Higher Risk Of Admission Research Articles

Natural Language Processing Identification of Symptoms in Emergency Department Visits in Patients Receiving Radiation

Patients undergoing radiotherapy (RT) for cancer often require emergency department (ED) attention with possible hospitalization. Designing strategies to mitigate hospital admissions requires understanding the causal symptoms to tailor interventional strategies. Natural language processing (NLP) has previously been shown to accurately identify documented symptoms and may help characterize factors contributing to admission. The objective of this study was to use NLP to identify documented symptoms during ED visits and their association with subsequent hospital admission of patients undergoing RT. A de-identified, single tertiary-care institution cohort of patients who received radiation between 2013 and 2022 was identified from the electronic health record using International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. We applied a previously validated clinical Text Analysis and Knowledge Extraction System (cTAKES)-based NLP pipeline to extract Common Terminology Criteria for Adverse Events (CTCAE) encoded symptoms from ED encounter clinical notes. Chi-squared testing was used to compare demographics, and logistic regression was used to identify symptoms associated with subsequent admission from ED visits. We identified 14,007 patients who received radiation, of whom 270 (1.9%) experienced 302 ED visits during their radiation course. 141 (46.7%) of ED visits resulted in an admission. Among patients with an ED encounter, there were no differences in admission rates based on primary language (p = 0.771), sex (p = 0.824), marital status (p = 0.753), race (p = 0.222), or age (p = 0.123). In admitted patients, the top 5 symptoms were pain (94.3%), nausea (92.1%), vomiting (73.7%), constipation (70.9%), and weakness (63.8%). In patients who did not require admission, the most common symptoms were pain (84.5%), nausea (67.1%), vomiting (47.2%), headache (36.6%), and weakness (35.4%). The 10 symptoms most associated with admission from the ED based on logistic regression were malaise (OR 21.7, [95% CI 10.1 - 51.0]), lethargy (19.1, [8.5 - 51.3]), flushing (15.7, [8.6 - 30.4]), agitation (12.4, [3.5 - 78.7]), somnolence (10.3, [4.7 - 25.9]), fall (8.5, [3.7 - 23.2]), fatigue (7.8, [4.6 - 13.4]), constipation (6.9, [4.2 - 11.6]), nausea (5.8, [3.0 - 12.2]), and swelling (5.4, [3.3 - 9.1]). Admitted and non-admitted ED patients with cancer seen in the ED during radiotherapy are documented to experience similar symptoms, but certain symptoms are associated with a higher risk of hospital admission. NLP may offer a mechanism for early, automated identification to facilitate supportive interventions for patients at high risk for admission during radiotherapy.

103 Impact of dedicated consultant geriatrician involvement on direct discharge of frail patients from the emergency department (ED): a pilot study

Abstract Background Timely assessment and tailored intervention by a dedicated multi-disciplinary Frailty Intervention Therapy Team (FITT) in ED helps facilitate direct discharge from ED of frail older people who may otherwise be admitted. We assessed the impact of additional consultant geriatrician involvement on safe admission avoidance in suitable older patients. Methods A consultant geriatrician, registrar and an ANP worked in conjunction with FITT, ED colleagues, and teams on call. This pilot service ran 9 am-5 pm Tuesdays to Thursdays. All patients >75y in the ED were recorded and discussed at regular huddles. Frail patients at high risk for admission had consultant geriatrician review, to facilitate discharge where possible. Results We completed 27 days over a 9-week period, with both registrar and ANP present on 17/27 (63%) days. 315 patients were discussed. Commonest reasons for presentation included falls (57%), generally unwell (15%) and abdominal pain (12%). Of those actively reviewed (165), 116 were discharged (70.3%; 4.3 patients daily). Mean age was 76y (75–101), 44% were > 80y and 71% were female. CFS was 5–8 in 64%. Most came from home (68%) or nursing home (29%). Rapid follow-up was arranged for outpatient/day hospital (38;33%), NH outreach (18;16%), ICPOP (8; 7%), falls/fracture clinics (6;5%), community allied professionals (4;3%) and Palliative services (2;1.7%). Of those discharged, 11 returned to ED within four weeks (9.5% return rate). Conclusion Geriatrician input with FITT and ANP services in ED efficiently facilitated additional daily discharges of frail patients who were at high risk for unnecessary admission. With a mean of 4.3 discharges a day, a five day service should achieve 1,118 discharges a year. Allowing for a return rate of 9.5% and a mean length of stay of 14 days, such annual discharges would result in 14,168 bed days saved annually, well in excess of the annual bed-days activity on a 35 bed ward.

