Differences In Hospital Outcomes Research Articles

Risk factors for abusive head trauma in the pediatric population.

Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations. The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05). The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001). Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.

Association between initial ventilation mode and hospital outcomes for severe congenital diaphragmatic hernia

ObjectiveTo determine the association between initial delivery room (DR) ventilator (conventional mechanical ventilation [CMV] versus high frequency oscillatory ventilation [HFOV] and hospital outcomes for infants with severe congenital diaphragmatic hernia (CDH).Study designQuasi-experimental design before/after introducing a clinical protocol promoting HFOV. The primary outcome was first blood gas parameters. Secondary outcomes included serial blood gas assessments, ECMO, survival, duration of ventilation, and length of hospitalization.ResultsFirst pH and CO2 were more favorable in the HFOV group (n = 75) than CMV group (n = 85), median (interquartile range (IQR)) pH 7.18 (7.03, 7.24) vs. 7.05 (6.93, 7.17), adjusted p-value < 0.001; median CO2 62.0 (46.0, 82.0) vs 85.9 (59.0, 103.0), adjusted p-value < 0.001. ECMO, survival, duration of ventilation, and length of hospitalization did not differ between groups in adjusted analysis.ConclusionAmong infants with severe CDH, initial DR HFOV was associated with improved early gas exchange with no adverse differences in hospital outcomes.

Frailty is a predictor for worse outcomes in patients hospitalized with Clostridioides difficile infection.

Frailty has major health implications for affected patients and is widely used in the perioperative risk assessment. The Hospital Frailty Risk Score (HFRS) is a validated score that utilizes administrative billing data to identify patients at higher risk because of frailty. We investigated the utility of the HFRS in patients with Clostridioides difficile infection (CDI) to determine whether they were at risk for worse outcomes and higher healthcare resource utilization. Using the 2017 National Inpatient Sample, we identified all adults with a primary diagnosis of CDI. We classified patients into 2 groups: those who had an HFRS <5 (NonFrailCDI) and those with a score ≥5 (FrailCDI). We assessed differences in hospital outcomes and healthcare resource utilization based on frailty status. We identified 93,810 hospitalizations, of which 54,300 (57.88%) were FrailCDI. FrailCDI patients were at higher risk for fulminant CDI (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.6-2.3), requiring colectomy (OR 4.1, 95%CI 1.5-11.2), and inpatient mortality (OR 4.5, 95%CI 2.8-7.1). Furthermore, FrailCDI patients had higher odds of requiring Intensive Care Unit admission (OR 13.7, 95%CI 6.3-29.9) or transfer to another facility on discharge (OR 2.2, 95%CI 2.0-2.4), and had longer hospital stays and higher total charges when compared with NonFrailCDI. Frailty as defined by the HFRS is an independent factor for worse outcomes and higher healthcare utilization in adults admitted for CDI. Risk stratifying patients by frailty may improve outcomes.

Gender Differences in Hospital Outcomes among COVID-19 Hospitalizations.

Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database. We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission. There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38-1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31-1.39), vasopressor use (OR 1.59, 95% CI 1.51-1.66), mechanical ventilation (OR 1.62, 95% CI 1.47-1.78), and ICU admission rates (OR 1.58, 95% CI 1.51-1.66) were significantly higher among male hospitalizations. Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity.

Association between Race and Social Deprivation in Patients with Hematologic Malignancies

