Hospital Admission Research Articles (Page 1)

Burden and medical expenses of cardiovascular disease hospitalizations attributable to non-optimum temperature in China.

Long-term effectiveness of live zoster vaccine against herpes zoster and related complications: a nationwide emulated target trial in South Korea.

Cognitive function (CF) is likely an important determinant of outcome after traumatic brain injury (TBI) and a predisposing factor for TBI. Previous research measures CF using estimates of pre-TBI CF. We studied the association between measured preinjury CF and functional outcome after injury and whether CF differed based on future TBI. This retrospective, observational study assessed the role of preinjury CF in post-TBI functional outcome and the association with future TBI in Finnish male conscripts. We included patients with TBI treated at Helsinki University Hospital between December 1997 and December 2020. We operationalized CF with the Finnish Defense Forces P1 test, which measures visuospatial, verbal, and arithmetic abilities (range 1-9, higher scores indicating higher CF). We assessed functional outcome as the 6-month Glasgow Outcome Scale (GOS, range 1-5, higher scores indicating better functional outcome). Only patients with TBI who had a pre-TBI CF and functional outcome assessment were included. We defined GOS 1-3 as unfavorable outcome and GOS 1-4 as incomplete recovery. We used logistic regression to assess the association between CF and functional outcome, adjusting for age at hospital admission for TBI and TBI severity. We used Mann-Whitney U tests to compare CF between patients with TBI and non-TBI controls to examine whether CF differed based on future TBI. Of 547 male (0% female) patients with TBI who had CF assessed, 377 had pre-TBI CF and available GOS (69%); of these patients, 18% had unfavorable outcome and 55% incomplete recovery. The median age at time of injury was 40 years (interquartile range [IQR], 31-47), 49% had Glasgow Coma Scale 3-12, and a median P1 score of 5 (IQR, 4-6). We found that CF was associated with incomplete vs complete recovery (OR, 0.86; 95% CI, 0.76-0.96). Non-TBI controls had significantly higher CF than patients with TBI: both p < 0.001, r = 0.46 (95% CI, 0.38-0.55) and r = 0.44 (95% CI, 0.36-0.52). CF was associated with incomplete recovery after TBI. Patients with TBI had lower CF than non-TBI controls, suggesting that CF may influence susceptibility to TBI. However, the generalizability of our findings may be limited because our study involves a single center and includes only male patients.

In May 2024 with a subsequent update in June 2025, the Swedish Medical Products Agency's expert group revised guidelines on the management and treatment of respiratory syncytial virus (RSV) infection. This is an abridged version and commentary on the full recommendation including specific recommendations for the RSV-season 2025/2026. Key points are: (i) RSV is a seasonal, highly contagious infection. Almost all children are infected by age two, usually with mild illness; (ii) Some infants, children with underlying conditions, and frail elderly are at risk for developing severe disease requiring hospital care; (iii) Preventive measures-such as hand hygiene and avoiding contact with people with colds-are essential to protect infants and the elderly; (iv) Prophylactic treatment with monoclonal antibodies reduces the risk of infants developing severe RSV disease and requiring hospital care. The long-acting drug nirsevimab is preferred over the shorter-acting palivizumab; (v) Universal prophylaxis in infants reduce disease burden for both families and society; (vi) If supply is limited, children at highest risk should be prioritised for prophylaxis; (vii) Maternal vaccination during pregnancy lowers the risk of severe RSV in newborns, decreasing hospital admissions. The protective effect is considered to be equivalent to that of monoclonal antibodies. Recommendations and funding decision for maternal vaccination is under investigation during the autumn of 2025; (viii) In the elderly, vaccination is the most effective pharmacological prevention; (ix) There is no effective antiviral treatment for established RSV disease; management is symptomatic and supportive. Hospitalised children should not be subjected to measures with no proven effect, preferable minimal interventions, with treatment focused on ensuring adequate nutrition; (x) The Swedish recommendations state that during the RSV season 2025/2026, nirsevimab should be administered to prevent RSV infection in all infants aged 0-3 months during the RSV season and to infants under 12 months with increased risk of severe RSV and certain high risk children under 24 months.

