Higher Hospital Admission Rates Research Articles

Clostridioides difficile infection, recurrence and the associated healthcare consumption in Sweden between 2006 and 2019: a population-based cohort study

BackgroundClostridioides difficile infection (CDI) causes a major burden to individuals and society, yet the impact may vary depending on age, sex, underlying comorbidities and where CDI was acquired (hospital or community).MethodsThis Swedish nationwide population-based cohort study (2006–2019) compared all 43,150 individuals with CDI to their 355,172 matched controls (first year and entire follow-up). Negative binomial regression models compared the cumulated length of stay, number of in-hospital admissions, outpatient visits and prescriptions after the first CDI episode expressed as incidence rate ratios (IRR) and 95% confidence intervals for the entire follow-up.ResultsOverall, 91.6% of CDI cases were hospital acquired, and 16.8% presented with recurrence(s); 74.8%of cases were ≥ 65 years and 54.2% were women. Compared to individuals without CDI, in-hospital stay rates were 18.01 times higher after CDI (95% CI 17.40–18.63, first-year: 27.4 versus 1.6 days), 9.45 times higher in-hospital admission (95% CI 9.16–9.76, first-year: 2.6 versus 1.3 hospitalisations), 3.94 times higher outpatient visit (95% CI 3.84–4.05, first-year: 4.0 versus 1.9 visits) and 3.39 times higher dispensed prescriptions rates (95% CI 3.31–3.48, first-year: 25.5 versus 13.7 prescriptions). For all outcomes, relative risks were higher among the younger (< 65 years) than the older (≥ 65 years), and in those with fewer comorbidities, but similar between sexes. Compared to those without recurrence, individuals with recurrence particularly showed a higher rate of hospital admissions (IRR = 1.18, 95% 1.12–1.24). Compared to community-acquired CDI, those with hospital-acquired CDI presented with a higher rate of hospital admissions (IRR = 7.29, 95% CI 6.68–7.96) and a longer length of stay (IRR = 7.64, 95% CI 7.07–8.26).ConclusionCDI was associated with increased health consumption in all affected patient groups. The majority of the CDI burden could be contributed to hospital-acquired CDI (~ 9/10), older patients (~ 3/4) and those with multiple comorbidities (~ 6/10 Charlson score ≥ 3), with 1/5 of the total CDI burden contributed to individuals with recurrence. Yet, relatively speaking the burden was higher among the younger and those with fewer comorbidities, compared to their peers without CDI.

Pregnancy Outcomes in Patients with Prosthetic Heart Valves in Saudi Arabia

Background: Pregnancies in women with heart prostheses are high-risk pregnancies with increased maternal and fetal adverse outcomes. Advances in prosthetic heart valve design and anticoagulation have improved these outcomes over the past decades. Objectives: To study the pregnancy outcomes in pregnancies with heart prostheses and to compare these outcomes between mechanical and biosynthetic heart prostheses in Saudi patients. Methods: In this single centered retrospective study conducted at King Saud Medical City (KSUMC) between January 2011 and February 2020, we have reviewed all pregnant women’s heart prostheses. Fetal and maternal data were obtained, and outcomes were compared between pregnancies with mechanical heart prostheses and bioprostheses. Results: A total of 111 pregnancies were reviewed. A total of 51.4% of pregnancies had bioprostheses, 48.6% had mechanical prostheses, and 64.0% of participants were obese. The majority of the participants had a parity in the range of 2-9 (N=107, 96.4%). The most frequent type of rheumatic heart disease was mitral regurgitation (N=49, 44.1%), followed by mitral stenosis (N=32, 28.8%). There was no maternal mortality and no structural valve failure. There was a high rate of hospital admission in both groups, up to 55% of pregnancies. The rates of abortion, postpartum hemorrhage and transfusions were higher than those in general pregnancies; however, there was no difference in maternal and fetal complications between the two types of prostheses, i.e., bioprostheses and mechanical. Conclusion: Although women with prosthetic heart valves have higher rates of adverse outcomes, they generally tolerate pregnancy well. There was no difference in adverse outcomes between bioprosthetic and mechanical prostheses

