Adult Hospital Admissions Research Articles

A Mixed Methods Systematic Review of the Effectiveness, Acceptability, and Feasibility of Advanced Care Plans for Older Adults Without Life-Limiting Conditions

Context: Advance care planning (ACP) is a comprehensive procedure aimed at helping individuals understand and articulate their values, life goals, and preferences concerning future medical treatment. Despite extensive research on ACP in populations with terminal illnesses, dementia, and those in long-term care, there is a lack of focus on its impact among older adults without life-limiting conditions. Objectives: To investigate the effectiveness, acceptability, and feasibility of ACP for older adults without life-limiting conditions. Methods: We searched 11 electronic databases, spanning from inception to November 2023, complemented by extensive grey literature and reference searches. Rigorous quality assessments were conducted using the Mixed Methods Appraisal Tool (MMAT). Our approach adopted a dynamic convergent mixed-methods design, incorporating thematic and narrative synthesis. Findings: From over 12,600 citations, a total of 16 studies, comprising four randomised controlled trials (RCTs), nine qualitative studies, and three mixed methods studies met the inclusion criteria. Limited findings indicate that ACP interventions are generally effective in improving document completion rates and reducing hospital readmissions. Acceptability and feasibility of these interventions were high, although significantly influenced by cultural and religious factors. Limitations: Evidence supporting the effectiveness, acceptability, and feasibility of ACP in reducing unplanned hospital admissions in older adults without life-limiting conditions was limited. We excluded observations based on unwell older people, though some material with unclear distinctions may have been included. Quality assessments revealed that one of four RCTs had a high risk of bias, three had unclear risks; all nine qualitative studies had low risk; and one of three mixed methods studies had low risk while two had unclear risks. Implications: Further targeted research is necessary to assess the intervention’s value for this population. Rigorous real-world evidence studies involving older adults without life-limiting conditions and their proxies is crucial to enabling providers to tailor ACPs to diverse populations, whilst respecting individuals’ religious and cultural beliefs.

Associations Between Physical Activity, Systemic Inflammation, and Hospital Admissions in Adults With Heart Failure

Purpose: Among individuals with diagnosed heart failure (HF), the impact of physical activity on systemic inflammation and risk of hospital admissions remains unclear. Therefore, the purpose of this study was to examine the associations between physical activity and (1) systemic inflammation measured through C-reactive protein (CRP) levels and (2) frequency of hospital admissions in those with HF. Methods: We used data from the National Health and Nutrition Evaluation Survey in this observational cross-sectional study to include 377 community-dwelling adults with HF. Demographic, clinical, and functional variables were extracted from the data and included in the regression models as covariates during analysis. Associations between activity and hospital admissions were examined using Poisson regression. Multivariable logistic regression analysis was used for association between CRP and physical activity. Results: We found a direct linear relationship between CRP levels and hospital admissions, with higher levels of CRP significantly associated with greater number of hospital admissions in HF (incidence rate ratio [IRR] = 1.18, P < .001). Similarly, participating in vigorous activity was significantly associated with decreased expected rate of hospital admissions (IRR = 0.38, P = .013 (C.I. = 0.18–0.80) and with a significant decrease in the CRP levels (B = −0.44, P = .018 (C.I. = −0.80 to −0.83). Conclusion: To the best of our knowledge, this is the first study using population-level data to examine the association between physical activity level, systemic inflammation, and hospitalizations in individuals with HF. The findings of this study demonstrate that irrespective of sex, engagement in physical activity at higher intensity levels is strongly associated with favorable health outcomes in older adults with HF.

Impact of community-based multidomain preventive health program on healthcare utilisation among elderly persons in Singapore: a propensity score matched and difference-in-differences study

ObjectivesAgeing populations present substantial challenges for healthcare systems. Community-based health worker (CHW) interventions for promoting healthy ageing and preventing/managing non-communicable diseases have gained considerable attention in recent years. This study...

