General Inpatient Population Research Articles

Effectiveness of Nursing Strategies on Risk for Pneumonia Among Patients Connected to Mechanical Ventilator in Intensive Care Unit

It has been reported that the incidence of nosocomial infections in the ICU is about 2–5 times higher than in the general in-patient hospital population. The study's objective was to evaluate the effectiveness of Nursing Strategies on Risk for Pneumonia among Patients connected to Mechanical Ventilator in Intensive Care Unit. The study adopted randomized controlled trial. Forty patients were enrolled in the study after screening using CPIS scale. If the score <6 the patients were included in the study and eligibility criteria were age between 25 to 60 years, duration of ventilator 48 hours and medical patients with respiratory, renal, MODS, and sepsis diagnosis. Patients subjected to surgery and connected with non-invasive ventilation were excluded from the study. Standardized questionnaire such as demographic variables, clinical variables, and Clinical Pulmonary Infection Scoring (CPIS). The data was analyzed using descriptive statistics, independent ‘t’ test, paired t test and ANOVA were used to analyze the data. Seven (35%) of them were in the age group of 51-60 years in the study group, whereas six (30%) of the patients were in the age group of 61-70 years in the control group. 12(60%) of the patients were male and eight (40%) of them were female in the study group and 10(50%) of patients were male and female respectively in the control group. Regarding mode of ventilation, 12(50%) and six (30%) of patients ventilator setting were CMV and ASV respectively, in the study group, whereas seven (35%) and six (30%) of patients ventilator settings were ASV and CMV respectively in the control group. The pretest CPIS mean score was 4.40 with a standard deviation of 0.59 and the posttest III mean value was 2.60 with a standard deviation of 0.58 and the mean difference was 1.80 between the pretest and the posttest III, which was statistically significant at p<0.001 in the study group. Nursing strategies such as demand suctioning, second hourly position change, changing ventilator flow sensor every 72 hours, and oral care every fourth hour with chlorhexidine help reduce ventilator-associated pneumonia.

Depression, anxiety, and poor well-being at discharge from psychiatric hospitals: prevalence and risk factors.

Being ready for discharge is vital to successful hospital-to-home transitions. For many patients, however, the transition from psychiatric hospital care to outpatient care can be challenging. An in-depth understanding of the mental health conditions of patients at discharge is crucial and instructive for recovery research. The purpose of this study was to determine the prevalence and risk factors of depression, anxiety, and poor well-being symptoms among patients who are about to be discharged from psychiatric units in Alberta, Canada. Our aim was to help determine the prevalence of anxiety, depression, and overall well-being among the general psychiatric inpatient population in Alberta before discharge and the potential factors which may influence this. This epidemiological study used a cross-sectional quantitative survey from March 8, 2022, to November 5, 2023, to assess depression, anxiety, and well-being. Participants were invited to complete an online questionnaire that contained demographics, clinical information, and responses to the PHQ-9, GAD-7, and WHO-5 questionnaires. SPSS version 25 was used to analyze the data. Descriptive, univariate, and multivariate regression analyses were employed. The study found that the prevalence of likely depression, anxiety, and poor well-being among patients about to be discharged was 37.1%, 56.4%, and 48.3%, respectively. Based on a logistic regression model, there was a statistically significant association between anxiety, depression, and poor well-being diagnoses and multiple socio-demographic and clinical factors such as ethnicity, primary mental health diagnoses, education level, housing status, depression, anxiety, and well-being at baseline. Mental health assessment at discharge is a critical step in the recovery and transition of care. There is still a need for further research to identify the underlying causes and robust predictors of mental health symptoms in patients about to be discharged and to provide appropriate interventions and supportive resources both before and following discharge. Future research utilizing these findings may help identify key opportunities to improve outcomes for patients after discharge.

A joint program of antimicrobial stewardship and hospital-acquired infection control to reduce healthcare-associated infections after kidney transplantation: The Hipomenes study

