Independent Predictors Of Hospital Admission Research Articles

Is insurance payor associated with hospital admission of emergency department adult patients with odontogenic infections?

Patients who present to the emergency department (ED) with severe odontogenic infections are often hospitalized for surgical drainage and medical management. However, inpatient management of these patients can be financially burdensome. While medical indications for hospital admission are well established, it remains unclear if patient insurance status is associated with admission. The purpose of this study was to determine the nationally representative estimates of the incidence of hospital admission for patients with odontogenic infections and the association with insurance payor. This retrospective cohort study used the 2018 Nationwide Emergency Department Sample. Patients with odontogenic infections (based on International Classification of Diseases, 10th Revision codes) were included. Patients aged <18years or who had missing data were excluded. The primary predictor variable was primary payor (private insurance, Medicare, Medicaid, self-pay, and other). The primary outcome variable was hospital admission (yes/no). Covariates included sociodemographic, medical, infection, and hospital variables. Descriptive, bivariate, and multivariable logistic regression analyses were used to determine national estimates and predictors of admission. Odds ratios and 99% confidence intervals were computed. Discharge weights were accounted for in all analyses to provide nationally representative estimates. This study included 31,221 weighted ED encounters, of which 10,451 (33.5%) were admitted. In the study cohort, 7,687 (24.6%) had private insurance, 5,046 (16.2%) had Medicare, 10,070 (32.3%) had Medicaid, 7,436 (23.8%) were self-pay, and 982 (3.1%) had other. Bivariate analysis suggested that payor status was significantly associated with hospital admission (P<.01). The multivariable analysis showed that self-pay patients had significantly lower odds of hospital admission compared to those with private insurance (odds ratio, 0.54; 99% confidence interval, 0.42-0.70). Other independent predictors of hospital admission included infection in more than 1 location based on International Classification of Diseases, 10th Revision code, higher Charlson comorbidity index, and alcohol/substance use disorders. Approximately one-third of patients presenting to the ED with odontogenic infections were admitted. Patients with no insurance were less likely to be admitted compared to those with private insurance. This finding may reflect multiple possibilities, including hospital financial incentives.

Pedestrians injuries in the north east region of Jamaica: a cross sectional study

ABSTRACT To describe the sociodemographic data of injured pedestrians, temporal patterns of injury, injury patterns, and the independent predictors of hospital admission. A two year cross-sectional study was conducted at the Saint Ann’s Bay Regional Hospital in pedestrians with injuries post collision with a motor vehicle. A census was performed in all patients who received either emergency room treatment, hospital admission, or surgical intervention. A 30-item interviewer questionnaire was administered to collect the data. A logical regression model was used to determine independent predictors for hospital admission. Ninety pedestrians were included. Age range: 6-86 years old (Mean=39.9). Males were 63.3%, 75.6% were employed, 31% had a chronic illness and 27% reported marijuana use. Most injuries occurred in April, lowest injury rates occurred in August and September. Twenty two percent of collisions occurred on Saturdays. Most injuries occurred at 5pm and 3pm. Many (54.4%) had a fracture, 73.5% were closed. Approximately 32% had contusions and 6.7% had lacerations. Independent predictors of admission were history of marijuana use and having a fracture. Those with history of marijuana use were 4.21 times more likely to be admitted. Those with fractures were 7.10 times more likely to be admitted. Injury patterns spanned a wide age range. They often involved a high energy mechanism of injury as evidenced by the frequency of fractures, hospital admission and surgery intervention rates. The data also suggests a need to implement marijuana testing programmes in our road users.

Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy.

Our retrospective database study investigatessex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS 1day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58-108) and 81 (61-109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007-1.788) and obesity (aOR 1.427, 95% CI 1.095-1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002-1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301-1.706), obesity (aOR 1.309, 95% CI 1.151-1.489), dyspnea (aOR 1.394, 95% CI 1.041-1.865), chronic steroid use (aOR 1.674, 95% CI 1.193-2.351), and COPD (aOR 1.534, 95% CI 1.048-2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483-2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443-5.247) for males (P < 0.005). In conclusion,predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resourceutilization. Level of Evidence: IV. The online version contains supplementary material available at 10.1007/s12070-023-04444-3.

