Main Cause Of Admission Research Articles

Serum 25 Dihydroxyvitamin D3 Levels in Predicting the Severity in Patients with Cirrhosis of Liver

Aim: To estimate the levels of serum 25OH vitamin D3 in patients with cirrhosis. To assess relation of vitamin D3 deficiency to the severity of liver impairment as evidenced by Child-Turcotte-Pugh (CTP) score and Model for Endstage Liver Disease (MELD) score. Methods: The study was conducted in 50 patients admitted to our Liver Unit between June 2013 and May 2014 for the treatment of cirrhosis compensated or decompensated. Diagnosis of cirrhosis was established by clinical, laboratory parameters, and ultrasonographic findings. Results: A total of 55 patients enrolled in the study and 50 completed the study. There were 47 men (94%) and 3 women (6%) and the mean patient age was 41 years (range: 18–70 years). The main cause of admission in the series was ascites in 42 (82%) patients, hepatic encephalopathy in 32 (64%) patients, variceal bleeding in 12 (24%) patients, and HRS in 10 (20%) patients. The cause of cirrhosis was alcoholism in 44 cases and hepatitis B virus in 6 patients. The mean Child-Pugh score was 8.5. Vitamin D was low in all 50 patients (<30 ng/ml). Insufficiency (10–30 ng/ml) was present in 31 (62%) patients and deficiency <10 ng/ml was seen in 19 (38%) patients. All CTP A patients had insufficiency whereas CTP B has both insufficiency and deficiency. CTP C had deficiency. Patients MELD score <15 has insufficiency. A MELD ≥25 correlated with deficiency. Conclusion: Vitamin D deficiency is very important with various roles in human physiology. Patients with cirrhosis have a deficiency of this vitamin. In our study the severity of deficiency correlates with the severity of cirrhosis.

Retrospective evaluation of prognostic score performances in cirrhotic patients admitted to an intermediate care unit

BackgroundThe prognosis of cirrhotic patients in the Intensive Care Unit requires the development of predictive tools for mortality. We aimed to evaluate the ability of different prognostic scores to predict hospital mortality in these patients. MethodsA single-centre retrospective analysis was conducted of 281 hospital stays of cirrhotic patients at an Intermediate Care Unit between June 2009 and December 2010. The performance of the Simplified Acute Physiology Score (SOFA), the Simplified Acute Physiology Score (SAPS) II or III, Child–Pugh, Model for End-Stage Liver Disease (MELD), MELD-Na and the Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure score (CLIF-C ACLF) in predicting hospital mortality were compared. ResultsMean age was 58.2±12.1 years; 77% were male. The main cause of admission was acute gastrointestinal bleeding (47%). The in-hospital mortality rate was 25.3%. Receiver operating characteristic curve analyses demonstrated that SOFA (0.82) MELD-Na (0.82) or MELD (0.81) scores at admission predicted in-hospital mortality better than Child–Pugh (0.76), SAPS II (0.77), SAPS III (0.75) or CLIF-C ACLF (0.75). We then developed the cirrhosis prognostic score (Ci-Pro), which performed better (0.89) than SOFA. ConclusionSOFA, MELD and especially the Ci-Pro score show the best performance in predicting hospital mortality of cirrhotic patients admitted to an Intermediate Care Unit.

Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

Causes of Admission and out Comes Among Preeclampsia and Eclampsia Mothers Admitted to Jimma University Specialized Hospital Intensive Care Unit

Background: Preeclampsia is a multisystem hypertensive disorder of pregnancy with new onset after 20 weeks gestation which is a leading cause of worldwide maternal and fetal morbidity-mortality. Objective: To assess causes of ICU admission and outcomes among pre-eclampsia and eclampsia mothers admitted to Jimma University Specialized Hospital. Methods: A retrospective cross sectional study was conducted at JUSH from May 3 to 8, 2015, all ICU admitted preeclampsia and eclampsia mother’s records from January 1, 2010 to December 31, 2014 were included by consecutive sampling with inclusion and exclusion criteria. Causes of admission, complications and outcomes were obtained from patient records and analyzed by SPSS version 16.0, finally the results presented using simple frequency tables and figures. Chi square (x2) test calculated to analyze the statistical association between patients outcome and other variables, p-value less than 0.05 was considered statistically significant. Result: A total of 1981 patients admitted to Jimma University specialized hospital ICU over the last five years (January 1, 2010 to December 31, 2014) from this 326 of them were preeclampsia and eclampsia mothers and this gives admission rate of 16.5%. For this study only total of 314 preeclampsia and eclampsia mothers records were used and 12mothers cards were excluded by exclusion criteria. The main causes of admission to ICU were eclampsia 106 (33.8%), General condition need close observation 77(24.5%), pulmonary edema 63 (20.1%), postoperative bleeding 31(9.9%) While the main complications were pulmonary edema 82(26.1%), acute renal injury 76(24.2), HELLP syndrome 57(18.2%) and mortality rate of 7.3%.There is association level of blood pressure with maternal outcomes. Conclusion: Rate of maternal admission, complications and mortality is found to be high at JUSH ICU, Jimma University with other stakeholders has to work in improving high quality of cares provided to reduce maternal complications and mortality

