Risk Of Intensive Care Unit Admission Research Articles

Association of admission serum triglyceride levels with intensive care unit hospitalization rates in acute pancreatitis patients: A retrospective study.

Acute pancreatitis (AP) is a complex and unpredictable condition, of which hypertriglyceridemia (HTG) is the third most prevalent cause. This study aimed to conduct a retrospective analysis of clinical data from hospitalized AP patients to uncover a potential correlation between triglyceride (TG) levels and the necessity for intensive care unit (ICU) admission. This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV) critical care dataset, incorporating data from 698 patients with hypertriglyceridemic acute pancreatitis (HTG-AP). The analysis employed the RCS model along with univariate and multivariate logistic regression methods to affirm the association between triglyceride levels and ICU admission. Subgroup analysis was performed to investigate specific populations. The study included 698 patients with AP, 42.41% of whom experienced HTG during hospitalization. RCS analysis revealed a linear association between TG levels and risk of ICU admission (p for nonlinear = .219, p for overall = .009). Multivariate logistic regression analysis indicated an increased risk of ICU admission in the TG range of 1.7-5.65 mmol/L (aOR = 1.83, 95% CI 1.12-2.99, P = .015) and TG >11.3 mmol/L (aOR = 5.69, 95% CI 2.36-13.74, P < .001) compared to the normal group. Similar results were observed across the various subgroups. As triglyceride levels increased, there was a corresponding increase in ICU admissions. Patients within the 1.7 to 5.65 mmol/L and > 11.3 mmol/L triglyceride groups exhibited higher rates of ICU admissions. Moreover, we observed a higher risk of ICU hospitalization even with mild TG elevation.

The role of plant-based dietary patterns in reducing COVID-19 risk and/or severity in adults: A systematic review and meta-analysis of observational studies

Background & AimsPlant-based dietary patterns (PBDs) might protect against COVID-19 risk and reduce severity of infection. This systematic review with meta-analysis aimed to examine the association between PBDs and risk of COVID-19 infection, hospitalization, intensive care unit (ICU) admission, and/or mortality, in adults. MethodsPubmed, Embase, CINAHL and Web of Science were searched for observational studies, published in English up to 3rd April 2023, comparing the highest with the lowest adherence to a specific PBD. Data were screened, extracted, and risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale, by independent reviewers. ResultsSeven studies (one cross-sectional, three case-control, and three prospective cohort), reporting on 649,315 participants, were eligible. Across them, there were 8,512 events of COVID-19 infection (six studies), and 206 events of COVID-19 hospitalization (four studies), in addition to one study reporting on a composite hospitalization outcome (740 events). The pooled analysis showed that PBDs are associated with a 59% (odds ratio (OR)=0.41, 95% confidence intervals (CI) 0.23-0.59; two studies) and 18% (OR=0.82, 95% CI 0.78-0.85; three studies) reduction in COVID-19 infection risk in case-control and cohort studies, respectively. The pooled analysis of one case-control and two cohort studies showed an inverse association between high adherence to a PBD and risk of COVID-19 hospitalization (OR=0.38, 95% CI 0.04-0.72). ConclusionFindings suggest a protective role of PBDs against the risk of COVID-19 infection and severity. More studies are needed to establish the association between PBDs and risk of ICU admission and mortality due to COVID-19.

Effect of Vitamin D3 Supplementation on Severe COVID-19: A Meta-Analysis of Randomized Clinical Trials.

Since the beginning of the COVID-19 pandemic, vitamin D has attracted interest due to its immunomodulatory properties. Numerous studies show a correlation between vitamin D levels and COVID-19 cases and mortality. Therefore, we conducted a meta-analysis in order to assess the relationship between vitamin D3 supplementation and COVID-19 severity. We included 13 randomized clinical trials that contained the analyzed endpoints: length of COVID-19 hospitalization, number of intensive care unit (ICU) admissions, length of stay in the ICU, number of cases requiring any supplemental oxygenation, duration of any supplemental oxygenation, number of overall mortality and number of deaths associated with COVID-19. The relative risk with 95% confidence interval (CI) and the mean difference with 95% CI were calculated to compare the effect. A random effects model was used to calculate effect sizes. Our meta-analysis showed a positive effect of vitamin D3 supplementation on ICU admission (RR = 0.73; 95% CI [0.57; 0.95], p = 0.02, I2 = 19.6%) and mortality associated with COVID-19 among patients (RR = 0.56; 95% CI [0.34; 0.91]; p = 0.02; I2 = 0%). Vitamin D3 supplementation may potentially reduce the risk of ICU admission and death associated with COVID-19.

