Need For Hospital Admission Research Articles

Lessons learned for preventing health disparities in future pandemics: the role of social vulnerabilities among children diagnosed with severe COVID-19 early in the pandemic

<sec><title>Background</title><p>Hispanic ethnicity is associated with an increased risk for severe disease in children with COVID-19. Identifying underlying contributors to this disparity can lead to improved health care utilization and prevention strategies.</p></sec><sec><title>Methods</title><p>This is a retrospective cohort study of children 2–20 years of age with positive SARS-CoV-2 testing from March–October 2020. Univariable and multivariable logistic regression models were fitted to identify demographic, comorbid health conditions, and social vulnerabilities as predictors of severe COVID-19 (need for hospital admission or respiratory support).</p></sec><sec><title>Results</title><p>We included 1572 children with COVID-19, of whom 45% identified as Hispanic. Compared to non-Hispanic children, patients who identified as Hispanic were more often obese (28% vs. 14%, p < 0.0001), preferred a non-English language (31% vs. 3%, p < 0.0001), and had Medicaid or no insurance (79% vs. 33%, p < 0.0001). In univariable analyses, children who identified as Hispanic were more likely to require hospital admission (OR 2.4, CI: 1.57–3.80) and respiratory support (OR 2.4, CI: 1.38–4.14). In multivariable analyses, hospital admission was associated with obesity (OR 1.9, CI: 1.15–3.08), non-English language (OR 2.4, CI: 1.35–4.23), and Medicaid insurance (OR 2.0, CI: 1.10–3.71), but ethnicity was not a significant predictor of severe disease.</p></sec><sec><title>Conclusions and Relevance</title><p>The high rates of severe COVID-19 observed in Hispanic children early in the pandemic appeared to be secondary to underlying co-morbidities and social vulnerabilities that may have influenced access to care, such as language and insurance status. Pediatric providers and public health officials should tailor resource allocation to better target this underserved patient population.</p></sec>

Clinical profile of pediatric hospital patients diagnosed with urinary tract infections

Urinary tract infection (UTI) is one of the most common bacterial infections, especially in young women. It is known that, in children, the clinical manifestations of UTI are heterogeneous and imprecise. Therefore, given this scenario, it is essential to develop studies that aim to assist in the early diagnosis and adequate management of urinary tract infections in pediatric patients, optimizing therapy and minimizing complications. This research was carried out through a cross-sectional study of a retrospective and descriptive nature drawn from the medical records available in the system of a university hospital. The sample consisted of 196 medical records of patients admitted for UTI in the pediatrics sector of a university hospital. The majority of patients were female, older than 2 months (96.4%). The main symptoms identified were fever (78.17%) and abdominal pain (24.36%). From the data collected, it is possible to determine that this knowledge helps the general practitioner to understand cases in which there is a need for hospital admission and a risk of complications.

Impact of Cardiorespiratory Fitness on COVID-19–Related Outcomes: The Exercise Testing and Health Outcomes Study (ETHOS)

ObjectiveTo assess the association between cardiorespiratory fitness (CRF) and COVID-19–related health outcomes including mortality, hospitalization, and mechanical ventilation. Patients and MethodsIn a retrospective analysis of 750,302 patients included in the Exercise Testing and Health Outcomes Study, we identified 23,140 who had a positive result on COVID-19 testing between March 2020 and September 2021 and underwent a maximal exercise test in the Veterans Affairs Health Care System between October 1, 1999 to September 3, 2020. The association between CRF and risk for severe COVID-19 outcomes, including mortality, hospitalization due to COVID-19, and need for intubation was assessed after adjustment for 15 covariates. Patients were stratified into 5 age-specific CRF categories (Least-Fit, Low-Fit, Moderate-Fit, Fit, and High-Fit), based on peak metabolic equivalents achieved. ResultsDuring a median of follow-up of 100 days, 1643 of the 23,140 patients (7.1%) died, 4995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19–related reasons. When compared with the Least-Fit patients (referent), the Low-Fit, Moderate-Fit, Fit, and High-Fit patients had hazard ratios for mortality of 0.82 (95% CI, 0.72 to 0.93), 0.73 (95% CI, 0.63 to 0.86), 0.61 (95% CI, 0.53 to 0.72), and 0.54 (95% CI, 0.45 to 0.65), respectively. Patients who were more fit also had substantially lower need for hospital admissions and intubation. Similar patterns were observed for elderly patients and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category. ConclusionAmong patients positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, body mass index, or the presence of comorbidities.