Predictors of 30-day mortality in cancer patients with septic shock

In cancer patients, sepsis is the main cause of admission to the ICU and is associated with elevated mortality rates and healthcare costs. In this population, specific factors such as poor functional status and immunosuppression secondary to malignancy and/or antineoplastic treatment contribute to decreased survival. The aim of this study is to identify predictors of mortality in cancer patients admitted to the ICU with septic shock.

Main characteristics observed in patients with hematologic diseases admitted to an intensive care unit of a Brazilian university hospital

ObjectiveTo evaluate the clinical characteristics of patients with hematological disease admitted to the intensive care unit and the use of noninvasive mechanical ventilation in a subgroup with respiratory dysfunction.MethodsA retrospective observational study from September 2011 to January 2014.ResultsOverall, 157 patients were included. The mean age was 45.13 (± 17.2) years and 46.5% of the patients were female. Sixty-seven (48.4%) patients had sepsis, and 90 (57.3%) patients required vasoactive vasopressors. The main cause for admission to the intensive care unit was acute respiratory failure (94.3%). Among the 157 studied patients, 47 (29.9%) were intubated within the first 24 hours, and 38 (24.2%) underwent noninvasive mechanical ventilation. Among the 38 patients who initially received noninvasive mechanical ventilation, 26 (68.4%) were subsequently intubated, and 12 (31.6%) responded to this mode of ventilation. Patients who failed to respond to noninvasive mechanical ventilation had higher intensive care unit mortality (66.7% versus 16.7%; p = 0.004) and a longer stay in the intensive care unit (9.6 days versus 4.6 days, p = 0.02) compared with the successful cases. Baseline severity scores (SOFA and SAPS 3) and the total leukocyte count were not significantly different between these two subgroups. In a multivariate logistic regression model including the 157 patients, intubation at any time during the stay in the intensive care unit and SAPS 3 were independently associated with intensive care unit mortality, while using noninvasive mechanical ventilation was not.ConclusionIn this retrospective study with severely ill hematologic patients, those who underwent noninvasive mechanical ventilation at admission and failed to respond to it presented elevated intensive care unit mortality. However, only intubation during the intensive care unit stay was independently associated with a poor outcome. Further studies are needed to define predictors of noninvasive mechanical ventilation failure.

Assessment of the exposure to heavy metals in Griffon vultures (Gyps fulvus) from the Iberian Peninsula

Griffon vultures (Gyps fulvus), by virtue of their position at the top of the food chain and as obligate scavengers, are at risk of accumulating and concentrating heavy metals in their tissues and may be more predisposed to their toxic effects. The aim of this study is to investigate heavy metal concentrations in Griffon vultures in Portugal and Catalonia, Spain and to determine if heavy metal concentrations in the blood of weak and/or injured Griffon vultures admitted to wildlife rehabilitation centres (WRC) reflect contamination profiles in the local, free-living and outwardly healthy population. Whole-blood samples taken from 121 Griffon vultures caught in the wild or admitted to WRC in Portugal and Catalonia, Spain were examined for cadmium (Cd), mercury (Hg) and lead (Pb) by inductively coupled plasma mass spectrometry (ICP-MS). Cd and Hg were not detected in most samples (98.3% and 95%, respectively), while Pb was detected in all birds in concentrations ranging between 4.97 and 300.23µg/dl. Birds admitted to WRC had significantly lower Pb concentrations (24.15±15.07 and 25.98±18.04µg/dl in Portugal and Catalonia, Spain, respectively) than animals caught in the wild (29.67±13.19 and 42.22±50.08µg/dl in Portugal and Catalonia, Spain, respectively) (p<0.05). This may be explained by the fact that malnutrition was the main cause of admission of Griffon vultures to WRC, as ingestion has been described as the most significant pathway for Pb exposure in raptors. Therefore Griffon vultures admitted to WRC do not seem to be representative of the local, free-flying populations, so it remains necessary to continue catching when one intends to monitor Pb exposure in this species. The population of vultures captured in Catalonia, Spain showed the highest mean blood Pb concentration, perhaps due to the municipal rubbish dump located near the feeding station, with rubbish providing a significant fraction of their trophic needs. The ingestion of game meat with bullet fragments in carcasses or with Pb shots embedded in their flesh could also be the cause of the high blood Pb concentrations found in some vultures. The potential risk of Pb exposure in Griffon vulture populations must be given consideration, since most individuals evaluated had Pb concentrations between 20 and 100µg/dl, which is considered to be subclinical exposure to Pb, and which is above the threshold level at which Pb can affect antioxidant system in this species (15µg/dl).

