the Head of the unit to better understand the unit’s functioning. Out of the 250 admissions, we evaluated 249 case files. About 30.8% of all patients were referred from the main operating theatre, and 20.7% from the casualty (emergency medicine). Head injury (26.7%) and peritonitis (15.7%) were the commonest causes of admission. The overall mortality was 52.2% with more females (57.5%) dying than males (47.9%). Head injury and peritonitis had the highest contribution to the mortality accounting for 25.3% and 16.9% of all deaths respectively. In conclusion, despite the new unit registering an improved performance compared to the old unit’s 2012 mortality of 60.9%, the current mortality rate of 52.2% generally reflects a suboptimal performance. The intensive care unit is still grappling with a number of challenges that need immediate attention including few working beds, shortage of critical care specialists and nursing staff and lack of standard admission criteria.

2236 Emergency department attendance stratified by cause and frailty status: a national cohort study of over 155 million patients

Abstract Introduction Data are limited on whether the causes of Emergency Department (ED) attendance and clinical outcomes vary by frailty status. Methods Using data from the Nationwide Emergency Department Sample, all ED attendances from 2016 to 2018 were stratified by the cause of attendance and Hospital Frailty Risk Score (HFRS) category. Logistic regression was used to determine adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) of ED and overall mortality. Results A total of 155,497,048 ED attendances were included, of which 125,809,960 (80.9%) had a low HFRS (<5), 27,205,257 (17.5%) had an intermediate HFRS (5–15) and 2,481,831 (1.6%) had a high HFRS (>15). The most common cause of ED attendance in the high HFRS group was infectious diseases (43.0%), followed by cardiovascular diseases (CVD) (24.0%) and respiratory diseases (10.2%). Musculoskeletal diseases were the most common cause of admission for the low HFRS group (21.2%), followed by respiratory diseases (20.6%), and gastrointestinal diseases (18.5%). On adjusted analysis, high HFRS patients had increased overall mortality (combined ED and in-hospital) across most attendance causes, compared to their low HFRS counterparts (p < 0.001). High HFRS patients with infectious diseases (aOR 23.88 95% CI 23.42–24.34), CVD (aOR 2.58 95% CI 2.55–2.61) and respiratory diseases (aOR 36.90 95% CI 36.18–37.62) had an increased risk of overall mortality, compared to their low-risk counterparts (p < 0.001). Conclusions A significant proportion of patients attending the ED are frail, with the cause of attendance varying by frailty status. Frailty is associated with increased overall mortality across most attendance causes.

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis.

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%-4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9-14)]; respiratory [9 (95% CI 5-13)]; and gastrointestinal [9 (95% CI 6-11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231-280)]; infectious [214 (95% CI 193-234)]; and gastrointestinal [166 (95% CI 143-190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Background: Driving pressure has been identified as a more accurate indicator of mortality risk than low tidal volume (VT) and pulmonary compliance (Ppl). It was also noted that when this pressure surpasses the 18 cm H2O mark, there is a significant elevation in the relative risk of death. This study aimed to evaluate the effect of driving pressure guided ventilation in acute respiratory distress syndrome (ARDS). Patients and Methods: The study included 64 subjects selected from the respiratory intensive care unit (RICU) of Al-Azhar University Hospital (Damietta). All participants received management through a protective lung strategy that was informed by driving Pressure. The study outcomes included 1). Determination of weaning categories; 2). Adverse events; 3). Length of ICU stay and duration of mechanical ventilation; 4). Mechanical Ventilation-free days, and 5). Organ/s dysfunction. Results: The commonest cause of admission was pneumonia (36%), and least percentage was septic shock (1.6%). The median ICU stay was 7 days (4 to 25 days) and weaning success rate was 76.6% with mortality rate of 23.4%. The severity was mainly severe (40.6%) and moderate (31.2%). Driving pressure at day 1 of ≤ 21 had sensitivity of 97.96%, specificity of 80.0% and area under curve (AUC) of 0.952. The driving pressure was significantly increased in cases with failure weaning than the success weaning (24.67 ± 1.05 vs 16.86 ± 1.24, respectively). In addition, it was significantly increased in died than alive patients. There was progressive significant increase of driving pressure from mild to moderate to severe cases. Pneumothorax was recorded among 9.4% and pleural effusion was recorded for 7.8% of patients. Conclusion: Use of driving pressure guided ventilation in patients with ARDS improves lung compliance, decreases the duration of mechanical ventilation and the length of ICU stay. Driving pressure < 21 can predict mortality.