Golf cart injuries have similar severity to all-terrain vehicle injuries in children: a multicenter comparison over a 5-year period

BackgroundGolf carts (GCs) and all-terrain vehicles (ATVs) are popular forms of personal transport. Although ATVs are considered adventurous and dangerous, GCs are perceived to be safer. Anecdotal experience suggests increasing...

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes by Race/Ethnicity in a Large Integrated Health Care System.

Recent studies have reported associations between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy and adverse perinatal outcomes but the extent to which these associations vary by race/ethnicity remains uncertain. Therefore, we examined how the association between prenatal SARS-CoV-2 infection and adverse perinatal outcomes may be modified by race/ethnicity. A retrospective cohort study was performed using data on 67,986 pregnant women extracted from the Kaiser Permanente Southern California electronic health records between April 6, 2020, and December 31, 2021. Upon admission to labor and delivery, all women were routinely tested for coronavirus disease 2019 (COVID-19) using real-time reverse-transcriptase polymerase chain reaction test. Adjusted odds ratios (aORs) were used to estimate associations. During the study period, COVID-19 was diagnosed in 4,960 (7%) of singleton pregnancies, with the highest rates observed among Hispanics (9.4%) and non-Hispanic Blacks (6.2%). Compared with non-Hispanic Whites, Hispanics (aOR: 1.12, 95% CI: 1.03, 1.21) with SARS-CoV-2 infection had the highest odds of a pregnancy associated with nonreassuring fetal heart rate tracing. Neonates of all races/ethnicities, except for non-Hispanic Blacks, showed significantly increased odds of SARS-CoV-2 infection, with the highest risk observed among Asians/Pacific Islanders (aOR: 10.88, 95% CI: 1.33, 89.04). Non-Hispanic White mothers who tested positive were admitted to intensive care unit (ICU) at a higher rate at delivery and within 7 days of delivery (aOR: 34.77, 95% CI: 11.3, 107.04; aOR: 26.48, 95% CI: 9.55, 73.46, respectively). Hispanics were also at a significantly higher odds of admission to ICU (aOR: 4.62, 95% CI: 2.69, 7.94; aOR: 4.42, 95% CI: 2.58, 7.56, respectively). Non-Hispanic Black, Hispanic, and Asian/Pacific Islander mothers who tested positive for SARS-CoV-2 prenatally, were at increased risk for preeclampsia/eclampsia, and preterm birth as compared to non-Hispanic White mothers. The findings highlight racial/ethnic disparities in the association between SARS-CoV-2 infection and adverse perinatal outcomes. The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders. We also observed a remarkably high risk of ICU admission for non-Hispanic White mothers infected with SARS-CoV-2. · Race/ethnicity influences perinatal outcomes in pregnancies impacted by SARS-CoV-2.. · The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders.. · White mothers had a notably high risk of ICU admission at delivery following SARS-CoV-2 infection..

Superinfections in COVID-19

Introduction Bacterial superinfection rates in SARS-CoV-2 (COVID-19) range from 8% to 49.6%, but the diagnosis remains a challenge. We conducted a study to determine the utility of the Pneumonia Severity Index (PSI) to predict the risk of superinfections and outcomes in COVID-19 patients. Methods A cross-sectional retrospective study was conducted on COVID-19 positive patients admitted during 2020–2022. The PSI scores were calculated at admission and at every 72-hour intervals. Data regarding clinical course, antibiotic use and overall outcome were collected. Results A total of 149 patients were included, with a mean age of 67 years. The PSI score at admission and the mean PSI score were higher for those who required antibiotics, intensive care unit (ICU) admission, or succumbed. Patients with a PSI score &gt;107 at admission had a high risk of ICU admission, &gt;113 had a high risk of antibiotic requirements, and &gt;110 had a higher risk of death. An increase in PSI score ≥25 between the day of admission and day 3 of hospitalization; or between day 3 and day 6 of hospitalization, predicted a higher chance of mortality; but had no association with the development of superinfections. Discussion The PSI score at admission can be used to predict the severity of disease requiring ICU admission, antibiotic requirement, and overall mortality, with serial monitoring of the score predicting possible clinical deterioration and increased mortality. However, it was not helpful in predicting the chances of developing superinfections and the need for antibiotic therapy. Conclusions The PSI score can be used to prognosticate the outcome in patients admitted with COVID-19, but further studies are needed to determine its utility in predicting the risk of superinfections.