Diagnostic agreement between emergency medical service and emergency department physicians, a prospective multicentre study

IntroductionEarly and adequate preliminary diagnosis reduce emergency department (ED) and hospital stay and may reduce mortality. Several studies demonstrated adequate preliminary diagnosis as stated by emergency medical services (EMS) ranging between 61 and 77%. Dutch EMS are highly trained, but performance of stating adequate preliminary diagnosis remains unknown.MethodsThis prospective observational study included 781 patients (> 18years), who arrived in the emergency department (ED) by ambulance in two academic hospitals. For each patient, the diagnosis as stated by EMS and the ED physician was obtained and compared. Diagnosis was categorized based on the International Classification of Diseases, 11th Revision.ResultsThe overall diagnostic agreement was 79% [95%-CI: 76–82%]. Agreement was high for traumatic injuries (94%), neurological emergencies (90%), infectious diseases (84%), cardiovascular (78%), moderate for mental and drug related (71%), gastrointestinal (70%), and low for endocrine and metabolic (50%), and acute internal emergencies (41%). There is no correlation between 28-day mortality, the need for ICU admission or the need for hospital admission with an adequate preliminary diagnosis.ConclusionIn the Netherlands, the extent of agreement between EMS diagnosis and ED discharge diagnosis varies between categories. Accuracy is high in diseases with specific observations, e.g., neurological failure, detectable injuries, and electrocardiographic abnormalities. Further studies should use these findings to improve patient outcome.

The accuracy of predicting hospital admission by emergency medical service and emergency department personnel compared to the prehospital MEWS: a prospective multicenter study

IntroductionOvercrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient’s disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission.MethodsA prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients’ need for hospital admission.ResultsIn total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7–95.9% versus 60.6%, all p < 0.001).ConclusionsHealthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.

The impact of cardiorespiratory fitness on COVID-19 related outcomes: the ETHOS Study

Abstract Background Comorbidities such as cardiovascular disease, diabetes, obesity and hypertension are associated with more severe COVID-19 outcomes, but the relative impact of cardiorespiratory fitness (CRF) on outcomes in COVID-positive patients is largely unknown. Objective To assess the association between objectively measured CRF and COVID-19-related health outcomes including mortality, hospitalization, and mechanical ventilation in non-COVID vaccinated patients. Design, Setting and Participants. Retrospective analysis of 750,302 subjects (23,140 [mean age 65.8±12.0 years] with a positive COVID-19 test between March 2020 and September 2021) who underwent a maximal exercise test between 1999 and 2020. Main Outcomes and Measures. Association between all-cause mortality, hospitalization due to COVID-19, and need for intubation with risk for severe COVID-19 outcomes after adjustment for 15 covariates. Subjects were stratified into five age-specific CRF categories (Least-fit, Low-fit, Moderate-fit, Fit and High Fit), based on peak metabolic equivalents achieved. Results During a median of follow-up of 100 days, 1,643 (7.1%) patients died, 4,995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19 related reasons. When compared to the Least-Fit subjects (referent), the Low-Fit, Moderately-Fit, Fit, and High-Fit subjects had hazard ratios for mortality of 0.82 (95% CI; 0.72-0.93), 0.73 (95% CI; 0.63-0.86), 0.61 (95% CI; 0.53-0.72), and 0.54 (95% CI; 0.45-0.65), respectively (Figure). Subjects who were more fit also had significantly lower need for hospital admissions and intubation. Similar patterns were observed for elderly subjects and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category. Conclusion Among subjects positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, BMI, or the presence of comorbidities.

The efficacy and safety of ginger (Zingiber officinale) rhizome extract in outpatients with COVID-19: A randomized double-blind placebo-control clinical trial.