Background: Admission of an individual for a 72-h assessment for mental problems is a critical period for evaluating an individual’s mental health and determining the need for further treatment. Family members play a pivotal role during the care, treatment and rehabilitation (CTR) of an individual subjected to 72-h assessments. Aim: The study aimed to describe the experiences of family members during a 72-h assessment admission. Setting: Purposive sampling was used to select 16 family members from two selected public general hospitals in the Vhembe district, Limpopo province. Methods: A qualitative approach was employed using explorative, descriptive and contextual designs. Data were collected through semi-structured face-to-face individual interviews from 10 family members who were purposively selected. Tesch’s open coding method was employed to analyse the obtained qualitative data. Results: Family members shared varied negative lived experiences of the 72-h assessment admission of mental healthcare users (MHCUs), which compromises their quality of life. These experiences were based on the CTR of MHCUs. Three themes emerged from data analysis, namely, narratives related to the care provision practices of MHCU during the 72-h assessment period, narratives related to structural constraints, and narratives related to post-72-h assessment referral to another hospital logistics. Conclusion: The study concludes that the experiences of family members regarding the 72-h assessment admission in public hospitals call for attention to some measures to be put in place to address their diverse needs. Contribution: This article contributes to the body of knowledge regarding family members’ experiences of 72-h assessment admission regarding the kind of support needed by family members. The article further provides insights into the experiences of family members.

This study aimed to evaluate the predictive value of plasma biomarkers for myocardial injury and the need for hyperbaric oxygen therapy (HBOT) in patients presenting to the emergency department (ED) with carbon monoxide (CO) poisoning. This prospective observational study included patients over 18years of age who presented to a tertiary care ED with CO poisoning between December 1, 2022, and March 31, 2024. Demographic and clinical data, blood gas and hemogram parameters, and plasma biomarkers including CRP, fibrinogen, albumin, D-dimer, NT-proBNP, and creatine kinase were recorded. Hospital admission, length of stay, complications, and HBOT requirements were also assessed. A total of 82 patients were included (53.7% female, mean age 54 ± 3.9years). HBOT was administered to 26.6% of patients; 28% were hospitalized, and two patients died. Multivariate analysis revealed that neutrophil-to-lymphocyte ratio (NLR) was an independent predictor of myocardial injury (OR: 1.15; 95% CI: 1.008-1.312; p = 0.038). ROC analysis showed that D-dimer (AUC: 0.791; 95% CI: 0.680-0.902; cut-off: 395; sensitivity 77.3%, specificity 73.3%) and NLR (AUC: 0.787; 95% CI: 0.662-0.912; cut-off: 7.4; sensitivity 77.3%, specificity 86.7%) were the most accurate biomarkers for predicting myocardial injury. For predicting HBOT need, D-dimer (AUC: 0.737; cut-off: 395; sensitivity 70%, specificity 76.9%) and NT-proBNP (AUC: 0.702; cut-off: 126.9; sensitivity 66.7%, specificity 69.2%) were found to be significant predictors. D-dimer, NT-proBNP, and NLR may serve as useful biomarkers in predicting myocardial damage and the need for HBOT in patients with CO poisoning.

Penetrating cardiac injury (PCI) is rare; however, it poses a significant challenge during emergency surgery. This study retrospectively analyzed cases of PCI to provide insights into management strategies and outcomes. A retrospective observational study was conducted on 43 patients with PCI who underwent surgical management at our institution between 2008 and 2023. Eligible cases included patients who were alive upon hospital admission and had PCI confirmed intraoperatively during thoracotomy. Patients with incomplete or missing clinical records were excluded. Demographic, intraoperative, and postoperative variables were extracted for analysis. The mean age was 33.8 ± 15.1 (15-80). Most patients had stabbed penetrating wounds (88.4%). The time from the injury to the hospital was 70 minutes. PCI at the region of "cardiac box" accounted for 83.7%. Hemorrhagic shock and cardiac tamponade upon arrival at the hospital occurred in 60% and 62% of the patients, respectively. Median sternotomy and left anterolateral thoracotomy were the most frequently used procedures, accounting for 97.7%. The most frequent injuries were simple wounds of the right ventricle (46.5%) and simple wounds of the left ventricle (27.9%). Intraoperative blood transfusion volume was 1513.1 ± 984.6 mL. Of 43 patients, 37 survived to hospital discharge (86.0%), while 6 patients died (4 intraoperatively and 2 postoperatively. Postdischarge follow-up revealed interventricular septal hypokinesia in 3 patients and a conal ventricular septal defect in one patient. This retrospective observational study delineates the surgical management and outcomes of PCI at a tertiary institution in Vietnam. While highlighting the importance of timely surgical intervention, its retrospective and observational nature limits causal interpretation. Further prospective studies are needed to confirm these findings and guide standardized management.