Has multimorbidity and frailty in adult hospital admissions changed over the last 15 years? A retrospective study of 107 million admissions in England

BackgroundFew studies have quantified multimorbidity and frailty trends within hospital settings, with even fewer reporting how much is attributable to the ageing population and individual patient factors. Studies to date have tended to focus on people over 65, rarely capturing older people or stratifying findings by planned and unplanned activity. As the UK’s national health service (NHS) backlog worsens, and debates about productivity dominate, it is essential to understand these hospital trends so health services can meet them.MethodsHospital Episode Statistics inpatient admission records were extracted for adults between 2006 and 2021. Multimorbidity and frailty was measured using Elixhauser Comorbidity Index and Soong Frailty Scores. Yearly proportions of people with Elixhauser conditions (0, 1, 2, 3 +) or frailty syndromes (0, 1, 2 +) were reported, and the prevalence between 2006 and 2021 compared. Logistic regression models measured how much patient factors impacted the likelihood of having three or more Elixhauser conditions or two or more frailty syndromes. Results were stratified by age groups (18–44, 45–64 and 65 +) and admission type (emergency or elective).ResultsThe study included 107 million adult inpatient hospital episodes. Overall, the proportion of admissions with one or more Elixhauser conditions rose for acute and elective admissions, with the trend becoming more prominent as age increased. This was most striking among acute admissions for people aged 65 and over, who saw a 35.2% absolute increase in the proportion of admissions who had three or more Elixhauser conditions. This means there were 915,221 extra hospital episodes in the last 12 months of the study, by people who had at least three Elixhauser conditions compared with 15 years ago. The findings were similar for people who had one or more frailty syndromes. Overall, year, age and socioeconomic deprivation were found to be strongly and positively associated with having three or more Elixhauser conditions or two or more frailty syndromes, with socioeconomic deprivation showing a strong dose–response relationship.ConclusionsOverall, the proportion of hospital admissions with multiple conditions or frailty syndromes has risen over the last 15 years. This matches smaller-scale and anecdotal reports from hospitals and can inform how hospitals are reimbursed.

Predictors of high hospital admission and criminal reoffending in adults experiencing homelessness: a retrospective cohort study

ObjectivesTo examine the costs and predictors of high hospital use and criminal reoffending in adults experiencing homelessness. ApproachRetrospective cohort study of 2,140 adults who attended homeless hostel clinics in New South Wales, Australia using linked clinic, health, criminal offence, and mortality data from 1 July 2008 to 30 June 2021. Multivariable logistic regression examined predictors of high all-cause hospital use (≥4 emergency department presentations in 12 months) and predictors of recidivism. ResultsThere were 27,466 hospitalisations at a total cost of AUD$548.2 million. Twenty-seven percent of the cohort had high hospital use. Factors associated with high use were age ≥45 years, female (AOR: 1.52; 95%CI 1.05-2.22), presence of a mental disorder, substance use disorder (AOR: 1.36; 95%CI: 1.03-1.82), or being homeless for >1 year (AOR: 1.31; 95%CI: 1.06-1.62). There were 1,646 (76.9%) adults who had contact with the criminal justice system. Most (75.3%) reoffended within 24 months after index offence, and reoffenders were more likely to be younger, have a personality disorder (AOR: 1.31; 95% CI: 1.04-1.67), substance use disorder (AOR: 1.60; 95%CI 1.14-2.23), and had a previous charge dismissed on mental health grounds (AOR: 1.79; 95% CI: 1.31-2.46). Reoffenders more likely to have a principal theft-related offence (AOR: 1.85; 95%CI: 1.29-2.66). Total court finalisation costs were AUD$11.3 million. ConclusionsThe high use of hospital and criminal justice services lends support to strategies to develop models of supported housing with a focus on integrated care, mental health support, improved referral pathways, and better coordination with community-based support agencies.

Social and built environmental factors associated with adult asthma hospital admission in the North Central Texas

