Discharge Outcomes Research Articles

Effect of basic activities of daily living independence on home discharge and long-term outcomes in patients hospitalized with heart failure

Effect of basic activities of daily living independence on home discharge and long-term outcomes in patients hospitalized with heart failure

Factors Influencing Postoperative Inpatient Rehabilitation Requirement After Surgical Intervention for Isolated Hip Fracture: A Multicenter Study.

Hip fractures in the elderly, especially those discharged to a rehab facility, have historically been associated with poor outcomes. There has yet to be identified which patients have a higher likelihood of a rehab discharge after isolated hip fracture fixation. The purpose of this study was to identify factors that predispose patients to require short or long-term rehab after surgical intervention of traumatic, isolated hip fractures. Patients undergoing operative management of hip fractures (n = 71,849) from 2017 to 2019 at institutions that submitted data to a nationwide database were analyzed retrospectively. Various factors were compared between patients discharged to inpatient rehab (n = 56,178) versus home (n = 15,671). The rehab discharge group was significantly older and predominantly female. This cohort had a longer average hospital stay, higher incidence of diabetes, congestive heart failure, chronic renal failure, history of cerebrovascular accident, functionally dependent health status, hypertension, chronic obstructive pulmonary disease, dementia, baseline anticoagulation therapy, and history of myocardial infarction. DVT during hospitalization was encountered more often in patients discharged to rehab. Patients with femoral neck fractures and those undergoing total hip arthroplasty were more often discharged home. Patients with intertrochanteric hip fractures and those undergoing fracture fixation were more often discharged to rehab. Multiple risk factors associated with a significantly higher likelihood of a rehab discharge after isolated hip fracture surgery were identified. Early identification of these patients may provide an opportunity to optimize patients for home discharge and better outcomes. Level III, Case-Control Study.

BN SO38 - Bile Duct Injuries Referrals and Management in a Tertiary Centre in UK– A 6-year study

Abstract Background Laparoscopic Cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis. It has been associated with serious complications, such as vascular/biliary injuries (0.4-0.7% of cases) requiring surgical, endoscopic or radiological interventions. Objective To evaluate the management, intervention and outcomes post bile duct injuries (BDI) Methods We conducted a retrospective analysis on all patients referred with BDIs from regional centres, following a planned LC operation and treated at the HPB unit of Queen Elizabeth Hospital Birmingham between 2018 - 2023. Patients were followed up for at least one year. Results In our unit, 22 (12 male) patients, with a median age of 60 years (16-85) were treated, primarily for gallstone disease (n=14). Most sustained grade E injury (n=19) and were recognised and transferred on average in 4 days (0-43 days). 20 patients had a hepaticojejunostomy. Using the Clavien-Dindo classification, three patients had grade III complications requiring intervention, and one had grade IV complication with sepsis and cardiac failure, necessitating ITU transfer for inotropic support. Discharge occurred within 10 days (4-96), with follow-up over 18.8 months (5-65). Seven await further follow-up, six were discharged and two await PTC for anastomotic stricture. Conclusion Our cohort underscores the complexity and critical nature of these injuries. Most patients required hepaticojejunostomy, with a median recognition and transfer of four days. While the early discharge and follow-up outcomes are promising, ongoing monitoring is essential, as patients might commonly develop anastomotic strictures, requiring conservative, radiological or surgical management. These findings highlight the necessity for prompt recognition and referral to specialised HPB units to optimise patient outcomes and reduce the long-term complications associated with BDIs.

099. Artificial Intelligence and Machine Learning in Trauma Outcome Prediction: A Literature Review

Introduction: Trauma remains a leading cause of mortality and disability globally, particularly among young adults. Despite advancements, accurate prediction of trauma outcomes remains challenging. Artificial intelligence (AI) and machine learning (ML) has the potential to detect patterns and analyzing complex relationship of data from trauma patients to support decision making in the management of trauma. This study aims to explore the potential of AI and ML to enhance trauma outcome prediction in order to healthcare workers with basic understanding of AI and ML and the potential for them to utilize it management of trauma patients. Methods: A literature review was conducted using studies from PubMed, SCOPUS, Cochrane, EBSCOHost, and ScienceDirect database using PRISMA protocol. Data extraction focused on study design, population, interventions, outcomes, and methodological quality using the Oxford Centre for Evidence-Based Medicine levels of evidence. Results: From the literature review, 15 studies from total of 585 studies were included in this literature review. XGBoost and Neural Networks were the most common algorithms (60%). While six studies predicted mortality, others focused on length of stay and discharge outcomes. Overall, ML significantly improved trauma diagnosis by enhancing predictive models for injury severity and mortality. Conclusions: Machine learning models have shown superior performance compared to traditional scoring systems in their ability to predict trauma outcomes and could effectively forecast critical outcomes and guide treatment decisions. Subsequent studies should concentrate on creating more resilient models based on prospectively gathered data to enhance the performance of created algorithms.