Pit viper snakebite envenoming remains a critical global health challenge, with tissue necrosis and subsequent amputation posing significant morbidity despite antivenom availability. Existing prediction tools lack integration of dynamic laboratory parameters and iatrogenic factors, limiting their clinical utility. A retrospective cohort study analyzed 1,527 pit viper snakebite envenoming cases from the People's Hospital of Lichuan City (2012-2025). Data encompassed demographics, bite characteristics, treatment timelines, and laboratory parameters (neutrophil-to-lymphocyte ratio [NLR], D-dimer, fibrinogen [FIB]). Univariate and multivariate logistic regression analyses identified independent predictors, and a nomogram was constructed using R software. Model performance was evaluated via area under the curve (AUC), calibration curves, Hosmer-Lemeshow tests, and decision curve analysis (DCA). Key predictors included tourniquet misuse (OR = 15.45, 95% CI: 9.27-25.77), antivenom injection time (> 6h; OR = 11.82, 95% CI: 7.18-19.45), the time from injury to admission (> 6h; OR = 3.90, 95% CI: 2.46-6.20). Elevated NLR (OR = 1.25) and D-dimer (OR = 1.12) predicted amputation risk, whereas higher FIB demonstrated a non-significant protective trend (OR = 0.79, P = 0.090). The nomogram demonstrated exceptional discrimination (AUC: 0.893 training, 0.881 testing) and calibration (Hosmer-Lemeshow P > 0.14), with high sensitivity (90-93%) and moderate specificity (68-72%). DCA confirmed clinical utility across risk thresholds (2-100%). This study highlights the interplay of temporal and laboratory parameters in amputation risk. The nomogram provides a robust tool for early risk stratification, emphasizing timely antivenom use and standardized first aid. This model offers a valuable reference for the implementation of prompt preventive and therapeutic interventions.

Anemia is a common comorbidity among patients with acute heart failure (AHF) and is associated with worse clinical outcomes. However, there is limited data on the effects of anemia in AHF patients in Asian populations. Moreover, the impact of anemia at varying severity levels in patients presenting to the emergency department (ED) is still not well understood. This study aimed to evaluate the prevalence and severity of anemia, together with its association with clinical outcomes in adult patients with AHF. A retrospective analysis was conducted on 890 adult AHF patients extracted from 100,420 ED visits at Srinagarind Hospital between October 2021 and March 2023. Anemia was classified into three categories: mild (hemoglobin 11.0g/dl to normal), moderate (hemoglobin 8.0-10.9g/dl), and severe (hemoglobin < 8.0g/dl). Patient characteristics, laboratory markers, and outcomes were compared among groups. Of the 890 patients, 71% were anemic, with 25% having mild, 51% moderate, and 24% severe anemia. Anemic patients, particularly those with moderate and severe anemia, were older (median age 74 and 71.5 years vs. 64 years for non-anemic, p-value < 0.001) and had higher rates of comorbidities, including chronic kidney disease and diabetes. Severe anemia was associated with worse kidney function (median eGFR 28.9 vs. 62.9 mL/min/1.73m² for non-anemic, p-value < 0.001) and higher initial cardiac troponin T levels (85.8 vs. 39.1 ng/dL, p-value < 0.001). Hospital admission rates increased with anemia severity, with 93% of severely anemic patients being admitted compared to 81% of non-anemic patients. In-hospital mortality was highest in the severe anemia group (8.6%), though this was not statistically significant (p-value = 0.238). Anemia is common in patients with AHF, with many exhibiting moderate or severe levels of anemia. Greater severity of anemia correlates with older age, more comorbidities, and higher hospital admission rates, along with a trend toward higher mortality. Not applicable.

