Emergency Room Admissions Research Articles

Changes in air quality and its effect on emergency admissions

INTRODUCTION: Air pollution is an emerging problem in developing countries as well as the world. Effects of air pollution due to short-term exposure may lead to increase in daily mortality, respiratory and cardiovascular hospital admissions, respiratory and cardiovascular emergency room admissions, respiratory and cardiovascular primary care visits and acute respiratory symptoms. The objective of our study was to examine the relationship between air pollution and diagnoses of patients in family medicine outpatient clinic located in emergency room. MATERIAL AND METHODS: Our study enrolled 17869 patients who were admitted to the family practice outpatient clinic implemented in emergency department. The relationship between patients’ diagnosis and air quality was examined. RESULTS: The genders of the patients were 50.8% female (n = 9077) and 49.2% male (n = 8792). The mean age was 43.9 ± 19.9. Respiratory system diagnosis showed a statistically significant relationship with the air quality measurement of PM10 (p < 0.05). Patients diagnosed with upper respiratory tract disease and fatigue and hypertension on sensitive air days were found to be significantly higher than those with good air quality. There was a statistical significance between air temperature, and fatigue and cough complaints (p < 0.05). CONCLUSIONS: For human health protection, continuity of life, and environmental sustainability, air pollution should be reduced and brought under control. In our study, with the increase of particulate matter, we observed that patients with respiratory system diseases, fatigue complaints, and hypertension increased. Sharing these results with province-wide authorities may help the settlement and industrial planning in the upcoming years.

Identifying Populations and Neighborhoods at High Risk for Hospital Admission-Driven Radiotherapy Interruption Using Geospatial Analytics

Hospital admission driven radiotherapy interruption (HADRI) remains understudied despite its association with increased costs and inferior cancer outcomes. In this study we benchmark HADRI for patients receiving external beam radiotherapy (RT), identify predictors for HADRI, and geographically map HADRI at the neighborhood level across a large region served by a single academic referral center. Data was collected for all patients treated with RT at our center from January 1, 2015 to December 31, 2017. HADRI was defined as postponement of at least one RT treatment due to either hospital inpatient or emergency room admission. We examined differences in the proportion of patients with HADRI by cancer type, race, insurance, and patient predicted income (PPI) which was modeled using 2017 US Census data by patient residence census tract and categorized as low (<$34k), middle, or high (>$67k). Proportion of patients with HADRI were compared using Pearson’s Chi square testing and mapped by patient residence at the neighborhood (census tract) level. 82,773 total fractions (median 24, IQR 10-30) were delivered to 3729 patients with 7107 interruptions (8.6%) in 1928 patients (51.7%). 2022 (54.5 %) were Caucasian, 1577 (42.3%) were African American, and 120 (3.2%) were other races. Insurance status was defined as Commercial, Medicare, or Medicaid/Uninsured in 1794 (48.1%), 1503 (40.3%), and 432 (11.6%) patients, respectively. There were 727 interruptions (10.2%) due to hospital admission in 197 (5.3%) patients. Statistically significant elevations in HADRI were seen in patients treated for HN, lung, metastatic, and GYN cancers (19.9%, 18.5%, 10.3% and 8.9% of patients with each tumor type, respectively; p = <0.0001). Elevations in HADRI were seen between Medicaid/Uninsured patients v. those with Commercial or Medicare insurance (7.4% v. 3.5% p = <0.0001; OR 2.21 [95%CI 1.48-3.32]), African American v. Caucasian patients (5.1 % v 3.1% p = 0.002; OR 1.66 [95%CI 1.19-2.32]), and low PPI v. high PPI patients (5.5% v 2.4% p = 0.0002; OR 2.31 [95%CI 1.48-3.62]). The most common clinical causes for HADRI were: dehydration (22.3%); acute respiratory failure (13.6%); fever/sepsis (11.4%); renal disease (11.4%); radiation induced mucositis or dermatitis (9.1%); and PEG tube complication (6.8%). Spatial analysis revealed elevated rates of HADRI in low income, majority African American neighborhoods (p = 0.0002). Significant elevation in hospital admission driven RT interruption was seen in low income, racial minority, Medicaid/uninsured populations and patients with cancer sites associated with high morbidity. Geospatial analytics revealed neighborhood hotspots eligible for targeted intervention. Further investigation of hospital admission driven RT interruption could prevent treatment interruption and reduce costs in cancer care delivery in the era of value-based care.