Asthma, one of the most common chronic diseases of adults and children, is an important public health concern. The cause of asthma is thought to be a combination of genetic and environmental factors, and a growing body of research has investigated the possible geographic and contextual factors that contribute to asthma prevalence. However, few studies have incorporated geographic and environmental variables into their designs, despite evidence that geography is associated with asthma exacerbation. Additionally, studies of asthma exacerbations among adults are limited. The situation regarding asthma is particularly concerning in North Central Texas (NCT) compared to the national context. In light of this, we analyzed the geographic variation of approximately 12,000 adult patients hospitalized for asthma in the North Central Texas Region, and their association with built environmental features such as land use types, dwelling characteristics, exposure to traffic parameters at the Census Block Group (CBG) level, and pollutant concentrations in the relevant counties for the year 2014. We applied the Hierarchical Linear Model (HLM), and our analysis indicates that there are significant health disparities in the region. We found that the adult asthma hospitalization rate is significantly higher in low-income, low-education neighborhoods with a significant Black population. Furthermore, factors such as increased travel distance to work and substandard dwelling conditions have been found to trigger an increase in hospital visits for asthma patients. Conversely, the presence of greenspace in the surrounding area has been found to help reduce the frequency of asthma-related hospital visits. It is worth noting that both indoor and outdoor environmental quality contribute to adult asthma hospitalizations. Overall, our study highlights the importance of considering geographic and environmental factors in understanding the prevalence and exacerbation of asthma. Our findings suggest that targeted interventions, such as improving indoor and outdoor environmental quality and increasing access to greenspace, may help reduce the burden of asthma in high-risk communities.

Exploring the Clinical Outcomes of End-Organ Damage in Hypertensive Emergency: A National Perspective

Background: The number of emergency department visits for hypertensive emergency has been increasing and was reported to be 496,894 visits in 2013 1. Current recommendations are to admit these patients to the ICU and start on intravenous blood pressure-lowering medications. This study aims to assess the prevalence of each end organ damage and their effects on the outcomes during hospitalization. Methods: This study analyzed data from the 2016-2020 National Inpatient Sample (NIS) database, focusing on adult hospital admissions. We utilized International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes to identify cases of hypertensive emergency (I16.1) and other relevant comorbidities. The primary objective was to assess the prevalence of end-organ damage and its impact on mortality. We employed multivariable logistic regression to adjust for demographics, comorbidities and other potential confounders. Results: Our comprehensive analysis included 1,032,860 hospitalizations due to hypertensive emergencies, with a notable increase in prevalence from 1,149 to 10,255 cases per 1 million patients between 2016 and 2020. The mean age of the cohort was 62.10 (± 15.97 years), with females constituting 50.7% and whites 44.97%. The most common chronic comorbidities identified were chronic kidney disease (CKD) at 44.87%, diabetes mellitus (DM) at 44.22%, coronary artery disease (CAD) at 42.49%, and congestive heart failure (CHF) at 42.46%. Among end-organ damages, acute kidney injury was most prevalent (33.37%), followed by acute heart failure/pulmonary edema (26.38%), Acute Coronary Syndromes (ACS) (15.33%), ischemic stroke (11.55%), hemorrhagic stroke (9.79%), hypertensive encephalopathy (5.30%), and aortic dissection (1.11%). In patients with hypertensive emergencies, the in-hospital mortality rate was 3.9%, and the median length of stay was 5.96 days (range: 5.91 - 6.01). Subgroup analysis revealed the highest mortality rates in patients with hemorrhagic stroke (20.0%), followed by those with aortic dissection (7.1%). Consistently, hemorrhagic stroke (OR 11.45, 95% CI 10.83-12.10, p<0.001) and aortic dissection (OR 3.11, 95% CI 2.54-3.80, p<0.001) emerged as the most significant predictors of increased in-hospital mortality after adjusting for demographics, comorbidities, and various types of end-organ damage. Conclusions: This study highlights a significant ongoing rise in hospital admissions due to hypertensive emergencies from 2016 to 2020, emphasizing the increasing burden of this condition. Our findings demonstrate prevalent comorbidities, end-organ damages and notable mortality rates among patients admitted with hypertensive emergencies. The study emphasizes the need for personalized patient care, underscoring the vital role of early detection and outpatient management of hypertension to prevent the onset of hypertensive emergencies and improve patient outcomes. With the rising incidence of hypertensive emergencies, it is imperative for healthcare systems to evolve, adopting new protocols and refining risk stratification criteria to effectively meet these emerging challenges.

Implementable Prediction of Pressure Injuries in Hospitalized Adults: Model Development and Validation.