Acute promyelocytic leukemia (APL), a high-risk subtype of acute myeloid leukemia, necessitates rapid diagnosis upon hospital admission to mitigate early mortality. Current diagnosing approaches relying on time-consuming genetic testing or morphological expertise are particularly challenging in resource-limited settings. Herein, this study introduces a novel machine learning approach leveraging routine lab data to enable immediate APL suspicion, offering a new diagnostic possibility for under-resourced hospitals. We developed a two-stage machine learning model using multi-center retrospective data. The cohort included 94 confirmed APL patients (2020-2024) from three tertiary hospitals, with an external validation set (n = 541) from an independent center. Using four VGG-16 networks, we extracted APL-specific 3D scatterplot features from DIFF and WNB channels of routine blood tests. These features were then fed into an optimized random forest classifier-scatterplot (RFC-S) model, refined via recursive feature elimination and threshold tuning. The RFC-S model achieved near-perfect discrimination, with an AUC of 0.9893 in the test set and 0.9979 in external validation. It maintained 98.15% sensitivity and 95.52% specificity-outperforming conventional methods. SHAP analysis confirmed that key scattergram-derived features (e.g., N_APL_Ratio_YZ) drove predictions. Critically, the model requires no additional tests, making it deployable even in low-resource clinics. The RFC-S model represents an innovative approach to APL screening by combining deep learning-derived scattergram features with routine blood parameters. This two-stage methodology achieves high diagnostic accuracy (AUC > 0.98) while maintaining computational efficiency. Importantly, the model's ability to utilize existing laboratory data without requiring additional tests makes it particularly valuable for resource-constrained settings where access to genetic testing or hematological expertise may be limited. Our findings suggest this approach could serve as a practical tool for early APL identification, potentially reducing diagnostic delays in diverse clinical environments.

The authors provide an updated analysis of inpatient healthcare utilization, associated costs, and mortality trends for pediatric hydrocephalus in the US from 2006 to 2019. The goals were to describe patient, hospital, and hospitalization characteristics and determine factors associated with mortality. This cross-sectional study used 2006, 2009, 2012, 2016, and 2019 data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, which collects nationally representative weighted data samples of pediatric hospital discharges. Admissions related to hydrocephalus were categorized as being associated with permanent cerebrospinal fluid (CSF) diversion (including CSF shunt management and endoscopic third ventriculostomy [ETV] with or without choroid plexus cauterization [CPC]) or unrelated to permanent CSF diversion. Each year, there were approximately 30,000-32,000 hydrocephalus-related admissions, resulting in 331,000-526,000 hospital days and US$3.4-5.0 billion charges, for pediatric patients. In 2019, hydrocephalus accounted for 0.5% of all pediatric hospital admissions, 1.4% of all pediatric hospital days, and 2.4% of all pediatric hospital charges in the US. The median (IQR) length of stay across all hydrocephalus-related admissions decreased from 4 (2-15) days in 2006 to 3 (2-9) days in 2019. CSF shunt-related admissions decreased from 11,111 in 2006 to 7959 in 2016; notably, admissions for CSF shunt malfunctions/revisions decreased over time (12,327 in 2006 to 5960 in 2019). In 2019, hospital stays were shorter (4.99 vs 6.69 days) and charges were lower (US$108 million vs US$128 million) in patients who underwent ETV or ETV+CPC compared to those who had initial shunt placement, respectively. However, these unadjusted differences likely reflect baseline patient selection rather than inherent procedural superiority. Patients admitted for periventricular-intraventricular hemorrhage of prematurity (pIVH) had longer hospital stays (p < 0.001) and higher mean costs than others. Compared with survivors, children who died were younger, had pIVH, had a birth-related admission, were self-paying, and were admitted to a nonchildren's hospital (p < 0.05). Pediatric hydrocephalus continues to pose a heavy burden in the US. Despite advancements in management, it remains associated with high costs, significant hospital utilization, and substantial morbidity and mortality. ETV admissions were associated with shorter hospital stays and lower costs, and pIVH was associated with particularly high resource utilization and markedly higher in-hospital mortality. Future efforts should focus on reducing mortality and improving care delivery for high-risk subgroups, particularly those with pIVH and birth-related etiologies.