Impact of Surgical Approaches on Complications, Emergency Room Admissions, and Health Care Utilization in Patients Undergoing Lumbar Fusions for Degenerative Disc Diseases: A MarketScan Database Analysis

To identify the impact of different surgical approaches for lumbar degenerative disc disease (DDD) on complications, reoperations/readmissions, and health care utilization. We used International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes to extract data from MarketScan. Patients were divided into 6 groups: single-level anterior only (sA), single-level anterior+ posterior (sAP), single-level posterior (sP), multilevel anterior (mA), multilevel anterior+ posterior (mAP), and multilevel posterior only (mP). Outcomes of interest were cumulative complication rates, reoperation rates, readmission, and health care utilization at 6, 12, and 24 months. Of 148,499 patients, 3% had sA fusion and 54% had mP procedures. Patients in the mAP cohort incurred higher cumulative complication rates (21%) compared with sA (13%), sAP (15%), sP (14%), mA (18%), and mP (18%). Emergency room admissions within 30 days were highest in the mA cohort (14%) followed by mAP (11%) and mP (8%). At 12 and 24 months, patients with mA procedures were most likely to have either new fusion or refusion (8% and 12%) followed by sA (7% and 10%), sAP (4% and 7%), mAP (4% and 8%) mP (4% and 7%), and sP (3% and 7%). Compared with the mP cohort, patients in the mA cohort incurred 1.2 times the overall median payments, whereas mAP and sA incurred 1.1 times the payments at 12 months. This difference was further reduced at 24 months. mAP procedures are associated with higher cumulative complications and health care utilization compared with other procedures and the difference in health care utilization tends to decrease over 12 and 24 months.

Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients.

In the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery. A prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions. Of 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million. Risk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.

Feasibility and efficacy of home monitoring for patients with suspected or confirmed COVID-19.

The MonCOVID study aimed to assess the feasibility of early home management and monitoring of patients with suspected or confirmed CoViD-19, and to evaluate if this would ensure a rapid and adequate transfer to hospital care. This pilot, open-label, single-arm study included adult symptomatic patients with suspected or confirmed CoViD-19 for whom the general practitioner or other carer had decided not to proceed to hospitalization. Participants were monitored daily at home, by measuring the pulse oximetry (SpO2) at rest and after a rapid walking test. The study assessed feasibility outcomes (at least 80% of patients recommended to be sent to the competent emergency room actually transferred within 24 hours from reporting) and efficacy (SpO2 at emergency room admission). Patients with SpO2 values below 90% (86% if affected by chronic pulmonary diseases) at rest or with a decrease in SpO2 of five percentage points after a rapid walking test were recommended for hospital care. Thirty-seven participants reported by the local health unit of Alessandria and the Metropolitan City of Turin were included in the study. Enrollment, initially planned for two months to reach a target of 340, was interrupted early due to the drastic reduction in the number of cases. On average, each participant was monitored for 8.2 (median 6.0) days, for a total of 302 visits. The participants showed milder symptoms than those observed in the first phase of the epidemic, at least in terms of pulmonary impairment. No patient had a decrease in SpO2 of 5 percentage points or greater and only one patient required hospitalization due to a worsening of the disease. The cases collected were not sufficient to demonstrate or refute the hypothesis of the monitoring test effectiveness. However, the study showed the feasibility of such a program, and raised some elements of interest regarding hospital territory integration, the need to develop tools to support home care and the variability of the clinical manifestations of the CoViD-19 disease.