Trends and outcomes in pediatric laparoscopic appendectomy: a NSQIP-P analysis of same-day discharge and readmission rates.

Practice patterns of same-day discharge for pediatric laparoscopic appendectomy for non-perforated appendicitis are not well-analyzed. Our aim is to evaluate current practice patterns and outcomes of same-day discharge for these patients. NSQIP-P retrospective registry identified patients (2017-2021) who underwent laparoscopic appendectomy for non-perforated appendicitis. Annual same-day discharge (SDD) rate was determined. SDD patients were compared to those discharged postoperative days 1-2 (non-SDD). Sub-group analysis was performed on ICD-10 code K35.30. Regression was performed. Overall, 67,214 patients were identified. The SDD rate increased from 33.3% (2017) to 52.5% (2021) with decreased 30-day readmissions between SDD and non-SDD (1.3% vs 2.1%, p < 0.001). Sub-group analysis identified 7,330 patients with SDD rates from 50.7% (2019) to 60.4% (2021) with decreased 30-day readmissions (1.3% vs 2.1%, p < 0.001) for SDD versus non-SDD. No increase in adverse events for SDD occurred in either analysis. Regression identified esophageal/gastric/intestinal diseases increased odds of early readmission or reoperation (OR 1.85, p = 0.042). Same-day discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to increase in frequency without a significant increase in adverse outcomes. SDD rates are 20-30% lower than previously published single-center studies, indicating there is a likely a larger percentage of patients that could discharge same-day. Level III.

Outcomes in patients with out-of-hospital cardiac arrest according to prehospital advanced airway management timing: a retrospective observational study.

In patients with out-of-hospital cardiac arrest (OHCA), guidelines recommend advanced airway (AA) management at the advanced cardiovascular life support stage; however, the ideal timing remains controversial. Therefore, we evaluated the prognosis according to the timing of AA in patients with OHCA. We conducted a retrospective observational study of patients with OHCA at six major hospitals in Daegu Metropolitan City, South Korea, from August 2019 to June 2022. We compared groups with early and late AA and evaluated prognosis, including recovery of spontaneous circulation (ROSC), survival to discharge, and neurological evaluation, according to AA timing. Of 2,087 patients with OHCA, 945 underwent early AA management and 1,142 underwent late AA management. The timing of AA management did not influence ROSC in the emergency department (5-6 minutes: adjusted odds ratio [aOR], 0.97; p=0.914; 7-9 minutes: aOR, 1.37; p=0.223; ≥10 minutes: aOR, 1.32; p=0.345). The timing of AA management also did not influence survival to discharge (5-6 minutes: aOR, 0.79; p=0.680; 7-9 minutes: aOR, 1.04; p=0.944; ≥10 minutes: aOR, 1.86; p=0.320) or good neurological outcomes (5-6 minutes: aOR, 1.72; p=0.512; 7-9 minutes: aOR, 0.48; p=0.471; ≥10 minutes: aOR, 0.96; p=0.892). AA timing in patients with OHCA was not associated with ROSC, survival to hospital discharge, or neurological outcomes.

Incidence, predictors and outcomes of non-home discharge following transcatheter aortic valve implantation: a multicentre Australian experience. The NHD TAVI study