The Role of Prognostic Nutrition Index in Predicting Hospitalization of Patients With Heart Failure With Mildly Reduced Ejection Fraction.

Background The prognostic nutritional index (PNI), consisting of albumin and lymphocyte counts, has been associated with satisfactory predictive values ​​for in-hospital mortality or clinical follow-up outcomes in acute situations. In this study, we aimed to evaluate the use of PNI for the prediction of hospital admission in individuals withmildly reduced ejection fraction heart failure (HFmrEF). Methodology This retrospective study was conducted between January 2019 and May 2022 and included 200 patients with HFmrEF detected by transthoracic echocardiography.Data from hospitalized patients (group 1) and outpatients (group 2) were compared. Results In the multivariable regression analysis, brain natriuretic peptide (odds ratio (OR) = 1.001; 95% confidence interval (CI) = 1.000-1.001, p = 0.001) and PNI (OR = 0.783; 95% CI = 0.720-0.853; p < 0.001) were independent predictors of hospital admission in patients with HFmrEF. The PNI value was statistically significantly higher in group 2 (52.36 ± 5.36) than in group 1 (38.3 ± 8.63, p < 0.001). The PNI value <46.75 is a predictor of hospitalization in patients with HFmrEF, with 86% sensitivity and 88% specificity. Conclusions Lower PNI levels predict hospital admission in HFmrEF patients. This measure, which can be easily evaluated in daily cardiological practice, allows for quick and precise decisions for hospitalization.

Predictors of Emergency Department service outcome for people brought in by police: A retrospective cohort study

BackgroundPeople brought in by police (BIBP) to the emergency department (ED) can present with complicated health conditions that may impact care delivery. We sought to identify factors predictive of an ED length of stay (LOS) ≥4 hours and hospital admission for presentations BIBP. MethodsThis retrospective cohort study comprised a sample of all adults (aged ≥ 18 years old) BIBP to public hospital EDs across Queensland, Australia between 1 January 2018 and 31 December 2020. Univariate and multivariate logistic regression were used to identify predictors of an ED LOS ≥4 hours and hospital admission for presentations BIBP. ResultsOf the 42,502 presentations BIBP, independent predictors of an ED LOS ≥4 hours included higher priority triage categories, hospital transfer/admission, evening/night shift arrival, an Emergency Examination Authority (EEA), (i.e. an involuntary presentation), and a non-descript mental health diagnosis. Independent predictors of hospital admission included higher priority triage categories, increasing age, day/evening shift arrival, a ‘mental or behavioural issues’ diagnosis, and an ED LOS ≥4 hours. ConclusionsNoted predictors of a LOS ≥4 hours and hospital admission indicate further need to support intra and inter-agency interventions to optimise patient outcomes.

Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS-CoV-2 infection.

ObjectiveTo measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic emergency department patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection.MethodsThis study is a cohort study of symptomatic patients presenting to a single emergency department (ED) with laboratory‐confirmed SARS‐CoV‐2 infection from March 7‐August 9, 2020. We collected patient‐level information regarding demographics, insurance status, comorbidities, level of care, and mortality using a structured chart review. We compared characteristics of patients categorized by (1) home discharge, (2) general hospital ward admission, and (3) intensive care unit (ICU) admission or death within 30 days of the index visit. Univariate and multivariable logistic regression analyses were performed to report odds ratios (OR) and 95% confidence intervals (95% CI) between hospital admission versus ED discharge home and between ICU care versus general hospital ward admission.ResultsIn total, 994 patients who presented to the ED with symptoms were included in the analysis with 551 (55.4%) patients discharged home, 314 (31.6%) patients admitted to the general hospital ward, and 129 (13.0%) admitted to the ICU or dying. Patients requiring admission were more likely to be Black or to have public insurance (Medicaid and/or Medicare). Patients who were admitted to the ICU or dying were more likely aged ≥ 65 years or male. In multivariable logistic regression, old age, public insurance, diabetes, hypertension, obesity, heart failure, and hyperlipidemia were independent predictors of hospital admission. When comparing those who needed ICU care versus general hospital ward admission in univariate logistic regression, patients with Medicaid (OR 2.4, 95% CI 1.2–4.6), Medicare (OR 4.2, 95% CI 2.1–8.4), Medicaid and Medicare (OR 4.3, 95% CI 2.4–7.7), history of chronic obstructive pulmonary disease (OR 2.2, 95% CI 1.2–4.2), hypertension (OR 1.7, 95% CI 1.1–2.7), and heart failure (OR 2.6, 95% CI 1.4–4.7) were more likely to be admitted into the ICU or die; Black (OR 1.1, 95% CI 0.4–2.9) and Hispanic/Latino (OR 1.0, 95% CI 0.6–1.8) patients were less likely to be admitted into the ICU; however, the associations were not statistically significant. In multivariable logistic regression, old age, male sex, public insurance, and heart failure were independent predictors of ICU care/death.ConclusionComorbidities and public insurance are predictors of more severe illness for patients with SARS‐CoV‐2. This study suggests that the disparities in severity seen in COVID‐19 among Black patients may be attributable, in part, to low socioeconomic status and chronic health conditions.