No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation.

Patients suffering from schizophrenia are at high risk for admission and treatment in locked units. This study investigated gender differences in the pharmacological emergency treatment of schizophrenia patients over a 21-year observation period. The current retrospective study was conducted at the Division of Psychiatry I of the Medical University Innsbruck. All adult patients (n = 845; 425 female) suffering from schizophrenia who were admitted involuntarily to one of the acute psychiatric units in the years 1997, 2002, 2007, 2012 and 2017 were included in the study. In the years mentioned above, 590 schizophrenia patients (297 men, 293 women) admitted to a locked unit received pharmacological emergency treatment. With the exception of clozapine which was more frequently administered to men no significant differences between men and women were found in terms of the choice, dosage, and type of application of medication (antipsychotics and benzodiazepines). Since most treatment guidelines for schizophrenia do not consider gender differences at all, it is not surprising that acute treatment is almost the same for men and women. However, in times when individualized therapies gain more and more importance, the consideration of sex differences should be part of new treatment concepts.

Complicating breast cancer treatment: Reasons patients present to the ED.

e13668 Background: Breast cancer is a very common cancer that provides a significant amount of stress on patients’ lives. These patients can have many cancer-related complications, which lead them to present to the ED. However, few studies have identified common reasons for these patients to present to the ED and factors associated with high risk of admission. Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to identify the common primary diagnoses of breast cancer patients in the ED. A multivariate logistic regression was used to identify characteristics that were significantly associated with a higher chance of inpatient admission. A p-value less than 0.05 was considered significant. Results: Between 2006 and 2012, 2,160,701 breast cancer patients presented to the ED. Most patients were at least 80 years old (53.0%), female (99.1%), Medicare beneficiaries (64.4%), of the highest income quartile (26.2%), living in the South (36.8%), presented to non-trauma hospitals (52.7%), and presented to metropolitan non-teaching hospitals (44.8%). Most patients were admitted (53.1%). The most common primary diagnoses of breast cancer patients were chest pain (5.4%), urinary tract infection (3.3%), pneumonia (3.1%), secondary malignancy (3.0%), and cardiac arrhythmia (3.0%). The primary diagnoses associated with the highest risk of inpatient admission are the following: septicemia (odds ratio: 39.4, 95% confidence interval (CI): 33.8-45.9,p < 0.001), femur fracture (OR:19.1, 95% CI: 16.6-22.0,p < 0.001), secondary malignancy (OR:17.7, 95% CI: 16.2-19.4,p < 0.001), acute cerebrovascular disease (OR:5.8, 95% CI:5.3-6.3,p < 0.001), pneumonia (OR:4.9, 95% CI:4.7-5.2,p < 0.001), and complication of previous surgical or medical therapy (OR:2.2, 95% CI:2.0-2.3,p < 0.001). Primary diagnoses associated with a lower risk of admission are the following: contusion (OR:0.06, 95% CI:0.06-0.07,p < 0.001), abdominal pain (OR:0.14, 95% CI:0.13-0.15,p < 0.001), and connective tissue disorder (OR:0.17, 95% CI:0.16-0.19,p < 0.001). Interestingly, patients that paid with Medicaid (OR:0.84, 95% CI:0.79-0.89,p < 0.001) or private insurance (OR:0.89, 95% CI:0.86-0.93,p < 0.001) were less likely to be admitted. Furthermore, uninsured patients were also less likely to be admitted (OR:0.52, 95% CI:0.48-0.57, p < 0.001). Conclusions: Breast cancer patients frequently present to the ED for many reasons, with septicemia and femur being the most severe diagnoses. Physicians should keep these risk factors in mind to prevent these complications and reduce patient stress.