Background: Recent therapeutic advances including biologics, immunomodulators, and cellular therapies have transformed management paradigms for hematologic malignancies. Nevertheless, disparities exist in terms of access to care, and non-White individuals are historically underrepresented in clinical trials. As it remains unknown whether there are inequalities in care related to adverse events of these therapeutic approaches, in this study we explored whether racial and social differences are related to outcomes of patients with hematologic malignancies. Methods: This was a retrospective chart review from January 2011 to December 2021 that included adult patients across our cancer center network with diagnostic codes for malignant neoplasms of lymphoid, myeloid, and hematopoietic origin who were receiving an immunologic therapy at the time of an emergency department visit. Data were compared according to White and non-White individuals. The non-White group comprised of Black or African American, Asian Indian, Chinese, Asian, or unspecified/other. Differences in continuous variables between groups were assessed using the Wilcoxon rank-sum test, and Chi-square or Fisher's exact test was used to compare categorical variables. Outcomes included time to admission, length of stay within the hospital, ICU admissions, and differences in social deprivation index (SDI). SDI is a composite measure of a geographic region's socioeconomic variation in health outcomes based on demographic characteristics collected by the U.S Census Bureau (www.census.gov/programs-surveys/acs). Higher SDI scores indicate more severe social deprivation. Results: 180 patients were identified with 142 patients meeting inclusion criteria. Among these, 43% were non-White patients. The median age for the White group was 71.6 and for the non-White group 65.8 (P=.001). The most common immunotherapies were lenalidomide (50%), pomalidomide (19.7%), daratumumab (12.7%), methotrexate (9.9%), and rituximab (8.5%). The main chief complaint that was statistically different between the two groups was musculoskeletal complaints; the incidence among the White group was 8.6% and 29.5% among the non-White group (P=0.001). Other reasons for presentation included neurological complaints (21)%, infection/sepsis (16%), respiratory issues (12%), and abnormal laboratory values (3.5%). There were no differences in time to hospitalization for White versus non-White patients (5 versus 6 hours, P=0.12). Differences in ICU admissions, 30 day-readmissions, and length of stay were also not statistically significant between the two groups. However, the median SDI for the White group was statically greater among the non-White group (p&amp;lt;0.001). Discussion: In this retrospective study, non-White patients with hematologic malignancies were found to have greater social deprivation than White patients, however this did not impact inpatient metrics. We found that non-White patients with hematologic malignancies were more likely to originate from socially disadvantaged backgrounds, although there were no differences in hospitalization outcomes among the two groups. Results suggest that social determinants may impact factors unrelated to access to acute care in patients with hematologic therapies receiving immunologic therapies.

Abstract 16440: Gender Differences of In-Hospital Outcomes in Acute Myocardial Infarction and Cardiogenic Shock Patients Using Impella: From the Nation Inpatient Sample 2016-2019

Background: There is a lack of independent studies on gender differences in hospital outcomes with Impella in patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS). Our study aims to provide evidence on the impact of gender differences on AMI-CS patients receiving Impella with a nationally representative sample. Methods: Data were obtained from the National Inpatient Sample (NIS) from 2016 to 2019. Patients with AMI and CS were searched in the NIS using ICD-10 CM codes, and those with Impella were screened using ICD-10PCS codes. Patients treated with Impella were then stratified by gender. We used multivariate regression analysis with inverse probability weighting(IPTW) based on propensity scores to compare the risk of in-hospital death after Impella among patients of different genders. Results: From 2016-2019, a total of 2,953 inpatients with AMI combined with CS using Impella were identified. Of these, 28.5% were women. Women treated with Impella were older (mean age 68.42 versus 64.68 years, P&lt;0.0001). Male inpatients on Impella had a higher proportion of NSTEMI, and were more likely to have smoking, congestive heart failure, cardiac arrhythmias, and acute renal failure. Female inpatients were more likely to have STEMI and were more likely to have Chronic pulmonary disease, uncomplicated hypertension, hypothyroidism, and valvular disease. After IPTW-adjusted baseline clinical covariates, women using Impella had a higher risk of in-hospital death than men, while length of stay and total hospital cost did not differ significantly between genders (OR, 1.33 [95%CI, 1.10-1.60]; Beta, -0.05 [95%CI, -0.80-0.71]; and Beta, 8105.24 [95%CI, -25376.84-9166.35]; respectively). Conclusions: Impella use was lower in women. However, in-hospital mortality was significantly higher in women among AMI-CS patients using Impella. Further studies are needed to explore the reasons for higher mortality in female patients using Impella.

Racial Disparities in Plasma Cell Leukemia Outcomes Among Hospitalized Patients in the United States.

Plasma cell leukemia (PCL) is a rare, aggressive subtype of multiple myeloma (MM) with a poor prognosis. Prior studies have shown that racial disparities affect MM patients in various ways, which may affect patients' outcomes. In this study, we aimed to investigate racial differences in hospitalization outcomes for PCL using Nationwide Inpatient Sample data. Overall, hospitalization rates for PCL tended to decrease over the past decade. Among hospitalized patients with a primary diagnosis of PCL, there was no statistically significant association between race/ethnicity and hospitalization rates, between NH-White patients and NH-Black patients (OR 1.94; 95%CI 0.3-3.54, p 0.95), and Hispanic patients (OR 0.47; 95% CI 0.05-4.23, p 0.5). Additionally, there was no significant association between race/ethnicity and inpatient mortality. The overall lower incidence of PCL, more significant disease burden, and poor prognosis across all groups may contribute to our findings. With increasing evidence that PCL is cytogenetically distinct from MM, more investigation into biological and sociodemographic factors that affect healthcare utilization and treatment outcomes should be carried out.

