Hospital Course Research Articles

The differences in injury patterns and outcomes of thoracic trauma between rural and urban level two trauma centers in a single country.

Equal level trauma centers in the same country might have significant differences regarding their demographics and types of trauma. Understanding geographic variations in injury patterns are essential for optimal care. Here we describe the differences in injury patterns and associated outcomes of thoracic trauma patients between rural and urban level-II trauma centers in a single country. A retrospective analysis of patients with thoracic trauma over a three-year period in a rural level-II and an urban level-II in Israel were compared. Demographics, mechanism of injury, prehospital care, transport, hospitalization course, discharge disposition, and outcomes were all analyzed. There were significant differences between the demography, mechanisms of injury, and sustained injuries. The urban population was older, with more pedestrians hit by motor vehicles, falls from standing or sitting, and penetrating injuries. The rural population suffered from more motor vehicle crashes and falls from heights, with injuries related to higher velocity mechanisms such as lung contusions, sternal fractures, and liver injuries. There was no significant difference in transportation time or injury severity scores. More advanced life support ambulances were utilized in the rural setting together with more transfers to a higher level of care, while more patients in the urban center were lost to follow-up. Understanding the differences between geographic locations is crucial towards optimizing trauma care. The complexities of thoracic trauma patients are an important example of the variations between rural and urban trauma centers. Respecting these differences will help to improve preparedness and treatment for trauma patients.

Timing of acute decompensated heart failure in patients with heart failure and mildly reduced ejection fraction.

This study investigates the prognosis of acute decompensated heart failure (ADHF) on admission (i.e., primary ADHF) as compared to ADHF onset during course of hospitalization (i.e., secondary ADHF) in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). Limited data regarding the prognostic impact of the timing of onset of ADHF is available. Consecutive patients with HFmrEF and ADHF were retrospectively included at one institution from 2016 to 2022. Patients with primary ADHF were compared to patients with secondary ADHF with regard to the primary endpoint all-cause mortality at 30 months. Kaplan-Meier, uni- and multivariable Cox proportional regression analyses were applied for statistics. From a total of 484 patients hospitalized with HFmrEF and ADHF, 67.98% (n = 329) were admitted with primary ADHF. Patients with secondary ADHF had higher rates of concomitant acute myocardial infarction, alongside with a higher extend of coronary artery disease. The risk of all-cause mortality at 30months was not affected by the timing of ADHF (hazard ratio (HR) = 0.853; 95% confidence interval (CI) 0.653-1.115; p = 0.246). However, patients with primary ADHF were associated with a higher risk of HF-related rehospitalization at 30months (HR = 2.513; 95% CI 1.555-4.065; p = 0.001), which was still evident after multivariable adjustment (HR = 2.347; 95% CI 1.418-3.883; p = 0.001). The timing of onset of ADHF was not associated with long-term mortality in HFmrEF, however primary ADHF was associated with a higher risk of HF-related rehospitalization.

Cytokine storm in a massively burned pediatric patient.

Cytokine storm can occur in many different clinical conditions and lack of recognition can lead to death. While cytokines have been measured and trended in burn patients, cytokine storm has not been widely discussed or its treatment reported. We present herein the diagnosis and the treatment of a 5-year-old, 91% burn patient, who developed cytokine storm three times during his hospital course. Aggressive treatment led to successful resolution. Cytokine storm should be entertained in patients who develop classic storm signs and symptoms, along with supporting laboratory. Treatment should be tailored to the patients' clinical picture. More study is warranted to define cytokine storm as well as its treatment in burn patients.

"Clinical outcomes and healthcare costs in status epilepticus: A multivariable analysis from a tertiary center in a resource-limited setting".