Outcomes of home-isolated coronavirus disease 2019 patients in Bahrain.

The coronavirus disease 2019 (COVID-19) pandemic resulted in a huge burden on healthcare systems and necessitated a risk assessment of patients and an update of the treatment protocol to include home isolation for low-risk patients. The primary objective was to describe the outcome of home isolation and the characteristics of patients at higher risk of admission. The secondary objectives were to determine the proportion of patients with pneumonia and hypoxemia and the correlation between cycle of the threshold (CT) value and severity of the disease. For this study, 394 patients were randomly selected from a total of 8000 home-isolated COVID-19 patients during July to October 2020, and were followed by Bahrain International Hospital (BIH). All data were obtained from a live Excel sheet completed by physicians covering BIH during the study period. Data analysis included Chi-square test to determine significant association between categorical variable, Pearson correlation, and logistic regression analysis. Of the 394 home-isolated patients followed, 18 patients with missing data were excluded. The overall admission rate was 50% for ≥50 age group compared to 13.3% for 18-49 age group, while only 2.8% in <18 age group. Moreover, Intensive Care Unit (ICU) admissions were significantly higher in the older age group: 15.2% for ≥50 age group (P < 0.001). About 14% of the patients with comorbidities needed ICU admission, compared with 1.8% of those without comorbidities (P < 0.001). Of the home-isolated patients, 6.3% were diagnosed with pneumonia and 9.9% of those presenting had low oxygen saturation. The CT value was significantly correlated with the severity of symptoms and the need for admission. Home isolation of low-risk patients with monitoring and follow-up was a safe and necessary step in dealing with the COVID-19 pandemic.

Ethnic disparities in clinical severity of coronavirus disease 2019 (COVID-19) upon admission

Abstract Background Reports from all over the world have shown great ethnic disparities in COVID-19 morbidity and mortality. Recent European studies have found discrepancies between higher risk of admission and intensive care treatment among ethnic minorities but lower mortality rates compared to the ethnic majority. This study will elucidate the ethnic differences in disease severity upon admission as a possible factor in explaining these discrepancies. Methods A retrospective cohort study of 1442 patients admitted with COVID-19 at three hospitals in Copenhagen, Denmark, between 1st February 2020 and 31st May 2022. Clinical, demographic and ethnicity data were extracted from health care records and collected using REDCap. Severity upon admission (&amp;lt; 24 hours) was assessed as 1) oxygen need, 2) oxygen administration and 3) need for intensive care. Results Ethnicity was registered on 1341 patients (57,0% Danish, 34,8% non-Western). Over all, preliminary descriptive analyses show patients of non-Western origin had symptoms of COVID-19 for a longer period (8,0 vs 6,7 days, p &amp;lt; 0,0001) and had a higher oxygen need (7,0L vs 5,2L, p = 0,02) upon admission compared to patients of Danish origin. A higher percentage of patients of non-Western origin needed high flow oxygen administration upon admission (30,2% vs 22,9%, p = 0,006) and were transferred to the ICU within the first 24 hours (4,9% vs 2,2 %, p = 0,02) compared to patients of Danish origin. Further analysis will be done, including biochemistry and link to registers in order of obtaining more accurate info on country of birth and migration status. We will do logistic regression regarding ethnic differences in severity of COVID-19 upon admission adjusting for comorbidities, age, sex and BMI. Conclusions Preliminary data on disease severity of COVID-19 upon admission show some ethnic disparities. Language barriers, low health literacy or the fear of stigma might explain this. Further analyses are needed. Key messages • Preliminary data from this cohort study suggest that patients of non-Western origin had symptoms of COVID-19 for a longer period before being admitted compared to patients of Danish origin. • Preliminary data on disease severity of COVID-19 upon admission show ethnic disparities with regard to oxygen need, oxygen administration and need for intensive care.