Multiple hospitalizations at the department of internal medicine of a tertiary hospital

Background and objectivesPatient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. Patients and methodsA total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. ResultsWhen compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. ConclusionsMultiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

Multiingreso en el Servicio de Medicina Interna de un hospital terciario

Background and objectivesPatient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. Patients and methodsA total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. ResultsWhen compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. ConclusionsMultiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

Admission of Hematopoietic Cell Transplantation Patients to the Intensive Care Unit at the Pontificia Universidad Católica de Chile Hospital

Patients undergoing hematopoietic cell transplantation (HCT) can have complications that require management in the intensive care unit (ICU). We conducted a retrospective study of patients undergoing HCT between 2007 and 2011 with admission to the ICU. We analyzed 97 patients, with an average age of 37 (range, 15 to 68). The main indications for HCT were hematologic malignancies (84%, n = 82). Ninety percent (n = 87) received myeloablative conditioning. Thirty-one percent were admitted (autologous transplant recipients 15%, allogeneic transplant recipients 34%, and umbilical cord blood [UCB] transplant recipients 48%) with an average length of stay of 19 days (range, 1 to 73 days). The average time between transplantation and transfer was 15 days. The main causes of admission were acute respiratory failure (63%) and septic shock (20%). ICU mortality was 20% for autologous transplantations and 64% for allogeneic transplantations (adult donor and UCB combined). On average, patients died 108 days after the transplantation (range, 4 to 320 days). One-year overall survival, comparing patients entering the ICU with those never admitted, was 16% versus 82% (P < .0001) for allogeneic transplantations (adult donor and UCB combined) and 80% versus 89% (P = not significant) for autologous transplantations. Acute graft-versus-host disease was significantly associated with death in ICU after UCB HCT. ICU support is satisfactory in about one half of patients admitted, characterized by a short and medium term prognosis not as unfavorable as has been previously reported.

Utilización de recursos sanitarios y costes asociados al manejo de los pacientes con infarto cerebral cardioembólico agudo en la Comunidad de Madrid: Estudio CODICE

IntroductionStroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. MethodsA multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients’ socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. ResultsDuring an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. ConclusionsAcute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.

LA ADMISIBILIDAD DEL PROCESO ADMINISTRATIVO EN EL ORDENAMIENTO GLOBAL

From the incorporation of the international treaties constitutional texts-such as in our country through art. 75 paragraph 22 of the Constitution Nacional- both Articles 8 and 25 of the Pact of San José de Costa Rica and the remaining provisions constitute direct source application, and therefore has traditionally reinforced what we recognized as due process under the own national constitutions. In this context, we have tried to provide an overview of doctrinal and jurisprudential analysis of the different aspects and specific problems that relate to the admissibility of the administrative proceedings, which by its particularities have earned an adjusted treatment by local courts to achieve an adequate definition of its content and scope. To do this, we have examined the various procedural requirements related to administrative litigation and the main causes of admission and inadmissibility of special judicial process from analysis and study of specific real situations to provide guidance on the interpretation of objective law by the judges as a practical and concrete strategy for the various operators of law.

When to use and not to use spirometry in patients admitted to the internal medicine wards for the diagnosis of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the main causes for admission to an internal medicine ward, due to exacerbations of the disease itself or to comorbidities leading to dyspnea as an intriguing symptom. In many cases, a diagnosis of COPD is made only on clinical grounds, but well-accepted guidelines strongly suggest measuring the lung function to diagnose and stage such a common disease. Problems with the equipment, its use and data interpretation lead to underuse spirometry in general and in patients in internal medicine in particular.

Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems.