IJCM_103A: Cost Benefit Analysis Related to Community Acquired Pneumonia inpatients among Geriatric Age Group-A Study Conducted in A Tertiary Care Hospital

Background: Community-acquired pneumonia (CAP) is a common acute infectious disease among elderly people, and is associated with high rates of hospital admission and mortality. Old Age and male sex are known risk factors for CAP among adults and many comorbidity are also risk factors for CAP, such as chronic obstructive pulmonary disease (COPD), diabetes, cancer, dementia, congestive heart failure, and liver function failure. Objective: This study aimed to estimate the economic burden of community- acquired pneumonia (CAP) among elderly patients in Berhampur, Odisha. In addition, the study evaluated the relationship between total treatment cost and CAP risk factors. Methodology: A cross-sectional study was conducted in the IPD of MKCG MKCG Medical College of Berhampur in the period of September-November 2023. Purposive sampling was used and data was collected using semi structured questionnaire and analyzed by MS Excel 2017 Results: Among 348 are inpatient CAP episodes the mean ages were 63±8 years in outpatient group and 70±4 yrs in inpatient groups respectively. The Median treatment cost is Rs.3000/-INR per outpatient episode and Rs 10060/-INR per inpatient episode.Old patient, Male sex, Diabetes, Chronic obstructive Pulmonary Disease, liver dysfunction were associated with increased treatment cost. Conclusion: The economic burden of CAP might be decreased by reducing the number of hospitalizations for mild CAP and the incidence of severe CAP. Therefore, preventative care (e.g. oral hygiene or pneumococcus vaccination) is recommended for patients with related risk factors, such as male sex, older age, diabetes, chronic obstructive pulmonary disease.

Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial

Higher temperatures are associated with higher rates of hospital admissions for nephrolithiasis and acute kidney injury. Occupational heat stress is also a risk factor for kidney dysfunction in resource-poor settings. It is unclear whether ambient heat exposure is associated with loss of kidney function in patients with established chronic kidney disease. We assessed the association between heat index and change in estimated glomerular filtration rate (eGFR) in participants from the DAPA-CKD trial in a post-hoc analysis. DAPA-CKD was a randomised controlled trial of oral dapagliflozin 10 mg once daily or placebo that enrolled participants aged 18 years or older, with or without type 2 diabetes, with a urinary albumin-to-creatinine ratio of 200-5000 mg/g, and an eGFR of 25-75 mL/min per 1·73 m2. In this post-hoc analysis, we explored the association between time-varying daily centre-level heat index (ERA5 dataset) and individual-level change in eGFR in trial participants using linear mixed effect models and case-time series. The DAPA-CKD trial is registered with ClinicalTrials.gov, NCT03036150. Climate and eGFR data were available for 4017 (93·3%) of 4304 participants in 21 countries (mean age: 61·9 years; mean eGFR: 43·3 mL per 1·73 m2; median 28 months follow-up). Across centres, a heat index of more than 30°C occurred on a median of 0·6% of days. In adjusted linear mixed effect models, within each 120-day window, each 30 days' heat index of more than 30°C was associated with a -0·6% (95% CI -0·9% to -0·3%) change in eGFR. Similar estimates were obtained using case-time series. Additional analyses over longer time-windows showed associations consistent with haemodynamic or seasonal variability, or both, but overall estimates corresponded to an additional 3·7 mL per 1·73 m2 (95% CI 0·1 to 7·0) loss of eGFR per year in a patient with an eGFR of 45 mL per 1·73 m2 located in a very hot versus a temperate environment. Higher ambient heat exposure is associated with more rapid eGFR decline in those with established chronic kidney disease. Efforts to mitigate heat exposure should be tested as part of strategies to attenuate chronic kidney disease progression. None.

Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data

Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.

A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL)

ObjectivesAcute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting. MethodsPatients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. ResultsA total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed. ConclusionsPatients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.