Ginger, a potent antiviral, anti-inflammatory, and antioxidant remedy, is a potential therapeutic option for COVID-19. However, there was not enough clinical evidence about ginger and COVID-19. We evaluated the efficacy and safety of ginger on clinical and paraclinical features in outpatients with COVID-19. In this randomized controlled trial, the outpatients with confirmed COVID-19 were randomly assigned in a 1:1 ratio to receive ginger (1000 mg 3 times a day for 7 days) or placebo. The primary outcome was viral clearance after the end of the intervention. Oxygen saturation (SPO2), body temperature, respiratory rate (RR), hospital admission, and the incidence of adverse events were also assessed. A total of 84 patients (42 in the ginger and 42 in the control groups) were randomized. The viral clearance was not statistically improved in the ginger group (41.6%) compared to the placebo group (42.8%). The findings indicated that SPO2, body temperature, and RR had no significant difference between the groups at the end of the intervention. The imaging finding indicated pulmonary infiltrate significantly reduced on the 7th day of the intervention in the ginger group. The percentage of patients with SPO2 <96% in the ginger group decreased over the study compared to the placebo group. Moreover, the need for hospital admission and the incidence of adverse drug events were not different between the groups over the follow-up period. Ginger had no significant impact on the clinical and paraclinical parameters of patients. However, this intervention demonstrated a safe profile of adverse events and reduced pulmonary infiltrate. The trial was registered as IRCT20200506047323N1.

Extracorporeal shock wave lithotripsy versus laser lithotripsy in the treatment of post-SWL steinstrasse: a randomized comparative study.

To compare the efficacy of Holmium laser lithotripsy with that of extracorporeal shock lithotripsy (SWL) for post-SWL ureteral steinstrasse. From January 2022 to July 2023, 36 patients with post-SWL ureteral steinstrasse were randomly divided into laser lithotripsy and SWL groups. Patients with pain, moderate to marked hydronephrosis, large leading stone fragments, and showing no spontaneous resolution within 3-4weeks after medical expulsive therapy were included. Patients with sepsis were excluded. The success rate was the primary outcome. We compared the perioperative data between the groups. The success rate was higher in the ureteroscopy group than in the SWL group (p = 0.034). SWL was a significantly longer operation, and the fluoroscopy time was significantly longer in the SWL group than in the URS group (p = 0.027). Auxiliary procedures were more frequently performed in the SWL group than in the URS group (p = 0.02). JJ stents were inserted in 100% of patients in the URS group. Three patients (16.7%) underwent conversion to laser ureteroscopy after the second SWL session failed. No significant difference in the incidence of postoperative complications was observed between the groups, but the incidence of postoperative LUT was high in the ureteroscopy group. The mean hospital stay was 30h in the ureteroscopy group. SWL was performed without the need for hospital admission. Ureteroscopic laser lithotripsy for steinstrasse was safe and effective, with a higher success rate, shorter fluoroscopy time, and shorter recovery period than SWL.

Presenting clinical symptoms of post-COVID-19 breakthrough infection: Predictors of mortality in a Middle Eastern population

ObjectiveBreakthrough COVID-19 infections are common following immunisation with various types of vaccines. The patterns of infections have not been well established. We aimed to analyse the signs and symptoms of post vaccination infections in addition to the need for hospital admission, ER visit and supplemental oxygen in relation to age and gender. MethodsA cross-sectional cohort study was conducted in JUH from March 2021 to August 2022, we interviewed 1479 individuals who are >15 years of age and got a breakthrough infection. The statistical analysis was performed using STATA statistical software. ResultsOut of the 1479 cases, 50.2 % and 69.4 % were females and less than 45 years of age respectively. Symptoms of cough, fever and headache were reported by nearly 50 % of the patients, while one-third complained of dyspnoea. We found that participants older than 45 years had worse clinical outcomes (P-value < 0.001). 13 deaths were identified in this study due to breakthrough infection, 92.3 % of them were older than 45 years (P-value < 0.001). Participants ≥45 years who experienced a breakthrough infection of COVID-19 were 0.7 times less likely to be females using adjusted logistic regression. ConclusionThis study indicates that despite more severe symptoms reported in younger patients, the major clinical outcomes were worse among older patients, which makes age a major risk for poor outcomes regardless of symptoms. Thus, older people should be evaluated carefully when presenting with mild symptoms of COVID-19 breakthrough infection. The study also confirms that there is no difference in the incidence of COVID-19 breakthrough infections between males and females. Prospective studies are needed to risk stratify COVID-19 breakthrough infections, which should take into account variants of the virus and comorbidities.

Adverse Effects Post COVID-19 Vaccination and its Association with Age, Gender and Comorbid Disease in Basrah City Southern of Iraq.

