Retrospective Observational Cohort Study Research Articles

Short-term effectiveness of intelligent navigated laser photocoagulation versus subthreshold micropulse laser in patients with chronic central serous chorioretinopathy

AIM: To compare the short-term effectiveness of intelligent navigated laser photocoagulation and 577-nm subthreshold micropulse laser (SML) treatment in patients with chronic central serous chorioretinopathy (cCSC). METHODS: This observational retrospective cohort study included 60 consecutive patients who underwent intelligent navigated laser photocoagulation (n=30) or 577-nm SML treatment (n=30) for cCSC between Jan. 2021 and Oct. 2022. During 3mo follow-up, all patients underwent assessments of best correct visual acuity (BCVA) and optical coherence tomography (OCT). RESULTS: The operation of laser treatment was successful in all cases. At 1mo, BCVA improved significantly more in the intelligent navigated laser photocoagulation group compared to the SML group (P<0.05). The change was not significantly different at 3mo (P>0.05). Central macular thickness (CMT) in the intelligent navigated laser photocoagulation group was lower than in the SML group at 1mo (P<0.05). The subfoveal choroidal thickness (SFCT) in two groups were all significantly improved at 3mo (all P<0.05). The change between two groups was not significantly different at 1mo or at 3mo (P>0.05). CONCLUSION: Intelligent navigated laser photocoagulation is superior to SML for treating cCSC, leading to better improvements in vision and CMT for short term.

Use of machine learning to identify prognostic variables for outcomes in chronic low back pain treatment: a retrospective analysis

ABSTRACT Objectives Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed ‘Holy Grail’ questions, one being: ‘What are the most important (preventable) predictors of chronicity’ for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses. Methods This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables. Results The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender. Conclusion This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates.

Does the type of aortic pathology affect periprocedural outcomes in patients undergoing thoracic endovascular aortic repair?

Aim: To examine whether the type of aortic pathology affects periprocedural outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Material and Methods: This retrospective observational cohort study included 47 TEVAR patients in total. Based on the kind of aortic pathology, the patients were categorized into three groups: Group 1 (n=23) included patients with type B aortic dissection (TBAD), Group 2 (n=14) included patients with descending thoracic aortic aneurysm (DTAA), and Group 3 (n=10) included patients with thoracic aortic mural thrombus (TAMT). Preprocedural basic clinical features, procedural data, and postprocedural outcomes and complications were compared between the groups. Results: The study population consisted of 36 males and 11 females, with a mean age of 62.48±14.2 years. Most of the patients in Groups 1 and 2 were male (82.6% and 92.8%), while 40% of the patients in Group 3 were male, and this difference was statistically significant. Compared to patients in other groups, individuals in Group 2 were significantly older and exhibited a higher incidence of chronic obstructive pulmonary disease and coronary artery disease. Group 3 required thromboembolectomy more frequently during the postprocedural period. In terms of other postprocedural outcomes, complications and mortality, there were no significant differences between the groups. Conclusion: Our study demonstrated that the type of aortic pathology did not significantly influence periprocedural outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). The TEVAR procedure can be effectively performed in suitable patients with various pathologies of the descending thoracic aorta.

Hyponatremia Associated with the Use of Common Antidepressants in the All of Us Research Program.

Selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), and norepinephrine-dopamine reuptake inhibitor (NRI) antidepressants can cause hyponatremia through syndrome of inappropriate antidiuretic hormone secretion (SIADH). This study assesses the differential risks of hyponatremia associated with commonly prescribed SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram), SNRIs (duloxetine, venlafaxine) and NRI (bupropion), as well as omeprazole as a reference, with a retrospective observational cohort study in the All of Us Research Program, a national multicenter research cohort containing de-identified electronic health records (EHR). Participants who had been prescribed monotherapy with any of eight common antidepressants were included, with each drug considered as a separate arm indexed with a start date. Events were defined as the first occurrence of a low plasma sodium measurement or a clinical diagnosis recorded for either hyponatremia or SIADH. Those who did not have events were censored at their last plasma sodium measurement. A total of 17,439 individuals were exposed to one of the eight antidepressants as monotherapy. The overall incidences for hyponatremia were 0.87% in the first 30 days and 10.5% in the first 3 years in the antidepressant arms. Compared to sertraline, duloxetine (hazard ratio [HR] = 1.37 [1.19-1.58]) and escitalopram (HR = 1.16 [1.01-1.33]) were associated with the highest overall risk of hyponatremia, and bupropion (HR = 0.83 [0.73-0.94]) and paroxetine (HR = 0.78 [0.65-0.93]) were associated with the lowest risk. The risks were unchanged after adjusting for comorbidity and polypharmacy. Such information could help guide providers in managing patients and their risks of hyponatremia when on common antidepressants.