As a debilitating and severe repercussion, the clinical and economic impact of Status epilepticus (SE) has not been thoroughly explored in various regions around the world, especially those with limited resources. Therefore, we aimed to identify the predictors of mortality and healthcare costs associated with SE in one tertiary care center with limited resources. This retrospective single-center cohort study, carried out at Namazi Hospital, Shiraz, Iran, included 130 SE cases from March 21, 2021, to March 20, 2022. Patient data were extracted from medical records, including demographics, clinical presentations, hospital course, treatment modalities, and costs. Multivariable regression models were used to identify factors associated with mortality and hospital stay costs. Patients were aged 1month to 92years (mean 20.36years, median 7), with a male predominance of 59.23%. Pre-existing epilepsy was found to be associated with lower mortality (p<0.05), while cardiovascular complications (p<0.05) and cerebrovascular disease (p<0.001) were significantly associated with increased mortality risks. In addition, Intensive Care Unit (ICU) admission, necessitated by complex treatment regimens, was linked to significantly higher healthcare costs (p<0.001). Older age and the use of sedatives were also associated with higher costs, while psychiatric disorders were linked to lower costs. SE imposes a substantial clinical and economic burden in resource-limited settings, as limited availability of ICU beds is common. Thus, screening SE cases based on clinical characteristics (e.g., comorbidities) is paramount. Therefore, targeted strategies are essential for optimizing care and reducing costs.

Skin colonization by pathogenic bacteria as a risk factor for neonatal sepsis.

Neonatal sepsis continues to be a leading cause of mortality among the NICU admitted neonates. The most common causative organisms have been proven to be hospital-acquired organisms. This study was planned with aim of understanding the pathological colonization of neonatal skin and associated risk factors as well as finding a possible correlation between blood culture isolates and neonatal skin colonizers and their antimicrobial resistance patterns. This prospective cohort study was conducted at a tertiary care centre in Northern India from January 2021 to June 2022. The study participants were 50 pre-term neonates and 50 term neonates, who were born in our hospital and subsequently admitted to the NICU. Skin swabs, taken from 5 body sites within 24h of birth and at discharge, were cultured for isolation of pathological bacteria. Neonates were followed-up during their hospital stay for observing any occurrence of blood culture positive sepsis. Out of 100 neonates, 31 pre-term and 28 term neonates were colonized within 24h of birth while almost all were colonized by discharge. Posterior auricular fossa was the most colonized site. Coagulase Negative Staphylococcus (n=195) and Escherichia coli (n=51) were the most common isolates. Risk factors found to be significantly associated with colonization were low birth weight (<2500g), premature rupture of membranes (PROM), invasive mechanical ventilation and positive urine and vaginal cultures of mothers. Neonates with culture positive sepsis also had colonization with MDROs. Neonatal skin colonization and their antimicrobial resistance rates increased over the course of hospital stay, having a possible contribution towards culture positive sepsis.

Can clinical findings at admission allow withholding of antibiotics in patients hospitalized for community acquired pneumonia when a test for a respiratory virus is positive?

BackgroundCurrent guidelines recommend empiric antibiotic therapy for patients who require hospitalization for community-acquired pneumonia (CAP). We sought to determine whether clinical, imaging or laboratory features in patients hospitalized for CAP in whom PCR is positive for a respiratory virus enable exclusion of bacterial coinfection so that antibiotics can be withheld.MethodsFor this prospective study, we selected patients in whom an etiologic diagnosis was likely to be reached, namely those who provided a high-quality sputum sample at or shortly after admission, and in whom PCR was done to test for a respiratory virus. We performed quantitative bacteriologic studies on sputum to determine the presence of bacterial infection or coinfection and reviewed all clinical, imaging and laboratory studies.ResultsOf 122 CAP patients studied, 77 (63.1%) had bacterial infection, 16 (13.1%) viral infection, and 29 (23.8%) bacterial/viral coinfection. Underlying pulmonary disease and a history of smoking were more common in bacterial pneumonia. Upper respiratory symptoms were more common, and mean white blood cell (WBC) counts were lower viral pneumonia. Nevertheless, no clinical, laboratory or imaging findings allowed exclusion of bacterial coinfection in patients who tested positive for a respiratory virus. In fact, patients with bacterial/viral coinfection were sicker than those with bacterial or viral pneumonia; 30% were admitted required transfer to the ICU during their hospital course, compared to 17% and 19% of patients with bacterial or viral infection, respectively (p < .05). In this study, 64.4% of patients who tested positive for a respiratory virus had a bacterial coinfection.ConclusionsIf a test for a respiratory virus test is positive in a patient hospitalized for CAP, no sufficiently differentiating features exclude bacterial coinfection, thereby supporting the recommendation that empiric antibiotics be administered to all patients who are sufficiently ill to require hospitalization for CAP.

A dataset and benchmark for hospital course summarization with adapted large language models.

