Nationwide Retrospective Observational Study Research Articles

Medical Malpractice in Neurosurgery: An Analysis of Claims in the Netherlands.

Studying malpractice claims is important to improve quality of health care and patient safety and to educate the individual healthcare providers. The objective of this study was to describe characteristics of neurosurgical claims in the Netherlands. A nationwide retrospective observational study of neurosurgery-related claims closed by Centramed and MediRisk, 2 major insurance companies in the Netherlands, was performed. Relevant data, including type of neurosurgical pathology, theme and category of the claim, type and severity of injury, outcome, and financial burden, were extracted from anonymized claim files. The estimated annual risk was used to determine the risk for claims by adjusting for the number of annually practicing neurosurgeons in the Netherlands. A total of 388 claims against neurosurgeons were closed between 2007 and 2021. Liability was denied in a slight majority of claims (n = 230; 59%). The total burden during this period was €6 165 000 (amount paid out to patients: €5 497 000). The estimated annual risk per Dutch neurosurgeon for a claim was 15.5%, meaning 1 claim per 6.5 years. The case-level analysis of 238 available anonymized claims revealed that most claims were related to spinal pathology (81.5%), followed by cranial pathology (10.9%) and peripheral nerve (7.6%). The motivations for filing claims were mostly related to alleged surgical (56.3%) or diagnostic errors (22.3%). Most of these claims were denied (151/238; 63.4%), and fewer were settled (42/238; 17.6%), sustained (31/238; 13.0%), or closed without final decision (14/238; 5.9%). Neurosurgery-related malpractice claims primarily involved spinal pathology and were mostly related to alleged treatment errors. Most claims did not result in compensation because there seemed to be no liability or culpable injury. However, the annual risk for a claim for Dutch neurosurgeons is considerable.

6,126 hepatectomies in 2022: current trend of outcome in Italy

PurposeWhether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume.MethodsThis is a nationwide retrospective observational study conducted on data collected by the National Italian Registry “Piano Nazionale Esiti” (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added.Results6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively).ConclusionsHigh-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.

The epidemiology and outcomes of severe road traffic injury by road user type in Korea: A nationwide retrospective observational study

ObjectivesRoad traffic injuries (RTIs) pose a significant public health burden, and more than half of these fatalities are attributed to vulnerable road users (VRUs). This study aimed to evaluate the epidemiology and outcomes of severe RTIs in Korea by focusing on different types of road users. MethodsThis is nationwide retrospective observational study. Using data from the Korean Nationwide Severe Trauma Registry, this study analyzed severe RTI cases from 2016 to 2020. The study included EMS-treated severe trauma patients, defining severe RTI as cases with an injury severity score (ISS) ≥16 or out-of-hospital cardiac arrest (OHCA). The main variable of interest was the road user type, classified as motor vehicle occupants (MVOs), pedestrians, motorcyclists, and bicyclists. Trends and injury characteristics by road user type were analyzed, and multivariate logistic regression was conducted to calculate the adjusted odds ratios (AORs) and 95 % confidence intervals (CIs) of road user type for in-hospital mortality. ResultsOf the 143,021 EMS-treated severe trauma cases, 24,464 were included in this study. Pedestrians represented the largest group (n = 8,782; 35.9 %). More than half of the patients died (n = 12,620, 51.6 %), and a high proportion of patients had OHCA (n = 10,048, 41.1 %). There was no significant change in the overall severe RTI numbers from 2016 to 2020, but a decrease in pedestrian cases and an increase in motorcyclist cases were noted (both p for trend<0.05). Low usage of safety devices was observed (28.2 % of motor vehicle occupants used seat belts, 35.9 % of motorcyclists used helmets, and 9.6 % of bicyclists used helmets). Head injuries were most common, particularly among bicyclists (77.0 %) and motorcyclists (69.8 %). Compared to motor vehicle occupants, pedestrians (AOR [95 % CI] 1.12 [1.04–1.20]) and others (AOR [95 % CI] 1.30 [1.02–1.65]) had higher odds of mortality, while motorcyclists (AOR [95 % CI] 0.64 [0.59–0.69]) and bicyclists (AOR [95 % CI] 0.68 [0.60–0.76]) had lower odds of mortality. ConclusionWe found varying trends and injury characteristics in severe RTIs according to road user type. Adapting prevention strategies for evolving road user patterns, with particular attention to increasing safety device usage and addressing the high mortality associated with severe RTIs are warranted.

Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study

Introduction: Psychiatric comorbidities have a significant impact on patients’ quality of life and often go undetected in neurologic practice. The aim of this study was to describe and characterize psychiatric comorbidities among patients hospitalized due to a neurologic disorder in mainland Portugal.Methods: A retrospective observational study was performed by analyzing hospitalization with a primary diagnosis of neurologic disorder defined as categories 76, 77, 79 - 85, 95, 109 of the Clinical Classification Software for International Classification of Diseases, Ninth Revision, Clinical Modification, occurring between 2008 and 2015 in adult patients (≥ 18 years of age). Psychiatric comorbidities were determined as the presence of a secondarydiagnosis belonging to the Clinical Classification Software categories 650 to 670.Results: A total of 294 806 hospitalization episodes with a primary diagnosis of a neurologic disorder were recorded in adult patients between 2008 - 2015 in Portuguese public hospitals. Approximately 26.9% (n = 79 442) of the episodes had a recorded psychiatric comorbidity (22.1%; 32.2%, female versus male hospitalizations). Patients with registered psychiatric comorbidities were younger (66.2 ± 16.2 vs 68.6 ± 17.2 with no psychiatric comorbidities, p &lt; 0.001), presented lower all-cause in-hospital mortality rates, and significantly longer mean hospital stays. ‘Delirium, dementia, amnestic and other cognitive disorders’ were recorded in 7.4% (n = 21 965) of the hospitalizations, followed by alcohol-related disorders in 6.5% (n = 19 302) and mood disorders in 6.1% (n = 18 079). Epilepsy/seizures were the neurologic disorders with the highest proportion of recorded psychiatric comorbidities (39.9%).Conclusion: Psychiatric comorbidities were recorded in more than a quarter of the hospitalizations with a primary diagnosis of a Neurologic disorder. Psychiatric comorbidities varied among neurological disorders and were associated with different demographic and clinical features.

OR6-8 | Obesity Paradox In Patients With Non-ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Nationwide Retrospective Observational Study

OR6-8 | Obesity Paradox In Patients With Non-ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Nationwide Retrospective Observational Study

A-32 | Nationwide Analysis of the Outcomes of Multivessel PCI versus Culprit Vessel-Only PCI in Patients With NSTEMI: A Nationwide Retrospective Observational Study

A-32 | Nationwide Analysis of the Outcomes of Multivessel PCI versus Culprit Vessel-Only PCI in Patients With NSTEMI: A Nationwide Retrospective Observational Study

Trends and regional differences in antidiabetic medication use: a nationwide retrospective observational study

Background The prevalence of diabetes is increasing, and several new drug groups have been authorized and used successfully in the treatment of diabetes, while older drug groups are still in use. Our aim was to assess the utilization tendencies and regional differences in antidiabetic medication consumption in Hungary between 2015 and 2021 and to identify the possible determinants of regional differences in antidiabetic medication use.MethodsFor this retrospective drug utilization study, yearly wholesale database was used, which provides total coverage for ambulatory antidiabetic drug sales in Hungary, including both reimbursed and non-reimbursed medications. Data were expressed as Defined Daily Dose per 1000 inhabitants per day (DDD/TID), percentage of total use and the ratio of the highest and lowest utilization values among the counties (max/min ratio). To assess the potential reasons for regional differences in antidiabetic drug use, we analyzed the associations between regional drug utilization data and possible determinants.ResultsThe total national antidiabetic medication use has increased by 7.6% and reached 94.8 DDD/TID in 2021. Regarding antidiabetic subgroups, the use of metformin and novel antidiabetics (DPP4Is, GLP1As and SGLT2Is) and their combinations increased in all counties, while sulfonylurea consumption decreased, and insulin use was stable. In 2021, 19.2–24.1% of the total antidiabetic medication consumption was novel antidiabetics, 39.1–47.2% metformin, 14.8–25.8% sulfonylureas and 23.6–30.5% were insulins. Regional differences in antidiabetic medication consumption were considerable mainly in the case of GLP1As (max/min ratio:3.00), sulfonylureas (2.03) and SGLT2Is (1.92) in 2021. The association between antidiabetic medication use and possible determinants was confirmed in the case of unemployment rate and sulfonylurea use, the number of public medical card holders per ten thousand inhabitants and human insulin and sulfonylurea use. GLP1As were the only antidiabetic drug group that did not correlate with any of the investigated factors.ConclusionsAlthough novel antidiabetic drug use was growing dynamically in Hungary, sulfonylurea use is still considerable. Differences in antidiabetic drug consumption were substantial between the regions.