Families' Perception of Classic Ketogenic Diet Management in Acute Medical Conditions: A Web-Based Survey.

Objective: To describe families’ experiences in managing epileptic patients undergoing ketogenic dietary therapies (KDTs) in acute medical settings. Methods: We conducted a short online survey addressed to the families of patients undergoing a classic ketogenic diet (cKD) for at least three months. The survey was composed of 18 questions exploring the following issues: demographic characteristics, epilepsy diagnosis, ketogenic-diet treatment history, the reason for emergency-ward admission and patient management, surgery-procedure management, and outcomes. Results: A sample of 50 families agreed to participate. Out of 50 patients, 33 (66%) had been undergoing a cKD for more than two years. Fifteen (30%) patients had been admitted at least once to the Emergency Room (ER), and 8.2% had undergone surgical procedures during cKD treatment. The causes of ER admission were the following: seizures, infection, trauma, and gastrointestinal or respiratory problems. In 75% of cases, blood ketonemia was not monitored during ER admission, and according to 46% of responders, the medical staff intervening did not have a basic knowledge of KDTs. Conclusions: According to both our experience and caregivers’ reports, it might be useful to search for standardized specific approaches to patients undergoing KDTs in the emergency setting.

Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia.

Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer's disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD. Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis. The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43-1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27-1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80-0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82-0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant. Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.

Minimally invasive search for a missing vibrator

Objective To report a unique surgical procedure that was utilized to locate a missing vibrator in the pelvis of a patient. Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff of hospitals in the United States usually are skilled in the detection and removal of these devices. Occasionally, surgical intervention is warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator that was lost during sexual activity. A flat plate X-ray showed it to be in the abdominal cavity. Careful questioning of the patient revealed that the device had an unusually small diameter. Surgical intervention showed that the device ultimately ended up in the bladder without causing traumatic injury.Methods We created a narrated video to demonstrate the surgical procedure (Canadian Task Force Classification III).Results Laparoscopy and cystoscopy were used to visualize and successfully remove the device. The patient recovered uneventfully.Conclusion Following laparoscopic confirmation of the location of the device, it was removed via cystoscopy. This case demonstrates how background information, such as the size of the missing device in this case, can be critical to providing high quality patient care.

Pleural infection-an indicator of morbidity and increased burden on health care.

Patients with pleural infections frequently have several comorbidities and inferior long-term survival. We hypothesized that these patients represent a vulnerable cohort with high rates of hospitalization and frequent use of healthcare services. This study aims to ascertain the need for and causes of treatment episodes after pleural infections during long-term follow-up. Patients treated for pleural infections at Tampere University Hospital between January 2000 and December 2008 (n = 191, 81% males, median age 58 years) were included and compared to a demographically matched population-based random sample of 1910 controls. Seventy percent of the pleural infections were caused by pneumonias and 80% of the patients underwent surgery. Information regarding later in-hospital periods and emergency room and out-patient clinic visits, as well as survival data, was obtained from national registries and compared between patients and controls. Patients treated for pleural infections had significantly higher rates of hospitalizations (8.19 vs 2.19), in-hospital days (88.5 vs 26.6), emergency room admissions (3.18 vs 1.45), out-patient clinic visits (41.1 vs 11.8) and procedures performed (1.26 vs 0.55) per 100 patient-months when compared to controls during 5-year follow-up, in addition to having increased mortality (30% vs 11%), P-value <0.00001 each. Particularly, episodes due to respiratory and digestive diseases, malignancies and mental disorders were more frequent. The patients' comorbidities, such as alcoholism or chronic pulmonary disease, were associated with more frequent use of healthcare services. Patients treated for pleural infections have high rates of hospitalizations, emergency room admissions and out-patient clinic visits during follow-up.