Short term exposure to low level ambient fine particulate matter and natural cause, cardiovascular, and respiratory morbidity among US adults with health insurance: case time series study

ObjectiveTo estimate the excess relative and absolute risks of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease associated with daily exposure to fine particulate...

Age-related and Gender-related Differences in Hospital Admission Rate and Hospital Costs of People Covered by the Iran Health Insurance Organization: A Retrospective Study

Objectives The impact of population aging on health expenditure is inevitable. It affects health expenditure by causing changes in people’s health status and the demand for health care services. In this study, we aim to investigate the age-related and gender-related differences in hospital admission rate, length of stay, and hospital costs of people in Iran. Methods &amp; Materials This is a quantitative, descriptive-analytical study with a cross-sectional design conducted on data of 41 million Iranian people covered by the Iran Health Insurance Organization in 2020. Hospital admission rate, length of stay, and hospital costs were dependent variables. Hospital costs included insurance payments, patients’ out-of-pocket spending, and government subsidies. Age and sex of the patients, ownership of the hospital, type of patients’ medical files were descriptive variables. The Mann-Whitney U test was used to compare hospital costs between elderly (&gt;60 years of age) and non-elderly (&lt;60 years of age) groups and between females and males. Spearman’s correlation test was used to find the correlation between age and dependent variables. Results During the study period, there were about 3,800,000 hospital admissions. The rate of hospital admission in the elderly was 3.7 times higher than that of non-elderly groups. The average length of stay was 1.3 days for the elderly, and 2.2 days for the non-elderly. In the elderly group, men had a higher hospital admission rate than women, while in non-elderly groups, women had a higher admission rate. The average hospital cost was 28 million IRR for the non-elderly and 45 million IRR for the elderly. The average cost of surgery, hospitalization, medicine and medical consumables for the elderly was 1.5 times more than that of the non-elderly. There was a positive and significant relationship between the hospital admission rate and age of the patients (r=0.879, P&lt;0.001). As the age of the patients increased, the length of stay in the hospital increased significantly (r=0.582, P&lt;0.001). The relationship between patients’ age and the average hospital cost was also positive and significant (r=0.582, P=0.006). Conclusion Hospital admission rate, length of stay, and average hospital costs are significantly higher for the elderly in Iran.

RECURRENT FALLS IN OLDER ADULTS ARE ASSOCIATED WITH MORTALITY AND HOSPITALIZATION

Abstract Annually, 1 in 4 older adults fall and roughly half have a second fall within 6 months. We studied 57 hospitals in the TriNetX Network. We included all older adults discharged home from the emergency department (ED) after a fall in 2022 for a total of 89,061 patients. Of these, 13,389 (15%) patients returned to the ED for another fall within 6 months. Patients with repeat falls were older (78.7 vs 76.5 years), more likely to have hypertension (76 vs 56%), prior myocardial infarction (14 vs 3%), heart failure (29 vs. 15%), peripheral vascular disease (18 vs 10%), cerebrovascular event (19 vs 10%), chronic obstructive pulmonary disease (COPD) (23 vs 14%), diabetes (40 vs 23%), liver disease (17 vs 11%), chronic kidney disease (30 vs 16%), and cancer (45 vs 32%); P&amp;lt; 0.001. Patients with recurrent falls were more likely to be prescribed cardiovascular medications (84 vs. 66%), central nervous system medications (87 vs 69%), opioids (71 vs 52%), sedatives/hypnotics (59 vs 42%), antipsychotics (23 vs 12%), antidepressants (51 vs 32%), antiparkinsonian agents (9 vs 4%), and antivertigo agents (15 vs 9%); P&amp;lt; 0.001. Patients with a recurrent fall within 6 months had higher hospital admission rate (46.2 vs 15.8%, OR 4.6 [95%CI, 4.4-4.7]) and higher mortality rate (6.2 vs 3.5%, OR 1.83 [95%CI 1.7-2.0]). Older adults discharged home from the ED after falling are at high risk of a second fall and those who have a repeat fall within 6 months are at higher risk of hospital admission and mortality.