Intensive Care Unit Admission After Spine Surgery: A Narrative Review.

Intensive care unit (ICU) admissions constitute a substantial financial challenge for health care systems and patients and are linked to various potentially life-altering complications. A wide range of patient-related, surgical, and medical factors are associated with an increased risk of ICU admission following spine surgery. The most notable examples include lung, heart, and kidney disease, as well as estimated blood loss and length of surgery. Various scores that include the most significant patient- and procedure-related factors have been described to assess the risk associated with surgery for individual patients. To date, the fusion risk score and the American Society of Anesthesiologists score have been the most useful in predicting postoperative complications and admission to the ICU. However, other risk factors have also been implicated in ICU admission and length of stay. The current scores must further adapt by using the available evidence to fulfill their intended purpose. Moreover, a handful of measures have shown efficacy in decreasing ICU admission and length of stay, with their benefits still to be demonstrated by future research. This review underscores the risk factors predictive of ICU admission following spine surgery and will help surgeons and clinicians in patient stratification. However, future studies are needed to validate the role of protective measures in preventing ICU admissions and the significance of certain risk factors.

Incidence and outcomes of emergency department patients requiring emergency general surgery: a 5-year retrospective cohort study.

Patients undergoing emergency general surgery are at high risk of complications and death. Our objectives were to estimate the incidence of emergency general surgery in a Swiss University Hospital, to describe the characteristics and outcomes of patients undergoing such procedures, and to study the impact of age on clinical outcomes. This was a retrospective cohort study of adult patients who visited the emergency department (ED) of Geneva University Hospitals between January 2015 and December 2019. Routinely collected data were extracted from electronic medical records. The primary outcome was the incidence of emergency general surgery among patients visiting the emergency department, defined as general surgery within three days of emergency department admission. We also assessed demographic characteristics, mortality, intensive care unit admission and patient disposition. Multivariable log-binomial regression was used to study the associations of age with intensive care unit (ICU) admission, one-year mortality and dependence at discharge. Age was modelled as a continuous variable using restricted cubic splines and we compared older patients (75thpercentile) with younger patients (25thpercentile). Between January 2015 and December 2019, a total of 310,914 emergency department visits met our inclusion criteria. Among them, 3592 patients underwent emergency general surgery within 3 days of emergency department admission, yielding an annual incidence of 116 events per 10,000 emergency department visits (95% CI: 112-119), with a higher incidence in females and young patients. Overall, 5.3% of patients were admitted to ICU, 7.8% were dependent on rehabilitation or assisted living at discharge and 4.8% were dead after one year. Older patients had a higher risk of ICU admission (adjusted risk ratio (aRR) 2.9 [1.5-5.4]), dependence at discharge (aRR 15.3 [5.5-42.4]) and one-year mortality (aRR 5.4 [2.2-13.4]). Emergency department visits resulting in emergency general surgery are frequent, but their incidence decreases with patient age. Mortality, ICU admission and dependence at discharge following emergency general surgery are more frequent in older patients. Taking into account the increased risk for older patients, a shared process is appropriate for making more informed decisions about their options for care.

The role of triglyceride/high-density lipoprotein cholesterol ratio in the prediction of intensive care unit admission in the earthquake victims