Clinical spectrum and outcome of Takayasu's arteritis in children

ObjectivesWe aimed to compare clinical spectrum and outcome between adults and children with Takayasu's arteritis (TAK) in a European population. MethodsWe made a nationwide retrospective observational study between 1988 and 2019. All adult patients met the ACR diagnostic criteria for TAK and all children met the EULAR/PRINTO/PRES criteria for paediatric TAK. ResultsWe identified 46 children and 389 adults with TAK. The male to female ratio was 34/46 (0.74) in the paediatric group compared to 241/274 (0.88) in the adult group (P<0.05). Children presented with significantly more systemic symptoms; i.e., fever (P<0.05), fatigue (P<0.001), weight loss (P<0.001), abdominal pain (P<0.05), and myalgia (P<0.05) while adults had more upper limb claudication (P<0.01). Topography of the lesions differed significantly between the two groups: adults had more damage at the cerebral vasculature (P<0.01), upper and lower limbs (P<0.001) while children had more kidney lesions (P<0.05). Children TAK had more frequent (P<0.01) and higher (P<0.001) biological inflammation than adults. Children received higher dose-weight of corticosteroids (P=0.001) and less biotherapy (P<0.010) at diagnosis. Relapses (P<0.05) and death (8.6% vs 4.9%) were more frequent in children TAK than in adults. ConclusionPaediatric TAK seems more severe than adult TAK. Therefore, paediatrics patients may require closer monitoring and systemic use of biological treatment.

Cardiovascular medications and overall survival in metastatic hormone-sensitive prostate cancer.

75 Background: The assessment of comorbid cardiovascular disease can predict health outcomes and may risk-stratify patients for adverse events and death. Current methods used to estimate patient risk, such as the Charlson Comorbidity Index (CCI), are based on International Classification of Diseases (ICD) codes, which are a poor indicator of severity and complexity of comorbid disease. Alternatively, the number of cardiovascular drugs could be an efficient tool for estimating patient risk. In this study, we examined the relationship between cardiovascular medications and survival in patients being treated for metastatic hormone-sensitive prostate cancer (mHSPC). Methods: A nationwide retrospective observational study of US Veterans with de novo mHSPC in the Veterans Health Administration between 2011-2021 with at least 1 prescription medicine of any class. We determined the number of cardiovascular drugs from Anatomic Therapeutic Chemical (ATC) drug class C prescribed in the year prior up to 14 days before initiation of treatment. Multivariable logistic regression and Cox proportional hazard modeling was used to assess the association between number of drugs with overall survival (OS) while accounting for important covariates including age, body-mass index (BMI), prostate specific antigen (PSA), CCI, race, and weight change. Results: Among 7,875 veterans, a median (IQR) of 2 (1-4) unique cardiovascular medications were filled in the year prior to treatment. The mean age was 74.3 years (SD 10.0) with a median CCI of 3 (3-6). Age was associated with increased number of cardiac medicines with a mean of 1.6 drugs in &lt;60 years, 2.2 drugs in 60-69, 2.5 drugs in 70-80, and 2.5 drugs in 80+ years (p&lt;0.001). Increased number of medications was associated with decreased OS using the Kaplan-Meier method (p&lt;0.001, see table). After adjusting for age, race, BMI, weight change, PSA, and CCI, the number of medications was independently associated with increased mortality with an adjusted hazard ratio (aHR) of 1.05 (1.03-1.06) for each additional cardiac drug. Increased mortality was observed in patients treated with 2 or more cardiac drugs (see table). Conclusions: The number of cardiovascular medications is associated with decreased survival in veterans undergoing treatment for mHSPC, even after accounting for important covariates including age, BMI, PSA, and CCI. The assessment of cardiovascular medications may provide a simple and reliable tool to estimate comorbid disease and survival in patients with cancer. [Table: see text]