Abstract 9444: Differences in Hospital Outcomes Following Watchman's Procedure Based on CHA 2 DS 2 VASc Score: Insight From National Inpatient Sample Database, 2016-2019

Background: Uncertainty exists whether a higher CHA 2 DS 2 VASc risk score is associated with poorer in-hospital outcomes than a lower risk score following Left Atrial Appendage Occlusion (LAAO) procedures. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with primary atrial fibrillation or flutter from 2016 to 2019 with codes for percutaneous left atrial appendage occlusion device placement. Cohorts with high (CHA 2 DS 2 VASc ≥5) and low (CHA 2 DS 2 VASc &lt;5) risk of stroke were compared. Weighted multivariable logistic regression was used to assess the association between CHA 2 DS 2 VASc score and in-hospital outcomes. Results: Out of 60,350 procedures performed, 50.61% had high CHA 2 DS 2 VASc score ( &gt; 5) and 49.39% had low score (&lt; 5) (table 1). All patients received the Watchman device. The primary outcome of in-hospital mortality was not statistically different between high and low risk (0.18% vs. 0.12%, OR: 1.53, 95% CI: 0.59-3.96, p=0.37), a finding that did not change when adjusted for comorbidities in multivariate analysis (adjusted OR: 1.44, 95% CI: 0.55-3.62, p=0.46). In the high-risk group, total complication rates were similar (adjusted OR: 1.16, 95% CI: 0.97-1.38, p=0.09) as was ischemic stroke (adjusted OR: 2.05, 95% CI: 0.82-5.13, p=0.13) while systemic embolism (adjusted OR: 5.09, 95% CI: 1.08-23.99, p=0.04) and major bleeding requiring transfusion (adjusted OR: 3.84, 95% CI: 1.41-10.42, p=0.08) were higher after adjusting for confounders in multivariable analysis (figure 1). Conclusion: This study demonstrates that the LAAO procedure had similar short-term outcomes between high and low-risk patients in a study of real-world patients.

RF23 | PSAT240 Suboptimal Thyroid Hormone Replacement is Associated with Worse Hospital Outcomes

Abstract Introduction Many patients in the US with hypothyroidism receive suboptimal treatment with thyroid hormone. Sustained off-target TSH levels have been shown to cause serious harm to patients, including increased risk of cardiovascular disease and excess mortality over time. Suboptimal treatment may also impact hospital outcomes. The primary objective of the study was to identify differences in hospital outcomes between patients with and without hypothyroidism. Methods This is a retrospective cohort study that utilized the propensity score-based fine stratification method to balance covariates. Patient data was extracted from a large, US-based, IBM MarketScan® Commercial Claims and Encounters Database from January 1, 2008 to December 31, 2015. Participants included patients 64 years and younger who had commercial insurance and a thyrotropin (TSH) level collected prior to a medical or surgical hospital admission. Covariates included age, sex, US region, type of admission (medical vs surgical), year of admission, and co-morbidities. The primary exposure was defined as clinical hypothyroidism, which was divided into 4 subgroups based on pre-hospitalization TSH level: low (TSH &amp;lt;0.40 mIU/L), normal (TSH 0.40–4.50 mIU/L), intermediate (TSH 4.51–10.00 mIU/L), and high (TSH &amp;gt;10.00 mIU/L). Non-hypothyroidism was the non-exposure (control). The primary outcomes were length of stay (LOS), in-hospital mortality, and readmission outcomes following medical and surgical admission. Results A total of 46,235 patients were included in the final study population, of whom 9,394 had a diagnosis of hypothyroidism. Those with a high pre-hospitalization TSH level had a LOS that was 1.2 days longer (95% CI [1.1–1.3]; p = 0.001), a 41% higher risk of 30-day readmission (RR 1.41, 95% CI [1.13–1.75]; p = 0.002), and 33% higher rate of 90-day readmission (RR 1.33, 95% CI [1.13–1.56]; p &amp;lt;0.001) compared to balanced controls. Patients with intermediate TSH levels exhibited increased likelihood of 30-day readmission (RR 1.20, 95% CI [1.01–1.43]; p = 0.04). Conversely, those with a normal pre-hospitalization TSH level had a decreased risk of in-hospital mortality (RR 0.55, 95% CI [0.34–0.89]; p = 0.02) and 90-day readmission (RR 0.91, 95% CI [0.85–0.99]; p = 0.02). Conclusions Suboptimal treatment of hypothyroidism appears to be associated with worse hospital outcomes, including longer LOS and higher rate of readmission. Public health strategies designed to deliver appropriate, consistent outpatient treatment of hypothyroidism are needed to improve hospital outcomes in those patients with off-target TSH levels. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:30 p.m. - 12:35 p.m.