Numerous pressure injury prediction models have been developed using electronic health record data, yet hospital-acquired pressure injuries (HAPIs) are increasing, which demonstrates the critical challenge of implementing these models in routine care. To help bridge the gap between development and implementation, we sought to create a model that was feasible, broadly applicable, dynamic, actionable, and rigorously validated and then compare its performance to usual care (ie, the Braden scale). We extracted electronic health record data from 197,991 adult hospital admissions with 51 candidate features. For risk prediction and feature selection, we used logistic regression with a least absolute shrinkage and selection operator (LASSO) approach. To compare the model with usual care, we used the area under the receiver operating curve (AUC), Brier score, slope, intercept, and integrated calibration index. The model was validated using a temporally staggered cohort. A total of 5458 HAPIs were identified between January 2018 and July 2022. We determined 22 features were necessary to achieve a parsimonious and highly accurate model. The top 5 features included tracheostomy, edema, central line, first albumin measure, and age. Our model achieved higher discrimination than the Braden scale (AUC 0.897, 95% CI 0.893-0.901 vs AUC 0.798, 95% CI 0.791-0.803). We developed and validated an accurate prediction model for HAPIs that surpassed the standard-of-care risk assessment and fulfilled necessary elements for implementation. Future work includes a pragmatic randomized trial to assess whether our model improves patient outcomes.

Multimorbidity-associated emergency hospital admissions: a “screen and link” strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol

Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Risk factors for asthma-related hospital and intensive care admissions in children, adolescents and adults: a cohort study using primary and secondary care data

BackgroundAsthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in...

Brief report: Effect of cardiac multi-morbidity on COVID hospitalization outcomes.

The COVID-19 pandemic has stretched healthcare resources thin and led to significant morbidity and mortality. There have been no studies utilizing national data to investigate the role of cardiac risk factors on outcomes of COVID hospitalizations. The aim of this study was to examine the effect of cardiac multimorbidity on healthcare utilization and outcomes among COVID hospitalizations during the first year of the pandemic. Using the national inpatient sample (NIS), we identified all adult hospital admissions with a primary diagnosis of COVID in 2020, using International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD010-CM). Coronary artery disease, diabetes mellitus, heart failure, peripheral vascular disease, previous stroke, and atrial fibrillation were then identified as cardiac comorbidities using ICD-10-CM codes. Multivariable logistic regression was used to evaluate the effect of cardiac multimorbidity on mortality and mechanical ventilation. We identified 1,005,040 primary COVID admissions in 2020. Of these admissions, 216,545 (20.6%) had CAD, 413,195 (39.4%) had DM, 176,780 (16.8%) had HF, 159,700 (15.2%) had AF, 30735 (2.9%) had PVD, and 25,155 (2.4%) had a previous stroke. When stratified by number of comorbidities, 428390 (40.8%) had 0 comorbidities, 354960 (33.8%) had 1, 161225 (15.4%) had 2, and 105465 (10.0%) had 3+ comorbidities. COVID hospitalizations with higher cardiac multimorbidity had higher mortality rates (p<0.001) higher MV rates (p<0.001). In our multivariable regression, these associations remained with increasing odds for mortality with each stepwise increase in cardiac multimorbidity (1: OR 1.48 (1.45-1.50); 2: OR 2.13 (2.09-2.17); 3+: OR 2.43 (2.38-2.48), p<0.001, all). Our study is the first national examination of the impact of cardiac comorbidities on COVID outcomes. A higher number of cardiac comorbidities was associated with significantly higher rates of MV and in-hospital mortality, independent of age. Future, more granular, and longitudinal studies are needed to further examine these associations.

Causes, outcomes and diagnosis of acute breathlessness hospital admissions in Malawi: protocol for a multicentre prospective cohort study.

Hospital admission due to breathlessness carries a significant burden to patients and healthcare systems, particularly impacting people in low-income countries. Prompt appropriate treatment is vital to improve outcomes, but this relies on accurate diagnostic tests which are of limited availability in resource-constrained settings. We will provide an accurate description of acute breathlessness presentations in a multicentre prospective cohort study in Malawi, a low resource setting in Southern Africa, and explore approaches to strengthen diagnostic capacity. Primary objective: Delineate between causes of breathlessness among adults admitted to hospital in Malawi and report disease prevalence. Secondary objectives : Determine patient outcomes, including mortality and hospital readmission 90 days after admission; determine the diagnostic accuracy of biomarkers to differentiate between heart failure and respiratory infections (such as pneumonia) including brain natriuretic peptides, procalcitonin and C-reactive protein. This is a prospective longitudinal cohort study of adults (≥18 years) admitted to hospital with breathlessness across two hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Chiradzulu, Malawi. Patients will be consecutively recruited within 24 hours of emergency presentation and followed-up until 90 days from hospital admission. We will conduct enhanced diagnostic tests with robust quality assurance and quality control to determine estimates of disease pathology. Diagnostic case definitions were selected following a systematic literature search. This study will provide detailed epidemiological description of adult hospital admissions due to breathlessness in low-income settings, which is currently poorly understood. We will delineate between causes using established case definitions and conduct nested diagnostic evaluation. The results have the potential to facilitate development of interventions targeted to strengthen diagnostic capacity, enable prompt and appropriate treatment, and ultimately improve both patient care and outcomes.