Infection is a common complication in kidney transplant recipients (KTRs). The usefulness of antimicrobial stewardship programs (ASP) and hospital-acquired infection control (HAIC) initiatives in the general inpatient population is well established. We performed a quasi-experimental study to evaluate a joint ASP/HAIC initiative focused on KTRs. A dedicated ASP team optimized antimicrobial prescriptions in consecutive KTRs during the intervention period (June 2015-March 2016). A multifaceted, evidence-based HAIC program was concurrently implemented. Results were compared with the preceding period (June 2014-March 2015). We included 96 and 100 KTRs in the intervention and preintervention periods, respectively. There was a reduction in the consumption of meropenem (rate ratio [RR]: 0.63; 95% confidence interval [CI]: 0.53-0.75; P <.0001), ceftazidime (RR: 0.31; 95% CI: 0.21-0.45; P <.0001), vancomycin (RR: 0.65; 95% CI: 0.53-0.8; P <.0001), and ciprofloxacin (RR: 0.66; 95% CI: 0.55-0.81; P <.0001) and an increase of fosfomycin (RR: 1.80; 95% CI: 1.17-2.76; P =.008) during the intervention period. The incidence of cystitis (RR: 0.30; 95% CI: 0.28-0.33; P <.001) and upper urinary tract infection (RR: 0.56; 95% CI: 0.33-0.95; P =.04) decreased. A specific ASP/HAIC initiative was effective in optimizing antimicrobial use and reducing the incidence of common bacterial infections among KTRs.

Prevalence and pattern of multidrug resistant Gram-negative bacilli isolated from patients in the intensive care unit of a tertiary care hospital in Coastal Karnataka

Infections due to Gram negative bacilli (GNB) are the leading cause of mortality in ICU patients and are associated with higher morbidity rates, longer hospital stays and increased healthcare expenditures. Infections due to GNB in the ICU is about 2 to 5 times higher than in the general in-patient hospital population. This study aims to look at the prevalence of multi drug resistant gram-negative bacilli and proportion of ESBL producers in the MICU and to determine susceptibility patterns of GNB isolated, to various antibiotics. A total of 616 samples were collected from 396 patients admitted to the MICU during the 4-month study period. After the samples were inoculated and identified, the gram-negative isolates were subjected to Antibiotic susceptibility testing using Kirby Bauer Disc Diffusion technique with 17 different antibiotic disks. Strains showing decreased sensitivity to Ceftazidime/Cefotaxime were screened for ESBL production. Among the 616 samples tested, 149 (24.2%) samples showed growth of Gram-negative bacteria exclusively. Total number of GNB’s isolated were 173 due to some samples showing polymicrobial growth. The most common GNB found was (27.7%) which was followed by Klebsiella pneumonia at 26.0% and Acinetobacter baumannii at 18.5%. 64.2% of all GNB’s were Multi Drug Resistant which included 75% , 71.1% Klebsiella pneumoniae and 84.4% Acinetobacter baumannii. The study shows that the MDR GNB infections are on the rise in the ICU with GNBs being highly resistant to many previously effective first line antibiotics like Penicillins, newer Cephalosporins and Fluoroquinolones with susceptibility rates below 25% and even 0% for earlier generation Cephalosporins.

Clinicians' Perceptions of an Artificial Intelligence-Based Blood Utilization Calculator: Qualitative Exploratory Study.

According to the US Food and Drug Administration Center for Biologics Evaluation and Research, health care systems have been experiencing blood transfusion overuse. To minimize the overuse of blood product transfusions, a proprietary artificial intelligence (AI)-based blood utilization calculator (BUC) was developed and integrated into a US hospital's electronic health record. Despite the promising performance of the BUC, this technology remains underused in the clinical setting. This study aims to explore how clinicians perceived this AI-based decision support system and, consequently, understand the factors hindering BUC use. We interviewed 10 clinicians (BUC users) until the data saturation point was reached. The interviews were conducted over a web-based platform and were recorded. The audiovisual recordings were then anonymously transcribed verbatim. We used an inductive-deductive thematic analysis to analyze the transcripts, which involved applying predetermined themes to the data (deductive) and consecutively identifying new themes as they emerged in the data (inductive). We identified the following two themes: (1) workload and usability and (2) clinical decision-making. Clinicians acknowledged the ease of use and usefulness of the BUC for the general inpatient population. The clinicians also found the BUC to be useful in making decisions related to blood transfusion. However, some clinicians found the technology to be confusing due to inconsistent automation across different blood work processes. This study highlights that analytical efficacy alone does not ensure technology use or acceptance. The overall system's design, user perception, and users' knowledge of the technology are equally important and necessary (limitations, functionality, purpose, and scope). Therefore, the effective integration of AI-based decision support systems, such as the BUC, mandates multidisciplinary engagement, ensuring the adequate initial and recurrent training of AI users while maintaining high analytical efficacy and validity. As a final takeaway, the design of AI systems that are made to perform specific tasks must be self-explanatory, so that the users can easily understand how and when to use the technology. Using any technology on a population for whom it was not initially designed will hinder user perception and the technology's use.