Management of patients presenting with low back pain to a private hospital emergency department in Melbourne, Australia.

Recent studies suggest many patients with non-specific low back pain presenting to public hospital EDs receive low-value care. The primary aim was to describe management of patients presenting with low back pain to the ED of a private hospital in Melbourne, Australia, and received a final ED diagnosis of non-specific low back pain. We also determined predictors of hospital admission. Retrospective review of patients who presented with low back pain and received a final ED diagnosis of non-specific low back pain to Cabrini Malvern ED in 2015. Demographics, lumbar spinal imaging, pathology tests and medications were extracted from hospital records. Multivariate logistic regression was used to determine independent predictors of hospital admission. Four hundred and fifty presentations were included (60% female); 238 (52.9%) were admitted to hospital. One hundred and seventy-seven (39.3%) patients received lumbar spine imaging. Two hundred and eighty (62.2%) patients had pathology tests and 391 (86.9%) received medications, which included opioids (n = 298, 66.2%), paracetamol (n = 219, 48.7%), NSAIDs (n = 161, 35.8%), benzodiazepines (n = 118, 26.2%) and pregabalin (n = 26, 5.8%). Predictors of hospital admission included older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.05), arrival by ambulance (OR 2.03, 95% CI 1.06-3.90) and receipt of pathology tests (OR 3.32, 95% CI 2.01-5.49) or computed tomography scans (OR 1.86, 95% CI 1.12-3.11). We observed high rates of imaging, pathology tests and hospital admissions compared with previous public hospital studies, while medication use was similar. Implementation of strategies to optimise evidence-based ED care is needed to reduce low-value care and improve patient outcomes.

Predictors of Hospital Admission for Pediatric Cyclic Vomiting Syndrome

To identify predictors of hospitalization in pediatric patients presenting to an emergency department (ED) for a cyclic vomiting syndrome (CVS) attack. We retrospectively reviewed patients with CVS seen at our institution between 2015 and 2018 and included those who met the Rome IV criteria for CVS. We identified all CVS-related ED visits and subsequently performed a case-control analysis, utilizing multivariate logistic regression, to identify clinical and demographic factors that may predict hospitalization. In total, 219 patients with CVS (usingInternational Statistical Classification of Diseases and Related Health Problems, 10th Revision) were identified, of which 65% met the inclusion criteria (median age 11years). We identified 152 CVS-related ED visits, of which 62% resulted in hospitalization. Factors found to predict hospitalization using multivariate analyses included male sex (P=.04), younger age (P=.027), delayed presentation (>24hours) to the ED (P<.001), and longer wait time prior treatment with antiemetics (P=.029). One-quarter of all patients with CVS had presented to the ED and nearly two-thirds of these ED visits resulted in hospitalization. A delayed presentation to the ED following the onset of symptoms was the strongest independent predictor of hospital admission, alongside male sex, younger age, and longer ED wait times before treatment with antiemetics. These findings suggest that early intervention may be key to successfully mitigating the risk of hospitalization for a CVS attack.