Effect of Delirium on Interhospital Transfer Outcomes.

Interhospital transfer (IHT) and in-hospital delirium are both independently associated with increased length of stay (LOS), mortality, and discharge to facility. Our objective was to investigate the joint effects between IHT and the presence of in-hospital delirium on the outcomes of LOS, discharge to a facility, and in-hospital mortality. This was a single-center retrospective cohort study of 25,886 adult hospital admissions at a tertiary-care academic medical center. Staged multivariable logistic and linear regression models were used to evaluate the association between IHT status and the outcomes of discharge to a facility, LOS, and mortality while considering the joint impact of delirium. The joint effects of IHT status and delirium were evaluated by categorizing patients into one of four categories: emergency department (ED) admissions without delirium, ED admissions with delirium, IHT admissions without delirium, and IHT admissions with delirium. The primary outcomes were LOS, in-hospital mortality, and discharge disposition. The odds of discharge to a facility were 4.48 times higher in admissions through IHT with delirium when compared with ED admissions without delirium. IHT admissions with delirium had a 1.97-fold (95% confidence interval 1.88-2.06) longer LOS when compared with admission through the ED without delirium. Finally, admissions through IHT with delirium had 3.60 (95% confidence interval 2.36-5.49) times the odds of mortality when compared with admissions through the ED without delirium. The relationship between IHT and delirium is complex, and patients with IHT combined with in-hospital delirium are at high risk of longer LOS, discharge to a facility, and mortality.

Age-specific transmission dynamics of SARS-CoV-2 during the first 2 years of the pandemic.

During its first 2 years, the SARS-CoV-2 pandemic manifested as multiple waves shaped by complex interactions between variants of concern, non-pharmaceutical interventions, and the immunological landscape of the population. Understanding how the age-specific epidemiology of SARS-CoV-2 has evolved throughout the pandemic is crucial for informing policy decisions. In this article, we aimed to develop an inference-based modeling approach to reconstruct the burden of true infections and hospital admissions in children, adolescents, and adults over the seven waves of four variants (wild-type, Alpha, Delta, and Omicron BA.1) during the first 2 years of the pandemic, using the Netherlands as the motivating example. We find that reported cases are a considerable underestimate and a generally poor predictor of true infection burden, especially because case reporting differs by age. The contribution of children and adolescents to total infection and hospitalization burden increased with successive variants and was largest during the Omicron BA.1 period. However, the ratio of hospitalizations to infections decreased with each subsequent variant in all age categories. Before the Delta period, almost all infections were primary infections occurring in naive individuals. During the Delta and Omicron BA.1 periods, primary infections were common in children but relatively rare in adults who experienced either reinfections or breakthrough infections. Our approach can be used to understand age-specific epidemiology through successive waves in other countries where random community surveys uncovering true SARS-CoV-2 dynamics are absent but basic surveillance and statistics data are available.

Multimorbidity-associated emergency hospital admissions: a "screen and link" strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol.

The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub-Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng'ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