Brief hospital course (BHC) summaries are clinical documents that summarize a patient's hospital stay. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as synthesizing BHCs from clinical notes have not been shown. We introduce a novel preprocessed dataset, the MIMIC-IV-BHC, encapsulating clinical note and BHC pairs to adapt LLMs for BHC synthesis. Furthermore, we introduce a benchmark of the summarization performance of 2 general-purpose LLMs and 3 healthcare-adapted LLMs. Using clinical notes as input, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to 3 open-source LLMs (Clinical-T5-Large, Llama2-13B, and FLAN-UL2) and 2 proprietary LLMs (Generative Pre-trained Transformer [GPT]-3.5 and GPT-4). We evaluate these LLMs across multiple context-length inputs using natural language similarity metrics. We further conduct a clinical study with 5 clinicians, comparing clinician-written and LLM-generated BHCs across 30 samples, focusing on their potential to enhance clinical decision-making through improved summary quality. We compare reader preferences for the original and LLM-generated summary using Wilcoxon signed-rank tests. We further request optional qualitative feedback from clinicians to gain deeper insights into their preferences, and we present the frequency of common themes arising from these comments. The Llama2-13B fine-tuned LLM outperforms other domain-adapted models given quantitative evaluation metrics of Bilingual Evaluation Understudy (BLEU) and Bidirectional Encoder Representations from Transformers (BERT)-Score. GPT-4 with in-context learning shows more robustness to increasing context lengths of clinical note inputs than fine-tuned Llama2-13B. Despite comparable quantitative metrics, the reader study depicts a significant preference for summaries generated by GPT-4 with in-context learning compared to both Llama2-13B fine-tuned summaries and the original summaries (P<.001), highlighting the need for qualitative clinical evaluation. We release a foundational clinically relevant dataset, the MIMIC-IV-BHC, and present an open-source benchmark of LLM performance in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. Our research effectively integrates elements from the data assimilation pipeline: our methods use (1) clinical data sources to integrate, (2) data translation, and (3) knowledge creation, while our evaluation strategy paves the way for (4) deployment.

Early Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric Traumatic Brain Injury: Single-Center, Retrospective Cohort, 2010-2020.

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes. Retrospective cohort study. PICU within a quaternary care hospital. Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission. None. Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features (p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90-0.98). Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.

Surgery of brainstem cavernous malformations: surgical nuances and outcomes of a monocentric series of 34 patients.

Brainstem cavernous malformations (BCM) constitute one of the most controversial and challenging neurological pathologies: both natural course and surgical manipulation can lead to severe neurological symptoms by direct compression or following hemorrhage of this highly eloquent brain region. The vascular section of the prospectively collected neurosurgical database of our center (2011-2023) was retrospectively reviewed, seeking all patients operated on for a sporadic BCM. Clinical, radiological and surgical data, operative records and videos were analyzed by independent reviewers with the assistance of a dedicated neuropsychologist, blinded to the hospital course. Thirty-four patients aged between 19 and 70 years were identified and considered for analyses, with different brainstem localizations. The clinical onset was hemorrhagic in almost all cases: the average mRS on admission was 2.47 (21 patients ≤ 2). Surgical treatment was performed on average 15.1 weeks after the last bleeding. At hospital discharge, the mean mRS was 3.26 (6 patients ≤ 2). After a mean follow-up of 56.59 weeks, 29 patients (85.3%) presented an improved or stable mRS compared to hospitalization and 5 had a slight worsening (14.7%). Brainstem cavernoma is a rare entity with aggressive features due to the involved eloquence despite of the benign histology itself. Microsurgical resection should be tailored for each patient to the peculiar characteristics of the harbored lesion. Advanced planning techniques reduced morbidity; patients should be centralized in wide caseload hospitals with high specialization in neurovascular pathologies and should receive an appropriate counseling about natural history and risks of interventional treatment.

Utility of Aprepitant in the Management of Pediatric Patients with Cyclical Vomiting Syndrome.