BACKGROUND Acute variceal bleeding (AVB) in patients with cirrhosis remains life-threatening; moreover, the current risk stratification methods have certain limitations. Rebleeding and mortality after AVB remain major challenges. Although preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) can improve outcomes, not all patients benefit equally. Accurate risk stratification is needed to guide treatment decisions and identify those most likely to benefit from p-TIPS. AIM To develop an artificial intelligence (AI)-driven model to guide AVB treatment decisions, and identify candidates eligible for p-TIPS. METHODS Patients with cirrhosis and AVB, from two multicenter retrospective cohorts in China, who received endoscopic variceal ligation plus pharmacotherapy (n = 1227) or p-TIPS (n = 1863) were included. Baseline data within 24 hours of hospital admission were obtained. The AI-AVB model, based on the six-week failure and one-year mortality rates, was developed to predict treatment efficacy and compared with standard risk scores. Outcomes and adverse events of the treatments were compared across the high- and low-risk subgroups stratified using the AI-AVB model. RESULTS The AI-AVB model demonstrated superior predictive performance compared to traditional risk stratification methods. In the internal validation cohort, the model achieved an area under the curve (AUC) of 0.842 for predicting six-week treatment failure and 0.954 for one-year mortality. In the external validation cohort, the AUCs were 0.814 and 0.889, respectively. The model effectively identified patients at high risk of first-line treatment failure who may benefit from aggressive interventions such as p-TIPS. In contrast, advancing the treatment strategy for low-risk patients did not notably improve the short-term prognosis. CONCLUSION The AI-AVB model can predict treatment outcomes, stratify the failure risk in cirrhotic patients with AVB, aid in clinical decisions, identify p-TIPS beneficiaries, and optimize personalized treatment strategies.

Crimean-Congo haemorrhagic fever (CCHF) is a severe tick-borne viral infection with a high mortality rate. The multi-inflammatory index (MII), consisting of MII-1, MII-2 and MII-3, has been proposed as a prognostic biomarker in infectious diseases. However, its role in CCHF prognosis remains unclear. This retrospective observational study analysed 290 CCHF patients admitted to Erzurum Regional Training and Research Hospital between January 2019 and September 2024. The MIIs were calculated from blood samples obtained on the day of hospital admission. Patients were categorized based on mortality outcomes, and logistic regression and receiver operating characteristics curve analyses were conducted to assess the predictive value of the MIIs. Mortality occurred in 9.31% of patients, with significantly higher MII-1, MII-2 and MII-3 levels in non-survivors. MII-1 showed the highest predictive accuracy (area under the curve 0.846, sensitivity 88%, specificity 75%). No significant difference was found in ribavirin administration between survivors and non-survivors. MIIs, particularly MII-1, serve as independent predictors of mortality in CCHF patients. Early evaluation of MII levels may aid risk stratification and clinical decision-making. Future studies should explore the dynamic changes in these indices and their impact on treatment outcomes.