FATORES PREDITORES DE HOSPITALIZAÇÃO E ÓBITO EM IDOSOS COM COMPROMETIMENTO COGNITIVO: UM ESTUDO LONGITUDINAL

ABSTRACT Objective: to identify sociodemographic factors, clinical conditions and sarcopenia parameters that predict hospital admission and death in older adults with cognitive impairment. Method: this is a longitudinal observational study carried out with 170 older adults with cognitive impairment assessed between 2019 and 2021. Predictor variables were sociodemographic characteristics, clinical conditions and sarcopenia parameters. Sarcopenia was operationalized through handgrip muscle strength (dynamometry), muscle mass (calf circumference) and the Timed Up and Go test. Occurrence of hospital admission and death within one year after assessment of older adults were the predicted variables. Analyzes were carried out using descriptive statistics, independent Student’ t-test, Mann-Whitney U test, chi-square test and univariate logistic regression. Results: most participants were female (±77.57 years old), with low education, sedentary, 15.9% with sarcopenia and 13% with a history of hospital admission. It was identified that education level had an effect on occurrence of hospital admission (U=1,423.5, p=0.027) and death (U=647.0, p=0.025) within one-year follow-up. Furthermore, there is an association between history of hospital admission in the last 6 months and occurrence of hospital admission [χ2(1)=4.729; p=0.030] and death [χ2(1)=3.919; p=0.048] within one year follow-up. It was identified that history of hospital admission in the last 6 months was associated with occurrence of hospital admission within one-year follow-up (OR=2.963; 95%CI 1.076-8.165, p=0.036). Conclusion: history of hospital admission in the last six months is associated with occurrence of hospital admission over a year in older adults with cognitive impairment.

The Irish national chronic obstructive pulmonary disease quality improvement collaborative: an adaptive learning collaborative

BackgroundChronic obstructive pulmonary disease (COPD) is the the most common disease-specific cause of adult emergency hospital admissions in Ireland. Preliminary groundwork indicated that treatment of acute exacerbations of COPD (AECOPD)...

888. Estimation of the Incidence of RSV-attributable Circulatory and Respiratory Hospital Admissions in Adults in Germany between 2015–2019, Overall and for Specific Conditions

Abstract Background Respiratory syncytial virus (RSV) can cause severe outcomes in adults, especially those with underlying risk factors. However, RSV incidence in adults is usually underestimated because of non-specific symptomatology and limited standard of care testing. We retrospectively estimated RSV-attributable incidence of hospital admissions in adults in Germany between 2015–2019. Methods Information from inpatient visits was gathered from a Statutory Health Insurance database (approximately 3,5 million insured people). A quasi-Poisson regression model was used to estimate RSV-attributable incidence among both respiratory and circulatory hospital admissions accounting for within-season fluctuations and virus activity stratified by age groups (18–44, 45–59, 60–75, ≥75 years), risk status, and disease subgroups (5 respiratory and 4 circulatory). Results The highest RSV-attributable incidence rates of hospital admissions were observed for circulatory diseases among older patients and those with risk factors (Table). In adults aged 60 years or older, arrythmia and acute coronary/myocardial infarction accounted for the highest incidence and stroke for the lowest incidence within circulatory hospitalizations (Table). Within respiratory hospitalizations in adults ≥75 years, RSV-attributable incidence was highest for hospital admissions related to influenza/pneumonia and chronic obstructive pulmonary disease; it was lowest for hospital admissions related to upper respiratory diseases (Table). RSV Incidence Rate Ranges Estimated RSV-attributable Incidence Rate per 100,000 Inhabitants Related to Circulatory and Respiratory Diseases in Adults Reported as Ranges from 2015 to 2019, Stratified by Age Group (in Years) and Risk Status, Germany Conclusion This study showed that RSV causes a considerable burden of hospitalizations in adults in Germany, and, like other respiratory viruses’ (e.g., influenza and SARS-CoV-2), contributes to both respiratory and circulatory hospitalizations. This highlights the need to implement effective prevention strategies especially among the oldest and those with underlying risk factors. Disclosures Caroline Beese, n/a, Pfizer: CB is an employee of Pfizer, the sponsor of this study Gordon Brestrich, PhD, Pfizer: GB is an employee of Pfizer, the sponsor of this study Elizabeth Begier, M.D., M.P.H., Pfizer: EB is an employee of Pfizer, the sponsor of this study|Pfizer: Stocks/Bonds Aleksandra Polkowska-Kramek, n/a, P95: APK is an employee of P95, paid by Pfizer to conduct the study Robin Bruyndonckx, n/a, P95: RB is an employee of P95, paid by Pfizer to conduct the study Charles Nuttens, n/a, Pfizer: CN is an employee of Pfizer, the sponsor of this study Thao Mai Phuong Tran, n/a, P95: TMPT is an employee of P95, paid by Pfizer to conduct the study Worku Biyadgie Ewnetu, n/a, P95: WBE is an employee of P95, paid by Pfizer to conduct the study Juan Luis Ramirez Agudelo, n/a, P95: JLRA is an employee of P95, paid by Pfizer to conduct the study Lea Johanna Bayer, n/a, Pfizer: LJB is an employee of Pfizer, the sponsor of this study Caihua Liang, MD, PhD, Pfizer: CL is an employee of Pfizer, the sponsor of this study Bradford D. Gessner, M.D., M.P.H., Pfizer: I am an employee of Pfizer|Pfizer: Stocks/Bonds