COVID 19 in pregnant women and neonates: Clinical characteristics and laboratory and imaging findings. An overview of systematic reviews

Introduction: SARS-CoV-2 infection in the perinatal period may be associated with an increased risk of morbidity and mortality in both the mother and the neonate. Objective: To describe the clinical characteristics and, laboratory and imaging findings in pregnant women with COVID-19 and their newborns. Materials and methods: We searched PubMed, Scopus, Web of Science, and Cochrane databases for systematic reviews published between February 1, 2020, and May 30, 2021, describing clinical characteristics and laboratory and imaging (chest) findings in pregnant women with COVID-19 and their newborns; there were no language restrictions. Data were reanalyzed by means of Bayesian meta-analysis using Markov Chain Monte Carlo methods. The study protocol is registered in PROSPERO under code CRD42020178329. Results: Six systematic reviews were retrieved (for a total of 617 primary studies). A narrative synthesis of the proportions of signs, symptoms, and imaging and laboratory findings of both mothers and neonates was performed. The Odds ratios (OR) between pregnant women with and without COVID-19 were as follows: fetal well-being involvement: 1.9 (95%CI:1.09-3.63); stillbirth: 1.73 (95%CI:1.01-2.94); preterm birth: 1.77 (95%CI:1.25-2.61); maternal admission to the intensive care unit (ICU): 6.75 (95%CI:1-31.19). Regarding symptomatology, the following OR was obtained for myalgia between pregnant women and non-pregnant women with COVID-19: 0.67 (95% CI:0.51-0.93). Conclusions: Cough, fever, dyspnea, and myalgia are the most common symptoms in pregnant women with COVID-19; in addition, there is a higher risk of admission to the ICU. Regarding complementary testing, the most frequent alterations are lymphopenia and the evidence of lesions in chest imaging studies. The presence of COVID-19 in pregnant women is associated with premature birth. It seems that SARS-CoV-2 infection in neonates is not serious and the risk of vertical transmission is low, since no data about congenital malformations attributable to the virus were found.

Risk factors for SARS-CoV-2 infection and hospitalisation in children and adolescents in Norway: a nationwide population-based study

ObjectiveTo determine risk factors for SARS-CoV-2 infection and hospitalisation among children and adolescents.DesignNationwide, population-based cohort study.SettingNorway from 1 March 2020 to 30 November 2021.ParticipantsAll Norwegian residents<18 years of age.Main outcome...

Risk factors for intensive care unit admission and mortality among adult meningitis patients.

To assess the risk factors for intensive care unit admission and inpatient all-cause mortality among adult meningitis patients. The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised of patients of either gender aged ≥18 years diagnosed with bacterial, viral, or tuberculous meningitis between July 2010 and June 2019. Multivariable logistic regression analyses were used to explore independent predictors of inpatient mortality and intensive care unit admission. Data was analysed using SPSS 24. Of the 929 patients with suspected meningitis, 506(54.5%) had confirmatory diagnosis. Of them, 303(59.9%) were males. The overall median age of the sample was 47.0 years (interquartile range: 33.0 years). The most common aetiology was bacterial meningitis 324(64%), followed by viral meningitis 141(27.9%). Incidence of inpatient mortality was 53(10.5%), while 75(14.8%) patients required intensive care unit admission. Tuberculous aetiology, intensive care unit admission, concurrent encephalitis, hydrocephalus, inpatient neurosurgery, and longer length of hospital stay were predictors of mortality (p<0.05). Non-indication of blood culture was found to be associated with reduced risk of mortality (p<0.05). For intensive care unit admission, diabetes mellitus, presentation with seizure, imaging suggestive of meningitis, and inpatient neurosurgery were associated with higher risk of admission, while hypertension, presentation with headache, viral aetiology and non-indication of blood culture reduced the risk (p<0.05). Adult meningitis patients tend to have poor expected outcomes, and their management strategies should be planned accordingly.