Immunosuppressive Drugs in Early Limited Cutaneous Systemic Sclerosis May Prevent Global Damage Accrual.

Organ damage in systemic sclerosis (SSc) in individual organs such as the lungs may be prevented by immunosuppressive drugs (IS). A new measure of global organ damage, the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI), has allowed us to investigate whether IS may reduce global organ damage accrual in early SSc. This was a retrospective study of patients with < 2 years disease duration in Canadian and Australian SSc cohorts. Patients with either limited cutaneous (lcSSc) or diffuse cutaneous (dcSSc) SSc were observed separately and divided into ever or never exposed to IS groups. The SCTC-DI was the outcome and inverse probability of treatment weighting (IPTW) was used to balance the study groups and to fit a marginal structural generalized estimating equation (GEE) model. In the lcSSc cohort, there were 210 subjects of which 34% were exposed to IS at some time. Exposure to IS was associated with lower damage scores. In the dcSSc cohort, there were 192 subjects of which 76% were exposed to IS at some time. Exposure to IS was not associated with damage scores. In this retrospective observational cohort study, using IPTW to adjust for confounders, we found a protective effect of the use of IS on damage accrual in lcSSc. We were unable to determine such an effect in dcSSc but unknown confounders may have been present and prospective studies of IS in dcSSc should include the SCTC-DI to determine the possible effect of IS on damage accrual.

Deterioration in ankle reflex is associated with a reduced estimated glomerular filtration rate in patients with type 2 diabetes: A retrospective observational cohort study.

We investigated the association between the ankle reflex and the estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes. This was a single-center, retrospective, observational cohort study. A total of 1,387 patients who underwent an ankle reflex examination between January 2005 and December 2015 were included in the analysis for the primary outcome. The findings of the ankle reflex examination were classified into three groups: normal, decreased, or absent. The primary outcome was defined as the incidence of a 40% loss of eGFR from baseline. A survival time analysis using the Kaplan-Meier method and a regression analysis using a Cox proportional hazards model were conducted to evaluate the association between the ankle reflex test results and loss of eGFR. The ankle reflex test results were as follows: normal, n = 678 (48.9%); decreased, n = 270 (19.5%); and absent, n = 439 (31.6%) patients. The median follow-up period was 5.6 years in the observational period. In the univariate regression analysis, decreased and absent ankle reflexes were significantly associated with loss of eGFR. Moreover, decreased ankle reflex (hazard ratio: 1.83, 95% confidence interval: 1.16-2.87) and absent ankle reflex (hazard ratio: 2.57, 95% confidence interval: 1.76-3.76) were independently associated with loss of eGFR after adjusting for prognostic risk factors. Decreased and absent ankle reflexes are closely and independently associated with loss of eGFR in patients with type 2 diabetes.

Fetal Gastroschisis: Maternal Epidemiologic Profile and Influence of Possible Risk Factors on Neonatal Outcomes.

The aim of this study was to evaluate the maternal epidemiological profile for gastroschisis as well as to assess whether the presence of meconium at birth was associated with adverse neonatal outcomes. This was a retrospective observational cohort study that included 52 neonates with gastroschisis whose mothers had delivery at our service. The variables observed were the following: 1) socio-demographic data, 2) ultrasonographic data, 3) birth data, and 4) neonatal outcomes. Simple (univariate) and multiple (multivariate) logistic regression models were used to examine the influence of meconium on neonatal outcomes. Mean maternal age and body mass index (BMI) of the pregnant women were 21.9 years and 23.3 kg/m2, respectively. There was a similarity between mixed (50%) and white (48.1%) races, and 27.7% (13) reported to use an oral contraceptive (OC). Mean birth weight was 2,386.9 grams, and 24 of the neonates (46.2%) were premature (<37 weeks). The majority of neonates had neonatal sepsis (40.4%) and 39 were admitted to the neonatal intensive care unit with a median length of stay of 31 days. Forty neonates required mechanical ventilation, with a median duration of 5 days. Primary closure was achieved in 50% (26) of cases. Although not significant and with low precision, the point estimate suggested that the presence of meconium at birth, on average, reduced the chance of primary closure (OR=0.26, CI 95% [0.06; 1.16], p=0.077). Pregnant women with gastroschisis fetuses were more likely to be young, primigravida, with a normal BMI, white or mixed, and with a history of OC use. There was no evidence of an association between the presence of meconium at birth and adverse perinatal outcomes.