Evaluating process-mining interoperability: stroke case analysis on Italian health real-world data

Abstract Background The Institute for Health Sciences in Aragon developed a process-mining based algorithm deployed using a container solution to describe the Stroke Care Pathway reproducible in different Health Systems. Our aim is to apply the proposed solution to administrative data of an Italian region to explore interoperability in the case of the stroke care; the study is developed in the context of the Joint Action on Health Information 'InfAct' funded by the European Commission. Methods The target population included 1538055 residents in Marche Region who received National Health System (NHS) assistance in 2017. The collected information was sex, date of birth and death, residence from NHS Beneficiaries database; admission and discharge date/time, hospital code, admission type, discharge status, up to 6 diagnoses from Hospital Discharge database; admission date/time, urgent care facility code, discharge status, diagnosis from Emergency Care database. Patients without hospital/urgent care events were excluded from NHS Beneficiaries database. Care pathway traces and map with frequency information, timing across the pathway and timeline plots with time information were the outputs obtained. Results Data included 17752 patients, 10390 hospital, and 18329 urgent care events. Results were represented graphically, easy to read and spread: 500 episodes of stroke were detected, 66% of patients was hospitalised after emergency room (ER) admissions, 19% directly hospitalised and 10% discharged after ER admission. The most frequent access and exit points of the pathway were ER admission and hospital discharge. Conclusions The application of the stroke case to Italian data demonstrates feasibility and usefulness of interoperability in analysing health care administrative data for public health purposes. A European health information system is crucial to build capacity between researchers across Europe and improve health data on Health Monitoring and Health System Performance Assessment. Key messages Sharing a process-mining methodology deployed using a container solution is a useful strategy to describe care pathways and ensures results’ reliability across European Health Systems. Developing and testing tools to encourage interoperability between researchers across Europe is essential for public health policymaker in Europe.

Safety and effectiveness of a microcrystalline tyrosine-associated mite extract immunotherapy for allergic rhinitis.

Aim: To assess the safety and effectiveness of an allergen immunotherapy (AIT) with a microcrystalline tyrosine-associated mite allergoid in real-world patients with allergic rhinitis (AR). Materials & methods: Retrospective, multicenter study assessing the safety of AIT in patients aged 5 to 65years with AR, with or without asthma, sensitized to mites. Secondary objective was effectiveness, measured as unscheduled visits to healthcare centers and emergency rooms, rhinitis and asthma evolution, medication use and patients'and physicians' disease perception 12months before and after treatment. Results: The 306 patients evaluated, with a mean (standard deviation) age of 29.68 (14.66) years, received different treatment compositions and regimens, and 25 (8.2%) experienced nonserious adverse reactions. Unscheduled visits to the specialist and emergency room admissions significantly decreased after immunotherapy (mean [standard deviation]2.11 [1.95] and 0.3 [0.93] vs0.66 [1.09] and 0.02 [0.2], before and after treatment, respectively). Rhinitis and asthma classification ('AR and its impact on asthma' and 'Guía Española para el Manejo del Asma', respectively) significantly changed (p < 0.0001 for all classifications), showing symptom reduction after AIT. Median (interquartile range)-combined rhinitis and combined asthma medication scores significantly decreased (4.0 [1.33, 7.0] vs0.25 [0, 10.0]; p < 0.0001 and 6.94 [1.5, 6.0] vs0.67 [0, 4.67];p < 0.0001) within 12months before and after starting AIT, respectively. Conclusion: AIT with microcrystalline tyrosine-associated mite allergoid appears to be safe and effective in treating rhinitis caused by mites.