Number of prescription medications and overall survival in veterans with metastatic hormone-sensitive prostate cancer.

68 Background: Robustassessment of comorbid conditions is essential to clinical care and the risk-stratification of patients for adverse events and death. Prescription medications may be a simple and readily available tool to estimate patient risk independent of established comorbidity indices, such as the Charlson Comorbidity Index (CCI). Clinicians have access to medication lists, facilitating assessment of comorbidities. We sought to examine the relationship between prescription medications and long-term outcomes in veterans treated for metastatic hormone-sensitive prostate cancer (mHSPC). Methods: We conducted a nationwide retrospective observational study of United States Veterans diagnosed with mHSPC in the Veterans Health Administration from 2010-2021. We determined the number of unique drugs and their respective Anatomic Therapeutic Chemical (ATC) Level One classes prescribed in the year prior to the initiation of treatment. Multivariable logistic regression and Cox proportional hazard modeling was used to assess the association between number of drugs with all-cause 90-day mortality and overall survival (OS) while accounting for covariates including age, CCI, body mass index, prostate specific antigen, and race. Results: Among 8,434 Veterans, a median (IQR) of 9 (5-14) unique medications and 5 (3-7) unique ATC medication classes were filled in the year prior to treatment. The mean age was 74.2 (SD 10.1) years, and 2,126 Veterans were black (25.2%). The median CCI was 3 (2.75-6). Increasing age was associated with increased CCI across age strata with mean CCI of 3.16 in age &lt;60, 3.76 in 60-70, 4.43 in 70-80, and 5.25 in 80+ (p&lt;0.001). Increasing age was associated with an increased number of unique medicines with mean 8.59 in age &lt;60, 9.53 in 60-70, 10.1 in 70-80, and 10.4 in 80+ (p&lt;0.001). There was no significant difference in the number of medications prescribed based on race. Veterans with 1-4 medicines had the longest average survival at 38.2 months compared to 5-9 medicines (33.1 months), 10-14 medicines (27.1 months), and 15+ medicines (22.0 months) (p&lt;0.001). After adjusting for relevant patient, tumor, and treatment factors, the number of medications and drug classes were each independently associated with increased mortality with adjusted HR (95% CI) of 1.03 (1.02-1.03) and 1.05 (1.04-1.07), respectively. Veterans treated with 5-9, 10-14, and 15+ medicines had an increased risk of death compared to Veterans on 1-4 medicines [aHR 1.11 (1.03-1.19); 1.29 (1.19-1.39); and 1.51 (1.39-1.65) respectively]. Conclusions: The number of prescription medications and drug classes are independently associated with OS in patients diagnosed with mHSPC, even after accounting for important covariates including age and CCI. Assessment of patient medications may provide a simple, yet reliable tool to assess comorbidities, risk of adverse events, and death.

Which factors preceding dementia identification impact future healthcare use trajectories: multilevel analyses in administrative data

