Missing Age Data Research Articles

MOLECULAR SEXING AND ITS RELATIONSHIP WITH THE SEMI-CONCEALED YELLOW CORONAL PATCH OF THE WHITE-THROATED SPADEBILL PLATYRINCHUS MYSTACEUS CANCROMUS

In sexually monomorphic species, sex identification by molecular techniques is an important alternative. In this study, we employed molecular sexing to determine the sex of seven adult females, two immature females, one female with missing age data, and 21 adult males of White-throated Spadebills Platyrinchus mystaceus cancromus. The sex and age of each individual were associated with the presence or absence of a semi-concealed yellow coronal patch, typical of the species. All males displayed the semi-concealed patch, and four out of seven adult females also exhibited it. One of the two juvenile females exhibited a patch. The female with missing age data also exhibited the patch. This finding disputes previous reports that juveniles of this species do not have coronal patches. We conclude that semi-concealed yellow coronal patches are not sexually dimorphic in White-throated Spadebills. Both sexes can have a patch, but adults who do not have them are females.

Abstract 134: Population-level Trends In Clinal Outcomes And Endovascular Stroke Therapy In Acute Ischemic Stroke

Intro & Background: Following the publication of the randomized clinical trials in 2015 and 2018 on endovascular stroke therapy (EVT), procedural utilization has increased. The effect of EVT utilization on clinical outcomes in acute ischemic stroke (AIS) at the population-level, however, remains incompletely characterized. Methods & Materials: We performed a retrospective cross-sectional analysis using the Texas Public Use Data File with records from January 2016 through the first quarter of 2020. This dataset includes full sample data on all patients hospital discharged from all state-licensed hospitals. AIS hospitalizations were identified as those with a primary diagnosis of AIS by ICD-10 diagnostic codes. Patients <18 were excluded, as well as patients missing age data. EVT was defined using ICD-10 procedure codes. Excellent clinical outcome was defined as discharge to home. Trends for EVT and percentage of home discharge were assessed by quarter and the correlation between two trends were examined by cross-correlation. Results: Among 165,738 AIS cases, 61% were over 65 years old, 51% were female, 51% were White and 25% were Hispanic. Over the course of the study period, EVT utilization increased 0.25% per quarter [95% CI 0.23-0.27, P<0.001]. Excellent clinical outcomes also increased over this time period, with a 0.21% quarterly increase in patients being discharged home [95% CI 0.16-0.25, p<0.001] (Figure). At the population-level, we observed a positive correlation between increasing EVT utilization and excellent clinical outcomes (R=0.64, p< 0.003). Conclusion: In this state-wide cohort, increasing usage of EVT was positively correlated with excellent clinical outcomes. These data provide evidence for population-level improvements in AIS care with improving EVT access and utilization.

Evolving Treatment Patterns and Outcomes of Neovascular Age-Related Macular Degeneration Over a Decade

Management of neovascular age-related macular degeneration (nAMD) has evolved over the last decade with several treatment regimens and medications. This study describes the treatment patterns and visual outcomes over 10 years in a large cohort of patients. Retrospective analysis of electronic health records from 27 National Health Service secondary care healthcare providers in the UK. Treatment-naïve patients receiving at least 3 intravitreal anti-vascular endothelial growth factor (VEGF) injections for nAMD in their first 6 months of follow-up were included. Patients with missing data for age or gender and those aged less than 55 years were excluded. Eyes with at least 3 years of follow-up were grouped by years of treatment initiation, and 3-year outcomes were compared between the groups. Data were generated during routine clinical care between September 2008 and December2018. Visual acuity (VA), number of injections, and number of visits. A total of 15 810 eyes of 13 705 patients receiving 195 104 injections were included. Visual acuity improved from baseline during the first year, but decreased thereafter, resulting in loss of visual gains. This trend remained consistent throughout the past decade. Although an increasing proportion of eyes remained in the driving standard, this was driven by better presenting VA over the decade. The number of injections decreased substantially between the first and subsequent years, from a mean of 6.25 in year 1 to 3 in year 2 and 2.5 in year 3, without improvement over the decade. In a multivariable regression analysis, final VA improved by 0.24 letters for each year since 2008, and younger age and baseline VA were significantly associated with VA at 3 years. Our findings show that despite improvement in functional VA over the years, primarily driven by improving baseline VA, patients continue to lose vision after the first year of treatment, with only marginal change over the past decade. The data suggest these results may be related to suboptimal treatment patterns, which have not improved over the years. Rethinking treatment strategies may be warranted, possibly on a national level or through the introduction of longer-acting therapies.