Abstract Background Patients undergoing transcatheter aortic valve implantation (TAVI) commonly experience non-home discharge (NHD), a phenomenon associated with increased health-care expenditure and possibly poorer outcomes. Despite its relevance to patients, post-TAVI NHD remains poorly explored in the literature. Purpose To characterise the incidence and predictors of NHD following TAVI, understand its impact on quality of life, and identify the proportion of patients that require long-term residential care following initial NHD. Methods Retrospective analysis of prospectively collected data of 2229 patients undergoing TAVI from 2010–2023 included in an Australian TAVI Registry. Results Median age was 82 (IQR: 78-86) years and 41% were female. 257 (11.5%) patients were not discharged home following TAVI, with incidence falling over time (R2=0.636, p&amp;lt;0.001). Multivariable logistic regression modelling for NHD prediction was developed with excellent calibration and discrimination (C-Statistic 0.835). Independent predictors of NHD were post-procedural stroke (adjusted odds ratio [aOR] 11.1), procedure at a private hospital (aOR 3.0), living alone (aOR 2.4), vascular access site complications (aOR 2.1), frailty (aOR 1.9), age&amp;gt;80 (aOR 1.8), hypoalbuminemia (aOR 1.8), NYHA III-IV (aOR 1.7) and hospital length of stay (aOR 1.1) (all p&amp;lt;0.05). NHD was not associated with mortality at 30-days and less than one percent of all patients required longer-term residential care. Conclusion While common following TAVI, NHD does not predict short-term mortality and most patients successfully return home within 30-days. When used appropriately, NHD may serve as a brief and effective method of optimising functional status without compromising long-term independence.Predictors of Non Home Discharge

Octogenarians, nonagenarians and centenarians with myocardial infarction over time in Sweden

Abstract Background The aim of this study was to evaluate temporal changes in baseline characteristics, in-hospital management and medication at discharge in very elderly with myocardial infarction (MI). Methods Between 2003 and 2016, we included all consecutive patients 80 years or-older, with a MI, included in the nationwide SWEDEHEART registry. The study period was divided into seven equal admission periods. Outcomes included major adverse cardiac and cerebrovascular events (MACCE, including death, MI or stroke) and net adverse cardiac and cerebrovascular events (NACCE, including MACCE and bleeding). All patients had complete 1-year follow up. To evaluate any potential associations between in-hospital management/medications at discharge and clinical outcomes, we adjusted for baseline characteristics and clinical presentation using multivariable Cox regression models. Results We included 85,054 patients. Over time, the proportion of patients with comorbidities such as hypertension, diabetes mellitus, prior percutaneous coronary intervention and a previous bleeding significantly increased but patients were less likely to have a prior MI and previous heart failure (HF). On arrival, the proportion of patients with acute HF declined. Invasive management significantly increased over time as well as prescription of evidence-based medication at discharge. At 1 year, the cumulative rate of MACCE and NACCE significantly decreased. We found a significantly lower risk for death, MI and stroke and a higher risk for bleeding. The observed differences remained significant after adjustment. We found no significant interaction between infarct type and outcomes. Conclusion During the study period, the prognosis in very elderly patients with MI substantially improved. In a population that has been excluded from randomised control trials, implementation of evidence-based management for patients with a MI, seemed to be associated with the lower risk for MACCE and NACCE over time.Cumulative rate of MACCE

Association between nasogastric tube feeding and discharge outcomes in patients aged 80 and older with aspiration pneumonia: A propensity score‐matched retrospective cohort study

AbstractBackgroundThis study investigated the association between nasogastric tube feeding (NGF) and discharge rate to previous residences with oral intake in patients aged 80+ with aspiration pneumonia.MethodsA retrospective cohort study included 256 hospitalized patients with aspiration pneumonia from 2012 to 2022, which could not start oral intake within 48 h due to dysphagia. Using 1:2 matched‐pair analysis, the association of interest was examined using logistic regression analysis.ResultsNGF was associated with a lower discharge rate (odds ratio: 0.15; 95% CI: 0.05–0.46).ConclusionPatients with NGF had a lower discharge rate to previous residences with oral intake.

Hyperbaric Oxygen Therapy (HBOT) in Moderate Traumatic Brain Injury (TBI): A Randomized Controlled Trial