SummaryBackgroundEstimates of the burden of disease in adults in sub-Saharan Africa largely rely on models of sparse data. We aimed to measure the burden of disease in adults living in a rural area of coastal Kenya with use of linked clinical and demographic surveillance data.MethodsWe used data from 18 712 adults admitted to Kilifi District Hospital (Kilifi, Kenya) between Jan 1, 2007, and Dec 31, 2012, linked to 790 635 person-years of observation within the Kilifi Health and Demographic Surveillance System, to establish the rates and major causes of admission to hospital. These data were also used to model disease-specific disability-adjusted life-years lost in the population. We used geographical mapping software to calculate admission rates stratified by distance from the hospital.FindingsThe main causes of admission to hospital in women living within 5 km of the hospital were infectious and parasitic diseases (303 per 100 000 person-years of observation), pregnancy-related disorders (239 per 100 000 person-years of observation), and circulatory illnesses (105 per 100 000 person-years of observation). Leading causes of hospital admission in men living within 5 km of the hospital were infectious and parasitic diseases (169 per 100 000 person-years of observation), injuries (135 per 100 000 person-years of observation), and digestive system disorders (112 per 100 000 person-years of observation). HIV-related diseases were the leading cause of disability-adjusted life-years lost (2050 per 100 000 person-years of observation), followed by non-communicable diseases (741 per 100 000 person-years of observation). For every 5 km increase in distance from the hospital, all-cause admission rates decreased by 11% (95% CI 7–14) in men and 20% (17–23) in women. The magnitude of this decline was highest for endocrine disorders in women (35%; 95% CI 22–46) and neoplasms in men (30%; 9–45).InterpretationAdults in rural Kenya face a combined burden of infectious diseases, pregnancy-related disorders, cardiovascular illnesses, and injuries. Disease burden estimates based on hospital data are affected by distance from the hospital, and the amount of underestimation of disease burden differs by both disease and sex.FundingThe Wellcome Trust, GAVI Alliance.

SPECIE-SPECIFIC OUTCOMES OF WILD RAPTORS ATTENDED AT A WILDLIFE REHABILITATION CENTRE IN CATALONIA (1997-2005)

Outcome research of rehabilitation of wild birds of prey and owls are scarcely reported. The aim of th is study is to investigate specie-specific outcomes of the rehabilitation practice in wild raptor attende d in a wildlife center. A total of 6221 hospitalized wild raptors (3241 Strigiformes; 2980 Falconiformes) admitted at a Wildlife Rehabilitation Centre (WRC) of Catalonia from 1995 to 2007 were analysed. The outcomes indicators were based on ratios of Euthana sia (E r), Mortality (M r), Release (R r) and Captivity (C r). Stratified analyses by main causes of admission were performed for the different raptor species. Species from the Falconiformes order presented high er rates of euthanasia (33.9%) compared to the Strigiformes (18.6%). Species like B. buteo (45.7%) and M. migrans (47.6%) in the Falconiformes and B. bubo (33.6%) in the Strigiformes, presented the highest E r. Despite no differences between orders could be observed in the row mortality rates, data analys ed by the causes of admission showed that the M r of owls was significant higher than the Falconiformes for the trauma (13.2%; χ 2 = 49.97; p<0.001), non trauma (12.7%; χ 2 = 17.41; p<0.001) and orphaned young categories (4. 9%; χ 2 = 5.4; p = 0.02). The release rate was similar between orders. Based on s pecies, G. fulvus (69.2%), C. aeruginosus (56.3%) and A. gentillis (43.1%) in the Falconiformes and O. scops (48.5%) in the Strigiformes showed the highest R r. In the orphaned young category owls had better R r than the diurnal raptors, being S. aluco the specie with the best rates of release (84%), wherea s B. bubo had the worst values (50%). Specie-specific differences were found in the rehabilitation outcom es according to the different causes of admission. The stratified analysis of outcomes can be useful in or der to to identify specie-specific risk factors.

Application of pediatric index of mortality version 2: score in pediatric intensive care unit in an African developing country.

IntroductionOutcome of patients admitted to PICU can be evaluated by many illness severity scoring systems. This prospective observational study evaluated the outcome of patients admitted to PICU in Fayoum University hospital of a developing country using the pediatric index of mortality version 2 scoring system.MethodsAll patients included in this study were subjected to data collection including demographics, diagnoses at admission, duration of ICU stay (DOS), pediatric index of mortality version 2 (PIM2) score and hospital outcome. The ratio of observed to predicted mortality (standardized mortality ratio (SMR)) was calculated for the set of patients.ResultsThe study included 205 patients. The main causes of admission were respiratory, cardiovascular and neurological illnesses. Patients stay in ICU ranged from 1 - 45 days with a median 6 (interquartile range (IQ): 3-9) days. Discriminatory function of PIM2 scoring system was acceptable with the area under the ROC curve 0.76 (95%CI: 0.60-0.91). PIM2 calibrated well using Hosmer Lemeshow analysis (H-L X2= 1.410, df= 8, p=0.9). The mean predicted mortality was 5.6 (95% CI: 3.43 - 7.91) and the observed mortality was 8.8% giving a SMR 1.55.ConclusionPIM2 scoring system show adequate discriminatory function and well calibrated for the case mix of patients in PICU of Fayoum, Egypt. It can be used as beneficial tool for evaluation of risk adjusted mortality. Further larger scale studies in cooperation with other Egyptian universities and neighboring countries can improve the performance of our PICUs and critical care services.