S674 The Disparity in Hospitalization Outcomes for Patients With Variceal Hemorrhage Based on the Patients’ Living Area Household Income: A Study of the National Inpatient Sample

Introduction: Variceal hemorrhage (VH) is a dreaded condition that requires urgent hospitalization. Multiple studies have shown that socioeconomic disparities are linked to poor healthcare outcomes. In this study, we aim to characterize the differences in the hospitalization outcomes of VH based on the household income area. Methods: Patients with a 1ry discharge diagnosis of VH were identified from the national inpatient sample (NIS) 2016-2018 data and classified based on household income for patients’ living areas as: low [LIA] (≤ 50% ) or high [HIA] ( >50%). The living area household income was provided by Claritas as a quartile classification per ZIP code and incorporated into the NIS data. Inverse probability weighting based on propensity score was used to adjust for differences between the two groups. Our outcomes include time to first esophagogastroduodenoscopy (EGD) (early: ≤ 24 hours vs late: > 24 hours), length of hospital stay (LOS), hospital charges, mortality, and discharge disposition. Results: Out of 62,775 included patients, 37,420 were identified as LIA group. These patients were more likely to be Black or Hispanic, covered by Medicare or Medicaid, admitted to larger bed-size hospitals, use tobacco, had lower Elixhauser’s comorbidity score, and diagnoses of shock compared to the HIA group (Table). In the outcome analyses, the LIA group had lower odds ratio (OR) of having early EGD (0.86, 95% CI 0.78 – 0.95, P 0.002) and higher OR of death (1.3, 95% CI 1.028 – 1.644, P 0.03). There were no differences in LOS (MD 0.12, 95% CI -0.09 – 0.34, P 0.26), hospital charges (MD $1699.61, 95% CI -1707.76 – 5106.98, P 0.33), discharge to nursing facilities (OR 1.01, 95% CI 0.82 – 1.25, P 0.9), discharge with visiting nurse (OR 1.08, 95% CI 0.9 – 1.29, P 0.42), and discharge to other hospitals (OR 0.81, 95% CI 0.619 – 1.053, P 0.11). In an interaction term analyses, the differences in the EGD timing between LIA and HIA groups did not explain the differences in death or other hospitalization outcomes (Figure) Conclusion: This notional study showed that patients who lived in LIA and were admitted with VH had less likelihood of receiving EGD within 24 hours and a higher likelihood of death despite having fewer comorbidities compared to patients who lived in HIA. However, the differences in EGD timing did not explain the differences in death. More studies are needed to confirm these findings and to help understand and minimize the disparity in the healthcare system in the United States.Figure 1.: Hospitalization outcomes for patients with VH based on the interaction term analyses of household income and EGD timing. Abbreviations: EGD = Esophagogastroduodenoscopy, LOS= Length of hospital stay, OSH= outside hospital, VNA= home visiting nurse. Table 1. - Baseline characteristics Characteristics LIA HIA P-value Total number (Weighted) 37,420 25,355 Age (mean(SD)) 56.10 (11.97) 57.02 (12.47) <0.001 Female (%) 12,060 (32.2) 8,200 (32.4) 0.9 Race (%) <0.001 White 21,125 (57.8) 16,800 (68.2) Black 2,975 (8.1) 1,015 (4.1) Hispanic 9,730 (26.6) 4,725 (19.2) Others 2,715 (7.4) 2,105 (8.5) Patient Location: NCHS Urban-Rural Code (%) <0.001 "Central" counties of ≥1 million population 11,925 (31.9) 8,900 (35.1) "Fringe" counties of ≥1 million population 4,380 (11.7) 8,760 (34.5) Counties of 250,000-999,999 population 9,840 (26.3) 5,060 (20.0) Counties of 50,000-249,999 population 4,810 (12.9) 1,765 (7.0) Not metropolitan or micropolitan counties 6,460 (17.3) 870 (3.4) Expected primary payer (%) <0.001 Medicare 12,075 (32.4) 7,995 (31.6) Medicaid 11,065 (29.7) 6,035 (23.8) Private insurance 8,150 (21.8) 8,445 (33.3) Self-pay/ Others/No charge 6,020 (16.1) 2,855 (11.3) Shock (%) 4,295 (11.5) 3,290 (13) 0.01 Acute kidney injury (%) 6,870 (18.4) 4,775 (18.8) 0.51 Acute respiratory failure (%) 4,180 (11.2) 2,690 (10.6) 0.33 Blood transfusion (%)* 0.35 (0.51) 0.38 (0.53) 0.001 FFP or clotting factors transfusion (%)* 0.13 (0.38) 0.14 (0.40) 0.03 Advanced vascular access (%)* 2,550 (6.8) 1,775 (7) 0.69 Intubation and mechanical ventilation (%)* 4,125 (11) 2,920 (11.5) 0.4 Weighted Elixhauser’s score (mean(SD)) 14.18 (11.17) 15.30 (11.15) <0.001 Alcohol use disorder 22,835 (61) 15,205 (60) 0.26 Tobacco use 10,585 (28.3) 6,215 (24.5) <0.001 Long-term (current) anticoagulant use (%) 790 (2.1) 475 (1.9) 0.35 Long-term (current) aspirin use (%) 2,140 (5.7) 1,395 (5.5) 0.6 Long-term (current) NSAID and other antiplatelets/antithrombotic use (%) 870 (2.3) 515 (2) 0.27 Bed size of the hospital <0.001 Small 5,835 (15.6) 5,305 (20.9) Medium 11,395 (30.5) 8,285 (32.7) Large 20,190 (54) 11,765 (46.4) Abbreviations: EGD = Esophagogastroduodenoscopy, FFP = Fresh frozen plasma, HIA = High income area, LIA = Low income area, NSAID = Nonsteroidal anti-inflammatory drugs, NCHS = National Center for Health Statistics, SD = Standard deviation.*Procedures were done prior on the same day of EGD.