Abstract Introduction Hyperbaric oxygen therapy (HBOT) is a novel technique recently under investigation with intention to improve outcomes in traumatic brain injury (TBI). It increases the partial pressure of oxygen in the blood and tissues by inhaling pure oxygen in an environment pressurized to at least 1.4 times normal atmospheric pressure (ATM) at sea level. The rationale behind the use of HBOT in TBI is its potential to mitigate the secondary brain injury cascade initiated by the primary mechanical trauma. Tissue damage and neuroinflammation secondary to intricate and complex cellular biochemical processes are expected to be counteracted by increased oxygen availability during HBOT, which reduces oxidative stress and improves neuroplasticity. Materials and Methods All patients, except whose legal guardians denied informed consent, with moderate TBI presenting to the neurotrauma center, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, were included within the study period of June 2022 to July 2023. Patient allocation was randomized into two arms: namely, treatment and control arm. Simple randomization was done using randomization mobile app, RRApp. Each patient received standard of care per the Brain Trauma Foundation guidelines. Patients randomized under the treatment arm additionally received adjuvant HBOT sessions. One session daily for 10 consecutive days. Session duration was for 60 minutes each at 1.4 ATM. The primary objective of the study was to compare the Glasgow Coma Score (GCS) at discharge and 3-month post-TBI Glasgow Outcome Scale-Extended (GOS-E) among patients in the treatment arm (those who received adjuvant HBOT) with those in the control arm (those who received only standard of care). Results The mean GCS (±standard deviation [SD]) at discharge in the treatment arm was 14.37 (±00.51) with a median of 14 and a range of 14 to 15. Comparatively, the mean GCS (±SD) at discharge in the control arm was 13.40 (±00.84) with a median of 13 and a range of 12 to 15. The difference between the two arms was statistically significant (p &lt; 0.001). GOS-E at 3 months postinjury for the treatment arm was 7.62 ± 00.51 (mean ± SD) with a median of 8 (range: 7–8). For the control arm, GOS-E at 3 months postinjury was 6.40 ± 1.50 (mean ± SD) with a median of 7 (range: 4–8). The difference between the two arms was statistically significant (p &lt; 0.001). Conclusion The current study concludes that early adjuvant HBOT using 1.4 ATM with one session of one-hour daily for 10 days among adults sustaining moderate TBI significantly improves GCS at 10 days. Early adjuvant HBOT is also associated with significantly improved GOS-E at 3 months postinjury compared to standard of care alone.

The Real-World Effect of Early Screening for Palliative Care Criteria in a Medical ICU: An Instrumental Variable Analysis.

Early identification of ICU patients likely to benefit from specialist palliative care could reduce the time such patients spend in the ICU receiving care inconsistent with their goals. To evaluate the real-world effects of early screening for palliative care criteria in a medical ICU. We performed a retrospective cohort study in adults admitted to the ICU using a causal inference approach with instrumental variable analysis. The intervention consisted of screening ICU admissions for palliative care trigger conditions, and if present, offering specialist palliative care consultation which could be accepted/declined by the ICU. We evaluated specialist palliative care use in pre- and post-implementation cohorts from the year before/after screening implementation began (October 2022). In the post-implementation cohort, we compared use of specialist palliative care in those who received early screening versus not. We then estimated the effect of early screening on the primary outcome of days to do-not-resuscitate (DNR) code status or ICU discharge, with death without a DNR order placed at the 99th percentile of the days to DNR or ICU discharge distribution. Secondary outcomes included: DNR order, ICU/hospital lengths of stay, hospice discharge, and mortality metrics. To address unmeasured confounding, we used two-stage least-squares instrumental variables analysis. The instrument, which predicts early screening, comprised weekend vs. weekday admission and number of patients meeting palliative care criteria on a patient's ICU days 1 and 2. Amongst 1282 post-implementation admissions, 626 (45%) received early screening, and 398 (28%) received specialty palliative consultation. Early receipt of specialist palliative care was higher in patients who received early screening vs. not (17% vs 1% , p<0.001), and overall use of specialty palliative care was higher post- vs. pre-screening implementation (28 vs. 15%, p<0.001). In the post-implementation cohort, there were no statistically significant effects of early screening on the primary outcome of days to DNR or ICU discharge (15% relative increase, 95% CI [-11% to +48%]) or other secondary outcomes. Despite significantly increased specialty palliative care consultation there was no evidence that early screening for palliative care criteria affected time to DNR/ICU discharge or other secondary outcomes.

Early Hospital Discharge on Day Two Post-Robotic Lobectomy with Telehealth Home Monitoring.

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0-2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol.

Predicting Clinical Outcomes in COVID-19 and Pneumonia Patients: A Machine Learning Approach.