Background: In the study of vascular and metabolic diseases, the ratio of triglycerides to high-density lipoprotein (HDL) cholesterol (TG/HDL) is crucial. Its significance for earthquake victims hasn't been fully investigated, though. This study investigates the relationship between the TG/HDL ratio and critical care unit admission in earthquake victims.&#x0D; Methods: Sixty-four patients were enrolled. Both the laboratory results and the clinical features were documented. The TG/HDL ratio's prognostic value for intensive care unit (ICU) admission was then evaluated using ROC curve analysis. Spearman test was applied to analyze correlation between TG/HDL-c and inflammation markers. Logistic regression analysis was then used to elucidate the independent contribution of the TG/HDL-c ratio to the ICU admission risk.&#x0D; Results: Median age of the cohort was 28 (IQR 17-40) and thirty-seven (57.8%) of the patients were female. 27 patients (42.2%) were admitted to ICU. In the multivariate model, the TG/HDL ratio was associated with higher risk of ICU admission (OR: 1.225, 95% CI: 1.003-1.496, p=0.047). The TG/HDL-c ratio may be a predictor of ICU admissions, according to the ROC curve (AUC: 0.737, 95% CI: 0.610-0.864, p=0.001). The TG/HDL ratio was positively correlated with procalcitonin (r = 0.620, p

Predicting the risk of early intensive care unit admission for patients hospitalized with acute pancreatitis using supervised machine learning

Background Acute pancreatitis (AP) is a complex and life-threatening disease. Early recognition of factors predicting morbidity and mortality is crucial. We aimed to develop and validate a pragmatic model to predict the individualized risk of early intensive care unit (ICU) admission for patients with AP. Methods The 2019 Nationwide Readmission Database was used to identify patients hospitalized with a primary diagnosis of AP without ICU admission. A matched comparison cohort of AP patients with ICU admission within 7 days of hospitalization was identified from the National Inpatient Sample after 1:N propensity score matching. The least absolute shrinkage and selection operator (LASSO) regression was used to select predictors and develop an ICU acute pancreatitis risk (IAPR) score validated by 10-fold cross-validation. Results A total of 1513 patients hospitalized for AP were included. The median age was 50.0 years (interquartile range: 39.0–63.0). The three predictors that were selected included hypoxia (area under the curve [AUC] 0.78), acute kidney injury (AUC 0.72), and cardiac arrhythmia (AUC 0.61). These variables were used to develop a nomogram that displayed excellent discrimination (AUC 0.874) (bootstrap bias-corrected 95% confidence interval 0.824–0.876). There was no evidence of miscalibration (test statistic = 2.88; P = 0.09). For high-risk patients (total score >6 points), the sensitivity was 68.94% and the specificity was 92.66%. Conclusions This supervised machine learning-based model can help recognize high-risk AP hospitalizations. Clinicians may use the IAPR score to identify patients with AP at high risk of ICU admission within the first week of hospitalization.

High risk of malnutrition among hospitalised coronavirus disease 2019 (COVID-19) patients is associated with mortality and other clinical outcomes

IntroductionIncreasing evidence indicates an association between nutritional status and Coronavirus disease 2019 (COVID-19) disease severity. The aim of the study was to describe the risk of malnutrition, body mass index (BMI) and vitamin D status of hospitalised COVID-19 patients and assess whether they are associated with duration of hospital stay, intensive care unit (ICU) admission, mechanical ventilation, and mortality. MethodsThe study is a descriptive retrospective study of 273 patients with COVID-19 admitted to Hospital from February 2020 to March 2021. Patients were screened for risk of malnutrition using a validated screening tool. BMI was calculated from height and weight. Insufficient Vitamin D status was defined as 25(OH)vitD <50 nmol/L. Logistic regression analysis was used to assess the association between indicators of nutritional status of patients with COVID-19, and outcomes such as duration of stay >7 days, ICU admission, mechanical ventilation, and mortality. Interaction between risk of malnutrition and BMI of ≥30 kg/m2 was assessed using the likelihood ratio test with hospital stay, ICU admission, mechanical ventilation, and mortality as outcomes. ResultsScreening for risk of malnutrition identified 201 (74%) patients at a medium to high risk of malnutrition. Patients defined as being at a medium or high risk of malnutrition were more likely to be hospitalised for >7 days compared to those defined as low risk (OR: 10.72; 95% CI: 3.9-29.46; p<0.001 and OR: 61.57; 95% CI: 19.48-194.62; p<0.001, respectively). All patients who were admitted to ICU (n=41) and required mechanical ventilation (n=27) were defined as having medium or high risk of malnutrition. High risk of malnutrition was also associated with increased odds of mortality (OR: 8.87; 955 CI 1.08-72,96; p = 0.042). BMI of ≥30 kg/m2 (43%) and 25(OH)vitD <50 nmol/L (20%) were not associated with duration of stay >7 days or mortality, although BMI ≥30 kg/m2 was associated with increased risk of ICU admission (OR: 7.12; 95% CI: 1.59-31.94; p=0.010) and mechanical ventilation (OR: 8.86; 95% CI: 1.12-69.87; p=0.038). Interactions between risk of malnutrition and BMI ≥30 kg/m2 were not significant to explain the outcomes of hospital stay > 7 days, ICU admission, mechanical ventilation, or mortality. ConclusionHigh risk of malnutrition among hospitalised COVID-19 patients was associated with longer duration of hospital stay, ICU admission, mechanical ventilation and mortality, and BMI ≥30 kg/m2 was associated with ICU admission and mechanical ventilation. Insufficient Vitamin D status was not associated with duration of hospital stay, ICU admission, mechanical ventilation, or mortality.

Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures

BackgroundStudies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined....

Prevalence of vitamin D deficiency in patients with COVID-19 admitted to a tertiary hospital in Rio Grande do Sul

Background: Increasing data suggests a connection between vitamin D (vitD) and COVID-19. VitD may impact COVID-19 by affecting innate cellular immunity and exacerbating cytokine storms linked to severe respiratory syndrome from the virus. Objective: To assess the prevalence of vitD deficiency in COVID-19 patients hospitalized at Hospital Ernesto Dornelles and examine its links to in-hospital mortality, the need for Intensive Care Unit (ICU), patient demographics, and hospital stay duration. Methods: A cross-sectional study was performed, in which 3518 hospitalized patients with a confirmed diagnosis of COVID-19 were evaluated to obtain the prevalence of vitD deficiency, from March 2020 to August 2022. Data collection was performed using electronic medical records, excluding patients without serum levels of vitD measured during hospitalization, and including those with the exam in their medical records, which were later placed for statistical analysis. Results: 486 patients had their serum level of vitD measured, with a mean age of 68.3 years, 57.2% female, and 42.8% male. The prevalence of vitD deficiency was 60.1% (292 patients). There was no difference between the groups with and without vitD deficiency when comparing age, gender, and comorbidities. The median length of hospital stay, the need for ICU admission, and the outcome of death were significantly higher in the group with vitD deficiency (p&lt;0.001; p=0.005; p=0.03). After adjusting for confounding factors, only the risk of ICU admission remained 1.38x higher in the group with vitD deficiency than in the group without (p=0.015), as well as age and CRF were factors with a higher risk for ICU admission. Conclusions: The prevalence of vitD deficiency in patients with COVID-19 was 60%, being associated with a higher risk of ICU admission, possibly presenting or not an association with higher mortality rates and length of stay. Therefore, further studies are needed to establish a cause-and-effect association.

Phenobarbital treatment of alcohol withdrawal in the emergency department: A systematic review and meta-analysis.

Despite frequent treatment of alcohol withdrawal syndrome (AWS) in the emergency department (ED), evidence for phenobarbital (PB) as an ED alternative therapy is mixed. We conducted a systematic review and meta-analysis comparing safety and efficacy of PB to benzodiazepines (BZDs) for treatment of AWS in the ED. We searched articles and references published in English in PubMed, Web of Science, and Embase from inception through May 2022. We included randomized trials and cohort studies comparing treatment with PB to BZD controls and excluded studies focused on non-AWS conditions. Review was conducted by two blinded investigators and a third author; eight of 59 (13.6%) abstracts met inclusion criteria for review and meta-analysis using a random-effects model. Treatment superiority was evaluated through utilization, pharmacologic, and clinical outcomes. Primary outcomes for meta-analysis were the proportion of patients (1) admitted to the intensive care unit (ICU), (2) admitted to the hospital, (3) readmitted to the ED after discharge, and (4) who experienced adverse events. Eight studies (two randomized controlled trials, six retrospective cohorts) comprised data from 1507 patients in 2012 treatment encounters for AWS. All studies were included in meta-analysis for adverse events, seven for hospital admission, five for ICU admission, and three for readmission to the ED after discharge. Overall methodological quality was low-moderate, risk of bias moderate-high, and statistical heterogeneity moderate. Pooled relative risk of ICU admission for those treated with PB versus BZD was 0.92 (95% confidence interval [CI] 0.54-1.55). Risk for admission to the hospital was 0.98 (95% CI 0.89-1.07) and for any adverse event was 1.1 (95% CI 0.78-1.57); heterogeneity prevented meta-analysis for ED readmission. The current literature base does not show that treatment with PB significantly reduces ICU admissions, hospital admissions, ED readmissions, or adverse events in ED patients with AWS compared with BZDs alone.