S1465 Differences in Hospital Outcomes and Demographics of Hospitalized Patients With Obesity Compared to Those Without Obesity

S1465 Differences in Hospital Outcomes and Demographics of Hospitalized Patients With Obesity Compared to Those Without Obesity

Migraine and its relation to other risk factors in patients with acute ischemic stroke and acute coronary syndrome

BackgroundMigraine has been recently studied as a risk factor for ischemic stroke (IS) and a possible link to a broader range of ischemic vascular disorders including angina and myocardial infarction is suggested.Objectivesto study migraine and its relation to other risk factors in patients with acute IS and acute coronary syndrome (ACS).Patients and methodsWe studied 200 patients, 114 patients had acute IS and 86 patients with ACS, in addition to 850 control participants. All patients were subjected to detailed clinical and laboratory evaluation; including evaluation of traditional risk factors. All stroke patients were subjected to CT scan. Diagnosis of acute coronary syndrome was established clinically by ECG and cardiac specific enzymes. Migraine was diagnosed according to the international headache society and assessment of migraine severity was measured by the Migraine Disability Assessment (MIDAS) questionnaire.ResultsIn patients with ischemic stroke, Risk Ratios (RR) of migraine was 3.3 for all migrainous patients, higher for migraine with aura (MA). In the cardiovascular group, it was 2.75 and again higher in MA. A positive correlation between migraine severity and both stroke severity and cardiac affection severity was found though non-significant in the cardiovascular group. There was no significant difference in hospital outcome in migrainous patients in both groups.ConclusionsPatients with migraine have higher risk than non-migrainous patients for both cerebrovascular and coronary vascular diseases. Risk is stronger in MA in both conditions. Considering migraine in risk stratification of cerebrovascular and cardiovascular diseases is recommended.