P021: Outcomes of out of hospital cardiac arrest in London, Ontario

Introduction: Out of hospital cardiac arrest (OHCA) continues to carry a very high mortality rate, with approximately 10% surviving to hospital discharge. We sought to determine if outcomes from out of hospital cardiac arrest (OHCA) at our centre were consistent with recently published North American outcomes data from the Resuscitation Outcomes Consortium (ROC). Methods: We performed a retrospective analysis (Sept 2011 June 2015) of the Resuscitation Outcomes Consortium (ROC) database, which contains pre-hospital, in-hospital and outcomes data on adult, EMS-treated, non-traumatic OHCA. Patients under 18 years, with missing age data or with obvious non-cardiac causes of arrest were excluded. Results: During the study period, there were a total of 997 OHCA; 86 met exclusion criteria. Of the 911 remaining patients, 557 (61.1%) were transported to a local ED. 92 (35.1%) were receiving ongoing CPR at the time of their presentation to the ED. Of those transported to the ED, 262 (47.0%) achieved sustained ROSC, defined as survival to ED discharge. A total of 95 patients survived to hospital discharge (36.3% of patients who achieved sustained ROSC, 17.1% of those who were transported to the ED, and 10.4% of the all OHCA). Of those who survived to hospital discharge who had neurologic outcome data, 90.5% had a modified Rankin score of 2. Initial presenting rhythm with EMS was ventricular fibrillation or pulseless ventricular tachycardia in 233 patients. Of these, 212 (91.0%) were transported to the ED, 134 (57.5%) achieved sustained ROSC, and 71 (30.5%) survived to hospital discharge. 54/60 (90.0%) of those with a documented neurologic exam had a favourable neurologic outcome. Initial presenting rhythm with EMS was PEA or asystole in 636 patients. Of these, 320 (50.3%) were transported to the ED, 115 (18.1%) achieved sustained ROSC, and 17 (2.7%) survived to hospital discharge. 9/10 (90%) of those with a documented neurologic exam had a favourable neurologic outcome. 358 of the arrests were witnessed. Of these, 274 (76.5%) were transported to the ED, 150 (41.9%) achieved sustained ROSC, and 51 (15.9%) survived to hospital discharge. 47/53 (88.7%) of those with a documented neurologic exam had a favourable neurologic outcome. Conclusion: Outcomes from out of hospital cardiac arrest in London, Ontario are comparable to other sites across North America.

P020: Post-return of spontaneous circulation care and outcomes a single centre experience