Using explainable machine learning to characterise data drift and detect emergent health risks for emergency department admissions during COVID-19

A key task of emergency departments is to promptly identify patients who require hospital admission. Early identification ensures patient safety and aids organisational planning. Supervised machine learning algorithms can use data describing historical episodes to make ahead-of-time predictions of clinical outcomes. Despite this, clinical settings are dynamic environments and the underlying data distributions characterising episodes can change with time (data drift), and so can the relationship between episode characteristics and associated clinical outcomes (concept drift). Practically this means deployed algorithms must be monitored to ensure their safety. We demonstrate how explainable machine learning can be used to monitor data drift, using the COVID-19 pandemic as a severe example. We present a machine learning classifier trained using (pre-COVID-19) data, to identify patients at high risk of admission during an emergency department attendance. We then evaluate our model’s performance on attendances occurring pre-pandemic (AUROC of 0.856 with 95%CI [0.852, 0.859]) and during the COVID-19 pandemic (AUROC of 0.826 with 95%CI [0.814, 0.837]). We demonstrate two benefits of explainable machine learning (SHAP) for models deployed in healthcare settings: (1) By tracking the variation in a feature’s SHAP value relative to its global importance, a complimentary measure of data drift is found which highlights the need to retrain a predictive model. (2) By observing the relative changes in feature importance emergent health risks can be identified.

Respiratory syncytial virus bronchiolitis in congenital diaphragmatic hernia: A systematic review of prevalence rates and palivizumab prophylaxis.

The seasonality of respiratory syncytial virus (RSV) epidemics have been disrupted during the COVID-19 pandemic, possibly because of lockdowns and social restrictions reducing viral transmission. Given uncertainties around the severity of upcoming RSV bronchiolitis epidemics, debate exists whether palivizumab (RSV prophylaxis) should be administered to infants with Congenital Diaphragmatic Hernia (CDH), who may be vulnerable due to lung hypoplasia and pulmonary hypertension. To evaluate (1) if CDH infants have higher risk of admission with RSV bronchiolitis than infants in the general population; (2) if palivizumab prophylaxis may reduce this risk. We included all eligible studies examining the risk(s) of RSV-positive bronchiolitis requiring hospital admission in (1) CDH infants without palivizumab prophylaxis versus infants in the general population and (2) CDH infants with prophylaxis versus CDH infants without prophylaxis. The primary outcome evaluated was the risk of admission with RSV bronchiolitis. Data are reported descriptively and meta-analysed when appropriate. Three eligible retrospective cohort studies were identified: one study found CDH to be an independent risk factor for RSV hospitalisation (odds ratio, 3.30; 95% confidence interval [CI], 2.01-4.4); two studies compared RSV hospitalisation rates in CDH patients who had palivizumab versus those that did not. The pooled risk ratio was 1.11 (95% CI, 0.29-4.23; p = .88). Overall, the quality of evidence was considered poor and one study was industry funded. Whether CDH infants are at particular risk of severe bronchiolitis remains unclear. There is no evidence from this current systematic review that CDH infants should routinely receive palivizumab vaccination prophylaxis.

Seasonal variability and age-related risk in youth trampoline injuries.

The aim of this work was to estimate the difference in severity between musculoskeletal trampoline park injuries (TPIs) and home trampoline injuries (HTI) and identify the factors that might mediate or modify that effect. The National Electronic Injury Surveillance System database was used to identify musculoskeletal home trampoline injuries and TPIs in pediatric patients occurring in the 2009-2017 period. Injury mechanism and body region were inductively coded. The effect of TPI on risk of admission was estimated using a doubly robust logistic regression model for confounding adjustment. Adjustments were made for date, age, gender, injury mechanism, and body region. The comparative importance of injury mechanism and location and the effect modification of patient characteristics was explored using likelihood ratio tests. Trampoline park injuries were more likely to result in admission even in the model adjusted for injury mechanism and body region (odds ratio (OR) = 2.12 [1.30, 3.45]). Injuries sustained from falling off the trampoline were associated with significantly fewer hospitalizations (OR = 0.119 [0.029, 0.495]) than injuries from falling while on the trampoline. Patient age significantly modified the effect of setting on risk of admission (P = 0.042). Adolescents demonstrated an increased risk at trampoline parks (15years old OR = 3.23 [1.38, 7.56]), whereas younger children demonstrated a marginally lower risk (5years old OR = 0.77 [0.44, 1.35]). Trampoline park musculoskeletal injuries demonstrate an increased risk of admission even after rigorous adjustment for confounding. Injuries to the proximal limbs were associated with a much higher risk of admission than distal injuries. Adolescents face an increased risk of admission after TPI, underscoring the importance of public health interventions that target this age group.