Outpatient Hip Safety in an Ambulatory Surgery Center Is Independent of Approach

BackgroundThere are few data comparing the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in the outpatient setting. The purpose of this study is to compare 90-day complications between the 2 approaches. We hypothesized that they would be equally safe and effective. MethodsRetrospective review identified 432 THAs (346 DAA, 86 PA) performed at a single ambulatory surgery center (ASC). Outcomes compared included demographics, comorbidities, preoperative and discharge pain scores (visual analog scale [VAS]), overall time spent in the ASC, overnight stay, emergency room visits, admission, reoperation, and complications within a 90-day period. ResultsThere were no differences in mean preoperative VAS (DAA 4.7, PA 4.5), mean discharge VAS (DAA 0.8, PA 0.7), overall time spent in the ASC (DAA 9.0 hours, PA 9.3 hours), total number of overnight stays (DAA 0.9%, PA 1.2%), emergency room visits (DAA 1.7%, PA 1.2%), admissions (DAA 1.4%, PA 1.2%), reoperations (DAA 1.4%, PA 1.2%), or complications (DAA 3.5%, PA 2.3%). ConclusionThere were no differences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon’s preferred approach. This study indicates both DAA and PA are equally safe for THA in the outpatient setting, and the choice of surgical approach should be based on patient and surgeon preference.

Effect of backward medication switching on the risks of adverse events of schizophrenia patients using atypical antipsychotics

Many studies explore the effects of medication switching from second generation antipsychotic (SGA) to first generation antipsychotic (FGA), yet few exam the health effect of backward medication switching. This study investigated whether backward medication switching (from SGA to FGA) and reduced dosages on SGA increased adverse events in outpatient schizophrenia patients treated by SGA in Taiwan. This study applied a three-year historical cohort design and compared the risks of adverse events (outcome) in 2004, measured by emergency room and hospital admissions, of patients experienced backward medication switching or dosage reduction on SGA (exposure status) in 2003 with those who did not (control group). This study was based on a national fixed cohort (census) of 12,107 patients who have ever received SGA during the study period and used hospitals as regular source of care during 2002-2004. Most data were drawn from National Health Insurance claims provided by Department of Health. Cox proportional hazards model for recurrent events using Prentice, Williams and Peterson total-time approach was applied to estimate the hazard ratio (HR) of adverse events by exposure status of the patients while controlling the covariates. The results showed that backward medication switching in 2003 significantly increased the risk of emergency room or hospital admissions (HR=1.15, 1.00-1.31) in 2004. Backward medication switching and reduced dosages on SGA might increase the risk of adverse events of the schizophrenia patients treated by SGA in Taiwan.

Bringing radiology to patient's home using mobile equipment: A weapon to fight COVID-19 pandemic

Because of coronavirus disease 2019 (COVID-19) high contagiousness, it is crucial to identify and promptly isolate COVID-19 patients. In this context, chest imaging examinations, in particular chest x-ray (CXR), can play a pivotal role in different settings, to triage in case of unavailability, delay of or first negative result of reverse transcriptase-polymerase chain reaction (RT-PCR), and to stratify disease severity. Considering the need to reduce, as much as possible, hospital admission of patients with suspected or confirmed infection, the use of mobile x-ray equipment could represent a safe approach. We picture a potential sequence of events, involving a team composed by a radiographer and a nurse, going to patient's home to perform CXR, nasopharyngeal swab (and, if needed, also a blood sample), with fast radiologist tele-reporting, and resulting patient management approach (home isolation or emergency room admission, when needed). This approach brings healthcare to patient's home, reducing the risk of infected subjects referring to family doctors' office or emergency departments, and strengthening community medicine while maintaining a strong connection with radiology departments.

Production and characterization of elastomeric cardiac tissue-like patches for Myocardial Tissue Engineering

Cardiovascular disease remains the leading cause of death. Damaged heart muscle is the etiology of heart failure. Heart failure is the most frequent cause of hospital and emergency room admissions. As a differentiated organ, current therapeutics and techniques can not repair or replace the damaged myocardial tissue. Myocardial tissue engineering is one of the promising treatment modalities for repairing damaged heart tissue in patients with heart failure. In this work, random Polylactic acid (PLA), Polylactic acid/Polyethylene glycol (PLA/PEG) and random and aligned Polylactic acid/Polyethylene glycol/Collagen (PLA/PEG/COL) nanofiber patches were successfully produced by the electrospinning technique. In vitro cytotoxic test (MTT), morphological (SEM), molecular interactions between the components (FT-IR), thermal analysis (DSC), tensile strength and physical analysis were carried out after production. The resulting nanofiber patches exhibited beadless and smooth structures. When the fiber diameters were examined, it was observed that the collagen doped random nanofiber patches had the lowest fiber diameter value (755 nm). Mechanical characterization results showed that aligned nanofiber patches had maximum tensile strength (5.90 MPa) values compared to PLA, PLA/PEG, and PLA/PEG/COL (random). In vitro degradation test reported that aligned patch had the highest degradation ratio. The produced patches displayed good alignment with tissue on cardiomyocyte cell morphology studies. In conclusion, newly produced patches have noticeable potential as a tissue-like cardiac patch for regeneration efforts after myocardial infarction.