Serial invasive hemodynamics and clinical characteristics of patients with shock with and without invasive mechanical ventilation

Abstract Funding Acknowledgements None. Background Invasive mechanical ventilation (IMV) is commonly used in the Cardiac Intensive Care Unit (CICU) in patients with cardiogenic shock (CS). IMV causes hemodynamic changes that may impact outcomes based upon a patient’s profile. Our aim is to characterize the clinical profile and detailed serial hemodynamic parameters in the first 24-hours according to the use of IMV in patients with shock admitted to the CICU. Methods Retrospective analysis of consecutive patients with shock admitted to the CICU at Bellevue Hospital, undergoing pulmonary artery catheter (PAC) placement within the first 24 hours of admission, from February 2022 to June 2023. Clinical characteristics, as well as specific hemodynamic parameters collected and curated at times 0, 6, 12, 18 and 24 hours were from PAC placement compared between patients with and without IMV. Results A total of 101 patients were included (95% with cardiogenic shock), 59 receiving IMV (age 64 ± 15, 24% women) and 42 non-intubated (61 ± 13, 33% women). Non-intubated patients had higher prevalence of hypertension, prior coronary artery disease and heart failure with reduced ejection fraction (HFrEF), while acute coronary syndromes (44%) and cardiac arrest (12%) were more common causes of admission in patients undergoing IMV. Mixed shock predominated in IMV patients (51 vs 17%, p <0.001), whereas cardiogenic shock (CS) was more common in non-intubated patients (83 vs 41%, p <0.01). Patients with acute myocardial infarction CS (AMI-CS) were more likely to undergo IMV, while patients with heart failure CS (HF-CS) were more likely to be non-intubated. Patients undergoing IMV were more likely to have mechanical circulatory support (MCS) and ventricular dilatation compared to non-intubated patients (LVEDD 5.7 cm vs 4.9 cm, p 0.002). Patients undergoing IMV had a higher incidence of severe shock compared to the non-intubated group (31% vs 19% SCAI Shock D), higher lactate levels and greater use of vasoactive drugs (figure 1A). Patients undergoing IMV had significant improvements in cardiac power output (CPO), diastolic blood pressure and systemic vascular resistance (SVR) (figure 1B). Shock severity by SCAI SHOCK classification had a more notable improvement at 24 hours in patients with IMV compared to non-intubated patients (figure 1C), with a non-statistically significant improvement in lactate clearance in the first 24 hours (Figure 1D). Conclusions IMV in patients with CS is more commonly seen in patients with AMI-CS and among those with higher baseline shock severity and greater use of vasoactive medications. IMV is associated with significant improvements in shock severity, CPO and SVR at 24 hours when compared to patients with shock who are not intubated, which could be related to higher use of vasopressors. Further investigations are warranted to understand the impact of IMV on outcomes of patients with CS and how they might vary according to hemodynamic profile.

Changes in daily nursing needs and self-care capability of people with diabetes after in-hospital treatment for foot complications: A descriptive study.

A limited number of studies discuss the changes in patients' self-care skills and needs for assisted self-care after discharge from in-patient treatment due to diabetes foot ulcer-related complications. The aim of this study was to examine the ability to perform self-care and needs for assisted nursing interventions at hospital discharge, compared to pre-admission, for people with diabetes admitted and treated for foot ulcer-related complications. Retrospective patient record study. A retrospective assessment was done on the medical records of a total of 134 patients with diabetes consecutively admitted to a specialist in-patient unit due to foot ulcer complications, between 1 November 2017 and 30 August 2018. Data on daily self-care needs and home situations at admission and discharge were recorded. The median age was 72 years (38-94), 103 (76.9%) were men and 101 (73.7%) had diabetes type 2. The median length of admission was 10 days (2-39). Infection was the most common cause of admission (51%), with severe ischaemia in 6%, and a combination of both in 20% of patients. Surgical treatment was performed in 22% and vascular intervention in 19% of patients. The percentage of patients discharged to their home without assistance was 48.1% compared to 57.5% before admission, discharge to home with assistance was 27.4% versus 22.4% before admission and 9.2% were discharged to short-term nursing accommodation versus 6% before admission. Three patients died during their stay in hospital. The need for help with medications increased from 14.9% of patients at admission to 26.7% at discharge and for mobility assistance from 23.1% to 35.9%. Social services at home were increased in 21.4% of patients at discharge.