Pulmonary embolism and risk factors of ICU admission: systematic review

In order to forecast mortality and identify adult patients who required admission to an intensive care unit, we compared the efficacy of the most widely used Early Warning Scores. The present review assessed the pulmonary embolism and risk factors of intensive care unit (ICU) admission; systematic review. A search of the literature was conducted in the bibliographic databases PubMed and EMBASE between 2009 and 2022. Each reviewer verified independently that each possibly relevant title and abstract qualified. There were nine studies that were included in the review. NEWS was the best indicator of ICU admission; however, the Modified Early Warning Score performed better in sepsis patients. According to Emergency Department (ED) Mortality, the National Early Warning Score was the most accurate score for predicting mortality in the entire ED population, and the Mortality in Emergency Department Sepsis score was the most accurate measure for patients with sepsis. For all endpoints, National Early Warning Score and Modified Early Warning Score had good outcomes in the ICU and ED. numerous investigations should be conducted utilizing various prognostic scores on ED and ICU patients. Anemia in patients with venous thrombosis was associated with a higher risk of ICU admission and mortality.

Mayo Cardiac Intensive Care Unit Admission Risk Score (M-CARS) validation test to assess mortality during treatment in Cardiovascular Care Unit (CVCU) patients at Haji Adam Malik Hospital

Abstract&#x0D; Background: Approximately 85% of all in-hospital deaths occur in Cardiovascular Care Unit (CVCU) where M-CARS will be an important starting point for development of CVCU-specific mortality risk prediction models.&#x0D; Aim: This research aims to assess M-CARS validation to assess mortality during treatment in CVCU patients at Haji Adam Malik (HAM) General Hospital.&#x0D; Methods: This research is a prospective research that examines M-CARS score validity as a predictor of intra-hospital mortality in patients treated at CVCU HAM General Hospital Medan from September 2021 - January 2022. If correlation test results show a significant relationship, cut-off value M-CARS score will be taken using ROC (Receiver Operating Characteristic) curve analysis, then analysis of M-CARS score diagnostic value will be carried out according to cut-off value obtained to predict mortality during hospitalization. Then Hosmer-Lemeshow test was carried out to assess suitability of logistic regression on risk prediction assessment within population that being assessed.&#x0D; Results: M-CARS had a very good discriminatory ability (AUC 0.93) to predict intrahospital mortality. The calibration value using Hosmer Lemeshow test (R2 = 0.982; p = 1.516; p&gt;0.05) shows that there is no significant difference between observed and expected mortality rate by two scoring systems therefore considered as accurate.&#x0D; Conclusion: M-CARS is valid to be used in assessing risk of mortality events during CVCU treatment at H. Adam Malik Hospital Medan.&#x0D; Keywords: Mortality, Cardiovascular Care Unit, Mayo Cardiac Intensive Care Unit Admission Risk Score, Braden Score.