Suboptimal Thyroid Hormone Replacement Is Associated With Worse Hospital Outcomes.

Many patients with hypothyroidism receive suboptimal treatment that may affect hospital outcomes. This work aimed to identify differences in hospital outcomes between patients with and without hypothyroidism. A retrospective cohort study, using the propensity score-based fine stratification method to balance covariates, was conducted using a large, US-based, commercial claims database from January 1, 2008 to December 31, 2015. Participants included patients aged 64 years and younger who had a thyrotropin (TSH) level collected before a hospital admission. Covariates included age, sex, US region, type of admission, year of admission, and comorbidities. Exposure included clinical hypothyroidism, which was divided into 4 subgroups based on prehospitalization TSH level: low (TSH < 0.40 mIU/L), normal (TSH 0.40-4.50 mIU/L), intermediate (TSH 4.51-10.00 mIU/L), and high (TSH > 10.00 mIU/L). length of stay (LOS), in-hospital mortality, and readmission outcomes. A total of 43 478 patients were included in the final study population, of whom 8873 had a diagnosis of hypothyroidism. Those with a high prehospitalization TSH level had an LOS that was 1.2 days longer (95% CI, 1.1-1.3; P = .003), a 49% higher risk of 30-day readmission (relative risk [RR] 1.49; 95% CI, 1.20-1.85; P < .001), and a 43% higher rate of 90-day readmission (RR 1.43; 95% CI, 1.21-1.67; P < .001) compared to balanced controls. Patients with normal TSH levels exhibited decreased risk of in-hospital mortality (RR 0.46; 95% CI, 0.27-0.79; P = .004) and 90-day readmission (RR 0.92; 95% CI, 0.85-0.99; P = .02). The results suggest suboptimal treatment of hypothyroidism is associated with worse hospital outcomes, including longer LOS and higher rate of readmission.

Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study

The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects < 18 years with community-acquired pneumonia (CAP), assessing possible sex differences. We used Spanish national hospital discharge data to select all patients < 18 years with CAP. We identified 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was significantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03–1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p < 0.0001). There were no sex differences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls.Conclusion: The incidence of hospital admissions for CAP was higher among boys than among girls and rose significantly from 2016 to 2019. There were no sex differences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No differences were found in IHM over time.What is Known:• Community-acquired pneumonia is one of the most common reasons for hospitalizations among children.• There are few studies that allow to know the evolution of community-acquired pneumonia in children.What is New:• Incidence of hospital admissions for community-acquired pneumonia was higher in boys than girls and it rose significantly from 2016 to 2019.• Age 10 to 17 years, congenital heart disease, neurological diseases and use of mechanical ventilation were risk factors for in-hospital mortality in both sexes.

Racial and Ethnic Disparities in Hospitalization Outcomes Among Medicare Beneficiaries During the COVID-19 Pandemic

The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations. However, racial and ethnic disparities in hospitalization outcomes during the pandemic-for both COVID-19 and non-COVID-19 hospitalizations-are poorly understood, especially among older populations. To assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. In the 100% traditional Medicare inpatient data, there were 31 771 054 unique beneficiaries in cross-section just before the pandemic (February 2020), among whom 26 225 623 were non-Hispanic White, 2 797 462 were Black, 692 994 were Hispanic, and 2 054 975 belonged to other racial and ethnic minority groups. There were 14 021 285 hospitalizations from January 2019 through February 2021, of which 11 353 581 were among non-Hispanic White beneficiaries, 1 656 856 among Black beneficiaries, 321 090 among Hispanic beneficiaries, and 689 758 among beneficiaries of other racial and ethnic minority groups. Sensitivity analyses tested expanded definitions of mortality and alternative model specifications. Race and ethnicity in Medicare claims from the Social Security Administration. In-hospital mortality and mortality inclusive of discharges to hospice, deaths during 30-day readmissions, and 30-day all-cause mortality. Secondary outcomes included discharges to hospice and discharges to postacute care. The decline in non-COVID-19 and emergence of COVID-19 hospitalizations were qualitatively similar among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital COVID-19 mortality was not significantly different among Black patients relative to White patients, but was 3.5 percentage points higher among Hispanic patients (95% CI, 2.9-4.1; P < .001) and other racial and ethnic minority patients relative to White counterparts (95% CI, 3.0-4.1; P < .001). For non-COVID-19 hospitalizations, in-hospital mortality among Black patients increased by 0.5 percentage points more than it increased among White patients (95% CI, 0.3-0.6; P < .001), a 17.5% differential increase relative to the prepandemic baseline. This gap was robust to expanded definitions of mortality. Hispanic patients had similar differential increases in expanded definitions of mortality and model specification. Disparities in discharges to hospice and postacute care were evident. In aggregate across COVID-19 and non-COVID-19 hospitalizations, mortality differentially increased among racial and ethnic minority populations during the pandemic. In this cohort study, racial and ethnic disparities in mortality were evident among COVID-19 hospitalizations and widened among non-COVID-19 hospitalizations, motivating greater attention to health equity.