Introduction: Cyclical vomiting syndrome (CVS) is a recurrent debilitating illness characterized by intense episodes of nausea and emesis with widely varied pharmacological management across the country. Aprepitant is now increasingly used in patients with CVS. The impact of aprepitant as an abortive therapy in the readmission of pediatric patients with CVS is currently unknown. Methodology: We analyzed all pediatric patients with a primary diagnosis of CVS using the ICD-10 code in the Pediatric Health Information System database of the Children's Hospital Association. We evaluated the demographic data, comorbid conditions, and management details during the inpatient stay. CVS patients who received aprepitant during their inpatient hospitalization were compared with patients without aprepitant use. Seven-day readmission rate for CVS was used as the outcome variable to assess the effectiveness of the aprepitant in aborting an episode. Propensity score matching was used to match the two cohorts. Results: We analyzed 1775 patients of which 96 received aprepitant during the inpatient hospitalization. The aprepitant group had a more severe hospitalization course as evidenced by an increased duration of hospital stay (5 vs. 3 days) and total hospitalization costs ($11,790 vs. $6380). There were no significant differences in the 7-day (17% vs. 16%, p = 0.91) readmission rate and results were not altered by propensity score matching. Conclusions: Aprepitant use as an abortive therapy did not affect the 7-day CVS-related readmission rate. Further prospective studies are needed to explore the role of aprepitant as an abortive agent in the management of CVS in the pediatric population.

Machine Learning Reveals Demographic Disparities in Palliative Care Timing Among Patients With Traumatic Brain Injury Receiving Neurosurgical Consultation.

Timely palliative care (PC) consultations offer demonstrable benefits for patients with traumatic brain injury (TBI), yet their implementation remains inconsistent. This study employs machine learning methods to identify distinct patient phenotypes and elucidate the primary drivers of PC consultation timing variability in TBI management, aiming to uncover disparities and inform more equitable care strategies. Data on admission, hospital course, and outcomes were collected for a cohort of 232 patients with TBI who received both PC consultations and neurosurgical consultations during the same hospitalization. Patient phenotypes were uncovered using principal component analysis and K-means clustering; time-to-PC consultation for each phenotype was subsequently compared by Kaplan-Meier analysis. An extreme gradient boosting model with Shapley Additive Explanations identified key factors influencing PC consultation timing. Three distinct patient clusters emerged: cluster A (n = 86), comprising older adult White women (median 87years) with mild TBI, received the earliest PC consultations (median 2.5days); cluster B (n = 108), older adult White men (median 81years) with mild TBI, experienced delayed PC consultations (median 5.0days); and cluster C (n = 38), middle-aged (median: 46.5years), severely injured, non-White patients, had the latest PC consultations (median 9.0days). The clusters did not differ by discharge disposition (p = 0.4) or inpatient mortality (p > 0.9); however, Kaplan-Meier analysis revealed a significant difference in time-to-PC consultation (p < 0.001), despite no differences in time-to-mortality (p = 0.18). Shapley Additive Explanations analysis of the extreme gradient boosting model identified age, sex, and race as the most influential drivers of PC consultation timing. This study unveils crucial disparities in PC consultation timing for patients with TBI, primarily driven by demographic factors rather than clinical presentation or injury characteristics. The identification of distinct patient phenotypes and quantification of factors influencing PC consultation timing provide a foundation for developing for standardized protocols and decision support tools to ensure timely and equitable palliative care access for patients with TBI.

Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study

BackgroundAlthough mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknown, limiting the development of interventions to support this vulnerable population.MethodsWe performed a secondary analysis of data from a large multi-country prospective cohort [Childhood Acute Illness and Nutrition (CHAIN) Network] study. Data from 5 sites in Uganda, Kenya, and Malawi were included. Hospitalized children aged 2–23 months were followed from an index admission for 6 months after discharge to determine acute and long-term outcomes. Using perinatal HIV exposure (HEU and HUU) as the primary exposure and adjusting for child, caregiver, and household characteristics, we compared inpatient and 30-day survival outcomes, nutritional status, hospital length of stay, illness severity, and utilization of inpatient resources.ResultsWe included 1486 children: 217 HEU and 1269 HUU. HEU children had an increased risk of mortality both during hospitalization [adjusted OR 1.96, 95% CI (1.14–3.37)] and in the 30 days following hospital admission [adjusted hazard ratio 2.20, 95% CI (1.10–4.42)]. Wasting and stunting were more frequent in HEU than HUU children, with adjusted OR 1.41, 95% CI (1.03–1.95) and adjusted OR 1.91, 95% CI (1.34–2.70), respectively. HEU children were also more likely to have a prolonged hospital stay compared to HUU children [adjusted OR 1.58, 95% CI (1.08–2.29)], although admission diagnoses, illness severity at admission, and use of inpatient resources (supplemental oxygen, nasogastric tube, and second-line antibiotics) did not differ significantly between groups.ConclusionsHEU children are more likely to die during hospitalization and within 30 days of admission, to be wasted and stunted upon hospital admission, and to require a prolonged hospital stay, as compared to HUU children. Hospitals in settings with a high prevalence of women-living-with-HIV should ensure that maternal HIV status is established among children requiring admission and build capacity to provide additional hospital monitoring and early post-discharge support for HEU children.