2006. The Impact of Race and Rurality on Healthcare-Associated Infections and Downstream Adverse Outcomes

Abstract Background There is limited information on racial disparities and healthcare-associated infections (HAIs). The objective of this study was to evaluate the impact of race and rurality on HAIs and outcomes of HAIs including death and intensive care unit (ICU) admission. Methods We established a retrospective cohort of adults ≥ 18 years admitted ≥ 48 hours from 1/1/2017–8/31/2020 at three Missouri hospitals. HAIs were defined as positive cultures from urine, blood, or respiratory specimens ≥ 48 hours after admission. The primary exposure was patient race and rurality defined as combinations of race (Black or white) and residence (urban vs. rural based on patient ZIP code and using the National Center for Health Statistics Urban-Rural classification). We used a generalized estimating equations (GEE) model to determine disparity-related (i.e., race/rurality, sex, Medicaid payer, census median income quartile) risk factors for HAI accounting for clustering of admissions at the patient-level and adjusting for other factors (e.g., comorbidities, age, transfer status). Among HAI admissions, similar GEE models examined in-hospital death and ICU admission after HAI. Results The cohort included 214,955 admissions (Table 1), with HAIs occurring during 6,699 (3.1%) of admissions (1,572 blood; 3,146 urine; 2,497 respiratory HAIs). HAIs developed during 3.1% of admissions among white urban patients, 3.9% among white rural patients, 2.7% among Black urban patients, and 4.1% among Black rural patients (Figure 1). White rural patients had an increased risk of HAI (adjusted relative risk [aRR] 1.13; 95% confidence interval [CI] 1.06, 1.20) while Black urban patients had a decreased risk of HAI (aRR 0.82; 95% CI 0.76, 0.88) compared to white urban patients. Among HAIs, adverse outcomes were more common in Black rural patients (Figure 2). Specifically, Black rural patients had an increased risk of ICU admission (aRR 1.35; 95% CI 1.15, 1.58) and in-hospital death (aRR 1.85; 95% CI 1.31, 2.60) while white rural and Black urban patients had similar outcomes compared to white urban patients.Table 1.Patient characteristicsFigure 1.Proportion of admissions with an HAI by race and ruralityFigure 2.Among HAIs, proportion of admissions with adverse outcomes by race and rurality Conclusion We identified disparities related to race and rurality in HAIs and adverse outcomes from HAIs. Future work to understand the reasons underpinning these differences is critical to identify targets for intervention. Disclosures All Authors: No reported disclosures

A Characterization of Neurology Consults for Inpatients with SARS-CoV-2 Infection Compared to Other Respiratory Viruses.

Introduction: Neurological consultation for patients infected with SARS-CoV-2 is common; it is currently unknown whether the neurologist's approach to inpatient consultation of patients with SARS-CoV-2 should differ from the paradigm used to evaluate hospitalized patients with similar respiratory viruses. The goal of the present study is to determine if the preponderance of new neurologic diagnoses differs between inpatients with SARS-CoV-2 and similar non-SARS-CoV-2 respiratory viruses for whom neurology is consulted. Methods: We performed a retrospective chart analysis of inpatient neurologic consultations at three major Philadelphia-based hospitals. We compared the final neurologic diagnosis of 152 patients infected with SARS-CoV-2 to 54 patients with a similar ubiquitous non-SARS-CoV-2 respiratory virus (influenza A, influenza B, respiratory syncytial virus, rhinovirus, or adenovirus, the most commonly tested respiratory viruses at our institution). Secondary metrics included age, sex, level of care, prior neurologic diagnoses, and mortality. A multinomial logistic regression model was utilized to evaluate the relative difference between diagnostic category groups on all metrics. Results: The proportion of patients with seizure who were infected with SARS-CoV-2 admitted to an intensive care unit (ICU) was significantly higher than those who were admitted to a medical-surgical floor. SARS-CoV-2 was also associated with increased risk for ICU admission compared to other common respiratory viruses. SARS-CoV-2 inpatients requiring neurologic consultation were also more likely to be older and female as compared to the non-SARS-CoV-2 cohort. In other domains, the proportion of neurologic diagnoses between SAR-CoV-2 and non-SARS-CoV-2 respiratory viruses showed no significant difference. Conclusion: Patients requiring inpatient neurologic consultation with a diagnosis of SARS-CoV-2 infection or another respiratory virus were found to be remarkably similar in terms of their ultimate neurologic diagnosis, with the exception of a larger preponderance of seizure in critical-care-level patients with SARS-CoV-2 infection. Our study suggests that the neurological approach to patients hospitalized with SARS-CoV-2 should be similar to that for patients with similar common respiratory infections, noting that seizure was seen more frequently in critically ill patients infected with SARS-CoV-2.

The Impact of Screening for Perioperative ICU Admission in Geriatric Hip Fracture Patients: A Retrospective Analysis.