COVID-19 and the cardiovascular system in pregnancy

Pregnancy and coronavirus disease-2019 (COVID-19) share several common features which makes differentiation between the 2 difficult. Both are multisystem disorders, may present with breathlessness, are associated with hypercoagulability and frequently cause significant anxiety in both the patient and those around them. Pregnancy represents a state of partial immune suppression, with pregnant women more vulnerable to viral infections. However, these concerns have not been borne out in clinical practice and have not stood up to epidemiological scrutiny. From limited data available on COVID-19 in pregnancy, the outcomes are mostly favourable. While cardiac disease and hypertension are independent predictors of hospital admission with COVID-19 in pregnancy, the prevalence of cardiac disease in the pregnant COVID-19 population is low. Pregnant women are younger, and asymptomatic SARSCoV-2 infection and favourable outcomes are reported in those below 55 years of age. Indeed, large numbers of asymptomatic cases have been reported in pregnancy, suggesting that pregnant patients with more severe disease courses may be over-represented in the current literature, particularly the early case reports and case series. Cardiovascular involvement in pregnancy includes new-onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism and a pre-eclampsia-like syndrome.

Clinical and Chest Radiography Features Determine Patient Outcomes in Young and Middle-aged Adults with COVID-19.

BackgroundChest radiography has not been validated for its prognostic utility in evaluating patients with coronavirus disease 2019 (COVID-19).PurposeTo analyze the prognostic value of a chest radiograph severity scoring system for younger (nonelderly) patients with COVID-19 at initial presentation to the emergency department (ED); outcomes of interest included hospitalization, intubation, prolonged stay, sepsis, and death.Materials and MethodsIn this retrospective study, patients between the ages of 21 and 50 years who presented to the ED of an urban multicenter health system from March 10 to March 26, 2020, with COVID-19 confirmation on real-time reverse transcriptase polymerase chain reaction were identified. Each patient’s ED chest radiograph was divided into six zones and examined for opacities by two cardiothoracic radiologists, and scores were collated into a total concordant lung zone severity score. Clinical and laboratory variables were collected. Multivariable logistic regression was used to evaluate the relationship between clinical parameters, chest radiograph scores, and patient outcomes.ResultsThe study included 338 patients: 210 men (62%), with median age of 39 years (interquartile range, 31–45 years). After adjustment for demographics and comorbidities, independent predictors of hospital admission (n = 145, 43%) were chest radiograph severity score of 2 or more (odds ratio, 6.2; 95% confidence interval [CI]: 3.5, 11; P < .001) and obesity (odds ratio, 2.4 [95% CI: 1.1, 5.4] or morbid obesity). Among patients who were admitted, a chest radiograph score of 3 or more was an independent predictor of intubation (n = 28) (odds ratio, 4.7; 95% CI: 1.8, 13; P = .002) as was hospital site. No significant difference was found in primary outcomes across race and ethnicity or those with a history of tobacco use, asthma, or diabetes mellitus type II.ConclusionFor patients aged 21–50 years with coronavirus disease 2019 presenting to the emergency department, a chest radiograph severity score was predictive of risk for hospital admission and intubation.© RSNA, 2020Online supplemental material is available for this article.

Differences in Outcomes Associated With Individual Radiologists for Emergency Department Patients With Headache Imaged With CT: A Retrospective Cohort Study of 25,596 Patients.