Vaccination against COVID-19 virus is the most valuable tool available for protection during the pandemic of coronavirus. The clinical manifestation post-vaccination is a barrier to vaccination for many people in Iraq and worldwide. The objective of this study is identifying various clinical manifestations occurring after receiving vaccines among individuals in Basrah Governorate. Moreover, we examine its association with respondents' demographics and the type of vaccine they received. A cross-section study was conducted in Basrah, southern Iraq. Research data were collected through an online questionnaire. The data were analyzed using both descriptive and analytic statistical tools using the SPSS program. Most of the participants (86.68%) received the vaccine. The side effects were reported in 71.61% of vaccinated individuals. Fever and muscle pain were the two most experienced clinical manifestations, while lymph node enlargement and disturbances in taste and/or smell sensations were reported infrequently. Adverse effects were mostly reported with the Pfizer BioNTech vaccine receiver. Females and those in the younger age group also reported a significantly higher incidence of side effects. Most adverse effects related to the COVID-19 vaccine were minor and could be tolerated without the need for hospital admission.

The Value of Emergency Care Data Set (ECDS) Presentation Codes for Predicting Mortality and Inpatient Admission.

Early identification of patients at higher risk of death and hospital admission is an important problem in Emergency Departments (ED). Most triage scales were developed before current electronic healthcare records were developed.The implementation of a national Emergency Care Data Set (ECDS) allows for the standardised recording of presenting complaints and the use of Electronic Patient Records (EPR) offers the potential for automated triage. The mortality risk and need for hospital admission associated with the different presenting complaints in a standardised national data set has not been previously reported. This study aimed to quantify the risks of death and hospitalisation from presenting complaints. This would be valuable in developing automated triage tools and decision support software. We conducted an observational retrospective cohort study on patients who visited a single ED in 2021. The presenting complaints related to subsequent attendances were excluded. This patient list was then manually matched with a routinely collected list of deaths. All deaths that occurred within 30 days of attendance were included. Data was collected from 84,999 patients, of which 1,159 people died within 30 days of attendance.The mortality rate was the highest in cardiac arrest [32(78.1%)], cardiac arrest due to trauma [2(50%)] and respiratory arrest [3(50%)]. Drowsy [17(12%)], hypothermia [3(13%)] and cyanosis [1(10%)] were also high-risk categories. Chest pain [34(0.6%)] was not a high-risk presenting complaint. The initial presenting complaint in ECDS may be usefulto identify people at higher and lower risk of death. This information is useful for building automated triage models.

Real-Life Comparison of Antivirals for SARS-CoV-2 Omicron Infection in Patients With Hematologic Malignancies.

We aimed to describe a cohort of hematologic patients with COVID-19 treated with antivirals early. Non-interventional chart review study. Comparison of baseline characteristics and outcomes in high-risk hematologic patients treated with remdesivir between December 2021 and April 2022 versus those treated with nirmatrelvir/ritonavir between May and August 2022. Eighty-three patients were analyzed. Forty-two received remdesivir, and 41 nirmatrelvir/ritonavir. Patients with remdesivir were younger, vaccinated with lower number of doses, and received prior corticosteroids less frequently and sotrovimab, hyperimmune plasma and corticosteroids more often. Viral shedding median (IQR) duration was 18 (13-23) and 11 (8-21) days in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p = 0.004). Median (IQR) Ct values before treatment were similar in both groups. Within 5 days of treatment, median (IQR) Ct values were 26 (23-29) and 33 (30-37) in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p < 0.0001). All patients were hospitalized for remdesivir administration and only four (9.8%) in the nirmatrelvir/ritonavir group. The overall outcomes in this cohort of COVID-19 patients with Omicron variant was good, as no patient needed oxygen or ICU admission. One patient in remdesivir group died from septic shock. No severe adverse event was recorded in both treatment groups. Patients with hematologic malignancies and non-severe COVID-19 who received nirmatrelvir/ritonavir experienced faster decrease in viral load and shorter viral shedding. Furthermore, besides the advantage of oral administration, nirmatrelvir/ritonavir administration reduced the need of hospital admission.

Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study

BackgroundIdentifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden.MethodsA multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission.ResultsOf the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children’s EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children’s) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children’s only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2–2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7–2.9), referral from primary health aOR:1.5 (95%CI: 1.4–1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5–2.8 and aOR:1.5, 95%CI: 1.4–1.6, respectively). Predictors were similar when each site was considered separately.ConclusionsAlthough the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.