BackgroundHealthcare use patterns preceding a diagnosis of Alzheimer’s Disease and Related Diseases (ADRD) may be associated with the quality of healthcare use trajectories (HUTs) after diagnosis. We aimed to identify determinants of future favorable HUTs, notably healthcare use preceding ADRD identification.MethodsThis nationwide retrospective observational study was conducted on subjects with incident ADRD identified in 2012 in the French health insurance database. We studied the 12-month healthcare use ranging between 18 and 6 months preceding ADRD identification. The five-year HUTs after ADRD identification were qualified by experts as favorable or not. In order to take into account geographical differences in healthcare supply, we performed mixed random effects multilevel multivariable logistic regression model to identify determinants of future favorable HUTs. Analyses were stratified by age group (65–74, 75–84, ≥ 85).ResultsBeing a woman, and preventive and specialist care preceding ADRD identification increased the probability of future favorable HUT, whereas institutionalization, comorbidities, medical transportation and no reimbursed drug during [-18;-6] months decreased it. Besides, some specificities appeared according to age groups. Among the 65–74 years subjects, anxiolytic dispensing preceding ADRD identification decreased the probability of future favorable HUT. In the 75–84 years group, unplanned hospitalization and emergency room visit preceding ADRD identification decreased this probability. Among subjects aged 85 and older, short hospitalization preceding ADRD identification increased the probability of future favorable HUTs.ConclusionRegular healthcare use with preventive and specialist care preceding ADRD identification increased the probability of future favorable HUTs whereas dependency decreased it.

Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study

Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI. In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE. Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p=0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p=0.15). Consistent findings were found in 712 propensity score-matched patients. Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI. The funder had no role in the study design, data management, or writing.

Intracoronary imaging of complex coronary artery lesions: A lesion-level analysis from SCAAR simulating the IMPROVE trial

Abstract Background Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are two intracoronary imaging modalities which can be used to optimize stent implantation and expansion. The IMPROVE trial is an ongoing randomized study investigating the impact of IVUS on percutaneous coronary intervention (PCI) of complex lesions. We conducted a nationwide retrospective observational study simulating the IMPROVE trial. Purpose The aim of this study is to determine whether intracoronary imaging is associated with improved outcome after PCI of complex lesions. Methods Using the Swedish Coronary Angiography and Angioplasty registry (SCAAR) we identified complex lesions undergoing PCI between 1 January 2016 and 15 January 2022. Complex lesions were defined as (1) in-stent restenosis, (2) chronic total occlusions, (3) bifurcations and (4) lesions stented with a ≥ 28 mm stent. Lesions were stratified into two groups according to use of intracoronary imaging or not. The groups underwent propensity score (PS) matching to balance baseline demographics. Outcome was assessed with univariable cox regression models and Kaplan Meier estimates. The primary endpoint was target lesion revascularization (TLR) within 2-years assessed on lesion level where each patient could contribute with more than one lesion. Secondary endpoint included all-cause mortality analyzed on patient level. Results After PS-matching, two groups with 9,404 lesions each were formed. Baseline characteristics after PS matching did not show any significant demographic differences. The intracoronary imaging group contributed more often with more than one lesion. Intracoronary imaging was associated with significantly lower rates of TLR (hazard ratio (HR): 0.80 (95% confidence interval (CI): 0.67-0.94), p=0.008) and all-cause mortality (HR: 0.69 (95% CI 0.61-0.78), p&amp;lt;0.001). Conclusion In this study on complex lesions undergoing PCI, the use of intracoronary imaging was associated with an improved outcome. These results encourage intracoronary imaging when assessing complex lesions.Baseline characteristicsOutcome

Economic burden of sickle cell disease in Sweden: a population-based national register study with 13 years follow up

IntroductionSickle cell disease (SCD) describes a group of inherited disorders of hemoglobin. Globally, SCD occurs in approximately 300,000-400,000 births annually and is most prevalent in malaria-endemic countries. However, migration has impacted the epidemiology of SCD but data on the matter are scarce. The objective of this study was to describe the epidemiology, treatment uptake, and economic burden of SCD in Sweden, a country with substantial immigration over the last decades.MethodsThis nationwide retrospective observational registry cohort study identified patients with SCD from 2001 to 2018 and followed them from 2006 to 2018. Using data from high-quality population-based Swedish registers, we estimated prevalence, treatment uptake, and SCD-related health care resource use, sick leave and disability pension.ResultsBetween 2006 and 2018 the number of patients with SCD increased from 504 to 670; inpatient hospital stays and outpatient visits increased by 200% and 300%, respectively. Patients with pain crises had approximately twice the number of inpatient episodes and outpatient visit per year, and had higher productivity losses compared to patients without crises.ConclusionIn an era of emerging treatments for SCD, we have, to the best of our knowledge, for the first time comprehensively described epidemiological and economic aspects of SCD in a country where the disease is still rare and not well recognized by the healthcare system.