A clinical decision rule predicting outcomes of emergency department patients with altered mental status.

Study objectiveApproximately 5% of emergency department patients present with altered mental status (AMS). AMS is diagnostically challenging because of the wide range of causes and is associated with high mortality. We sought to develop a clinical decision rule predicting admission risk among emergency department (ED) patients with AMS.MethodsUsing retrospective chart review of ED encounters for AMS over a 2‐month period, we recorded causes of AMS and numerous clinical variables. Encounters were split into those admitted to the hospital (“cases”) and those discharged from the ED (“controls”). Using the first month's data, variables correlated with hospital admission were identified and narrowed using univariate and multivariate statistics, including recursive partitioning. These variables were then organized into a clinical decision rule and validated on the second month's data. The decision rule results were also compared to 1‐year mortality.ResultsWe identified 351 encounters for AMS over a 2‐month period. Significant contributors to AMS included intoxication and chronic disorder decompensation. ED data predicting hospital admission included vital sign abnormalities, select lab studies, and psychiatric/intoxicant history. The decision rule sorted patients into low, moderate, or high risk of admission (11.1%, 44.3%, and 89.1% admitted, respectively) and was predictive of 1‐year mortality (low‐risk group 1.8%, high‐risk group 34.3%).ConclusionsWe catalogued common causes for AMS among patients presenting to the ED, and our data‐driven decision tool triaged these patients for risk of admission with good predictive accuracy. These methods for creating clinical decision rules might be further studied and improved to optimize ED patient care.

Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

BackgroundPregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature.Objectivesto investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude.Methods6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed.ResultsPr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients.ConclusionsPr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

Hospital Admissions from the Emergency Department and Subsequent Critical Care Interventions for Influenza during Pregnancy.

The objectives of this study were to determine (1) whether obstetrical patients were more likely to be admitted from the emergency department (ED) for influenza compared with nonpregnant women, and (2) require critical care interventions once admitted. Using data from the 2006 to 2011 Nationwide Emergency Department Sample, ED encounters for influenza for women aged 15 to 54 years without underlying chronic medical conditions were identified. Women were categorized as pregnant or nonpregnant using billing codes. Multivariable log linear models were fit to evaluate the relative risk of admission from the ED and the risk of intensive care unit (ICU)-level interventions including mechanical ventilation and central monitoring with pregnancy status as the exposure of interest. Measures of association were described with adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). We identified 15.9 million ED encounters for influenza of which 4% occurred among pregnant women. Pregnant patients with influenza were nearly three times as likely to be admitted as nonpregnant patients (aRR = 2.99, 95% CI: 2.94, 3.05). Once admitted, obstetric patients were at 72% higher risk of ICU-level interventions (aRR = 1.72, 95% CI: 1.61, 1.84). Of pregnant women admitted from the ED, 9.3% required ICU-level interventions such as mechanical ventilation or central monitoring. Older patients and those with Medicare were also at high risk of admission and ICU-level interventions (p < 0.01). Pregnancy confers three times the risk of admission from the ED for influenza and pregnant women are significantly more likely to require ICU-level medical interventions compared with women of similar age. These findings confirm the significant disease burden from influenza in the obstetric population and the public health importance of reducing infection risk. · Pregnancy confers three times the risk of admission from the ED for influenza.. · Pregnant women admitted with influenza are significantly more likely to require ICU-level care.. · Influenza represents a significant disease burden in the obstetric population.