Abstract A124: Neighborhood, race and insurance predict for hospital admission during radiation therapy

Abstract Background: Hospital admission during radiotherapy (ADRT) is associated with increased cost, interrupted treatment, and inferior outcomes. The purpose of this study was to benchmark patient ADRT rates, define socioeconomic predictors for ADRT, and geographically map ADRT rates on the neighborhood level across a large Mid-Southern catchment region served by a single academic cancer referral center. Methods: Demographic, clinical and treatment information were collected for all patients treated with radiation therapy (RT) at our center from January 1, 2015 to December 31, 2017. Occurrence of ADRT included inpatient and emergency room admissions. ADRT was categorized as causing “minor interruption” if ADRT was associated with postponement in 1-4 RT treatments. “Major interruption” was defined as postponement in 5 or more treatments. Patients with Medicaid or no insurance were categorized as “At-Risk”. Patient predicted income (PPI) was modeled using 2017 US Census data for annual household income by patient residence census tract, categorized into low (&amp;lt;$34k), middle, and high (&amp;gt;$67k) thirds. ADRT rates were compared across variables, analyzed using Pearson’s Chi square testing, and geomapped by patient residence at the neighborhood (census tract) level. Results: 3,729 patients were included. 2,032 (54.5%) were Caucasian, 1,577 African American (42.3%), and 120 (3.2%) other. Insurance status was defined as Commercial, Medicare, or At Risk in 1,794 (48.1%), 1,503 (40.3%), and 432 (11.6%) patients. The mean PPI was $49,951 (range $10,871-$177,857). A total of 83,306 fractions (median 24, IQR 11-30) were delivered with 7,107 (8.5%) total interruptions. 727 interruptions (mean 0.19, range 0-21) were due to ADRT in 197 patients (5.3%). Minor interruption rates were significantly elevated in At Risk patients v. those with Commercial or Medicare insurance (7.4% v 3.5% p=&amp;lt;0.0001; OR 2.21 [95%CI 1.47-3.31]), African American v. Caucasian patients (5.1% v 3.1% p=0.002; OR 1.66 [95%CI 1.19-2.32]), and low PPI v. high PPI patients (5.2% v 2.5% p=&amp;lt;0.0005; OR 2.17 [95%CI 1.39-3.39]). Major interruption rates were similar across all groups: At Risk v. Commercial or Medicare insurance (1.6% v 1.2% p=0.591; OR 1.25 [95%CI 0.55-2.79]), African American v. Caucasian ([1.3% v 1.4% p=0.74; OR 0.91 [95%CI 0.51-1.61]), and low PPI v. high PPI (1.4% v 1.3% p=0.93; OR 1.03 [95%CI 0.52-2.05]). Elevated minor interruption rates were geographically associated with low income, predominately African American neighborhoods across our treatment region. Conclusion: At our high-volume academic radiotherapy practice, hospital admission during RT correlated significantly with uninsured or Medicaid coverage status, African American race, and low predicted income and mapped to low income neighborhoods, suggesting limited care access for these populations. Major hotspot locations have been identified, setting the stage for targeted studies to close gaps in RT quality. Citation Format: Daniel V Wakefield, Matthew Carnell, Bo Jiang, Austin Dove, Wesley Garner, Drucilla Edmonston, Adam Hubler, Esra Ozdenerol, Ryan Hanson, Maria Pisu, David L Schwartz, David L Schwarts. Neighborhood, race and insurance predict for hospital admission during radiation therapy [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A124.