Use of a bioactive matrix glove in the treatment of paediatric hand burns: a case series.

Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove. A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient. The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints. Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients.

Clinical outcomes and severity of laboratory-confirmed RSV compared with influenza, parainfluenza and human metapneumovirus in Australian children attending secondary care

IntroductionAcute lower respiratory infections (ALRIs) are a major contributor to the global infectious disease burden and a common cause of hospitalisation for children under 2 years. We compared clinical severity...

From routine to rescue: Thyroidectomy for life-threatening thyrotoxicosis.

Thyroidectomies are routinely same-day elective procedures. The aim of this study was to investigate outcomes in patients who underwent uncommon urgent thyroidectomy. We retrospectively reviewed patients diagnosed with thyrotoxicosis at a quaternary medical center between 2011 and 2023. Included patients were admitted nonelectively with thyroidectomies performed during same hospital stay. Patient demographics, comorbidities, hospital course, and operative outcomes were analyzed. Thirty patients met the inclusion criteria. The majority were female (60%) and Black (60%) with a mean age of 41±14years. At admission, 76.6% had undetectable thyrotropin levels (<0.01µU/mL) and 26.7% were diagnosed with thyroid storm. Common presenting comorbidities included atrial fibrillation (53.3%), heart failure (40%), and liver failure (16.7%). Graves' disease was diagnosed in 83.3% of patients, while 13.3% had amiodarone-induced thyrotoxicosis. Median hospital stay before surgery was 8days (interquartile range: 4-16). Indications for surgery were adverse medication events (30%), inadequate therapeutic effect by medication (30%), and worsening heart failure (26.7%). Postoperatively, 6.7% required reoperation for neck hematoma, 13.3% experienced temporary hypoparathyroidism, and 6.7% had hoarseness. Following surgery, 50% of patients with atrial fibrillation experienced resolution and 50% with heart failure with reduced ejection fraction showed ultrasonic improvement. Within 30days, 20% visited the emergency department, none due to thyroidectomy complications, and 13.3% were readmitted for comorbidities. One patient (3.3%) died from liver failure. Patients who require an urgent thyroidectomy often have life-threatening comorbidities particularly cardiac disease. Performing thyroidectomy in these patients can potentially create clinical homeostasis for further management of their comorbidities.

Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy.

To compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy. This retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal-Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed. There were 391 patients included in the study. There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (p < .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77-0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011). Among patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed. Level 3.

Does race and insurance status play a role in high-grade renal trauma in the pediatric population? - An analysis from the traumatic renal injury collaborative in kids (TRICK) consortium.

We sought to examine the potential role of race and insurance status on the presentation, management, and outcomes of high-grade renal trauma (HGRT) in a large trauma registry. A retrospective cohort study of a large, multi-center registry of high-grade pediatric renal trauma was performed. Patients < 18 years of age with HGRT (grades III, IV, and V) from 2007 to 2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes, and follow-ups were extracted and compared. A total of 341 patients were initially identified, 32 were excluded. 66.3% were Caucasian(C), 27.5% were African American(AA), and 6.2% were Other races(O). 43.7% had public insurance,49.8% had private insurance and 6.5% were self-pay. Association of Race: AA patients had a higher rate of penetrating trauma (9% AA vs. 4% C, 0% Others, p = 0.002). Those with O and AA races presented at a younger age (9.5 yo O vs. 12.5 yo AA vs. 14 yo C, p = 0.001). However, no differences were found between race groups in the hospital course or outcome. Association of Insurance status: Those with public insurance presented with higher rates of bowel injury and blood transfusion, no differences were found in hospital course or outcome. Private insurance had higher Urology follow up rates (49% Private vs. 34.6% Public vs. 35% Self pay, p = 0.041). Race and insurance status was associated with differences found on the mechanism of injury, transfusion rate and urology follow-up rate; however, they do not influence rates of surgical intervention, post-injury complications or mortality.