Background Cardiac arrest (CA) is common but deadly. Prior hospitalisation represents a missed opportunity for prevention and identification of high-risk groups before CA. This study aims to determine the extent of and underlying reasons for hospitalisations during the 30-day period preceding an admission with CA. Methods We conducted a retrospective cohort study using the United States National Readmission Database (NRD) during 2018–2020. We evaluated hospitalisations with a diagnosis of CA and admissions in the 30-day period before hospitalisation with CA. Multiple logistic regressions were used to identify factors associated with prior hospitalisation and mortality on admission with CA. Results Among 1,637,240 hospital episodes with CA, 255,500 (15.6%) had an admission to hospital in the 30-day period prior to hospitalisation with a diagnosis with CA. The categories for causes of previous admissions were disorders of the circulatory system (27%), infectious and parasite disease (13%), and disorders of the respiratory system (12%). The most common diagnoses were sepsis, hypertensive heart and renal disease, acute myocardial infarction, and respiratory failure. Cancer (OR 2.09 95%CI 2.04–2.15, p < 0.001), chronic kidney disease (OR 1.45 95%CI 1.42–1.48, p < 0.001), and chronic lung disease (OR 1.25 95%CI 1.22–1.27, p < 0.001) were the most significant factors associated with prior admission. Previous hospital admission was associated with increased odds of mortality (OR 1.58 95%CI 1.55–1.62, p < 0.001). Conclusions Hospitalisations within the 30-day period preceding an admission with CA are common and occur in about 1 out 6 patients. The most common primary diagnoses for prior hospitalisation were sepsis, renal and cardiovascular disease.

To assess characteristics of individuals who wanted to address mental health needs during hospital admission for stroke through structured, person-centered goal setting, and to describe the types of mental health-related goals. Analysis of aggregated baseline data from a randomized controlled trial (Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke). Trial participants were recruited from 11 Australian hospitals. Within 10 days of stroke admission, participants selected two to five recovery goals from five categories (health, mind and body, everyday activities, out-and-about, and health care). Baseline data included demographics, anxiety/depression status, health-related quality of life, unmet needs, and self-efficacy after stroke. Characteristics associated with selecting mental health-related goals were determined using multivariable logistic regressions. Among 465 participants (33% female, Mdn = 67 years), 50 (11%) selected a mental health-related goal. Content of most mental health-related goals focused on improving mental health (73%) and controlling another lifestyle factor (20%). Selection of mental health-related goals was associated with being under 65 years of age, OR = 2.1, 95% confidence interval (CI) = [1.1, 3.9]; history of mental health concerns, OR = 4.7, 95% CI = [2.5, 8.9]; elevated symptoms of depression or anxiety, OR = 6.6, 95% CI = [3.3, 13.0]; or reporting an unmet mental health need, OR = 5.5, 95% CI = [2.7, 10.9]. We highlight important characteristics associated with self-selecting mental health-related goals after stroke. Greater understanding of barriers for older individuals and those with elevated symptoms of depression/anxiety setting mental health-related goals is warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Globally, there are significant inequalities in risk for chronic respiratory disease patients with COVID-19 (CRD-COVID), and a comprehensive understanding of its determinants and their interactions is needed. This study quantified individual, environmental, and viral risks that impact hospital admission severity and survival outcomes in CRD-COVID patients utilizing multinational hospital records. We analysed data on CRD-COVID from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) dataset, covering January 2020 to July 2022 across 30 countries. The cohort included COVID-19 patients with asthma (Asthma, n = 36,365), chronic pulmonary disease (CPD, n = 36,332), and asthma-CPD overlap (ACO, n = 16,061). We matched these patients with their prehospital environmental and viral risk factors. The primary outcome was admission severity, which we assessed using generalised linear mixed models (GLMM), and GPBoost with Shapley Additive Explanations (SHAP) algorithm. The secondary outcome was 28-day mortality, evaluated using Cox regression and K-medoids clustering. The rates of severe admissions and 28-day mortality were 33.7% and 16.4% for the asthma cohort, 30.1% and 31.6% for the CPD cohort, and 15.9% and 25.8% for the ACO cohort, respectively. Common key risk factors impacting admission severity in CRD-COVID patients include age, sex, comorbidities, humidity, precipitation, and O3 concentration, while vaccination status, temperature, and SO2 concentration were only significant in asthma patients. The interactions analysis showed low Humidity had a greater impact on patients over 60years of age and those with comorbid hypertension. Individual, environmental, and viral factors accurately predicted admission severity, and their contribution was different for asthma (58% individual, 28% environmental, and 14% viral variants), CPD (57%, 33%, and 10%) and ACO (63%, 31%, and 6%) patients. Four clusters stratified by these risk factors within each disease group showed significant differences in 28-day mortality rates, particularly in the asthma and CPD patients. The cluster with the highest 28-day mortality rates featured low humidity (mean 55.5% for asthma, 54.4% for CPD) and older age (60.1 and 74.2years). The impact of prehospital individual, environmental, and viral risk on the severity of CRD-COVID patients was heterogeneous. Older people exposed to low humidity were at greatest risk.