In the clinical diagnosis of pneumonia, particularly during the COVID-19 pandemic, individuals who progress to a critical stage requiring mechanical ventilation are classified as mechanically ventilated critically ill patients. Accurately predicting the discharge outcomes for this specific cohort, especially those with COVID-19, is of paramount clinical importance. Missing data, a common issue in medical research, can significantly impact the validity of analyses. In this work, we address this challenge by employing two missing data imputation techniques: multiple imputation and missForest, to enhance data completeness. Additionally, we utilize the smoothly clipped absolute deviation (SCAD) penalized logistic regression method to select significant features. Our real data analysis compares the predictive performances of extreme learning machines, random forests, support vector machines, and XGBoost using 10-fold cross-validation. The results consistently show that XGBoost outperforms the other methods in predicting discharge outcomes, making it a reliable tool for clinical decision-making in the treatment of severe pneumonia, including COVID-19 cases. Within this context, the random forest imputation method generally enhances performance, underscoring its effectiveness in managing missing data compared to multiple imputation.

Changing epidemiology and antimicrobial susceptibility of bloodstream infections at a Vietnamese infectious diseases hospital (2010–2020)

Bloodstream infection (BSI) poses a global health problem, with diverse organisms and rising antimicrobial resistance (AMR). Here, we characterized trends in BSI prevalence, AMR, and antibiotic use at a Vietnamese infectious diseases hospital from 2010 to 2020. Among 108,303 cultured blood samples, 8.8% were positive, yielding 7995 pathogens. Of 7553 BSI cases, 86.4% were community-acquired. BSI prevalence varied from 17 to 35 cases/1000 admissions/year, highest in HIV/hepatitis wards and patients >60. The in-hospital mortality or hospice discharge outcome was 21.3%. The top three pathogens, E. coli (24%), K. pneumoniae (8.7%) and S. aureus (8.5%) exhibited increasing prevalence and multidrug resistance. Pathogens like Cryptococcus neoformans (8.4%), Talaromyces marneffei (6.7%), and Salmonella enterica (6.5%) declined. E. coli and K. pneumoniae were prevalent in older adults with community-acquired BSIs. Antibiotic use reached 842.6 DOT/1000 PD and significantly reduced after an antibiotic control policy. Enhanced surveillance and antimicrobial stewardship are crucial for managing BSIs in Vietnam.

Is the continuity of the therapist-patient relationship relevant for the discharge outcome in orthopaedic physical rehabilitation?

Continuity of care has been linked to patient satisfaction and self-reported outcomes. Following hip fractures in the elderly, rehabilitation aims at restoring patients' mobility and independence at the pre-fracture level and at the earliest possible time. Despite the potential role of physiotherapists' continuity on functional outcomes, this correlation has not yet been studied in an acute orthopaedic setting. Guaranteeing the presence of the same physical therapist on individual patients is challenging from an organizational point of view. An observational retrospective study was conducted on 129 aged patients (84 ± 8years) who underwent surgery for proximal hip fracture. Indicators of outcomes were ILOA score at discharge, length of stay and achievement of rehabilitation goals as defined by the Individual Rehabilitation Project. The number of physical therapists taking care of patients was monitored during the patient's hospital stay. No correlation was found between the number of physical therapists and functional goals at discharge. The frequent change of physical therapists providing rehabilitation to elderly patients who underwent surgery for hip fragile fracture is not related to functional outcomes.

Impact of an emergency department closure on out-of-hospital cardiac arrest survival and emergency medical service system in Ulsan, South Korea

IntroductionThis study evaluated the impact of an emergency department (ED) closure on out-of-hospital cardiac arrest survival outcomes and the emergency medical service system in Ulsan, South Korea. MethodsWe conducted a retrospective observational cohort study from March 2017 to February 2021 and compared survival to hospital discharge and favorable neurological outcomes. We investigated transport time intervals (TTIs) in the total study population and subgroup covered by the closed ED. The analysis methods included propensity score matching (PSM), inverse propensity weighting (IPW), and logistic regression analysis. ResultsThe study included 692 and 920 patients before and after ED closure groups, respectively. After adjusting for covariates, the adjusted odds ratios and 95 % confidence interval for survival discharge and favorable neurological outcomes were 1.040 (0.749–1.444, p = 0.814) and 2.845 (1.563–5.177, p = 0.001), respectively. PSM showed values of 1.015 (0.727–1.416, p = 0.932) for discharge survival and 1.777 (1.074–2.941, p = 0.025) for neurological outcomes. IPW showed values of 0.980 (0.762–1.261, p = 0.875) for discharge survival and 1.782 (1.196–2.656, p = 0.005) for neurological outcomes. The TTI increased from 5.8 ± 5.0 to 6.7 ± 5.5 min (p < 0.001) in the total population and from 9.2 ± 7.9 to 16.2 ± 6.5 min (p < 0.001) in the subgroup. ConclusionsThe findings suggest that while the overall system may remain stable, subgroups could be disproportionately affected by an ED closure, underscoring the importance of the ongoing monitoring of survival outcomes and transport times.