An Epidemiological Survey of Hand Burn Injuries Admitted to a Large Burn Center in the New York City Metropolitan Area.

Hand form and function play a vital role in daily living, and even minor trauma can significantly impair quality of life. There is a current paucity of data regarding hand burn patient and injury characteristics, particularly in urban areas in the United States. As the field of hand surgery expands, a demographic understanding of patients with severe injury potentially requiring surgical management is imperative. The aim of this study was to define the epidemiological characteristics of burn injuries involving the hand that were admitted to a large New York City burn center. A retrospective review of the electronic health record was conducted to identify all patients admitted to our burn center with burn injury involving the hand from August 2020 to December 2023. Patient demographics, injury etiology and characteristics, and hospital course details were recorded and analyzed. We identified 96 admitted patients with 140 hand burn injuries, with a patient median age of 38 years. Female patients presented to the hospital significantly later after initial injury than male patients and were more likely to suffer from flame-related injury. The median length of stay for initial admission was 17.5 days, with longer length of stay associated with hypertension comorbidity. Patients experiencing homelessness demonstrated higher rates of psychiatric disorder, substance use, and current smoking. Length of follow-up was positively correlated with estimated household income. Compared to the general city population, the patient cohort was made up of a lower percentage of "White alone" and "Asian alone" race categories and higher percentage of persons experiencing homelessness. We report the clinical and social characteristics of burn patients with hand involvement admitted to a large urban burn center. Hand burn injuries have distinct risk factors and morbidity implications, and consideration for higher-risk groups is imperative for optimal prevention, acute management, and long-term support.

Combination Prostatic Artery Embolization Prior to Water-Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy: A Propensity Score Analysis.

Objectives: To compare post-operative bleeding measures in patients who underwent prostatic artery embolization (PAE) prior to water-jet ablation (aquablation) vs. water-jet ablation alone. Methods: A retrospective review identified 145 patients treated with water-jet ablation for benign prostatic hyperplasia from December 2018 to June 2021. Patients were divided into two groups: water-jet ablation alone (n = 56) vs. pre-operative PAE and water-jet ablation (n = 89). Patient demographics, pertinent laboratory values, operative reports, and hospital courses were reviewed. Results: PAE was technically successful in all patients (n = 89), and all 89 patients underwent successful water-jet ablation within a median time of 2 days. Compared to water-jet ablation alone, pre-operative PAE resulted in a significant reduction in post-operative bleeding as measured via lower rates of continuous bladder irrigation, hemostatic measures, and hematuria. Pre-operative PAE was also associated with lower rates of post-operative urinary retention (odds ratio 17, p = 0.02) and less likely to require reoperation 30 days after the procedure (p = 0.003). There were no major PAE-related adverse events reported in the combination arm. Conclusions: Compared to water-jet ablation alone, pre-operative PAE resulted in fewer bleeding-related complications and urinary retention.

A Case of Fever of Unknown Origin -? Melioidosis Presenting as Severe Sepsis and Multiple Organ Dysfunction Syndrome

Melioidosis is an emerging infection in India1, well known for its protean clinical manifestations. We report a case of probable disseminated Melioidosis with hyperferritinemic septic shock and multi organ dysfunction syndrome. She presented as a case of PUO- with high fever- 1week, loose stools, headache and shortness of breath, to our hospital. She had a turbulent course in hospital, with fever not responding despite 2 weeks of hospitalization. Her respiratory system showed bilateral crackles. Per Abdomen examination revealed tenderness in right iliac fossa, suprapubic region and left iliac fossa, bowel sounds were sluggish. CECT chest and Abdomen showed right basal pneumonia, hydro-ureteronephrosis, with ureter showing narrowing at the region of right adnexa, PID, subcentrimetric , mesentric , and perirectal lymph nodes; rectal wall showing inflammatory changes with inflammation of mesorectal fascia . She responded well and fully recovered with injection Meropenem for 8 weeks; followed by oral Trimethoprim-Sulfamethoxazole for 3 months.