Introduction: Out of hospital cardiac arrest (OHCA) continues to carry a very high mortality rate, with approximately 10% surviving to hospital discharge. In 2015, the American Heart Association release updated guidelines dictating best practices in post-return of spontaneous circulation (ROSC) care, advocating for more liberal utilization of emergent coronary angiography. We sought to determine if the post-ROSC care at our centre during our study period adhered to the previously published (2010) guidelines. Methods: We performed a retrospective analysis (Sept. 2011 - June 2015) of the Resuscitation Outcomes Consortium (ROC) database, which contains pre-hospital, hospital and outcomes data on adult, EMS-treated, non-traumatic OHCA. Patients under 18 years, with missing age data or with obvious non-cardiac causes of arrest were excluded. Key variables included rates of post-ROSC emergent angiography, survival to hospital discharge and survival to hospital discharge with favourable neurologic outcome (modified Rankin score 2). Results: During the study period, there were a total of 997 OHCA; 86 met exclusion criteria. Of the 911 remaining patients, 557 (61.1%) were transported to a local ED. Of those transported to the ED, 262 (47.0%) achieved sustained ROSC, defined as survival to ED discharge. Of those who achieved sustained ROSC, median age was 65 years (IQR=21.75), 66.8% were male. ECG interpretation data was available on 214 patients, of whom 56 had definite STEMI, and 135 had definite absence of STEMI. 37/56 (66.1%) definite STEMI patients received coronary angiography within 24 hours of presentation, as per AHA guidelines. 58/262 (22.1%) post-ROSC patients overall received coronary angiography within 24 hours of presentation to the ED. Of those 58 patients who received emergent angiography, 38 (65.5%) underwent percutaneous coronary intervention (PCI). No patients received fibrinolysis. Of post-ROSC patients who received emergent coronary angiography, 40/58 (69.0%) survived to hospital discharge and 37/58 (63.8%) survived with good neurologic outcome. In comparison, 55/204 (27.0%) who did not receive emergent angiography survived to hospital discharge and 18.8% survived with good neurologic outcome. Conclusion: Only 22.1% of patients with OHCA, and only 66.1% with ECG-proven STEMI underwent emergent coronary angiography post-ROSC. Further investigation into causes for delay or the withholding of emergent angiography is necessary.

Incidence and Outcomes of Acute Respiratory Distress Syndrome in Patients With Acute Pancreatitis

Introduction: Acute pancreatitis is the leading gastrointestinal cause of hospitalization in the United States. Severe pancreatic damage leads to systemic inflammatory response syndrome (SIRS) and affects multiple organs including lungs, the severe form of which is acute respiratory distress syndrome (ARDS). We seek to analyze the incidence and in-hospital mortality in ARDS associated with pancreatitis. We also analyzed the predictors associated with the development of ARDS and the predictors of in-hospital mortality in these patients. Methods: Using the National Inpatient Sample 2003-2013, we identified adults (age>18 years) admitted for acute pancreatitis with ICD-9-CM code 577.0 Among these patients, ARDS was identified by ICD-9 code 518.82. Patients with missing data for age and gender were excluded. To identify the predictors associated with development of ARDS, we created a multivariate logistic regression model with covariates including demographics, Elixhauser comorbidities, and etiology of pancreatitis (alcohol/gallstone/hypertriglyceridemia). In-hospital mortality and length of stay (LOS) among these patients was studied. Predictors of in-hospital mortality were examined using similar multivariate logistic regression. Results: Between 2003-2013, there were a total of 2,787,590 hospitalizations for acute pancreatitis. Among these, 6,163 (0.2%) developed ARDS. The independent predictors for development of ARDS in these patients were age >65 (OR 1.52, P<0.001), male sex (OR 1.45, P<0.001), alcohol use (OR 1.18, P<0.001), hypertriglyceridemia (OR 1.56, P<0.001) and obesity (OR 1.43, P<0.001) Among patients with acute pancreatitis and ARDS, the mean age (SD) was 55.6 (17.6) years and 60.4% were males. Median LOS was 11 days and the in-hospital mortality was 11.4%. The independent predictors of inhospital mortality were age >65 (OR 5.93, P<0.001), male sex (OR 1.80, P<0.001) and underlying liver disease (OR 1.79, P<0.001) Conclusion: We noticed that the incidence of ARDS is low among individuals with acute pancreatitis and the mortality of ARDS in pancreatitis is 11%, which is lower than the mortality of ARDS from other disease processes.We also noticed that older males are more likely to develop ARDS and have higher incidence of in-hospital mortality. Furthermore, alcohol use, obesity and hypertriglyceridemia are associated with increased incidence of ARDS and underlying liver disease is associated with increased in-hospital mortality.

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience.