Prevalence of SIRS with primary epiploic appendagitis.

Primary epiploic appendagitis (PEA) is not an uncommon cause of abdominal pain. The systemic inflammatory response syndrome (SIRS) criteria have high sensitivity for early detection of inflammation and infection. To date, there is limited data about the association between SIRS and PEA. The aims of this retrospective study were to evaluate the prevalence of SIRS response and its clinical relevance in patients diagnosed with PEA within a large tertiary hospital network. A retrospective study was performed on all consecutive adult patients who presented to four major emergency departments with CT-confirmed PEA from 01 January 2022 to 27 March 2023. The fulfilment of SIRS criteria, hospital admission rate and treatments provided were analysed for these patients. Seventy-three patients had CT-confirmed PEA. Seventeen patients (23.2%) with PEA were SIRS positive. The hospital admission rate in the SIRS group trended higher than the non-SIRS group (odds ratio of 2.51, 95% CI (0.75, 8.39)). The odds of having an associated radiological comorbidity unrelated to PEA were 18.7 times higher in the SIRS positive group. Fifty-seven (78%) patients were discharged home, and 16 (22%) patients were admitted into hospital. Nearly all patients were treated conservatively (98.6%). PEA patients with SIRS response trend towards a higher hospital admission rate and are significantly more likely to have other radiological comorbidities than non-SIRS patients. It is important to look for other pathological conditions in a SIRS positive patient with a CT-diagnosis of PEA.

Integrated Primary Care Model Prevents Hospitalizations for People Living with Dementia

AbstractBackgroundPeople living with dementia (PLWD) have high rates of total and ambulatory care sensitive hospital admissions and emergency department utilization. Ambulatory care sensitive hospital admissions are those that could be avoided by robust outpatient care. The Integrated Memory Care (IMC) is a comprehensive dementia care model where patients and their family caregivers access dementia‐sensitive geriatric primary care.MethodsWe conducted a retrospective observational study of adult patients of IMC, Cognitive Neurology (CN), and Primary Care (PC) clinics aged 65 and older with a diagnosis of dementia in 2019‐2021. We matched patients by age, gender and race and measured the risk of hospitalization using logistic regressions controlling for clinic. Additionally, we conducted a regression adjusted for state of illness (proxied by activities of daily living (ADL)) for the IMC and CN clinics.ResultsOverall 509 patients seen in IMC were matched with 490 CN patients and 509 PC patients. Most patients were female and white and aged 70‐85. IMC patients had higher overall ADL scores than CN indicating more functional dependence. CN [PN] had 10% [2 times] higher odds (Odds Ratio (OR): 1.107; 95% Confidence Interval (CI): 0.87‐1.41; OR: 2.037; 95% CI: 1.440‐2.882), when compared to IMC patients in unadjusted models. After adjusting for ADL scores, CN patients had 66% higher odds (OR: 1.662; 95% CI: 1.260‐2.193) of having a hospital admission during the study period.ConclusionsDementia‐sensitive primary care reduces the rate of total and ambulatory‐sensitive hospitalizations reducing healthcare costs and causing less disruption to care.

Smoldering Multiple Myeloma Progressing to Active Multiple Myeloma Vs De-Novo Active Multiple Myeloma - a Comparison of Disease Characteristics, Organ Involvement and Outcomes in a Real-Life Multicenter Retrospective Cohort Study