Necrotizing Pneumonia: A Practical Guide for the Clinician

While rare, necrotizing pneumonia is a severe and potentially life-threatening manifestation of lung parenchyma infection. Initially documented in the 1940s, it was a significant contributor to mortality rates in both adults and children, with figures reaching up to 45%. Despite being a disease described in the literature for decades, data on the management of necrotizing pneumonia remain limited. Most available information comes from retrospective observational cohort studies. This article aims to provide a comprehensive summary of the existing literature on the subject.

A retrospective examination of risk factors for central line-associated bloodstream infections in home parenteral nutrition patients from a Queensland tertiary hospital.

Central line-associated bloodstream infections (CLABSIs) are a potential complication for home parenteral nutrition (HPN) patients. We sought to analyse risk factors of developing HPN-related CLABSI and assess CLABSI management in the Australian context. A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a central venous catheter (CVC) at a Queensland tertiary referral centre between 2016 and 2023. Patient charts were reviewed, and Kaplan-Meier analysis was employed to determine associations between characteristics and time to CLABSI in the first CVC using Peto-Peto Prentice test. A total of 39 CLABSI episodes occurred in 19 patients. Patients with ≥1 CLABSI used regular opioids more than those without CLABSI (P = 0.016). Fourteen (41%, n = 14/34) patients developed a CLABSI in their first CVC. No patient or line characteristics were found to be predictive of CLABSI in their first CVC. The CLABSI rate was 1.02/1000 catheter days. Most CLABSIs were caused by Enterobacterales (22%, n = 12/55) and Candida sp. (22%, n = 12/55). Empiric antimicrobial therapy was adequate in only 25% (n = 7/28), and the median time to effective antibiotic therapy was 22.7 h (interquartile range 4.8-29.8). There were three successful CVC salvages (8%, n = 3/39). In this cohort of patients, regular opioid use was associated with increased risk of developing CLABSI. Based on our findings, an empiric antimicrobial regime of vancomycin, cefepime and caspofungin will provide adequate coverage for most HPN-related CLABSIs in Australian IF units with a similar antimicrobial distribution and resistance pattern.

Time to Surgery Following Complete Cervical Spinal Cord Injury: Evolution of Clinical Practice Patterns Over a Decade from 2010 to 2020 Across North American Trauma Centers.

This study aims to quantify the change in time to surgery for treatment of complete traumatic cervical spinal cord injury (SCI) patients in American College of Surgeons accredited trauma centers across North America over the last decade (2010-2020). This multi-center retrospective observational cohort study used data from the Trauma Quality Improvement Program from 2010 to 2020. All surgically treated patients with complete traumatic cervical SCI were included. Primary outcome was time to spine surgery from treating hospital arrival in hours. Both descriptive statistics and a multi-variable Poisson regression model clustering standard of errors by each included trauma center were used to evaluate and quantify the annual change in time to surgical intervention. The study included 6855 complete traumatic cervical SCI patients managed across 484 trauma centers in North America. Median time to spine surgery was 14.6 h. A total of 4618 patients (67.3%) underwent surgical intervention within 24 h from hospital arrival. From 2010 to 2020, median time to surgery decreased by an average 0.6 h (±0.15) per year. A multi-variable adjusted model for time to surgery demonstrated a significant downward annual reduction of 5% in time to surgery between the years 2010 and 2020 (Incidence rate ratio = 0.95; 95% Confidence Interval: 0.93-0.96). This study provides compelling real-world based quantification of the change in time to surgical intervention following traumatic cervical SCI. A significant decreasing annual trend pertaining to surgical timing across trauma centers in North America over the past decade was demonstrated.