Impact and Feasibility of Mechanical Ventilation at a Surgical Center in Sierra Leone: Experience From EMERGENCY's Hospital in Goderich.

Despite the large burden of critically ill patients in developing countries, mechanical ventilation (MV) is scarce in these low-resource settings. In the absence of data, issues like costs and lack of training are often felt to outweigh the benefits of potential MV implementation in such places. We aimed to investigate the impact and feasibility of MV in a surgical ICU in West Africa. This is a 7-month retrospective observational study (from October 25, 2022, to May 25, 2023), covering all patients consecutively admitted to ICU. The NGO EMERGENCY's hospital in Goderich, Freetown, Sierra Leone. The hospital is a referral center for acute care surgery. Critical patients admitted to the hospital's ICU. Following brief, practical training of the nursing staff, one basic mechanical ventilator was installed at the hospital's ICU, under the supervision of two intensivists. Only patients with a body weight of over 15 kg and who met the "extreme criteria" for MV received this life-saving therapy. Of the 195 files of patients admitted to ICU during the study period, 162 were analyzed. The median age was 16 (interquartile range 7-27) and 48.1% of the population were under 14 years. The most common cause of admission was trauma (58.6%), followed by acute abdomen (33.3%), caustic soda ingestion (6.2%), and burns (1.9%). Of the overall population, 26 patients (16%) underwent MV (88.5% trauma cases vs. 11.5% acute abdomen). Median time on MV was 24 hours (12-64). The mortality rate in the MV group was 30.8% (8/26), while in the overall study population, it was 11.7% (19/162). One potentially life-threatening event of tube obstruction was handled appropriately. This study strongly supports the implementation of MV in low-resource settings. In our experience, the consistent benefit of reduced mortality among critical patients largely outweighs the associated challenges.

Insights into Early Onset Dementia: a protocol for an 8-year nationwide retrospective study using administrative data

IntroductionEarly-onset dementia (EOD) is defined as any type of dementia with an onset before the age of 65. Despite its profound impact on patients and their families, EOD has garnered less attention when compared to late-onset dementia (LOD), often resulting in its underestimation. In comparison to LOD, EOD commonly manifests with atypical and heterogeneous symptoms, encompassing mainly non-memory problems, ranging from language and executive impairments to behavioral-led dysfunction. Despite the importance of accurate data to organize appropriate healthcare, evidence regarding EOD patients in Portugal is lacking.ObjectivesThe primary aims of this study include identifying the causes for hospitalization in EOD patients, diagnosed with dementia either as a primary or secondary diagnosis, and comparing them with inpatients aged 65 and older (LOD). Additionally, the study aims to analyze key hospitalization outcomes for both groups, including length of stay, in-hospital mortality, and readmissions. As a secondary aim, this study seeks to describe subtypes of EOD.MethodsA retrospective observational study will be conducted following the RECORD statement. Data will be retrieved from an administrative database that gathers de-identified routinely collected hospitalization data from all Portuguese mainland public hospitals. Hospitalization episodes of inpatients younger than 65 years old, with a primary or secondary diagnosis of dementia (ascertained by ICD-9-CM codes 290.0-290.4, 294.0-294.2, 331.0, 331.1, and 331.82), will be extracted. Comparison patients will be selected by propensity score-matching from inpatients over 65 years with a dementia ICD-9-CM code (in any position), matched for Charlson Comorbidity Index (CCI).ResultsDescriptive and analytical statistics will be conducted to describe and characterize both group of inpatients. Variables such as age at admission, sex, place of residence, causes and type of admission, psychiatric comorbidities, length of stay (LoS), destination after discharge, readmissions, in-hospital mortality and hospital charges will be analyzed.ConclusionsWith this nationwide analysis of EOD hospitalizations, we aim to reveal critical aspects of this condition, including common causes of admission, diagnostic features and health outcomes, allowing for appropriate medical interventions and support tailored to the specific needs of this clinical group.Disclosure of InterestNone Declared