Development and validation of an early warning model for hospitalized COVID-19 patients: a multi-center retrospective cohort study

BackgroundTimely identification of deteriorating COVID-19 patients is needed to guide changes in clinical management and admission to intensive care units (ICUs). There is significant concern that widely used Early warning scores (EWSs) underestimate illness severity in COVID-19 patients and therefore, we developed an early warning model specifically for COVID-19 patients.MethodsWe retrospectively collected electronic medical record data to extract predictors and used these to fit a random forest model. To simulate the situation in which the model would have been developed after the first and implemented during the second COVID-19 ‘wave’ in the Netherlands, we performed a temporal validation by splitting all included patients into groups admitted before and after August 1, 2020. Furthermore, we propose a method for dynamic model updating to retain model performance over time. We evaluated model discrimination and calibration, performed a decision curve analysis, and quantified the importance of predictors using SHapley Additive exPlanations values.ResultsWe included 3514 COVID-19 patient admissions from six Dutch hospitals between February 2020 and May 2021, and included a total of 18 predictors for model fitting. The model showed a higher discriminative performance in terms of partial area under the receiver operating characteristic curve (0.82 [0.80–0.84]) compared to the National early warning score (0.72 [0.69–0.74]) and the Modified early warning score (0.67 [0.65–0.69]), a greater net benefit over a range of clinically relevant model thresholds, and relatively good calibration (intercept = 0.03 [− 0.09 to 0.14], slope = 0.79 [0.73–0.86]).ConclusionsThis study shows the potential benefit of moving from early warning models for the general inpatient population to models for specific patient groups. Further (independent) validation of the model is needed.

33288 Hidradenitis suppurativa and dermatologic comorbidities in adults: A national-cross sectional study

Hidradenitis suppurativa (HS) is a rare chronic, inflammatory condition characterized by the development of painful sinus tracts and is associated with numerous comorbidities. Several studies demonstrate an association of HS with pyoderma gangrenosum and acne conglobata, but there has been no broad-spectrum investigation into the dermatologic comorbidities associated with HS using nationally representative data. We analyzed the 2016-2018 National Inpatient Sample, a cross-sectional sample of 20% of all U.S. hospitalizations, for adult patients with and without HS. Compared with the general inpatient population, associations of HS with 25 dermatologic conditions were determined using multivariable logistic regression, adjusting for age, race, sex, and insurance type. Overall, 90,879,561 total hospitalizations were identified, with 62,785 having a diagnosis of HS. As seen previously, HS was more likely to affect females and Black patients. The prevalence of having any of the 25 dermatologic conditions was higher in patients with HS (24.60%, 95% confidence interval [CI]: 23.82%-25.42%) than without (5.30%, 95% CI: 5.26%-5.33%). In multivariable logistic regression models controlling for age, sex, race, and insurance type, HS was associated with having any dermatologic condition (adjusted odds ratio 7.17, 95% CI: 6.86-7.50). Specifically, HS was associated with 18 of the 25 dermatologic conditions. Our research highlights the association between HS and several dermatologic conditions not previously reported. While this study validates the complexity of the HS disease process, more research into HS pathology and etiology is strongly warranted.

Molecular characterization and antibiotic resistance of Clostridioides difficile in patients with inflammatory bowel disease from two hospitals in China

Patients with inflammatory bowel disease (IBD) are susceptible to Clostridioides difficile infection (CDI), resulting in poor outcomes and recurrence; therefore, the molecular characterization of C. difficile in IBD patients in China needs further investigation. C. difficile strains were isolated and identified from faecal samples of adult and paediatric IBD patients. Toxigenic strains were typed using multilocus sequence typing and whole genomic sequencing (WGS) to construct the phylogenetic tree. Susceptibility to 10 antimicrobials was evaluated using the Etest. Among the 838 IBD patients, 82 toxigenic C. difficile were identified, which comprised 46 from adults and 36 children. A total of 90.2% (74/82) of the isolates were positive for both toxin A and toxin B genes (A+B+), whereas the remaining 9.8% were negative for toxin A gene but positive for toxin B gene (A-B+). These toxigenic strains were susceptible to metronidazole and vancomycin, but highly resistant to clindamycin, erythromycin, and fluoroquinolones. All moxifloxacin-resistant isolates had mutations resulting in an amino acid substitution in gryA (T82I). The dominant types were ST-35 (20.7%), ST-2 (17.1%), ST-54 (13.4%), and ST-3 (13.4%) in all patients. The incidence and molecular epidemiology of C. difficile infection in adult IBD patients resembled CDI in the general inpatient population. A higher antibiotic resistance rate was identified among the C. difficile isolates obtained from paediatric IBD patients than from adult patients, and a few STs accounted for most multidrug-resistant strains. However, the molecular genetic features of the same ST type between these two groups remains highly correlated.

Primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome: analysis of the National Inpatient Sample.

Primary angiitis of the central nervous system (PACNS) and reversible cerebral vasoconstriction syndrome (RCVS) are two rare syndromes that affect the cerebral vasculature. Both conditions have been shown to cause severe neurologic complications. Distinguishing these two conditions in clinical practice is often challenging. Here, we compare the clinical features and outcomes of RCVS and PACNS hospitalizations against the general adult inpatient population. We conducted a retrospective review of hospitalizations with a diagnosis of PACNS or RCVS from 2016 to 2018 in the National Inpatient Sample (NIS) database. Multivariate analysis was performed to calculate adjusted odds ratios (ORadj) for hospital outcomes. In the NIS, 3305 hospitalizations had a diagnosis of RCVS and 6035 hospitalizations had a diagnosis of PACNS. RCVS hospitalizations had a significantly greater association with cerebral aneurysms (ORadj 23.80), hemiplegia/hemiparesis following subarachnoid hemorrhage (SAH) (ORadj 324.09), ischemic stroke (ORadj 7.59), and nontraumatic SAH (ORadj 253.61). PACNS hospitalizations had a significantly greater association with hemiplegia/hemiparesis following cerebrovascular accident (CVA) (ORadj 6.16), ischemic stroke (ORadj 11.55), nontraumatic SAH (ORadj 7.29), seizure (ORadj 2.49), and in-hospital mortality (ORadj 2.85). We performed an analysis of the NIS to better understand RCVS and PACNS hospitalizations. Severe neurologic events including CVA and SAH were elevated in both, but SAH and related hemiplegia/hemiparesis were extremely common among RCVS hospitalizations. In-hospital mortality was elevated in PACNS but not RCVS. This information can be used to help clinicians better understand, distinguish, and diagnose these conditions. Key Points • Despite clear description of RCVS and PACNS in the medical literature, there remains a scarcity of national population-based studies comparing these two entities against the general adult inpatient population. • This study aims to fill knowledge gaps in this area. • Here, we compare the clinical features and outcomes of RCVS and PACNS hospitalizations against the general adult inpatient population.

Development and Structure of an Accurate Machine Learning Algorithm to Predict Inpatient Mortality and Hospice Outcomes in the Coronavirus Disease 2019 Era.

Background:The coronavirus disease 2019 (COVID-19) pandemic has challenged the accuracy and racial biases present in traditional mortality scores. An accurate prognostic model that can be applied to hospitalized patients irrespective of race or COVID-19 status may benefit patient care.Research Design:This cohort study utilized historical and ongoing electronic health record features to develop and validate a deep-learning model applied on the second day of admission predicting a composite outcome of in-hospital mortality, discharge to hospice, or death within 30 days of admission. Model features included patient demographics, diagnoses, procedures, inpatient medications, laboratory values, vital signs, and substance use history. Conventional performance metrics were assessed, and subgroup analysis was performed based on race, COVID-19 status, and intensive care unit admission.Subjects:A total of 35,521 patients hospitalized between April 2020 and October 2020 at a single health care system including a tertiary academic referral center and 9 community hospitals.Results:Of 35,521 patients, including 9831 non-White patients and 2020 COVID-19 patients, 2838 (8.0%) met the composite outcome. Patients who experienced the composite outcome were older (73 vs. 61 y old) with similar sex and race distributions between groups. The model achieved an area under the receiver operating characteristic curve of 0.89 (95% confidence interval: 0.88, 0.91) and an average positive predictive value of 0.46 (0.40, 0.52). Model performance did not differ significantly in White (0.89) and non-White (0.90) subgroups or when grouping by COVID-19 status and intensive care unit admission.Conclusion:A deep-learning model using large-volume, structured electronic health record data can effectively predict short-term mortality or hospice outcomes on the second day of admission in the general inpatient population without significant racial bias.