Mechanism, frequency, transfusion and outcome of severe trauma in coagulopathic paediatric patients

PurposeAcute traumatic coagulopathy can result in uncontrolled haemorrhage responsible for the majority of early deaths after adult trauma. Data on the frequency, transfusion practice and outcome of severe trauma haemorrhage in paediatric patients are inconsistent.MethodsDatasets from paediatric trauma patients were retrieved from the registry of the German trauma society (TR-DGU®) between 2009 and 2016. Coagulopathy was defined by a Quick’s value < 70% (INR (international normalized ratio) > 1.4) and/or thrombocytes ≤ 100 k upon emergency room admission. Children were grouped according to age in 4 different groups (A: 1–5, B: 6–10, C: 11–15 and D: 16–17 years). Prevalence of coagulopathy was assessed. Demographics, injury severity, haemostatic management including transfusions and mortality were described.Results5351 primary admitted children ≤ 17 years with an abbreviated injury scale (AIS) ≥ 3 and complete datasets were included. The prevalence of coagulopathy was 13.7% (733/5351). The majority of the children sustained blunt trauma (more than 90% independent of age group) and a combination of traumatic brain injury (TBI) and any other trauma in more than 60% (A, C, D) and in 53.8% in group B. Coagulopathy occurred the most among the youngest (A: 18.2%), followed by all other age groups with approximately 13%. Overall mortality was the highest in the youngest (A: 40.9%) and among the youngest patients with traumatic brain injury (A: 71.4% and B: 47.1%). Transfusion of packed red blood cells (pRBCs) and fresh frozen plasma (FFPs) occurred almost in a 2:1 ratio (or less) across all age subgroups.ConclusionTraumatic haemorrhage in association with coagulopathy and severe shock is a major challenge in paediatric trauma across all age groups.

Risk factors associated to infectious complications in children with febrile neutropenia induced by chemotherapy: A cohort study.

e22535 Background: Children cancer is the second cause of mortality, most of deaths are related to infectious complications due to immunosuppression provoked by chemotherapy. Febrile neutropenia is one of the most common issues in oncological patients and it’s considered an emergency. Studies have tried risk predicting models implementation, although they still need to be validated, updated and reproducible in different scenarios. The aim of this study was the early identification of conditioning factors to severe infectious complications in patients with febrile neutropenia that would allow taking decisions for diagnosis and treatment. Methods: We present a prospective cohort study that estimated the risk associated to clinical and paraclinical factors and the development of infectious complications in pediatric patients with febrile neutropenia induced by chemotherapy on their admission of an emergency room (ER). The clinical features analyzed were: age, type of cancer, chemotherapy regime, time between chemotherapy administration and ER admission, use of colony-stimulating factors, presence of central venous catheter, highest temperature registered, tachycardia, polypnea, hypoxemia and hypotension. The paraclinical features included were leucocyte, neutrophil and monocyte count, and C-reactive protein levels. Results: From 186 febrile neutropenia events, 101 cases reported infectious complications (54%). Clinical infection was the most frequent issue (38%). On the multivariate analysis we found that the features independently associated to infectious complication were tachycardia (OR1.07, CI95% 1.70-6.99) and highest temperature level reported in the ER (OR1.07, CI95% 1.00-1.13). Conclusions: Febrile neutropenia is the most common complication in pediatric oncological patients and it is related to life-threatening infections and high mortality rate. Risk prediction during the initial assessment in the ER is important to stratify patients and offer target therapy to decrease complications and prolonged hospitalization.