Prevalence, aetiology, vaccination coverage and spatio-temporal pattern among patients admitted with acute bacterial meningitis to the sentinel hospital surveillance network in Yemen, 2014-20, before and during the civil war.

Acute bacterial meningitis (ABM) is a serious health issue in Yemen where civil war, which continues unabated, has crippled the healthcare system. We conducted a nationwide retrospective observational study in Yemeni sentinel hospitals to identify the prevalence, aetiology, vaccination coverage and spatio-temporal pattern of ABM in children aged <5 years before and during the civil war, 2014-20. Cerebrospinal fluid samples were collected from hospitalized children and were analysed macroscopically for appearance and microscopically by Gram stain and white blood cell count. Culture and latex agglutination tests were performed. Data on the prevalence of and vaccination coverage for ABM were obtained from the Ministry of Health. Joinpoint regression was used to assess the annual percent change (APC) of ABM prevalence and vaccination coverage. Pearson's correlation was used to evaluate the association between ABM prevalence and vaccination coverage. In total, 11339 hospitalized children had suspected cases of ABM (prevalence, 40.07/100000 of the whole Yemeni population) and 2.6% (293/11339) of suspected ABM cases were confirmed (prevalence, 1.04/100000 of the whole Yemeni population). The dominant pathogens were Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). The civil war reduced the Hib and pneumococcal vaccination coverage (APC = -1.92), reaching its lowest (79.5%) in 2018. The prevalence of suspected ABM increased (APC = 3.46), reaching its maximum (6.08/100000 of the whole Yemeni population) in 2019. The conflict inversely correlated with the ABM prevalence and vaccination coverage (Pearson correlation coefficient (r), -0.69 to -0.53). Ta'izz region, which was severely affected by the civil war, had the highest prevalence of suspected ABM (120.90/100000 of the whole Yemeni population) and lowest vaccination coverage (60%). The civil war had a negative impact on vaccination coverage and coincided with increasing prevalence of ABM in Yemen. Streptococcus pneumoniae is the dominant causative pathogen.

Resource utilization and preparedness within the COVID-19 pandemic in Tunisian medical intensive care units: A nationwide retrospective multicentre observational study

BackgroundThe worldwide SARS-CoV-2 pandemic represents the most recent global healthcare crisis. While all healthcare systems suffered facing the immense burden of critically-ill COVID-19 patients, the levels of preparedness and adaptability differed highly between countries. Aim: to describe resource mobilization throughout the COVID-19 waves in Tunisian University Medical Intensive Care Units (MICUs) and to identify discrepancies in preparedness between the provided and required resource. MethodsThis is a longitudinal retrospective multicentre observational study conducted between March 2020 and May 2022 analyzing data from eight University MICUs. Data were collected at baseline and at each bed expansion period in relation to the nation’s four COVID-19 waves. Data collected included epidemiological, organizational and management trends and outcomes of COVID-19 and non-COVID-19 admissions. ResultsMICU-beds increased from 66 to a maximum of 117 beds. This was possible thanks to equipping pre-existing non-functional MICU beds (n = 20) and creating surge ICU-beds in medical wards (n = 24). MICU nurses increased from 53 to 200 of which 99 non-ICU nurses, by deployment from other departments and temporary recruitment. The nurse-to-MICU-bed ratio increased from 1:1 to around 1·8:1. Only 55% of beds were single rooms, 80% were equipped with ICU ventilators. These MICUs managed to admit a total of 3368 critically-ill patients (15% of hospital admissions). 33·2% of COVID-19-related intra-hospital deaths occurred within the MICUs. ConclusionDespite a substantial increase in resource mobilization during the COVID-19 pandemic, the current study identified significant persisting discrepancies between supplied and required resource, at least partially explaining the poor overall prognosis of critically-ill COVID-19 patients.