OBJECTIVE. The purpose of this study was to determine whether diagnostic radiologists impart variation into resource use and patient outcomes in emergency department (ED) patients undergoing CT for headache. MATERIALS AND METHODS. This was a single-institution retrospective quality assurance cohort study of 25,596 unique adult ED patients undergoing head CT for headache from January 2012 to October 2017. CT examinations were interpreted by 55 attending radiologists (25 neuroradiologists, 30 radiologists of other specialties) who each interpreted a mean of 1469.8 ± 787.9 CT examinations. Risk adjustment for variables thought to influence outcome included baseline risk (demographics, Elixhauser comorbidity score), clinical factors (vital signs, ED triage and pain scores, laboratory data, hydrocephalus, prior intracranial hemorrhage, neurosurgical consultation within last 12 months), and system factors (time of CT, physician experience, neuroradiology training). Multivariable models were built to analyze the effect of individual radiologists on subsequent outcomes. Any p value less than 0.007 was considered significant after Bonferroni correction. RESULTS. The study found 57.5% (14,718/25,596) of CT interpretations were performed by neuroradiologists, and most patients (98.1% [25,119/25,596]) had no neurosurgical history. After risk adjustment, individual radiologists were not an independent predictor of hospital admission (p = 0.49), 30-day readmission (p = 0.30), 30-day mortality (p = 0.14), or neurosurgical intervention (p = 0.04) but did predict MRI use (p < 0.001; odds ratio [OR] range among radiologists, 0.009-38.2), neurology consultation (p < 0.001; OR range, 0.4-3.2), and neurosurgical consultation (p < 0.001; OR range, 0.1-9.9). CONCLUSION. Radiologists with different skills, experience, and practice patterns appear interchangeable for major clinical outcomes when interpreting CT for headache in the ED, but their differences predict differential use of downstream health care resources. Resource use measures are potential quality indicators in this cohort.

Motorized scooter injuries in the era of scooter-shares: A review of the national electronic surveillance system

IntroductionThere has been a spike in recent news regarding motorized scooter injuries due to the expansion of scooter sharing companies. Given the paucity of literature on this topic, the purpose of our study was to describe and quantify emergency department encounters associated with motorized scooter related injuries. MethodsThe National Electronic Injury Surveillance System (NEISS) was queried for motorized scooter related injuries from 2013 to 2017. Patient demographics, diagnosis, injury location, narrative description of incident, and disposition data were collected from emergency department encounters. ResultsThere were an estimated 32,400 motorized scooter injuries from 2013 to 2017. The estimated incidence did not change significantly over time with 1.9 cases per 100,000 in 2013 and 2.6 cases per 100,000 in 2017. A 77.0% increase in scooter injuries was noted for millennials from 2016 to 2017. Head injuries were the most common body area injured (27.6%). Fractures or dislocations (25.9%) were the most common diagnosis. The most common site of fracture was the wrist and lower arm (35.4%). There were no deaths. Major orthopaedic injury and concussion were the strongest independent predictors of hospital admission. ConclusionsHead injuries were the most commonly injured body part, while fractures or dislocations were the most common diagnosis. These results highlight the importance of using protective equipment while riding motorized scooters, and lay a foundation for future policies requiring helmet use.

The Ratio Serum Creatinine/Serum Cystatin C (a Surrogate Marker of Muscle Mass) as a Predictor of Hospitalization in Chronic Obstructive Pulmonary Disease Outpatients

Background: In chronic obstructive pulmonary disease (COPD), low muscle mass has been associated with several clinical outcomes such as low exercise capacity, hospital admission, and mortality. The Sarcopenia Index (SI) is a novel way to estimate muscle mass based on the ratio of serum creatinine (produced exclusively by muscle)/cystatin C (produced by all nucleated body cells). Objectives: This study aims to assess the SI in stable COPD outpatients, as compared with a healthy control group, to quantify its relationship with several important clinical features in COPD, and to study its potential usefulness to predict COPD exacerbations and hospital admissions. Methods: The SI was calculated in 18 healthy control subjects and 65 stable COPD outpatients were included in the study. Patients were prospectively followed for 1 year after being enrolled in the study. Results: COPD patients had a lower SI than controls, that is lower muscle mass. Furthermore, patients with a modified Medical Research Council dyspnea score ≥2, patients with a COPD Assessment Test score ≥10, and patients with a high risk of exacerbation had lower levels of SI compared with patients without these characteristics. SI correlated with FEV1 (r = 0.491, p < 0.001), the 6-min walking test (r = 0.560, p = 0.001), and the Fat-Free Mass Index (r = 0.431, p = 0.017). Univariate and multivariate Cox proportional risk analysis showed that a low SI is an independent predictor of hospital admission in COPD outpatients followed for 1 year (HR 5.16, p = 0.025). Conclusions: The ratio serum creatinine/serum cystatin C correlates with several COPD characteristics, and it can be used to predict COPD hospitalization.