Sex differences associated with adverse drug reactions resulting in hospital admissions

BackgroundAdverse drug events, including adverse drug reactions (ADRs), are responsible for approximately 5% of unplanned hospital admissions: a major health concern. Women are 1.5–1.7 times more likely to develop ADRs. The main objective was to identify sex differences in the types and number of ADRs leading to hospital admission.MethodsADR-related hospital admissions between 2005 and 2017 were identified from the PHARMO Database Network using hospital discharge diagnoses. Patients aged ≥ 16 years with a drug possibly responsible for the ADR and dispensed within 3 months before admission were included. Age-adjusted odds ratios (OR) with 95% CIs for drug-ADR combinations for women versus men were calculated.ResultsA total of 18,469 ADR-related hospital admissions involving women (0.35% of all women admitted) and 14,678 admissions involving men (0.35% of all men admitted) were included. Most substantial differences were seen in ADRs due to anticoagulants and diuretics. Anticoagulants showed a lower risk of admission with persistent haematuria (ORadj 0.31; 95%CI 0.21, 0.45) haemoptysis (ORadj 0.47, 95%CI 0.30,0.74) and subdural haemorrhage (ORadj 0.61; 95%CI 0.42,0.88) in women than in men and a higher risk of rectal bleeding in women (ORadj 1.48; 95%CI 1.04,2.11). Also, there was a higher risk of admission in women using thiazide diuretics causing hypokalaemia (ORadj 3.03; 95%CI 1.58, 5.79) and hyponatraemia (ORadj 3.33, 95%CI 2.31, 4.81) than in men.ConclusionsThere are sex-related differences in the risk of hospital admission in specific drug-ADR combinations. The most substantial differences were due to anticoagulants and diuretics.

Evaluation of anti-COVID-19 measures taken by the parents of children with celiac disease: a cross-sectional study.

Coronavirus disease 2019 (COVID-19) causes negative life changes brought about through lockdowns, in addition to severe complications and death. Among these changes, asplenism or hyposplenism has been reported in patients with celiac disease. It has been reported that the risk of pneumococcal sepsis is higher in celiac patients with hyposplenism. Moreover, celiac patients present high risk of admission to hospital due to influenza. To determine the degree of awareness of COVID-19 among parents of children with celiac disease and examine the measures that they take. Cross-sectional study at a university hospital in the Middle Anatolian region of Turkey. The diagnosis of celiac disease was confirmed through a survey conducted online among 73 parents between May and July 2020. The mean age was 37.57 ± 6.56 years for the mothers, 41.15 ± 5.56 years for the fathers and 11.36 ± 4.36 years for the children. 90.4% of the parents reported that COVID-19 was transmitted through "speaking, coughing, sneezing and infection of the face after contact with virus-infected surfaces". Moreover, 78.1% indicated that they did not have any difficulty in finding gluten-free foods. These parents of children with celiac disease believed that their children's risk of developing COVID-19 did not differ from that of healthy children. It was also observed that appetite and states of nervousness were higher among these children with celiac disease during lockdowns and that their sleep patterns were affected.

SALAD-BAAR: A numerical risk score for hospital admission or emergency department presentation in ambulatory patients with cardiovascular disease.

BackgroundWhile many interventions to reduce hospital admissions and emergency department (ED) visits for patients with cardiovascular disease have been developed, identifying ambulatory cardiac patients at high risk for admission can be challenging.HypothesisA computational model based on readily accessible clinical data can identify patients at risk for admission.MethodsElectronic health record (EHR) data from a tertiary referral center were used to generate decision tree and logistic regression models. International Classification of Disease (ICD) codes, labs, admissions, medications, vital signs, and socioenvironmental variables were used to model risk for ED presentation or hospital admission within 90 days following a cardiology clinic visit. Model training and testing were performed with a 70:30 data split. The final model was then prospectively validated.ResultsA total of 9326 patients and 46 465 clinic visits were analyzed. A decision tree model using 75 patient characteristics achieved an area under the curve (AUC) of 0.75 and a logistic regression model achieved an AUC of 0.73. A simplified 9‐feature model based on logistic regression odds ratios achieved an AUC of 0.72. A further simplified numerical score assigning 1 or 2 points to each variable achieved an AUC of 0.66, specificity of 0.75, and sensitivity of 0.58. Prospectively, this final model maintained its predictive performance (AUC 0.63–0.60).ConclusionNine patient characteristics from routine EHR data can be used to inform a highly specific model for hospital admission or ED presentation in cardiac patients. This model can be simplified to a risk score that is easily calculated and retains predictive performance.