Are hospitals with both medical/surgical and psychiatric services associated with decreased difficulty in ambulance transfer for patients with self-harm behaviour? A nationwide retrospective observational study using ambulance transfer data in Japan

ObjectivesAmbulance diversion and prolonged prehospital transfer time have a significant impact on patient care outcomes. Self-harm behaviour in particular is associated with difficulty in hospital acceptance and longer prehospital transfer...

The spectrum of pyridoxine dependent epilepsy across the age span: A nationwide retrospective observational study

BackgroundPyridoxine-dependent epilepsy (PDE) is a rare seizure disorder usually presenting with neonatal seizures. Most cases are caused by biallelic pathogenic ALDH7A1variants. While anti-seizure medications are ineffective, pyridoxine provides seizure control, and dietary interventions may be of benefit. As the natural history beyond adolescence is insufficiently explored, our study aimed to assess the spectrum of PDE at various ages in Norway. MethodsPatients were ascertained by contacting all Norwegian paediatric, neurological, and neurohabilitation departments and relevant professional societies. Medical records were collected and reviewed. ResultsWe identified 15 patients treated for PDE; 13 had ALDH7A1 variants (PDE-ALDH7A1), one had PNPO deficiency, and in one, aetiology remained obscure. Of those with PDE-ALDH7A1, 12 were alive at time of study; five were > 18 years old and six were < 4 years. Median age was 10 years (range 2 months–53 years). Estimated minimum prevalence was 6.3/million among children and 1.2/million among adults. Ten had seizure onset on the first day of life. Perinatal complications and neuroradiological abnormalities suggested additional seizure aetiologies in several patients. Pyridoxine had immediate effect in six, while six had delayed (>1 h) or uncertain effect. Median delay from first seizure to continuous treatment was 11 days (range 0–42). Nine experienced breakthrough seizures with intercurrent disease or due to pyridoxine discontinuation. Cognitive outcomes ranged from normal to severe intellectual disability. The condition appeared to remain stable in adult life. SignificanceWe found a much higher prevalence of PDE-ALDH7A1 in children relative to adults, suggesting previous underdiagnosis and early mortality. Perinatal complications are common and can delay diagnosis and initiation of pyridoxine treatment. Lifelong and continuous treatment with pyridoxine is imperative. Due to better diagnostics and survival, the number of adult patients is expected to rise.

Characteristics of poisoning patients visiting emergency departments before and after the COVID-19 pandemic

Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion: The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

Pulmonary Thromboembolism Developed During Hospitalization: A Nationwide Retrospective Observational Study Using Claims Data.

Evidence regarding the development of pulmonary thromboembolism (PE) during hospitalization is unclear. We hypothesized that the incidence of PE could vary depending on clinical department and aimed to conduct a survey on the incidence of in-hospital PE. We conducted a retrospective analysis using claims data of in-hospital patients in Japan. We collected background information regarding patients with and without PE occurrence during hospitalization. Further, we determined the incidence of PE and implemented prophylactic procedures in patients with and without surgery according to clinical department at admission. Finally, we examined the duration of hospital stay and in-hospital mortality rates in patients with and without PE. We found that 5007 (0.107%, 20.61 per 1000 person-years) patients developed PE during hospitalization and differed by clinical department at admission. Moreover, 2272 (0.095%, 19.3 per 1000 person-years) and 2735 (0.119%, 21.8 per 1000 person-years) patients with and without surgery, respectively, developed PE during hospitalization (P < 0.001). Further, 33.8% of inpatients underwent prophylactic procedures for PE; however, the implementation rate differed between patients with and without surgery (59.2% vs. 7.3%, P < 0.001). The median duration of hospital stay in patients with and without PE was 31.0 and 11.0days, and the in-hospital mortality rates in patients with and without PE were 11.0% and 3.5%, respectively (P < 0.001). The incidence of in-hospital PE differed according to patient characteristics, clinical departments, and presence/absence of surgery. The onset of PE during hospitalization leads to prolonged hospital stay and in-hospital death. It is important to conduct a proper risk assessment on admission as well as to implement proper prophylactic procedures to prevent the development of PE during hospitalization.