Impact of a 2-week flipped classroom virtual neurology clerkship versus a traditional 4-week rotation on NBME shelf exam scores

ObjectiveThere is conflicting evidence whether decreased clerkship duration is associated with reduced NBME shelf examination performance. We hypothesized that scores would remain stable for students in a shortened 2-week flipped classroom-based virtual rotation as compared to the traditional 4-week Neurology clerkship.BackgroundThere is conflicting evidence whether decreased clerkship duration is associated with reduced NBME shelf examination performance. We hypothesized that Neurology shelf exam scores would remain stable for students in a shortened 2-week flipped classroom-based virtual rotation as compared to the traditional 4-week Neurology clerkship with direct patient care supplemented by didactics.MethodsThis is a retrospective observational cohort study. In April 2020, the neurology clerkship at Rutgers Robert Wood Johnson Medical School switched from a traditional 4-week in-person clinical rotation supplemented by didactics to a 2-week flipped classroom-based virtual-only curriculum decoupled from a supplementary 2-week in-person clinical rotation to be completed later. Students were offered the opportunity to test after the 2-week virtual curriculum. NBME shelf scores for these “exam before clinical rotation” (EBC) students over the final quarter of the academic year 2019–2020 were compared to those of the “exam after clinical” (EAC) students undergoing the 4-week traditional rotation from July 2018 to March 2020.Results321 students completed the shelf exam between July 2018 and June 2020, of which 284 students comprised the EAC cohort and 37 students, the EBC cohort. Mean scores did not differ between the EBC and EAC cohorts (81.8 ± 6.7 versus 81.8 ± 6.5, p = 0.96). Additional analyses showed no significant differences in the performance of EBC students as compared to the EAC students that tested within the same academic year 2019–2020 or within the matched quarter of the prior academic year 2018–2019, and students completing the virtual rotation who delayed testing after the clinical experience.ConclusionsTesting after a 2-week flipped classroom-based virtual curriculum in Neurology without additional clinical training did not negatively affect neurology NBME shelf scores. Decoupling clinical experiences from knowledge acquisition and the evaluation of that knowledge base by means of NBME shelf examination is not likely to disadvantage learners with respect to shelf examination performance.

Analysis of the Association between In Vitro Fertilization/Assisted Conception and the Development of Retinopathy of Prematurity in Very-Low-Birth Weight Newborns.

The objective is to study to what extent the development of retinopathy of prematurity (ROP) is associated with assisted conception (AC) and in vitro fertilization (IVF) in a tertiary referral hospital. This study is a retrospective observational cohort study. Very-low-birth weight (VLBW) infants with gestational age (GA) <32 weeks or birth weight <1500 g were admitted to the neonatal unit of a tertiary care hospital between January 1, 2011, and December 31, 2021. The study determined the degree of ROP developed according to the type of fertilization used for conception. Main outcome measures were ROP prevalence in pregnancies obtained after IVF/intracytoplasmic sperm injection (ICSI) in the period from January 1, 2011, to December 31, 2021, in a tertiary hospital. Of the 408 infants included in the study sample, 105 (25.7%) were born following AC and 12.4% of these developed ROP. In our sample, the practice of IVF was not associated with an increase in the incidence of VLBW infants (R2 = 0.12; P = .29). Conception achieved via AC or IVF is not significantly associated with ROP in any degree of severity.