Background Smoldering Multiple Myeloma (SMM) is an intermediate precursor phase in Multiple Myeloma (MM) evolution. SMM patients are monitored for progression to active disease, supposing such surveillance will identify myeloma-defining events (MDEs) early and consequently hasten treatment, prevent complications and improve outcomes. To what extent this approach is successful is not well established. We aimed to compare disease characteristics, end organ involvement and outcomes between SMM patients who progressed to active MM vs newly diagnosed MM (NDMM) patients. Methods We performed a two-center real-world case-control retrospective cohort study. Consecutive patients receiving first line treatment for MM after progressing from SMM were identified; each was matched by age and year of diagnosis (±2 years) to a patient first presenting as NDMM. SMM, MM, MDEs and response were defined by the International Myeloma Working Group (IMWG) criteria (2014, 2016); progression-free survival (PFS) and overall survival (OS) were calculated from active MM diagnosis. Data was extracted in 07/2023. Results We identified two cohorts of newly diagnosed MM patients, presented between 09/2008and 02/2023: Post SMM (P-SMM, N=57) and De novo MM patients (D-MM, N=57). Median follow up time was 38.6 months (IQR 23.3 - 72.7). There were no differences in baseline demographics between gender (p=.19), and median age: 73.4 (range 42 - 88) in the P-SMM group and 72.9 (range 42 - 92) in the D-MM (p=.75). Comparing MDEs using SLiM-CRAB criteria between groups, more patients in the D-MM group presented with hypercalcemia (p=.02) and lytic lesions (p=.03). Other domains were similar between groups: anemia (p=.68), renal failure (p=.59), FLC ≥100 (p=.76), % bone marrow plasma cells (BMPC) ≥ 60 (p=.11). D-MM patients had higher ISS/R-ISS at presentation: ISS ≥ II (30 vs 11, p=.004) and R-ISS ≥ II (31 vs 13, p=.002). Additional disease characteristics were balanced at diagnosis of active MM: heavy chain (p=.53), light chain type (p=.69), M-Protein level (p=.23), extra medullary disease (p=.14), Al amyloidosis (p=.13), and high-risk cytogenetics (p=.65). Bone involvement was more frequent in D-MM vs P-SMM patients, with significantly more pathological fractures (p=.006), bone pain (p=.001), and a detrimental bone disease (p=.001) (defined as combination of pathological fracture and/or ≥ 3 lytic lesions) (Figure 1B). Significantly higher rates of hospital admissions for upfront therapy initiation were seen in the D-MM group compared with P-SMM, 18 vs 7 (p=.008), as well as more potentially irreversible MDEs (pathological fractures and/or renal injury): 43 (p=.009) vs 31 (41.9%) respectively. Treatment patterns were balanced excluding bortezomib used more often in the D-MM (p=.009) and daratumumab in the P-SMM group (p=.03). Best response rates to upfront therapy were comparable between groups, (p=.71) as well as ≥ very good partial response (VGPR) rates (p=.88), 52.4% vs 47.6% in P-SMM and D-MM respectively. Frequency of skeletal imaging tests up-to 2-year period prior to active MM diagnosis were associated with lower rates of detrimental bone disease (p=.006). Despite the similar ≥ VGPR rates between cohorts, PFS was longer in the P-SMM group vs D-MM group, 39.6 vs 21.6 months, respectively (log-rank 0.01). A superior PFS in P-SMM group vs D-MM remained after correction for % BMPC at diagnosis (46.2% vs 58.8%, p=.03). OS was also longer, not reached vs 93.7 months (log-rank=.047) (Figure 1A). Conclusions Patients who develop active MM post SMM clinic surveillance presented with a lower disease burden, as well as reduced rates of detrimental bone disease and potentially irreversible MDEs. P-SMM patients had favorable PFS and OS rates. This may reflect effectiveness of SMM monitoring resulting in lower disease burden at time of treatment onset; favorable long-term outcomes may also be affected by variability in treatment patterns between groups. Another possible explanation is that patients with more indolent MM biology may have extended periods of precursor condition, hence increasing their likelihood to be diagnosed by incidental laboratory tests during their SMM phase.

A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic

BackgroundFor ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities.MethodsCo-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis.ResultsThe analysis yielded five overarching themes contextualising service users’ experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT.ConclusionsAlthough this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.