Exploring Predictors of Long-Term Care Facility Admissions in Stroke Survivors: Insights from a Taiwanese Hospital-Based Study.

Acute stroke significantly increases the risk of long-term care facility (LTCF) admission, due to sudden functional impairments. This study aims to identify risk factors associated with LTCF admission among stroke patients, specifically targeting those who transitioned from independence to disability after stroke. We retrospectively enrolled 2027 stroke patients admitted between 2017 and 2022 from the Chi Mei Medical Center's stroke registry in Southern Taiwan, focusing on those with pre-stroke modified Rankin Scale (mRS) scores ≤ 2 and post-stroke mRS scores ≥ 3. Patients were categorized into LTCF and non-LTCF groups. Stroke severity, comorbidities, and discharge outcomes were evaluated, using logistic regression analyses to identify LTCF admission risk factors. Of the 2027 patients, 343 (16.9%) were admitted to LTCFs post-discharge. The LTCF group exhibited higher discharge mRS and National Institute of Health Stroke Scale scores, and lower Barthel Index scores. Factors linked to LTCF admission included higher discharge mRS scores, lower Barthel Index scores, nasogastric tube placement at discharge, and longer hospital stays. Barthel Index scores showed no significant change from admission to discharge in the LTCF group. Stroke severity, post-stroke functional status and nasogastric tube placement are significant predictors of LTCF admission in stroke patients. Early recognition of these factors is crucial for effective discharge planning and reducing the need for institutionalization. The study emphasizes the need for personalized interventions targeting these risk factors to improve patient outcomes and optimize medical resource utilization.

Características clínicas y epidemiológicas en pacientes con leucemia linfoblástica aguda de un instituto especializado en pediatría de Perú, periodo 2017-2022

Objective: To describe the clinical-epidemiological characteristics at the time of the diagnosis in patients with acute lymphoblastic leukemia (ALL) at a specialized pediatric institute in Peru, from 2017 to 2022. Materials and Methods: An observational, descriptive, cross-sectional, and retrospective study was conducted. Medical records of patients under 18 years old with a recent confirmed diagnosis of ALL were included. Variables analyzed included sex, age, origin, discharge outcome, hospital stay, signs, symptoms, history of chronic diseases, laboratory findings, and hematological complications. Data were collected through medical record review and processed using STATA v. 16. Results: Out of 247 medical records, 25 patients who did not meet inclusion criteria were excluded. The study sample consisted of 222 patients. 54.1% of the patients were male, with a median age of 5 years. 64.0% had fever, and 78.8% had pallor. 91.8% of patients had hemoglobin below 11 g/dL, 65.3% had platelets below 50,000/µL, and 13.1% had leukocytosis above 100,000/µL. The most common hematological abnormality was the simultaneous presentation of anemia, thrombocytopenia, and leukocytosis (43.0%). Conclusion: ALL predominantly occurred in male children and those under 5 years old. A high frequency of hematological alterations such as anemia, thrombocytopenia, and leukocytosis was observed. Clinically, two-thirds of the patients had fever, and nearly three-quarters had pallor. Further studies on the progression of ALL in the Peruvian population are suggested.