1376. A Retrospective Analysis of Intravenous Fluid Therapy Practice at Hospital Admission for Adults with Dengue

Abstract Background Dengue epidemics in Asia was almost exclusively a childhood disease but recently dengue in adults have become increasingly prevalent. Yet intravenous fluid replacement (IVFR), the main supportive therapy for dengue, was developed for pediatric dengue. Evidence-based guidance for fluid replacement, especially for older adults with concomitant chronic diseases that both increases risk of severe dengue and complicate fluid replacement, is lacking. We retrospectively analyzed the use of IVFR in adult dengue patients at admission to a tertiary hospital. Methods Medical records of patients diagnosed with dengue (confirmed by rapid NS1 kit or laboratory confirmation of RT-PCR, NS1 or IgM) from January 2020 to December 2022 were analyzed. Recovery phase was defined as fever defervescence for &amp;gt;12 hours with rising platelet count. Appropriateness of IVFR was based on disease severity according to the 2009 WHO dengue classification scheme. Results Preliminary analysis of the first 30 patients found an almost equal number of males (47%) and females. The median age was 52.5 years (range 15.0-83.0). 20 patients had at least one comorbidity with hyperlipidemia (33%), hypertension (23%) and ischemic heart disease (10%) being the most common. Average time from onset to presentation was 4.3 days (95% CI: 3.8-4.9). 16 (53%) met the WHO classification scheme as requiring IVFR at admission; 4 hypotension, 5 acute kidney injury (AKI), 2 hypotension with AKI, 4 hemoconcentration, 1 AKI with hemoconcentration. Of these 16, one also had altered mental status and another had hemophagocytic lymphohistiocytosis-like presentation. Despite 47% having uncomplicated dengue, all patients had IVFR at admission. Total fluid volume administered during hospitalization varied across the population and fluctuated daily for each patient, with 8 patients receiving IVFR beyond the recovery phase. One developed fluid overload while another had IV cannula-related thrombophlebitis. There was no mortality. Conclusion Preliminary findings of our on-going study suggest excessive use of IVFR and the lack of standardization possibly contributed to two iatrogenic complications. We call for development of evidence-based protocol on fluid management in older dengue patients. Disclosures All Authors: No reported disclosures

Racial, socioeconomic, and neighborhood characteristics in relation to COVID-19 severity of illness for adolescents and young adults.

This study tests the hypotheses that insurance status, race and ethnicity, and neighborhood characteristics are associated with hospital admission and severe health outcomes (Intensive Care Unit [ICU] admission and oxygen assistance) for youth and young adults who present to the emergency department (ED) with COVID-19 in a single, academic health system in Illinois, Rush University System for Health (RUSH). Demographic and clinical data from the electronic health record were collected for all 13- to 24-y-old patients seen at RUSH who tested positive for COVID-19 between March 2020 and 2021. Individual-level and neighborhood characteristics were analyzed to determine their association with hospital admission and severe health outcomes through generalized estimating equations. As of March 2021, 1,057 patients were seen in the ED within RUSH in which non-Hispanic White (odds ratio [OR], 2.96; 95% CI, 1.61-5.46; P = 0.001) and Hispanic (OR, 3.34; 95% CI, 1.84-6.10; P < 0.001) adolescents and youth were more likely to be admitted to the hospital compared with non-Hispanic Black/other adolescents and youth. Patients with public insurance or who were uninsured were less likely to be admitted to the ICU compared with those with private insurance (OR, 0.24; 95% CI, 0.09-0.64; P = 0.004). None of the neighborhood characteristics were significantly associated with hospital admission or severe health outcomes after adjusting for covariates. Our findings demonstrated that race and ethnicity were related to hospitalization, while insurance was associated with presentation severity due to COVID-19 for adolescents and young adults. These findings can aid public health investigators in understanding COVID-19 disparities among adolescents and young adults.