Cancer patients in the emergency department

A growing number of patients are living with cancer or have a history of cancer leading to increasing adverse effects of treatment or disease necessitating emergency department (ED) consultation. Long-term cancer survivors are at higher risk of comorbidities causing a substantial increase in health care resource utilization. The most frequent reasons for cancer-related ED visits are dyspnea, fever, pain, gastrointestinal or neurological symptoms leading to high hospital and intensive care unit admission rates. Acute respiratory failure in cancer patients necessitates timely diagnostic testing, whereby computed tomography is superior to chest X‑ray. Delay in intensive care unit (ICU) admission or mechanical ventilation increases mortality. Febrile neutropenia is an emergency with urgent need for antibiotic treatment. Treatment of neutropenic and nonneutropenic patients with sepsis does not differ. Cardiovascular disease is now the second leading cause of long-term morbidity and mortality among cancer survivors. Immunotherapy can lead to substantial and in some patients life-threatening complications that may not easily be recognized in the ED. Cancer-specific emergencies such as leukostasis, tumorlysis or hypercalcemia rarely present to ED and require interdisciplinary care. The constantly growing cancer population is likely to increase ED utilization. Knowledge about cancer treatment and disease-associated complications is crucial for emergency physicians. Palliative care education should secure appropriate end-of-life care avoiding futile interventions.

Trends in Pediatric Mild Traumatic Brain Injury During COVID-19-Related Lockdown-A Single-Center Study.

A relevant number of visits to pediatric emergency departments (pED) are associated with mild traumatic brain injury (mTBI). On March 16, 2020, the Bavarian government declared a first full lockdown (LD) related to the coronavirus (COVID-19) pandemic. The aim of the study was to investigate the impact of LD on pediatric mTBI. Retrospective chart review of presentations to a pED due to mTBI. Study periods covered LD (03/17/2020 through 05/05/2020) and the same time in 2017, 2018, and 2019 as reference period (RP). Comparative analyses were performed by Chi-square or Fisher's exact test. Numbers of mTBI cases decreased by half. Age distribution did not differ. A significantly higher proportion of mTBI were related to falls at home (p = 0.001). Further, a higher rate of hospital admissions (p = 0.03), a higher proportion of intensive care unit admissions (p = 0.001), a longer duration of hospital stay (p = 0.02), and a higher rate of intracranial pathologies on neuroimaging were observed during LD (p = 0.007). The decrease in mTBI presentations is likely due to an absolute decrease in numbers related to the LD measures, combined with a hesitation to present very minor mTBI to the hospital, because of fear of being infected or not to put additional strain on the healthcare system during this healthcare crisis. On the other hand, data of those that presented with mTBI tend to reflect the more severe spectrum of mTBI.

Electric Scooter Injuries in Tampa, Florida, Are Associated With High Rates of Head Injury, Hospital Admission, and Emergency Medical Service Transport and Low Rates of Helmet Use.

Background Standing electric scooters (e-scooters) were introduced in Tampa, Florida, in 2019. We reviewed 292 e-scooter injury cases at the Tampa General Hospital Emergency Department (ED) to determine what insights we could gain. We sought to identify the characteristics of such presentations, including chief complaint (CC), patient age, day of the week, time of day, length of stay, disposition, acuity, and means of arrival to the ED. We were particularly interested in studying the rates of hospital admission, Emergency Medical Service (EMS) transport, emergent acuity presentations, and head injuries. We also sought to identify the prevalence of alcohol use prior to e-scooter accidents and its effect on the above factors. Methodology This was a retrospective chart review and was exempt from the University of South Florida's Institutional Review Board approval (STUDY004031). Data from routine clinical care in the Tampa General Hospital ED, a Level-1 Trauma Center ED in Tampa, Florida, from July 19, 2019, to May 30,2022, were collected through an operational report within the business intelligence infrastructure of the hospital's electronic medical record system. Data from patients with scooter injury-related encounter codes were extracted to an electronicdata capture form and deidentified. Narratives were reviewed to exclude uncertain cases (e.g., patients with moped, kick scooter, mobility scooter injuries, etc.) and to flag for alcohol endorsement, altered mental status, helmet usage, and head injuries that were not listed as the CC. CC, means of arrival, acuity, disposition, arrival/departure day of week, and arrival/departure hour were collected. Data analysis was completed using Microsoft Excel version 16.5 (Microsoft Corp., Redmond, WA, USA) and SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). Results A total of 292 of 442 collected cases remained after removing irrelevant flags. Overall, 30.8% (n = 90) of patients were between the ages of 21 and 30, and most patients presented on weekends and nights. Moreover, 40.8% (n = 119) suffered head injuries, 40.8% (n = 119) arrived via EMS, 31.5% (n = 92) were admitted to the hospital, and 18.8% (n = 55) were designated as emergent acuity. Apart from the admission rate, these rates were all higher among alcohol endorsers (39, 13.4%) than non-endorsers (253, 86.6%). Only 2.1% of patients endorsed helmet use. Conclusions We found higher rates of hospital admission and EMS transports in our ED than many previous studies in urban areas have reported. Our data suggest that alcohol use increases the risk of more serious e-scooter injuries, characterized by higher acuity, EMS transport rate, and head injuries among alcohol endorsers. These findings are highly relevant due to the rapidly growing e-scooter presence across the United States and may serve to inform hospitals and EMS systems regarding their role in injury management, as well as future policy regarding their safe use.

Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre-post study.

Atrial fibrillation/flutter (AF/AFL) accounts for high rates of ED presentations and hospital admissions. There is increasing evidence to suggest that delaying cardioversion for acute uncomplicated AF is safe, and that many patients will spontaneously revert to sinus rhythm (SR). We conducted a before-and-after evaluation of AF/AFL management after a change in ED pathway using a conservative 'rate-and-wait' approach, incorporating next working day outpatient clinic follow-up and delayed cardioversion if required. We performed a before-and-after retrospective cohort study examining outcomes for patients who presented to the ED in Christchurch, New Zealand, with acute uncomplicated AF/AFL in the 1-year period before and after the implementation of a new conservative management pathway. A total of 360 patients were included in the study (182 'Pre-pathway' vs 178 'Post-Pathway'). Compared to the pre-pathway cohort, those managed under the new pathway had an 81.2% reduction in ED cardioversions (n = 32 vs n = 6), and 50.7% reduction in all cardioversions (n = 65 vs n = 32). There was a 31.6% reduction in admissions from ED (n = 54 vs n = 79). ED length of stay (3.9 h vs 3.8 h, net difference -0.1 h, 95% confidence interval [CI] -0.6 to 0.3), 1-year ED AF representation (32.4% vs 26.4%, net difference -6.0% [95% CI -16.0% to 3.9%]), 1-year ED ischaemic stroke presentation (2.2% in both groups) and 7-day all-cause mortality rates (hazard ratio 1.05 [95% CI 0.6 to 1.9]) were all similar. Using a conservative 'rate-and-wait' strategy with early follow-up for patients presenting to ED with AF/AFL can safely reduce unnecessary cardioversions and avoidable hospitalisations.

Diabetes mellitus-related hospital admissions and prescriptions of antidiabetic agents in England and Wales: an ecological study

BackgroundAround 6.5% of the population in the United Kingdom has been diagnosed with diabetes. It is associated with several long-term consequences and higher hospitalization rates.AimTo examine the profile of hospital admissions related to diabetes mellitus and the prescription rates of antidiabetic medications in England and Wales.MethodThis is an ecological study that was conducted for the period between April 1999 and April 2020 using publicly available hospitalisation data in England and Wales. Hospital admission data for patients of all ages was extracted from Hospital Episode Statistics in England and the Patient Episode Database for Wales. The difference between admission rates in 1999 and 2020, as well as the difference between diabetes mellitus medication prescription rates in 2004 and 2020, were assessed using the Pearson Chi-squared test. A Poisson regression model with robust variance estimation was used to examine the trend in hospital admissions.ResultsA total of 1,757,892 diabetes mellitus hospital admissions were recorded in England and Wales during the duration of the study. The hospital admission rate for diabetes mellitus increased by 15.2%. This increase was concomitant with an increase in the antidiabetic medication prescribing rate of 105.9% between 2004 and 2020. Males and those in the age group of 15–59 years had a higher rate of hospital admission. The most common causes of admissions were type 1 diabetes mellitus related complications, which accounted for 47.1% of all admissions.ConclusionThis research gives an in-depth overview of the hospitalization profile in England and Wales during the previous two decades. In England and Wales, people with all types of diabetes and related problems have been hospitalized at a high rate over the past 20 years. Male gender and middle age were significant determinants in influencing admission rates. Diabetes mellitus type 1 complications were the leading cause of hospitalizations. We advocate establishing preventative and educational campaigns to promote the best standards of care for individuals with diabetes in order to lower the risk of diabetes-related complications.