Pre-hospital care for children: a descriptive study from Central Norway

BackgroundPre-hospital incidents involving pediatric and neonatal patients are infrequent, and clinical characteristics and care for these patients differ from the adult population. Lack of knowledge, guidelines, and experience can make pre-hospital pediatric care challenging, and there is limited research on the epidemiology and best practice of care for this population. We examined the pre-hospital pediatric population in the county of Sør-Trøndelag, Norway, to improve our understanding of this population in our region.MethodsWe conducted a retrospective observational cohort study of emergency incidents involving children under twelve years of age with dispatch of Emergency Medical Services (EMS) in Sør-Trøndelag between 2018 and 2022. Incidents and patient characteristics were extracted from the Emergency Medical Communication Center (EMCC) database. In addition, data on patient characteristics and interventions for more serious incidents seen by the Helicopter Emergency Medical Service (HEMS) were included from the database LABAS. We provided descriptive statistics and estimated population incidences using Poisson regression.ResultsThe catchment area of EMCC Sør-Trøndelag has a population of approximately 43,000 children under the age of twelve years. During the five-year study period, there were 7005 emergency calls concerning this patient population, representing 6% of all emergency calls (total no. 108,717). Of these, 3500 (50%) resulted in the dispatch of an ambulance and/or HEMS, yielding an annual incidence of EMS dispatches of 17 per 1000 children. The three most common primary medical problems were respiratory distress, altered consciousness, and trauma. Among the 309 HEMS patients, 131 (42%) received advanced interventions from the HEMS physician. Assisted ventilation was the most frequent intervention.ConclusionsPediatric and neonatal patients make up a small proportion of pre-hospital patient dispatches in Sør-Trøndelag. Consequently, each EMS provider infrequently encounters children in the pre-hospital environment, resulting in less experience with pediatric advanced medical interventions. This study identifies some clinical characteristics and interventions regarding pediatric and neonatal patients that have been pointed out as focus areas for pediatric pre-hospital research.

Optimal Timing of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Early Predictors of Neurological Outcomes in Postcardiac Arrest Patients

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been recognized as predictors of various critical illnesses. Our study aimed to investigate whether the NLR and PLR measured at different timepoints could predict poor neurological outcomes at 6 months. This observational retrospective cohort study included adults who had experienced out-of-hospital cardiac arrest (OHCA) and received targeted temperature management between November 2015 and December 2020. Patients with an active infection, as confirmed by an initial blood culture, were excluded. Multivariate logistic regression models were used to determine the association between the NLR and PLR at 0, 24, and 48 h after return of spontaneous circulation and poor neurological outcomes, defined as a Cerebral Performance Category score of ≥3 at 6 months. The NLR at 24 h, but not the NLR or PLR at other timepoints, was significantly associated with poor neurological outcomes (odds ratio: 1.05; 95% CI: 1.01–1.09; p = 0.018). The NLR at 24 h showed moderate accuracy in predicting poor neurological outcomes, with an AUC of 0.619. A cutoff value of 9.0 achieved 72.5% sensitivity and 47.7% specificity. The NLR measured at 24 h after ROCS could be used for early neuroprognostication given its low cost and widespread availability.

Clinical, laboratory, and hospital factors associated with preoperative complications in Peruvian older adults with hip fracture.

To determine the clinical, laboratory, and hospital factors associated with preoperative complications in older adults with hip fractures. Analytical observational retrospective cohort study, whose population was older adults with a diagnosis of hip fracture treated in a hospital in northern Peru, during 2017-2019. 432 patients with a median age of 83 years (RIC: 77-88) were evaluated, with the female gender being the most prevalent (60.9%). The most common comorbidities included cardiovascular disease (68%) and diabetes (17.6%), and multimorbidity was observed in 47.2% of cases. The median number of geriatric syndromes was 2 (RIC: 1-5). The overall mortality rate was 3.2% (1.7-5.3). Analysis with the Poisson regression model found a significant association with MRC scale 3-5 degree (RR = 1.60), glucose on admission (RR = 1.01), and minimally significantly female sex (RR = 2.41). The most commonly observed complications were infectious in nature, including pneumonia, sepsis, and urinary tract infections. The MRC scale from 3 to 5 degrees increases the risk of developing a preoperative complication; the glucose levels upon admission show a clinically irrelevant association; and in females, there is a minimally significant association in older adults with hip fractures.

Evaluating the Clinical Impact of Ureteral Frozen Section Analysis During Radical Cystectomy: A Single-Center Retrospective Study.

Introduction The objective of this study is to find out if there are any differences in upper urinary tract recurrence and overall mortality between patients who underwent a frozen section analysis during radical cystectomy and those who did not. Materials and methods In an observational retrospective cohort study, we evaluated data from 164 patients who underwent radical cystectomy in our institution over a five-year period from 2013 to 2018. Fisher's exact test was applied to find any difference in upper urinary tract recurrence between the two groups. The Kaplan-Meier method and the log-rank (Mantel-Cox) test were used to determine differences or equivalence between treatment groups. Results The sensitivity was 84.6% and the specificity was 95.3% for the frozen section. There was no statistically significant relationship between performing a frozen section and upper urinary tract recurrence, as indicated by Fisher's exact test (p=0.619). The Kaplan-Meier test showed no statistically significant relationship between performing a frozen section analysis and overall mortality. Discussion The use of ureteric frozen section analysis during radical cystectomy is traditionally taught during surgical training, but the evidence base for this practice is sketchy. Frozen section analysis is thought to reduce the chances of local recurrence and arguably upper urinary tract recurrence. The overall upper urinary tract recurrence after radical cystectomy is reported to be 2-6%, consistent with the 3.3% observed in our study. Conclusion Our study demonstrates that while frozen section analysis is sensitive and specific in detecting dysplasia, it does not significantly impact upper tract recurrence or overall mortality.