Epidemiology of cerebral venous sinus thrombosis and cerebral venous sinus thrombosis with thrombocytopenia in the United States, 2018 and 2019

BackgroundPopulation‐based data about cerebral venous sinus thrombosis (CVST) are limited. ObjectivesTo investigate the epidemiology of CVST in the United States. Patients/MethodsThree administrative data systems were analyzed: the 2018 Healthcare Cost and Utilization Project National Inpatient Sample (NIS) the 2019 IBM MarketScan Commercial and Medicare Supplemental Claims Database, and the 2019 IBM MarketScan Multi‐state Medicaid Database. CVST, thrombocytopenia, and numerous comorbidities were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Incidence rates of CVST and CVST with thrombocytopenia were estimated (per 100,000 total US population [NIS] and per 100,000 population aged 0 to 64 years covered by relevant contributing health plans [MarketScan samples]). Comorbidity prevalence was estimated among CVST cases versus total inpatients in the NIS sample. Recent pregnancy prevalence was estimated for the Commercial sample. ResultsIncidence rates of CVST in NIS, Commercial, and Medicaid samples were 2.85, 2.45, and 3.16, respectively. Incidence rates of CVST with thrombocytopenia were 0.21, 0.22, and 0.16, respectively. In all samples, CVST incidence increased with age; however, peak incidence was reached at younger ages in females than males. Compared with the general inpatient population, persons with CVST had higher prevalences of hemorrhagic stroke, ischemic stroke, other venous thromboembolism (VTE), central nervous system infection, head or neck infection, prior VTE, thrombophilia, malignancy, head injury, hemorrhagic disorder, and connective tissue disorders. Women aged 18 to 49 years with CVST had a higher pregnancy prevalence than the same‐aged general population. ConclusionsOur findings provide recent and comprehensive data on the epidemiology of CVST and CVST with thrombocytopenia.

Clotting events among hospitalized patients infected with COVID-19 in a large multisite cohort in the United States.

IntroductionCOVID-19 infection has been hypothesized to precipitate venous and arterial clotting events more frequently than other illnesses.Materials and methodsWe demonstrate this increased risk of blood clots by comparing rates of venous and arterial clotting events in 4400 hospitalized COVID-19 patients in a large multisite clinical network in the United States examined from April through June of 2020, to patients hospitalized for non-COVID illness and influenza during the same time period and in 2019.ResultsWe demonstrate that COVID-19 increases the risk of venous thrombosis by two-fold compared to the general inpatient population and compared to people with influenza infection. Arterial and venous thrombosis were both common occurrences among patients with COVID-19 infection. Risk factors for thrombosis included male gender, older age, and diabetes. Patients with venous or arterial thrombosis had high rates of admission to the ICU, re-admission to the hospital, and death.ConclusionGiven the ongoing scientific discussion about the impact of clotting on COVID-19 disease progression, these results highlight the need to further elucidate the role of anticoagulation in COVID-19 patients, particularly outside the intensive care unit setting. Additionally, concerns regarding clotting and COVID-19 vaccines highlight the importance of addressing the alarmingly high rate of clotting events during actual COVID-19 infection when weighing the risks and benefits of vaccination.

Prevalence and impact of takotsubo syndrome in hospitalizations for acute ischemic stroke

Takotsubo syndrome (TTS) is characterized by acute and reversible left ventricular dysfunction with apical ballooning arising during acute stress situations. Acute ischemic stroke (AIS) is one of the known triggers of TTS; however, the impact of TTS on in-hospital outcomes of AIS remains unexplored. We utilized data from the National Inpatient Sample (2007–2014) to identify admissions for AIS with TTS and evaluated the temporal trends, baseline characteristics, in-hospital complications, length of stay, and all-cause mortality. Survey multivariable logistic regression was used to compute adjusted odds ratios (OR) and 95% confidence intervals (CI). An estimated 2242 (0.4%) TTS cases were identified among AIS hospitalizations (N = 4,392,471). The frequency of TTS was higher in elderly, white, and female patients. After adjustment for confounders, TTS incidence in AIS was associated with higher odds of in-hospital complications including cardiogenic shock (OR 8.84, CI 4.07–19.17, P < 0.001), cardiac arrest (OR 3.17, CI 1.57–6.42, P = 0.001), and venous thromboembolism (OR 1.68, CI 1.14–2.47, P = 0.008). Moreover, AIS hospitalizations with TTS showed higher odds of developing respiratory failure (OR 3.13, CI 2.42–4.05, P < 0.001) and requiring mechanical ventilation/intubation (OR 4.09, CI 3.14–5.32, P < 0.001) compared to the non-TTS cohort. The AIS-TTS cohort had a longer length of stay (8.59 vs 5.22 days), and their mortality rate was twice (10.2% vs 5.1%; P < 0.001) that of those without TTS. In conclusion, the prevalence of TTS in AIS remained ∼20 times higher than in the general inpatient population and predisposed AIS patients to worse inpatient outcomes. Further studies are needed to evaluate the impact of TTS on long-term outcomes in AIS.