Traumatic brain injury outcomes at the “epicenter of the epicenter” of the united states COVID-19 pandemic amidst ongoing socio-demographic challenges

Abstract Introduction Traumatic brain injury (TBI) poses a significant public health challenge with profound impacts at individual, family, community, and societal levels. Early during the COVID-19 pandemic, the neighborhood of Elmhurst, Queens in New York City was a hotspot dubbed the “epicenter of the epicenter” of the crisis in the United States, requiring major changes in healthcare resource allocation. This study investigates how different phases of the COVID-19 pandemic affected the incidence, severity, and clinical outcomes of TBI in this geographical area. Methods TBI admissions to NYC Health + Hospitals/Elmhurst, a Level 1 Trauma Center, during the first six months of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: pre-pandemic (1/1/19–6/30/19 and 1/1/20–2/29/20) [Group 1], first COVID-19 wave (3/1/20–6/30/20) [Group 2], and second COVID-19 wave (1/1/21–6/30/21) [Group 3]. Univariate analyses were conducted to explore factors potentially associated with TBI outcomes; variables that reached statistical significance (p &lt; 0.05) were included in a binary logistic regression analysis dichotomized into good outcome (discharge to home or acute rehabilitation disposition) and poor outcome (discharge to skilled nursing facility/subacute rehabilitation, hospice, or in-hospital mortality). Results Analysis of 443 TBI patients (median age 56 [range 38, 73]; mean admissions/week 5.6 ± 2.7) demonstrated no significant variance in age (H = 0.92; p = 0.63), sex (χ2 = 1.4, p = 0.51), or ethnicity (χ2 = 17.1; p = 0.07) across groups. Group 2 had significantly fewer weekly admissions (3.9 ± 2.6) compared to Groups 1 (5.9 ± 2.2; p = 0.02) and 3 (6.1 ± 2.9; p = 0.01). Over the course of the pandemic, the proportion of uninsured patients decreased from 15 to 4%, while Medicaid and Medicare coverage rates rose from 25 to 41% and 20% to 28%, respectively (p &lt; 0.001). A binary logistic regression model dichotomized by discharge outcome for all 443 TBI patients confirmed that increasing age (OR = 0.95; 95% CI 0.93–0.97; p &lt; 0.001) and Injury Severity Score (OR = 0.88; 95% CI 0.83–0.93; p &lt; 0.001) were inversely correlated with good outcome, while higher Glasgow Coma Scale (OR = 1.26; 95% CI 1.17–1.36; p &lt; 0.001) was positively correlated. Of particular interest, Black/Hispanic ethnicity (OR = 0.36; 95% CI 0.19–0.66; p = 0.002) and public health insurance (Medicaid/Medicare) coverage (OR = 0.83; 95% CI 0.68–1.00; p = 0.05) were both associated with less favorable outcomes. Neither group designation, patient sex, COVID-19 status, or need for neurosurgical intervention was correlated with outcome (p &gt; 0.05). Conclusion Despite the changes in TBI admission patterns throughout New York City during the COVID-19 pandemic, the quality of patient outcomes at our institution remained relatively consistent across the pandemic’s different phases, as assessed by discharge disposition. However, two important socioeconomic factors—ethnicity and health insurance status—were significantly associated with outcome, underscoring the need for systemic changes to address ongoing disparities in neurotrauma care.

Efficacy of a Nursing Home Liaison Service In Supporting Early Hospital Discharge For Long-Term Care Facility Residents

Abstract Background Long-term care facility residents (LTCR) are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. A new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) commenced recently with the aim of providing early supported discharge for LTCR admitted to hospital. This study aims to describe the efficacy of the NHL service in reducing length of stay (LOS) and readmission rates for LTCR in comparison to data from the year prior to NHL commencement. Methods Hospital In-Patient Enquiry (HIPE) data was retrospectively obtained for the pre-service group (PSG), consisting of all medically admitted LTCR in 2022. This included demographic data, International Classification of Diseases diagnosis, LOS, and discharge outcome. The same prospective data was obtained by chart review for the service group (SG), for LTCR following the initialization of NHL between September 2023 and March 2024. Unpaired t-test and Chi-squared test was used to determine significant difference between the two groups. Results There were 249 LTCR in the PSG and 171 in the SG. The average age (84 vs 81) and dementia diagnosis rate (60% vs 55%) were similar amongst the two groups. The most common reason for admission in both groups was infection (60% vs 40%). The median LOS was significantly lower for the SG as compared to the PSG (8 vs 6 days, p=0.02). The PSG also had higher seven-day (6.4% vs 4.1% p=0.3) and 30-day (14.5% vs 7.6% p=0.03) readmission rates. Conclusion The introduction of a dedicated NHL service for LTCR has resulted in a significant reduction in hospital LOS and readmission rates. By providing enhanced communication through telehealth review and assistance with advanced care planning, the NHL service effectively bridges the gap between acute and community care, resulting in improved patient flow and delivery of person-centred outcomes.