Mortality association with extremity trauma and transferring patients for higher level of care.

Rising healthcare costs and reduced Medicaid reimbursements pose lasting challenges for trauma centers. Various studies have highlighted the adverse effect of these cost-related circumstances on trauma center survival and the need for local hospitals to transfer patients to tertiary and quaternary care centers. Our study seeks to assess the relationship between patient transfer status to a higher-level health center and its association with mortality. A total of 19417 patients were identified, of which 15317 patients presented directly to the higher level health center, and 3830 patients who transferred from 49 different outside hospitals within a 500-mile radius. Data collection was collected from the receiving higher level of care hospital trauma registry. IBM SPSS version 23 was used to analyze the data. A 1:1 propensity-matched analysis based on age, sex, and injury severity score yielded 3566 patients that presented directly to ARMC and 3566 patients who were transferred to ARMC for a higher level of care. Amongst various factors we considered mechanism of injury, response levels, arrival methods, and transfusion of blood products. The univariate analysis of the propensity-matched analysis demonstrated 88% blunt injury in the nontransferred group and 82% in the transferred group (P<0.001). Overall, hospital mortality was 3% in nontransferred patients versus 4% in the transferred group (P<0.001). A multivariate logistic regression demonstrated mortality is more likely in patients with higher injury severity scores [odd ratio (OD) 2.351 (1.029-1.082), P<0.001] and lack of packed red blood cell (pRBC) transfusions received within first 4h [OD 6.852 (3.525-13.318), P=0.001]. The transfer of trauma patients with extremity injuries to level 1 trauma centers has significant implications on patient outcomes. In our retrospective observational cohort study, the authors noted increased mortality among patients with higher injury severity scores, penetrating injuries, pRBC administration within the first 4h of hospitalization, and among patient transfers.

Anesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation, A Retrospective Observational Cohort Study

Anesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation, A Retrospective Observational Cohort Study

Unveiling the Burden: A Six-Year Retrospective Analysis of Pressure Ulcer Epidemiology in a ICU

Objective: This study describes the epidemiological changes in pressure ulcers (PUs) in a Portuguese intensive care unit (ICU) from January 2017 to June 2023, characterizes critically ill patients with PUs, identifies specific risk factors, and assesses the effectiveness of implemented preventive measures. Materials and Methods: A retrospective observational cohort study was conducted, analyzing records of ICU patients with PUs during the specified period. Data were extracted from the institution’s Global Risk Management application and the ICU’s electronic PU registry. The study included patients with ICU stays longer than 24 h and excluded those with ineligible clinical records or incomplete characterization data. Results: Among 3816 evaluated patients, 257 developed a total of 345 PUs, averaging 1.4 PUs per patient. The average PU prevalence rate was 6.81%, with the highest prevalence in 2020 (11.0%) and the lowest in 2022 (3.48%). The average incidence rate was 3.76%, peaking at 5.71% in 2020 and declining to 2.54% in 2023. The sacrum and heels were the most commonly affected areas, with Category 2 PUs being the most frequent. Key intrinsic risk factors included systemic diseases and sensory deficits, with pressure identified as a significant extrinsic factor. Preventive measures focused on risk assessment and pressure control. Conclusions: The study reveals a PU prevalence of 6.81% and an average incidence of 3.76%, underscoring the need for enhanced preventive strategies, especially in anatomical areas like the sacrum and heels. It emphasizes the importance of personalized assessments, continuous education for nursing staff, and a multidisciplinary approach to improve patient outcomes and care quality in the ICU.

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register

BackgroundDue to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment. MethodsThe study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis. ResultsThe study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures. ConclusionCalcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically. Level of evidenceIV, retrospective observational cohort study