Hyperammonemia in patients receiving valproic acid in the hospital setting: A retrospective review.

IntroductionValproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric conditions. The reported incidences of hyperammonemia induced by VPA use is variable. The purpose of this study is to evaluate the incidence of VPA-induced hyperammonemia in the general adult inpatient population.MethodsAdult patients who received at least 1 dose of VPA and derivatives between June 1, 2017 to December 31, 2017 were included. Patients were excluded if they did not have VPA administered during their inpatient stay or if they had elevated ammonia levels (>33 μmol/L) prior to initiation of VPA. Patients with a confirmed diagnosis of liver cirrhosis were also excluded. The primary endpoint was the incidence of hyperammonemia. Secondary outcomes included symptoms of hyperammonemia, diagnosis of VPA-induced hyperammonemia, and treatment of VPA-induced hyperammonemia.ResultsA total of 162 patients were included in this study. A total of 33 (20.4%) patients were identified as having the primary outcome of hyperammonemia; 26 (16.0%) patients had symptoms of hyperammonemia, and 13 (8.0%) patients were diagnosed with VPA-induced hyperammonemia. Treatment modalities included administration of lactulose, levocarnitine, discontinuing VPA, or decreasing the VPA dose.DiscussionThe administration of VPA in the general adult inpatient population resulted in a 20.4% incidence of hyperammonemia, with a lower rate of diagnosed VPA-induced hyperammonemia. Clinicians should be encouraged to obtain ammonia levels in patients receiving VPA if symptoms of altered mental status or encephalopathy develop.

The Relationship Between Obstructive Sleep Apnea and Pediatric Obesity: A Nationwide Analysis.

Pediatric obstructive sleep apnea (OSA) can have both acute and chronic consequences when untreated. We hypothesize that a link exists between childhood obesity and OSA at nationwide level, with race, gender, and socioeconomic status conferring their own risk for pediatric OSA. This study examined nationwide discharges in 2016 using the Kids' Inpatient Database (KID). The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for obesity (E66.0) and OSA (G47.33) were used. Prevalence rates and odds ratios (ORs) were used to quantify associations between the obesity and OSA groups in the general pediatric inpatient population. Multiple binary logistic regression was utilized to compare cohorts of pediatric inpatient admissions. There were 36 266 285 weighted discharges in the 2016 KID. Among patients included in our dataset, 0.426% (26 684) were diagnosed with obesity and 0.562% (35 242) had OSA. Obesity was independently associated with a significantly increased risk of OSA (OR = 22.89; 95% C.I. = 21.99-23.84). Within the OSA inpatient population, obesity was associated with non-Hispanic black race, Hispanic ethnicity, and Native American race/ethnicity (OR = 1.45, 1.32, 2.51; 95% C.I. = 1.33-1.58, 1.21-1.44, 1.73-3.63). Obesity is independently associated with OSA in children after controlling for adenotonsillar hypertrophy. Non-Hispanic black race and Hispanic ethnicity are independent risk factors for OSA and are associated with obesity in the OSA inpatient population, which suggests that obesity may play a role in the increased risk of OSA within these groups.

Perioperative Implications of the 2020 American Heart Association Scientific Statement on Drug-Induced Arrhythmias—A Focused Review

The recently released American Heart Association (AHA) scientific statement on drug-induced arrhythmias discussed medications commonly associated with bradycardia, supraventricular tachycardias, and ventricular arrhythmias. The foundational data for this statement were collected from general outpatient and inpatient populations. Patients undergoing surgical and minimally invasive treatments are a unique subgroup, because they may experience hemodynamic changes associated with anesthesia and their procedure, receive multiple drug combinations not given in either inpatient or outpatient settings, or experience postprocedural inflammatory syndromes. Accordingly, the generalizability of the AHA scientific statement to this perioperative population is unclear. This focused review highlights important aspects of the new AHA scientific statement and their application to the perioperative setting. The authors review medications frequently encountered and given by anesthesiologists and their risk of drug-induced arrhythmias and discuss common anesthetic and adjunctive medications and their associated risks of bradycardia, atrial fibrillation, torsades de pointes, and drug-induced Brugada syndrome. In many instances, the risk of arrhythmia reported by the AHA scientific statement in the general population appeared to be higher than found in perioperative arenas. Furthermore, the authors discuss the arrhythmia risk of additional medications commonly ordered or administered by anesthesiologists that are not included in the AHA scientific statement. As patient and procedural complexity increases and novel anesthetic combinations propagate, further research and observational studies will be required to delineate further perioperative risks for drug-induced arrhythmia.