National Comprehensive Cancer Network (NCCN) category I/FDA-approved metastatic pancreatic adenocarcinoma (mPDAC) treatments in commercially insured patients: An analysis of inpatient (IP) and emergency room (ER) admissions.

e16739 Background: There are currently four NCCN category 1 systemic regimens approved in the United States for the treatment of mPDAC: FOLFIRINOX (FFX), gemcitabine+nab-paclitaxel (gem+nab-P), gemcitabine monotherapy (gem), and liposomal irinotecan + 5-fluorouracil/leucovorin (5-FU/LV) following progression with gem-based therapy. There is limited real-world research on the IP admissions and ER visit healthcare resource utilization (HRU) of patients receiving these treatments. Methods: Using the IQVIA PharMetrics Plus administrative claims database, data were analyzed for adult patients with mPDAC treated with NCCN category 1 regimens in first through fourth line of therapy between January 1, 2014 and May 31, 2019. For each line of therapy, continuous treatment was defined as the time from first administration of a therapy until the last administration. Mean all-cause and mPDAC-related IP admissions, ER visits, inpatient length of stay (LOS) during treatment were assessed. Results: Of the 2,731 patients with mPDAC included in the study, 101 (3.7%) were treated with a liposomal irinotecan based regimen, 1,316 (48.2%) were treated with gem+nab-P, 612 (22.4%) with FFX, and 624 (22.8%) with gem in any treatment line. The mean number of IP admissions was 1.2 for liposomal irinotecan treated patients, 1.5 for gem+nab-P, 1.5 for FFX, and 1.2 for gem. Among patients with at least one IP admission the mean LOS was 4.5 days for liposomal irinotecan, 5.4 days for gem+nab-P, 3.8 for FFX, and 5.1 for gem treated patients. Patients treated with liposomal irinotecan had a mean of 1.3 ER visits during treatment. Gem+nab-P, FFX, and gem-treated patients experienced 1.7, 1.4, and 1.8 mean ER visits, respectively. Mean mPDAC-related IP admissions ranged from 1.1 – 1.5, ER visits ranged from 1.1 – 1.7, and mean LOS ranged from 3.8 – 5.5 days. Conclusions: In this descriptive retrospective study patients receiving liposomal irinotecan, across all treatment episodes, generally experienced numerically lower mean IP admissions and ER visits. LOS was similar across all regimens. Further studies are necessary to characterize the IP and ER HRU burden among mPDAC patients treated with approved regimens.

Percepción de la Pandemia COVID-19 en los Servicios de Cirugía en Colombia

Introducción. La pandemia por COVID-19 ha llevado a modificar la estructura asistencial en los hospitales alrededor del mundo, buscando la mejor forma de adaptarse para responder al incremento de pacientes infectados por el virus, sin desantender las necesidades de los pacientes no afectados por el mismo. El objetivo de este trabajo es describir la percepción de la comunidad quirúrgica sobre el impacto que ha tenido la pandemia COVID-19 en los servicios de cirugía en Colombia.&#x0D; Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada compuesta por 10 preguntas de selección múltiple y 8 preguntas con items tipo Likert. Se distribuyó electrónicamente a residentes de cirugía general, cirujanos generales o sub-especialistas que tuvieran práctica clínica en Colombia. &#x0D; Resultados. Se incluyeron 464 participantes, 27.8 % fueron mujeres y 45.3 % cirujanos generales. Alrededor de la mitad residían en Bogotá (51.4 %) o trabajaban en un hospital universitario privado (48.3 %). El 78.8% de los encuestados consideraron que las recomendaciones de seguridad son efectivas y 76.6% se sienten seguros realizando procedimientos con ellas. Sin embargo, el 63% consideran que estas se cumplen parcialmente. Hasta el momento, 20% de los participantes reportó haber tenido contacto directo con pacientes COVID-19 positivos. Finalmente, la mayoría (93%) estan de acuerdo con la cancelación de procedimientos electivos y estan dispuestos a ser reubicados en otros servicios en caso de ser necesario.&#x0D; Conclusiones. Para el inicio de la fase de mitigación en Colombia existe consenso en la percepción del impacto de la pandemia COVID-19 en los servicios de cirugía. No se observó una variabilidad significativa respecto al nivel de entrenamiento ni al tipo institución hospitalaria.