Can acutely ill patients predict their outcomes? A scoping review

IntroductionThe full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients’ estimates of their likely prognosis have been explored in chronic care settings and...

COVID-19 diagnosis and hospital admissions in Brazil: a countrywide survey (Covitel, 2022).

To estimate the prevalence of COVID-19 diagnosis and hospital admissions, and to evaluate their correlates in a nationwide Brazilian sample. A cross-sectional study was carried out with secondary data from the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases in Times of Pandemic - Covitel 2022. The Covitel study uses cluster sampling, carried out through random digit dialing on landlines and cell phones, among people aged 18 years or over. The outcome of the "diagnosis of COVID-19" was based on a self-report of a confirmed case through laboratory tests or medical diagnoses. Those who reported COVID-19 were asked about the need for hospital admission due to COVID-19. Independent variables included sex, age, level of education, region, comorbidity, private health insurance plan, self-rated health, and employment status. The odds ratio was estimated using logistic regression models considering the complex sample design. From the sample of 9000 people, the prevalence of COVID-19 diagnosis was 25.4% (95%CI 23.8-27.1%), ranging from 23.0% (95%CI 20.0-26.3%) in the Northeast region to 28.5% (95%CI 25.3-31.7%) in the South region. Middle-aged adults (35-44 years old) had the highest prevalence of COVID-19 diagnosis. The higher the level of education, the higher the prevalence of COVID-19 diagnosis. The prevalence of COVID-19 diagnosis is markedly different from that of SARS-CoV-2 infection at the population level. Socioeconomic differences in access to testing are the likely explanation. Older adults and people with comorbidities were more likely to be admitted to hospital due to COVID-19 in Brazil.

Anxiety in Patients with Post-COVID Syndrome: Associated Factors.

The term "post-COVID-19 syndrome" describes a range of symptoms persisting beyond the acute phase of the disease. These symptoms predominantly include fatigue, muscle pain, shortness of breath, and psychological issues. Research additionally suggests the possibility of long-term neurological and psychiatric impairment associated with COVID-19. The study included patients who visited the post-COVID outpatient clinic between April 2020 and June 2022. The examination included the detailed history taking, including the COVID-19 course, posteroanterior chest X-ray and pulmonary function tests. Anxiety level was assessed using the Beck Anxiety Inventory (BAI). The relationship between anxiety, demographic data, and course of the disease, need for hospital admission during the acute phase, oxygen therapy, post-inflammatory changes on the chest X-ray and lung function parameters was investigated. This study included 1756 patients who experienced COVID-19 and visited a post-COVID outpatient clinic. The majority of individuals experienced a mild form of the infection. The results showed that younger age and female gender were associated with significantly higher anxiety scores. Inpatients had lower BAI values than those who were not hospitalized during acute phase. Patients with post-inflammatory changes on chest X-ray had surprisingly lower BAI values. Lower values of FEV1 (forced expiratory volume in 1 second), DLCO (diffusing capacity of the lungs for carbon monoxide), and KCO (carbon monoxide transfer coefficient) were associated with significantly higher BAI values. Female gender was associated with higher levels of anxiety. In contrast, higher FEV1 values reduced the risk of a pathological level of anxiety. In our study, the influence of age, gender, inpatient care during the acute phase of infection, the presence of post-inflammatory changes on the chest diagram and selected parameters of lung function (FEV1, DLCO, and KCO) were shown to be important factors in the assessment of anxiety symptoms in post-COVID patients.

Clinical Profile and Outcome of Children Using Mechanical Insufflation Exsufflation Device (Cough Assist) at a Tertiary Care Hospital in Bangalore, India