Abstract 11246: Racial Distribution and Regional Comparison in Hospital Outcomes Among Patients with Peripartum Cardiomyopathy in the United States

Introduction: Peripartum cardiomyopathy (PPCM) is a rare entity, first described over two centuries ago, associated with left ventricular systolic dysfunction in the last month of pregnancy and up to 5 months postpartum, in the absence of another identifiable etiology for heart failure. Black women are disproportionately affected by this condition. Our study sought to evaluate the racial distribution of each region and regional differences in-hospital outcomes among patients with PPCM in the United States. Methods: Data were obtained from the nationwide inpatient sample database (NIS) for 2016 and 2017. We included data on all adult females (aged 18 - 49 years) hospitalized with a principal diagnosis of PPCM using ICD-10 codes. Our primary outcome was in-hospital mortality. Secondary outcomes included: length of stay, cardiac arrest, and cardiogenic shock. Multivariable logistic and linear regression models were constructed to evaluate the relationship between PPCM and regional in-hospital clinical outcomes. A p-value &lt;0.05 was considered statistically significant. Results: A total of 3,030 hospitalizations for PPCM were included. Regional distribution for the northeast, midwest, south, and west were 12.0%, 20.8%, 50.0%, and 17.2%, respectively with a mean age of 31 years (CI of 28-34, P &lt; 0.01) across all regions. Inpatient mortality was 0.82% overall. Using northeast as the reference of comparison, there was no statistically significant difference in mortality across the regions. There was white predominant in the midwest and west compare to black predominant in the south and northeast (Table 1). In addition, we found no differences in the average length of stay, rates of cardiac arrest, or cardiogenic shock. Conclusion: There were no regional differences in hospital outcomes among patients admitted with PPCM in the US

Differences in Hospitalization Outcomes of Kidney Disease between Patients Who Received Care by Nephrologists and Non-Nephrologist Physicians: A Propensity-Score-Matched Study.

The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population.

Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes

Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64–80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Abstract Background Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p&amp;lt;0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnolόgico - CNPq) [grant number 465518/2014-1], Table 1. Clinical outcomes

Clinical Predictors of Transient versus Persistent Neonatal Hyperinsulinism

Introduction: Hyperinsulinism (HI), the most common neonatal cause of persistent hypoglycemia, can be associated with prolonged hospitalizations and risk for long-term neurological sequelae. Rapid identification of transient versus persistent forms of HI is crucial to optimize management. Objectives: The aims of the study were to assess the ability of clinical and biochemical features at presentation to predict transient versus persistent HI, and to evaluate differences in hospital outcomes. Methods: This study is a retrospective review of 79 infants with HI admitted to the Hospital for Sick Children, Toronto, from 2012 to 2017. Patients were classified into 3 groups: transient and the 2 persistent forms, diazoxide responsive and diazoxide unresponsive (DU). Results: Infants with birth weight >90th percentile had an 8-fold increased risk of having a persistent form of HI (OR 8.8, 95% CI 2.5–30) and a 21-fold increased risk of having a DU form of HI (OR 21.1, 95% CI 4.9–91.8). The majority of children with transient HI and a birth weight >90th percentile were born to mothers with gestational diabetes. There were no other useful clinical or biochemical presenting features that differentiated the groups. There were significant differences in outcome measures, with the DU children more likely to require gastrostomy tube insertion and have an extended length of hospital admission. Conclusion: A higher birth weight in the absence of maternal gestational diabetes is highly associated with a persistent form of HI. Given the marked difference in clinical outcomes between groups, expedited genetic testing should be considered in infants with this presentation to inform clinical management.