A Study of Nosocomial Infections in Intensive Care Units of Local Tertiary Care Hospitals

Introduction: It has been reported that the incidence of nosocomial infections in the intensive care unit (ICU) is about 2–5 times higher than in the general in-patient hospital population. The objectives of the present study were to determine the incidence of nosocomial infection, to identify possible risk factors for these infections, to clarify the distribution of the causative pathogens, and to evaluate the outcome of the infected patients in terms of length of ICU and hospital stay and mortality. Methods: This was a retrospective and analytical study. For classification of the different causative pathogens associated with nosocomial infections, all the microorganisms isolated on culture from each of the patients with confirmed infection according to the Centers for Disease Control and Prevention definitions were recorded and their relative frequency of isolation was determined as percentage. Bacterial isolates were identified by Gram stain, cultures on routine media and where necessary, selective media, and specific biochemical tests following standard protocols. Results: Nosocomial infections were in 28 patients. The most frequently diagnosed nosocomial infection was nosocomial pneumonia. A total of 39 pathogens were isolated on culture and accounted for the nosocomial infections in 28 patients. Some infections were polymicrobial. Gram-negative Enterobacteriaceae were the most frequently isolated pathogens. There was no statistically significant difference between the hospital mortality rates among the patients with and without nosocomial infection. Conclusion: Gram-negative Enterobacteriaceae, as a group, were the most frequently isolated pathogens, while Pseudomonas aeruginosa was the single most frequent causative organism. The acquisition of nosocomial infections in the ICU resulted in significantly increased length of ICU and hospital stay, but did not result in statistically significant increase in ICU or hospital mortality. These findings can now be utilized toward planning a surveillance program for nosocomial infection in our ICU setting as a first step toward a better infection control strategy.

Arrhythmia in tumor lysis syndrome and associated in-hospital mortality: A nationwide inpatient analysis.

BackgroundTumor lysis syndrome (TLS) is a life‐threatening oncologic emergency associated with fatal complications including arrhythmia. The epidemiology and mortality outcomes of arrhythmia in TLS are scarcely studied in the literature.MethodsWe used the National Inpatient Sample (NIS) to study the prevalence and outcome of arrhythmia in patients hospitalized with TLS (ICD‐9 code 277.88) from 2009 to 2014. Baseline characteristics, burden of arrhythmia, and pertinent outcomes were analyzed. Multivariable regression analysis was performed to identify the impact of underlying malignancy in predicting TLS‐related mortality.ResultsA total of 9034 cases of arrhythmia among 37 861 TLS patients were identified. More than half of the arrhythmia cases (67%) were found among white old (>65) males admitted to large bed size and urban teaching hospitals. Arrhythmic cohort showed higher frequency of comorbidities such as fluid‐electrolyte disturbances, hypertension, congestive heart failure, renal failure, dyslipidemia, diabetes, pulmonary circulatory disorders, chronic pulmonary disease, coagulopathy, and deficiency anemia. The most common malignancies were leukemia, lymphoma, metastatic tumor, and solid tumor without metastasis. We found significantly higher odds of in‐hospital mortality among patients with TLS compared to general inpatient population on unadjusted (OR 9.69, 95% CI: 9.27‐10.13, P < .001) and adjusted (OR 4.62, 95% CI: 4.39‐4.85) multivariable analyses. Overall in‐hospital mortality (32% vs 21.3%), median length of stay (11 days vs 9 days), and hospital charges were higher among arrhythmic than nonarrhythmic patients.ConclusionWith the availability of more advanced cancer therapy in the US, nearly one in four inpatient encounters of TLS had arrhythmia. Arrhythmia in TLS patients was associated with higher odds of mortality and increased resource utilization. Therefore, strategies to improve the supportive care of TLS patients plus timely diagnosis and treatment of arrhythmia are of utmost importance in reducing mortality and health‐care cost.