Hip fracture patients are a subset of trauma patients with high peri-operative mortality. To mitigate the mortality risk, the use of predictive scoring systems (e.g., RSI or Nomograms) for risk stratification and monitoring of high-risk patients in the intensive care unit (ICU) has been proposed. Screening patients for ICU admission with relatively low-cost tools may achieve high-quality, low-cost care. The aim of this study was to assess the effectiveness and feasibility of screening postoperative hip fracture patients for ICU admission. This is a retrospective single-site study comparing two groups ofpatients, before and after implementation of a hip fracture postoperative screening intervention in a level 1 trauma center in the United States. All hip fracture patients > 55 years of age admitted to the hospital between January 2021 and May 2023 were included. Trauma team members assessed and screened patients postoperatively in the post-anesthesia care unit (PACU), ordering standardized tests, including laboratory tests, a chest x-ray, and electrocardiogram (EKG). Assessment of the effect of the intervention included a comparison of a number of major adverse events (MAEs), mortality, planned and unplanned ICU admissions, ICU length of stay (LOS), and hospital LOS between pre- and post-intervention groups. Propensity score (PS) estimates were used to compare outcomes between the matched participants in the sample. A predictive model for ICU admission for the overall sample was estimated, and discriminative ability was assessed with an area under the curve (AUC) receiver operator characteristics (ROC) analysis. Lastly, feasibility was assessed by compliance with screening intervention and charges per patient related to the intervention. The sample consisted of 290 patients in the pre-intervention and 180 patients in the post-intervention groups, respectively, with a mean age of81.4 ± (9.9) years. There was a significant increase (p<0.01) in planned ICU admissions (OR=2.387, 95% CI (1.430, 3.983)) after screening protocol implementation. There was no significant difference between the pre-intervention group and post-intervention group in the number of MAEs (p=0.392), mortality (p=0.591), ICU LOS (p=0.617), and hospital LOS (p=0.151). When the PS-matched sample (n=424) was analyzed, there was a significant decrease (p=0.45) in unplanned ICU admissions (OR=6.40, 95% CI (0.81, 50.95)) after protocol implementation. Anticoagulants, emergency department (ED) respiratory rate (RR), injury severity score (ISS), number of comorbidities, substance use disorder (SAD), peripheral artery disease (PAD), and chronic obstructive pulmonary disease (COPD) were significant predictors of ICU admission (p=0.002, 0.022, 0.030, 0.034, 0.039, 0.039, and 0.042), respectively, and, demonstrated the discriminative ability between high and low risk for ICU admission (AUC=0.597, 0.587, 0.581, 0.578, 0.513, and 0.587, respectively). The screening intervention was achievable with 99% compliance (Kappa estimate 0.94) among trauma team members with an average charge of $282 per patient. The addition of a postoperative screening intervention for hip fracture patients > 55 years of age is achievable and decreases unplanned ICU admissions in matched samples. Presenting clinical indicators and comorbidities are associated with ICU admission and provide sufficient discriminatory ability as criteria for ICU admission.

COVID-19 in the neighbourhood: the socio-spatial selectivity of severe COVID-19 cases in Sweden, March 2020–June 2021

AbstractIn this paper we analyse spatial and temporal variation in the risk of intensive care unit (ICU) admission for COVID-19 in Sweden. The analysis is based on geocoded and time-stamped data from the Swedish Intensive Care Registry (SIR). We merge this data with a classification of Swedish neighbourhood cluster types constructed from multi-scalar measures of socio-economic and country of birth segregation (Kawalerowicz and Malmberg in Multiscalar typology of residential areas in Sweden, 2021 available from https://doi.org/10.17045/sthlmuni.14753826.v1). We examine 1) if residence in more socio-economically deprived or diverse neighbourhood cluster types was associated with a higher risk of ICU admission for COVID-19, 2) if residence in more affluent neighbourhoods was associated with a lower risk of ICU admission for COVID-19, and 3) how these patterns changed over time during the three first waves of the pandemic. While the highest overall risk was associated with residence in urban disadvantage coupled with diversity, models where neighbourhood cluster types were interacted with waves reveal that the highest risk was associated with living in a neighbourhood cluster type characterised by rural town disadvantage coupled with diversity under the 3rd wave (February 2021–June 2021). Residence in such a neighbourhood cluster type was associated with a four times higher risk of ICU admission, compared to the reference category of living in a homogeneous rural neighbourhood cluster type with average levels of deprivation under wave 1. Looking at disparities within each wave we found that residence in most affluent urban areas was at first associated with a slightly higher risk of ICU admission for COVID-19 as compared with the reference category of living in a homogeneous rural neighbourhood cluster type, but under waves 2 and 3 this risk was no longer statistically significant. The largest inequalities between different neighbourhood cluster types could be seen during the 1st wave. Over time, the risks converged between different neighbourhood cluster types.