Early prediction of hospital admission for emergency department patients: a comparison between patients younger or older than 70 years

ObjectiveThe aim of this study was to develop models that predict hospital admission to ED of patients younger and older than 70 and compare their performance.MethodsPrediction models were derived in...

A 10-year retrospective analysis of hospital admissions and length of stay among a cohort of homeless adults in Vancouver, Canada.

BackgroundHomelessness is associated with a very high prevalence of substance use and mental disorders and elevated levels of acute health service use. Among the homeless, little is known regarding the relative impact of specific mental disorders on healthcare utilization. The aim of the present study was to examine the association between different categories of diagnosed mental disorders with hospital admission and length of stay (LOS) in a cohort of homeless adults in Vancouver, Canada.MethodsParticipants were recruited as part of an experimental trial in which participants met criteria for both homelessness and mental illness. Administrative data were obtained (with separate consent) including comprehensive records of acute hospitalizations during the 10 years prior to recruitment and while participants where experiencing homelessness. Generalized Estimating Equations were used to estimate the associations between outcome variables (acute hospital admissions and LOS) and predictor variables (specific disorders).ResultsAmong the eligible sample (n = 433) 80 % were hospitalized, with an average of 6.0 hospital admissions and 71.4 days per person during the 10-year observation period. Of a combined total 2601 admissions to hospital, 1982 were psychiatric and 619 were non-psychiatric. Significant (p <0.001) independent predictors of hospital admission and LOS included a diagnosis of schizophrenia or bipolar disorder, as well as high (≥32 service contacts) non-psychiatric medical service use in the community.ConclusionsOur results demonstrate that specific mental disorders alongside high non-psychiatric service use were significantly associated with hospital admission and LOS. These findings suggest the importance of screening within the homeless population to identify individuals who may be at risk for acute illness and the implementation of services to promote recovery and prevent repeated hospitalization.Trial RegistrationISRCTN57595077; ISRCTN66721740

Red blood cell distribution width and haemoglobin are associated with hospital admission in patients with acute allergic reactions

Introduction: Red blood cell distribution width (RDW) is significantly associated with a variety of human disorders. This study aimed to investigate whether RDW value at admission may predict the need of hospitalisation in patients presenting to the emergency department (ED) with acute allergic reactions.Materials and Methods: The study population consisted of adult patients (aged > 17) admitted to the ED for acute allergic reactions.Results: One hundred and thirty-two subjects were included, 12 of whom (9%) required hospital admission for severity of symptoms. Patients who needed hospital admission displayed significantly lower values of haemoglobin and significantly higher values of RDW-coefficient of variation (RDW-CV). In multivariate analysis, haemoglobin and RDW-CV were found to be independent predictors of hospital admission. The area under the curve (AUC), sensitivity and specificity for predicting hospital admission were 0.72, 0.88 and 0.42 for haemoglobin and 0.73, 0.88 and 0.50 for RDW-CV, respectively. The combination of these tests (both positive) was characterised by 0.76 AUC, 0.83 sensitivity, 0.67 specificity, 0.96 negative predictive value and 0.30 positive predictive.Discussion: The results of this study suggest that two common and inexpensive parameters such as haemoglobin and RDW are independent predictors of hospital admission in patients presenting to the ED with acute allergic reactions.

Clinical predictors of hospital admission in acute lower respiratory tract infection in 2 months to 2-year-old children.