To analyze data from a registry of Japanese neonates with hypoxic respiratory failure associated with pulmonary hypertension (PH) to compare the effectiveness of inhaled nitric oxide (iNO) in neonates born <34 weeks vs. ≥34 weeks gestational age (GA). iNO was administered according to approved Japanese product labeling. Study data were collected before iNO administration and at predefined intervals until discontinuation. A total of 1,114 neonates were included (n=431, <34 weeks GA; n=675, ≥34 weeks GA; n=8, missing age data). Mean decrease from baseline oxygenation index (OI) was similar in both age groups. OI reduction was more pronounced in the <34 weeks subgroups with baseline OI ≥25. Survival rates were similar in the <34 weeks GA and ≥34 weeks GA groups stratified by baseline OI (OI<15, 89% vs. 93%; 15≤OI<25, 85% vs. 91%; 25≤OI≤40, 73% vs. 79%; OI>40, 64% vs. 66%). iNO improved oxygenation in preterm neonates as effectively as in late preterm and term neonates, without negative impact on survival. If clinically significant PH is present, as measured by pulse oximetry or echocardiography, a therapeutic trial of iNO might be indicated for preterm neonates.

Race-related Healthcare Disparities Among California Workers: Public Health Considerations for Immigration Reform

BackgroundHealthcare disparities are prevalent in medicine and identifying them will provide healthcare professionals, administrators, and policy makers needed information to address this public health concern. ObjectiveTo evaluate racial and ethnic disparities in the rates of hospital admission and death among California workers. MethodsWe performed an analysis of hospital and emergency department (ED) data from the Office of Statewide Health Planning and Development (OSHPD). Data was collected from California licensed acute care hospitals from 2008−2010. Inclusion criteria: patients >15 years of age whose expected source of payment was worker’s compensation. Exclusion criteria: patients <15 years; had missing data for age, sex, race, or injury; or were injured by a suicide attempt, poisoning, or complication of medical procedure. Multivariate logistic regression was used to evaluate the relationship of race/ethnicity and admission/death rates. ResultsThere were 393,298 patients discharged from the ED and 23,343 patients admitted from ED had workers compensation as their expected sources of payment and 150,277 met our inclusion criteria. The annual rate of ED treated injuries was 209/100,000 for Caucasians 343/100,000 for Hispanics, 258/100,000 for blacks and 97/100,000 for Asians. Compared to Caucasians, admission odds ratios (OR) were 1.15 (95% CI 1.07–1.25) for Hispanics, 1.08 (95% CI 0.87–1.33) for blacks, and 0.78 (95% CI 0.63–0.97) for Asians. ConclusionWe observed race and ethnicity related healthcare disparities among the occupationally injured in California, with Hispanics having the highest odds of admission and annual incidence of ED treated injuries. No difference in mortality rates was observed.

Pediatric drug safety surveillance in Italian pharmacovigilance network: an overview of adverse drug reactions in the years 2001 – 2012

Objective: To describe the characteristics of pediatric adverse drug reactions (ADRs) reported in Italian spontaneous reporting database.Methods: Reports of suspected ADRs related to children and adolescents were extracted from 2001 – 2012. After exclusion of duplicates, vaccines and reports containing missing age data, the report characteristics were investigated in terms of implicated drug and adverse drug event across different age-categories.Results: Among 123,129 selected reports, 8338 (6.8%) concerned pediatrics. Of these, 52.2% involved male patients compared to 47.5% female up to the age of 11. After the age of 11 this statistic reversed. 39.4% of pediatric reports were serious and of these, 75.2% required hospitalization mainly in very young children. Most of reports were issued by hospital physicians (61.9%), followed by pharmacists (10.1%), while reports from family pediatricians accounted for 8.1%. The most frequently implicated drug categories were anti-infectives for systemic use (44.9%), drugs for the nervous system (15.6%), and anti-inflammatory drugs (10.2%). The most frequently suspected compounds differed between children and adults and reports for the same drug were likely to be more serious in adults than in children.Conclusions: This ADR reporting system reflects real safety concerns for drugs used in children and emphasizes the need for stratifying analyses by age-subgroup to increase the sensitivity of signal detection procedure.