S0637 Incidence and Mortality of Gastrointestinal Hemorrhage Based on Anatomic Location of Gastrointestinal Tumors

INTRODUCTION: Gastrointestinal Hemorrhage (GIH) is common in patients with gastrointestinal tumors (GIT). Some literature studied the prevalence of GIT in GIH, but no previous research was inclusive for the incidence and mortality of GIH in all types of GIT. We aimed to study the incidence and mortality of GIH based on the anatomic location of GIT. METHODS: This was a retrospective cohort review of the 2016 National Inpatient Sample (NIS) database, which is the largest national inpatient database. NIS is drawn from all states and covers more than 97% of the U.S. population. Adult patients with age of 18 years or more were included in the analysis. ICD-10 CM codes were used to identify patients with GIH and GIT based on their anatomical location and primary or secondary status. Secondary GIT is defined as a metastatic tumor in the GI tract. Frequencies were presented in percentages. RESULTS: Out of more than 6 million hospitalizations studied, 145,624 cases (2.4%) had a diagnosis of GIT. Patients with GIT had significantly higher rates of GIH compared to patients without GIT (8.0% vs. 3.3%, P < 0.001). Incidence and mortality of GIH (Figure 1) in patients with primary GIT, respectively, are 9.5% and 9.7% in all primary tumors, 8.7% and 14.4% in esophageal, 15.2% and 7.5% in stomach, 12.1% and 6.4% in small bowel, 8.7% and 6.7% in colorectal, 12.1% and 17.7% in liver tumors, 6.3% and 15.5% in biliary, and 6.6% and 6.6% in others. Incidence and mortality of GIH in patients with secondary GIT are 6.6% and 15.2% in all secondary GIT, 11.8% and 10.9% in small bowel, 8.9%, and 12.2% in colorectal, 6.7% and 16.4% in liver, and 6.2% and 15.8% in others. CONCLUSION: GIT have a higher incidence of GIH compared to the general inpatient population. The most frequently bleeding primary GIT are gastric, small bowel, and liver tumors. The most frequently bleeding secondary GIT are small bowel, colorectal, and liver tumors. The highest mortality of hemorrhage appears to be in hepatobiliary tumors. Future studies should investigate the multifactorial relationship between GIH and GIT.Figure 1.: Histogram showing inpatient incidence and mortality of GIH based on the anatomic location of GIT.

Epidemiology and Outcomes of Takotsubo Syndrome in Hospitalizations With Systemic Sclerosis.

BackgroundSystemic Sclerosis (SSc) is associated with chronic inflammation which leads to macrophage activation and thus vascular insult and fibrosis. Macrophage activation is shown to precede Takotsubo syndrome (TTS) which may be a common pathophysiologic link to SSc. MethodsWe queried the National Inpatient Sample (2008-2014) for adult SSc-related hospitalizations and TTS using relevant International Classification of Diseases Clinical Modification, 9th Revision codes. We assessed the prevalence and trends in TTS during this time. We further assessed demographics, comorbidities, and outcomes were in SSc with and without TTS. The primary outcomes of the analysis were all-cause mortality and in-hospital complications including cardiac arrest and acute myocardial infarction (AMI), arrhythmias, and venous thromboembolism, and stroke. ResultsA total of 213,728 SSc-related hospitalizations were found, of which 357 experienced TTS (0.2%) with rising trends in TTS from 2008-2014 (0.06% to 0.3%, relative increase of 24%, ptrend<0.001). The TTS cohort was older (median age 68 vs 62 years), with 92.8% females and 80.1% white adults with TTS (p<0.001). Co-morbidities were higher in the TTS cohort including hypertension (62.2% vs. 51.5%, p<0.001), dyslipidemia (41.5% vs. 22.8, p<0.001), smoking (28.9% vs. 20.1%, p<0.001), peripheral vascular disease (17.8% vs. 9.1%, p<0.001), uncomplicated diabetes (18.1% vs. 11.9%, p<0.001). The all-cause in-hospital mortality (11% vs. 4.6%; adjusted odds ratio=1.82, 95% confidence interval: 1.21-2.72, p<0.005), cardiovascular complications like AMI (29% vs. 2.9%,p<0.001), arrhythmias (38.9% vs. 21.5%, p<0.001), and median length of stay [6 vs. 4 days] were significantly higher in the TTS cohort as compared to the non-TTS cohort.ConclusionThis analysis revealed a nearly 10 times higher prevalence of TTS in SSc-related hospitalizations compared to the general inpatient population. Concomitant TTS occurrence in SSc-related hospitalizations led to nearly two times higher odds of all-cause mortality. Cardiovascular co-morbidities in SSc may increase the risk of TTS and worsened outcomes.