Acute lower respiratory tract infections (ALRI) are a common cause of paediatric emergency visits in young children. We studied risk factors for hospitalization and developed a clinical score for predicting hospitalization among 2 months to 2-year-old children with ALRI. We conducted this prospective cohort study in the paediatric emergency department of a tertiary-care teaching hospital in India. Consecutive children, aged 2 months to 2 years with ALRI were enrolled from 15 December 2011 to 14 December 2012. A total of 26 a priori identified, putative risk factors were studied among enrolled children. We determined independent predictors of hospital admission (primary outcome) through multi-variable logistic regression analysis and assimilated them into a clinical risk score using regression coefficients. A total of 240 children (130 admissions) with ALRI were enrolled. Eleven clinical risk factors, which displayed association with hospital admission on univariate analysis (P < 0.1), were entered into multi-variable logistic regression analysis. Five factors retained independent association and were incorporated in a predictive score for hospitalization: tachypnoea (score of 5), chest retractions (score of 3), temperature > 37.8°C (score of 3), SpO2 < 92% at room air (score of 4), GCS < 15 (score of 6). Area under the receiver operator characteristic curve was 0.80 (95% CI: 0.75-0.85, P < 0.001). Five clinical risk factors-tachypnoea, chest retractions, fever > 37.8°C, SpO2 < 92% and GCS < 15-independently predicted hospital admission in infants with ALRI. A novel clinical score predicting hospital admission is presented.

P-050: Independent predictors of hospital admission in emergency department patients younger and older than 70 years of age

P-050: Independent predictors of hospital admission in emergency department patients younger and older than 70 years of age

Factors associated with hospital admission for proximal humerus fracture

BackgroundThe number of inpatient admissions for proximal humerus fracture is increasing, but the factors that determine hospitalization are not well documented. We sought to identify predictors of hospital admission among individuals presenting to the emergency department (ED) with a fracture of the proximal humerus. MethodsUsing the Nationwide Emergency Department Sample for 2010 and 2011, an estimated 285661 patients were identified and separated into those who were admitted to hospital (19%) and those who were discharged directly home (81%). Multivariable logistic regression modeling was used to identify independent predictors of hospital admission. ResultsFactors associated with admission included increasing age and Charlson comorbidity index, ED visit on a weekday, Medicare and Medicaid insurance, open fracture, injury due to motor vehicle crash, polytrauma, urban teaching hospital, and residence in the Northeast. The lowest ratio of hospital admission to home discharge was noted for uninsured patients (0.09). DiscussionFactors unrelated to medical complexity such as insurance status, geographic region, timing of ED visit, and hospital type are associated with inpatient admission for proximal humerus fracture. Interventions to reduce variation in hospital admission and the influence of nonclinical factors merit attention. Level of EvidenceLevel II, prognostic study.

Incidence and Treatment Patterns in Males Presenting with Lower Urinary Tract Symptoms to the Emergency Department in the United States

Due to varying clinical definitions of lower urinary tract symptoms, ithas been difficult to determine comparable prevalence and incidence ratesoflower urinary tract symptoms and their treatment modalities. Weassessed the incidence of emergency department visits in men with lowerurinary tract symptoms who presented to emergency departments in theUnited States and factors associated with an increased likelihood of hospitalization. Emergency department visits from 2006 to 2009 associated with a primary diagnosis of lower urinary tract symptoms using established criteria were abstracted from the Nationwide Emergency Department Sample. Age adjusted incidence rates of emergency department visits and charges were calculated. We performed multivariable analysis to examine patient and hospital characteristics of those hospitalized and those with benign prostatic hyperplasia related adverse events. A weighted estimate of 1,178,423 emergency department visits for lower urinary tract symptoms was recorded with a national incidence of 197.6/100,000 males per year. A total of 112,288 visits (9.5%) resulted in hospitalization. Adverse events were identified in 734,269 patients (62.3%). The most common adverse events were catheterization in 44.6% of cases, infection in 17.4%, hematuria in 9.6%, bladder stones in 1.7%, hydronephrosis in 1.2% and acute renal failure in 0.1%. On multivariable analysis independent predictors of hospital admission included comorbidities, socioeconomic status, hospital characteristics and adverse events such as sepsis, acute renal failure and hydronephrosis. Independent predictors of adverse events included patient age, year of visit, socioeconomic status, hospital characteristics and concomitant neurological disease. In 2009 total emergency department charges for lower urinary tract symptoms were $494,981,922. The number of men with lower urinary tract symptoms who visit the emergency department has remained stable, while emergency department charges have increased by 40%. The rate of adverse events increased during the study period. These findings might suggest over reliance on medical and conservative therapy in the contemporary era.