Lung Cancer Patients, At High Risk for Admission Due to Pneumonia, Did Not Require Hospitalization for COVID-19 at Creighton University Medical Center-Bergan Mercy in 2020

Background: Patients with lung cancer are at high risk for hospitalizations and death, although causes for admission in these patients are elusive. Also, the hospitalizations rates of patients with lung cancer in the COVID-19 pandemic are unclear. Methods: The objectives of this study are to evaluate causes for admission in lung cancer patients and to follow this group into 2020 to see if COVID-19 was a contributor to their hospitalizations. The design is a cohort, retrospective chart review. Participants were patients with an established diagnosis of lung cancer, pursing treatment, ages 19-89 at Creighton University Medical Center- Bergan Mercy (CUMC-B) Hospital Internal Medicine Department from January 1, 2019 through December 31, 2020. Measurements include basic demographics as well as causes for admission and COVID-19 status. Results and Discussion: Out of 37 patients, selected from 311 candidates, there were 47 causes for admission. Of total admissions from this cohort in 2019, 16.88% were due to pneumonia, 11% with acute respiratory failure with hypoxia. The top 14 causes for admission were responsible for 71.4% of the admissions of lung cancer patients in 2019. Of the surviving patients from 2019 into 2020, 1 had confirmed COVID-19. None were hospitalized for COVID-19 within this cohort. Although there were not COVID-19 related hospitalizations in this cohort, the percentage of overall people who died increased (10 deaths out of 37 (27%) from Jan 1, 2019-Feb 29, 2020 in comparison to 13 deaths out of 26 (50%) after March 1, 2020). Conclusion: Despite pneumonia being a leading cause for hospitalization in patients with lung cancer, nobody in this cohort was admitted with COVID-19. Although sample size is a limiting factor in this study, further investigation is warranted into why lung cancer patients in this cohort appear to have a steady or increased death rate, but did not contract COVID-19t.

An Algorithm for Classifying Patients Most Likely to Develop Severe Coronavirus Disease 2019 Illness.

To develop an algorithm that predicts an individualized risk of severe coronavirus disease 2019 illness (i.e., ICU admission or death) upon testing positive for coronavirus disease 2019. A retrospective cohort study. Cleveland Clinic Health System. Those hospitalized with coronavirus disease 2019 between March 8, 2020, and July 13, 2020. A temporal coronavirus disease 2019 test positive cut point of June 1 was used to separate the development from validation cohorts. Fine and Gray competing risk regression modeling was performed. The development set contained 4,520 patients who tested positive for coronavirus disease 2019 between March 8, 2020, and May 31, 2020. The validation set contained 3,150 patients who tested positive between June 1 and July 13. Approximately 9% of patients were admitted to the ICU or died of coronavirus disease 2019 within 2 weeks of testing positive. A prediction cut point of 15% was proposed. Those who exceed the cutoff have a 21% chance of future severe coronavirus disease 2019, whereas those who do not have a 96% chance of avoiding the severe coronavirus disease 2019. In addition, application of this decision rule identifies 89% of the population at the very low risk of severe coronavirus disease 2019 (< 4%). We have developed and internally validated an algorithm to assess whether someone is at high risk of admission to the ICU or dying from coronavirus disease 2019, should he or she test positive for coronavirus disease 2019. This risk should be a factor in determining resource allocation, protection from less safe working conditions, and prioritization for vaccination.