Intensive care admissions due to severe maternal morbidity

Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. Review of medical records of 89 pregnant women with a mean age of 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/ HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.

Epidemiologic profile, survival, and maternal prognosis factors among women at an obstetric intensive care unit

ObjectiveTo identify the epidemiologic profile, maternal survival, and prognosis factors that might affect survival rates in the obstetric intensive care unit (ICU). MethodsA prospective cohort study was conducted between January 2007 and February 2009 in a tertiary referral ICU, Belo Horizonte, Brazil. Critical patients during pregnancy and puerperium were followed from admission until discharge or death. Maternal survival was assessed in association with the cause of ICU admission, grouped into direct or indirect obstetric causes, by Kaplan–Meier curves and log-rank tests. ResultsAmong 298 patients admitted to the ICU during the study period, mortality was 4.7% (n=14). Hypertensive disorders (46.0%), hemorrhage (15.9%), sepsis (14.2%), and heart disease (5.7%) were the main causes of admission. Half of the patients who died were admitted for direct obstetric reasons (n=7). Survival was statistically linked to the cause of admission: most survivors were admitted for a direct obstetric cause (75.5%; P=0.044). Maternal survival rates of patients admitted for indirect obstetric causes were lower than those admitted for direct obstetric causes (27.8 and 19.6days, respectively; P=0.019). ConclusionThe main cause of admission was a decisive factor for maternal survival in the obstetric ICU. Direct obstetric complications had a better prognosis.

Pattern of use and presenting complaints of older patients visiting an Emergency Department in Italy

The number of older persons admitted to the Emergency Department (ED) is dramatically increasing due to their complex medical and social problems, which in turn lead to longer clinical evaluation times and increased use of resources compared to younger adults. However, scant data are available for Italian EDs. Similarly, no data are available about the reasons to ED visit and its role in determining the ED utilization pattern. The study aimed at describing the pattern of ED use by older patients and main presenting complaints. Cross-sectional descriptive study of 5,826 ED patients in the city of Fano (Italy). Identifiers and triage, clinical and social data were collected. Presenting complaints as recorded by triage nurses have been recoded according to the Canadian Emergency Department Information System list version 1.1. Data were analyzed comparing older patients (more than 65 years-old) with younger adults (less than 65 years-old). The prevalence of ED visits by older adults was 23.9 %. Their visits were characterized by higher emergency levels, admission rate and length of ED stay. Trauma was the main reason for ED presentation, especially among young adults, but elderly trauma patients were more frequently admitted because of hip fracture. Dyspnea and abdominal pain were the most frequent non-trauma presenting complaints among geriatric patients and represented the main causes for admission. Older adults use the ED appropriately also in Italy. Trauma with complications (fracture) and various presenting complaints underlying medical problems accounted for more than 50 % of ED visits and hospital admissions.

Accidentes de bicicleta atendidos en los Servicios de Urgencias. Estudio multicéntrico

ObjectivesTo describe epidemiological characteristics, types of injury, prognosis and medical management of bicycle-related Paediatric Emergency Department (ED) visits and to identify potential preventive measures. Patients and methodsThis multicentred, observational prospective study included all children between 3 and 16 years of age treated for bicycle-related injuries in the Emergency Departments of 15 Spanish Hospitals belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society between the 1st of June 2011 and the 31st of May 2012. Characteristics of all ED visits, as well as epidemiological data and accident-related information, were collected. ResultsA total of 846 patients were included in the study, with a male predominance (72.9%) and a median age of 9.6±3.6 years. Head injury was the third most common injury (22.3%) and the main cause of admission to the Pediatric Intensive Care Unit (PICU) (68.4%). More than three-quarters (77.9%) of the patients did not wear a helmet, which was significantly associated to a higher incidence of head injury and admission to PICU. Older children (OR 1.063) and bicycle injuries involving motor vehicles (OR 2.431) were identified as independent risk factors for worse outcomes. ConclusionsSince helmet use reduces up to 88% of central nervous system lesions secondary to head injury, promotion of its use should be the main preventive measure, followed by restriction of bike-riding to cycling areas.