Abstract Background and Objective: Children with neuromuscular disorders (NMDs) face a higher risk of recurrent pneumonias. Mechanical insufflation–exsufflation (MI-E) is a technique designed to enhance cough effectiveness, improve mucus clearance, and ultimately enhance lung health by boosting expiratory airflow and cough peak flow in coordination with a cough. We assessed the safety and adverse effects of MI-E in our cohort. Materials and Methods: This retrospective study was conducted over a period of 1.5 years at a tertiary care hospital in Bangalore, South India. Children between 1 and 18 years of age were included in the study. The demographic details of each child were collected from hospital records, along with the indication for starting MI-E and the duration of usage of MI-E. Results: Thirty-three children (18 boys) were started on MI-E. The most common indication was spinomuscular atrophy. Before the start of MI-E, 30 children were on noninvasive ventilation and 13 had a tracheostomy. The median insufflation and exsufflation pressures used were in the range of +15 to 25 cm H2O and −15 to −25 cm H20, respectively. Auto mode was used in all the cases, and 28 children used it on a long-term basis. There was a decrease in the frequency of hospitalization (especially in children with NMD). Adherence was very good without any evidence of barotrauma or any other complications. Conclusions: We found that the MI-E device is a valuable tool for aiding airway clearance in children with NMDs. Its use not only prevents intensive care unit admissions, reducing hospital stay duration but many times mitigates the need for hospital admissions altogether.

Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya: A Cross-sectional Study.

The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya. This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group. A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95-0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%-99.0%), and the specificity was 82.0% (95% CI, 77.0%-87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%-77.0%) and 98.0% (95% CI, 97.0%-100.0%), respectively. ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.

Comparison of Easy-to-Use Bronchiolitis Scores in the Post-COVID-19 Era-An Observational Study.

In the post-restrictions COVID-19 period, the incidence of bronchiolitis in infants has increased considerably. Several scores determine the degree of severity of the bronchiolitis episode, but few are clinician-friendly. The main aim of this research was to find the easy-to-use score that most accurately estimated the severity of patients' infections according to their clinical situations and most accurately predicted the need for hospital admission. An observational cross-sectional study was performed in a reference pediatric hospital during the post-restrictions period of the COVID-19 pandemic (2021 and 2022). A comparison was made between the severity estimate provided by five international acute bronchiolitis scales and the clinical severity of the acute bronchiolitis episode. Three hundred and seventy-seven patients participated in the investigation, with a mean age of 5.68 months; 68.7% of the participants had a mild episode of bronchiolitis, 24.5% had a moderate episode, and 6.9% had a severe episode. The severity estimated by the Tal scale modified by McCallum showed a statistically significant correlation with the clinical severity established by clinical criteria (0.836; p < 0.001). It showed a high correlation with other international scores, such as the Wang score (0.820; p < 0.05) and the Wood-Downes-Ferrés score (0.936; p < 0.001). In the multivariate analysis, the constituent variables of the modified Tal score appeared in the final model that predicts the need for hospital admission. In the context of increased incidence after COVID-19, the Tal score modified by McCallum is an easy-to-use measuring instrument that presents an excellent concordance with the clinical severity estimated at first care contact. It also offers a more significant prediction of the need for hospital admission.

Pyrethroid poisoning: Insecticide with mild human toxicity

BackgroundPyrethroid insecticides are commonly used insecticides. This study was undertaken to characterize the clinical profile and outcome of deliberate self-harm (DSH) with type 1 and type 2 pyrethroids and identify factors associated with need for hospitalization. MethodsThis retrospective study was conducted in a tertiary care hospital in South India to study the clinical features, treatment, and outcome of patients with pyrethroid poisoning due to DSH. Patients were categorized as poisoning with type 1 or type 2 pyrethroid compounds. Factors associated with need for hospital admission was explored using bivariate and multivariate regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CIs). ResultsA total of 379 patients presented with pyrethroid poisoning; 202 (53.3%) patients were male. The median (interquartile range) age was 26 (22–33) years. Transfluthrin (n = 48, 58%) and cypermethrin (n = 149, 50%) were the most frequently implicated type 1 compounds and type 2 compounds, respectively. Of the 130 (34.3%) patients who were admitted, 13 (3.4%) patients required mechanical ventilation. All patients survived. On multivariate logistic regression analysis, ingestion of type 2 pyrethroids (OR: 2.55, 95%CI: 1.31–4.97), history of seizures (OR: 2.62, 95%CI 1.06-6.48), and treatment prior to presentation to the referral hospital (OR: 2.99, 95%CI: 1.87–4.74) were associated with the need for hospitalization. ConclusionA third of patients with pyrethroid poisoning require hospitalization. Type 2 pyrethroid poisoning is more frequent in clinical practice. Ingestion of type 2 pyrethroids, seizures, and need for pre-hospital treatment are associated with hospitalization.