Background Intracerebral hemorrhage (ICH) can lead to respiratory dysfunction and pulmonary infection (PI). Objectives The present study aimed to investigate in-hospital factors influencing PIs in patients with spontaneous ICH and their prognosis. Methods Clinical data of patients with spontaneous ICH were retrospectively collected from January 2021 to December 2022 to assess nosocomial consolidation of PIs, with follow-up evaluations for up to 1 year. The clinical factors influencing the development of PI were analyzed and their impact on prognosis was determined in patients with or without PI development. Results A total of 864 patients with ICH were included in this study, of whom 568 (65.7%) had PIs. Independent factors influencing PIs included age, National Institute of Health Stroke Scale score at the time of admission, activities of daily living scale score at the time of admission, and C-reactive protein level (all p &amp;lt; 0.05). The adverse prognosis (70.8% vs. 39.5, 52.0% vs. 28.5, and 51.6% vs. 27.1%, respectively) and mortality rates (10.7% vs. 4.1, 6.5% vs. 1.8, and 10.3% vs. 3.2%, respectively) at the time of hospital discharge, 90 days after ICH onset, and 1 year after ICH onset were significantly higher in patients who developed PIs than in those who did not ( p &amp;lt; 0.05). Conclusion Pulmonary infection is a common complication of spontaneous ICH and may be influenced by patient age, length of hospital stay, and hospital admission status. Patients with spontaneous ICH and PI had worse prognoses and mortality rates than those without PI. Further clinical trial is necessary.

Background. Febrile neutropenia is a common cause of hospital admissions among pediatric cancer patients. To optimize personalized approaches for hospitalization and antibiotic treatment, risk stratification has been proposed. This study aimed to explore the impact of clinical and laboratory parameters on risk stratification for patient discharge. Methods. This prospective study included pediatric lymphoma and solid tumor patients who were hospitalized due to febrile neutropenia between June 2018 and June 2019. Patient characteristics, primary oncological diagnosis and disease status, comorbid conditions, time elapsed after the last course of chemotherapy, use of granulocyte-colony stimulating factor (G-CSF) prophylaxis, presence of port catheter, infection type, fever values/duration, physical examination findings, and duration of neutropenia were collected. Laboratory investigations including complete blood counts, acute phase reactants at the onset of the episode, culture results were also recorded. Results. The study examined 142 febrile neutropenic episodes from 88 consecutive patients. The median age of the study group was 6.8 years, with 19.3% of cases being lymphoma and 80.7% having solid tumors. The median hospital stay was 7 days. Factors associated with longer hospitalization periods included a lymphoma diagnosis, presence of comorbid conditions, bone marrow involvement, and febrile neutropenic period during hospitalization. Patients presenting with fever ≥ 39 °C at admission, poor general appearance, hypotension, prolonged capillary filling time, and severe infection signs had longer hospital stays. In febrile neutropenic episodes, absolute monocyte count ≤ 100 cells/mm3, platelet count ≤ 50,000/mm3, and prolonged neutropenia delayed discharge time. Patients with microbiologically defined infections, especially those with positive catheter cultures, also had delayed discharge. Conclusion. The diagnosis of lymphoma, poor general condition at admission, presence of microbiologically defined infection, thrombocytopenia, delayed recovery of absolute neutrophil counts, and prolonged fever duration were significant factors in determining the treatment duration and predicting discharge time.