Hospital admissions of school-age children with an intellectual disability: A population-based survey.

To describe the profiles of hospital admissions of school-age children identified with a learning disability (ICD-11 intellectual developmental disorder) and/or safeguarding needs compared to children without learning disability, in a population where proactive identification of learning disabilities in children is embedded in practice. Data were collected about the reasons for and duration of hospital admissions of school-age children living in the study catchment area between April 2017 and March 2019; the presence (or absence) of learning disability and/or safeguarding flags in the medical record was also noted. The impact of the presence of flags on the outcomes was explored using negative binomial regression modelling. Of 46 295 children in the local population, 1171 (2.53%) had a learning disability flag. The admissions of 4057 children were analysed (1956 females; age range 5-16 years, mean 10 years 6 months, SD 3 years 8 months). Of these, 221 out of 4057 (5.5%) had a learning disability, 443 out of 4057 (10.9%) had safeguarding flags, 43 out of 4057 (1.1%) had both, and 3436 out of 4057 (84.7%) had neither. There was a significantly increased incidence of hospital admissions and length of stay in children with either or both flags, compared to children with neither. Children with learning disabilities and/or safeguarding needs have higher rates of hospital admissions than children without. Robust identification of learning disabilities in childhood is required to make the needs of this group visible in routinely collected data as the first step towards needs being appropriately addressed. Children with learning disabilities must be consistently identified in populations so that their needs are made visible. Information about these needs must be collected from educational, health, and social care sources and scrutinized systematically. Children with learning disabilities and safeguarding needs have an increased incidence of hospital admissions and length of stay.

National Early Warning Scores Following Emergency Hospital Transfer: Implications for Care Home Residents.

Care home residents have high rates of hospital admission. The UK National Early Warning Score (NEWS2) standardizes the secondary care response to acute illness. However, the ability of NEWS2 to predict adverse health outcomes specifically for care home residents is unknown. This study explored the relationship between NEWS2 on admission to hospital and resident outcome 7days later. Repeated cross-sectional study. Data on UK care home residents admitted to 160 hospitals in two 24-hour periods (2019 and 2020). Chi-squared and Kruskal-Wallis tests, and multinomial regression were used to explore the association between low (score ≤2), intermediate (3-4), high (5-6), and critically high (≥7) NEWS2 on admission and each of the following: discharge on day of admission, admission and discharge within 7days, prolonged hospital admission (>7days), and death. From 665 resident admissions across 160 hospital sites, NEWS2 was low for 54%, intermediate for 18%, high for 13%, and critically high for 16%. The 7-day outcome was 10% same-day discharge, 47% admitted and subsequently discharged, 34% remained inpatients, and 8% died. There is a significant association between NEWS2 and these outcomes (P < .001). Compared with those with low NEWS2, residents with high and critically high NEWS2 had 3.6 and 9.5 times increased risk of prolonged hospitalization [relative risk ratio (RRR) 3.56; 95% CI 1.02-12.37; RRR 9.47; CI 2.20-40.67], respectively. The risk of death was approximately 14 times higher for residents with high NEWS2 (RRR 13.62; CI 3.17-58.49) and 54 times higher (RRR 53.50; CI 11.03-259.54) for critically high NEWS2. Higher NEWS2 measurements on admission are associated with an increased risk of hospitalization up to 7days duration, prolonged admission, and mortality for care home residents. NEWS2 may have a role as an adjunct to acute care decision making for hospitalized residents.