ObjectivesTo examine the association between exposure to greenness and hospital admissions for mental disorders, and to estimate greenness related hospital admissions under various greenness intervention scenarios.DesignMulticountry time series study.Setting6842 locations in seven countries (Australia, Brazil, Canada, Chile, New Zealand, South Korea, and Thailand).Participants11.4 million hospital admissions for mental disorders, 2000-19.Main outcome measuresHospital admissions for all cause mental disorders and for six categories in relation to greenness (measured by the normalised difference vegetation index (NDVI)): psychotic disorders, substance use disorders, mood disorders, behavioural disorders, dementia, and anxiety. Associations were estimated using quasi-Poisson regression models, controlled for weather conditions, air pollutants, socioeconomic indicators, seasonality, and long term trends. Models were stratified by sex, age, urbanisation, and season. Hospital admissions were estimated under different greenness intervention scenarios.ResultsDuring 2000-19, of hospital admissions related to mental health disorders, 30.8% (3 522 749 patients) were for psychotic disorders, 24.7% (2 821 860) for substance use disorders, 11.6% (1 325 305) for mood disorders, 7.4% (845 561) for behavioural disorders, 3.0% (348 149) for dementia, and 2.5% (283 914) for anxiety. A 0.1 increase in NDVI was associated with a 7% reduction in the risk of hospital admissions for all cause mental disorders (relative risk 0.93, 95% confidence interval (CI) 0.89 to 0.98) in pooled analyses. However, associations varied across countries and disorder types. Brazil, Chile, and Thailand showed consistent protective associations across most disorder categories, while modest adverse (ie, harmful) associations were observed in Australia and Canada for hospital admissions for all cause mental disorders and for several specific disorder categories. Exposure-response analyses showed a generally monotonic and approximately linear relation without clear thresholds. When limited to urban settings where associations were generally more consistent, an estimated 7712 (95% CI 6701 to 8726) hospital admissions for mental health disorders annually in urban areas were statistically attributable to observed greenness levels. Analysis by greenness intervention scenarios in urban areas suggested that a 10% increase in greenness was associated with reductions in hospital admissions for mental disorders ranging from ~1 per 100 000 in South Korea to ~1000 per 100 000 in New Zealand.ConclusionsGreenness was statistically associated with lower risks of hospital admissions for mental disorders in several countries, particularly in urban settings. Some adverse associations were, however, observed, and findings were heterogeneous across contexts.

To evaluate the impact of introducing a regional advanced care paramedic program on clinical outcomes for patients with out-of-hospital cardiac arrest transported to hospital by emergency medical services (EMS). We conducted a health records review of adult out-of-hospital cardiac arrest patients transported by emergency medicine services (EMS) to a Canadian tertiary care hospital between 2010 and 2014 (pre-implementation) and 2016 and 2019 (post-implementation) of a regional advanced care paramedic program. The transition year (2015) was excluded due to a phased rollout. Eligible patients were 18 years of age or older who experienced an out-of-hospital cardiac arrest. Patients with traumatic or overdose-related arrests were excluded. Primary outcomes were sustained return of spontaneous circulation, survival to hospital admission, and survival to hospital discharge. Multivariable logistic regression adjusted for witnessed arrest, bystander CPR, initial rhythm, and epinephrine administration. A total of 390 patients met inclusion criteria, with 228 in the pre-implementation group and 162 in the post-implementation group. Survival to hospital admission increased from 14.9 to 24.7% (adjusted odds ratio [aOR] 2.1, 95% confidence interval [CI] 1.2-3.7) and survival to hospital discharge increased from 3.1 to 11.1% (aOR 5.0, 95% CI 2.0-12.3). Return of spontaneous circulation occurred more frequently with borderline statisticalsignificance after adjustment (aOR 1.5, 95% CI 1.0-2.4). No other changes in prehospital protocols or hospital-based cardiac arrest care occurred during the study period. The implementation of an advanced care paramedic program was associated with significantly improved survival among out-of-hospital cardiac arrest patients transported to hospital by EMS. EMS systems with developing airway management, vascular access, and resuscitation capabilities may achieve meaningful outcome gains through strategic integration of advanced care paramedic providers into cardiac arrest response frameworks.