Hospital Admission Patterns Research Articles

Spatial patterns of heat exposure and child hospital admissions in Aotearoa New Zealand

Spatial patterns of heat exposure and child hospital admissions in Aotearoa New Zealand

Patterns of antidepressant prescribing and health-related outcomes among older adults in Northern Ireland: an administrative data study

Objectives This study identifies patterns of antidepressant prescribing and subsequent hospital admissions from 2010 to 2018 amongst older adults in Northern Ireland (NI). Method Participants comprised all General Practitioner (GP)-registered adults aged fifty-five years and above on 01/01/2010 (n = 386,119). Administrative data linkage included demographic information; antidepressant prescribing data from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant prescribing (from 2010 to 2018). Results RMLCA identified four latent classes: decreasing antidepressant prescribing (5.9%); increasing antidepressant prescribing (8.0%); no-antidepressant prescribing (68.7%); and long-term antidepressant prescribing (17.5%). Compared with those in no-antidepressant prescribing class, persons in the remaining classes were more likely to be female and younger, and less likely to live in either rural areas or less-deprived areas. Compared with no-antidepressant prescribing, those with increasing antidepressant prescribing were 60% and 52% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 11% and 8% higher in 2019 and 2020, respectively. Similarly, those with long-term prescriptions were 70% and 67% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 14% and 9% higher in 2019 and 2020, respectively. Conclusion Findings show that approximately 26% of the NI hospital admissions population were impacted by sustained or increasing antidepressant prescribing. Because of their increased likelihood of hospitalization, these individuals may benefit from psychosocial support and social prescribing alternatives to psychopharmacological treatment.

Carbapenemase-producing enterobacterales colonisation status does not lead to more frequent admissions: a linked patient study

BackgroundHospitals in any given region can be considered as part of a network, where facilities are connected to one another – and hospital pathogens potentially spread – through the movement of patients between them. We sought to describe the hospital admission patterns of patients known to be colonised with carbapenemase-producing Enterobacterales (CPE), and compare them with CPE-negative patient cohorts, matched on comorbidity information.MethodsWe performed a linkage study in Victoria, Australia, including datasets with notifiable diseases (CPE notifications) and hospital admissions (admission dates and diagnostic codes) for the period 2011 to 2020. Where the CPE notification date occurred during a hospital admission for the same patient, we identified this as the ‘index admission’. We determined the number of distinct health services each patient was admitted to, and time to first admission to a different health service. We compared CPE-positive patients with four cohorts of CPE-negative patients, sampled based on different matching criteria.ResultsOf 528 unique patients who had CPE detected during a hospital admission, 222 (42%) were subsequently admitted to a different health service during the study period. Among these patients, CPE diagnosis tended to occur during admission to a metropolitan public hospital (86%, 190/222), whereas there was a greater number of metropolitan private (23%, 52/222) and rural public (18%, 39/222) hospitals for the subsequent admission. Median time to next admission was 4 days (IQR, 0–75 days). Admission patterns for CPE-positive patients was similar to the cohort of CPE-negative patients matched on index admission, time period, and age-adjusted Charlson comorbidity index.ConclusionsMovement of CPE-positive patients between health services is not a rare event. While the most common movement is from one public metropolitan health service to another, there is also a trend for movement from metropolitan public hospitals into private and rural hospitals. After accounting for clinical comorbidities, CPE colonisation status does not appear to impact on hospital admission frequency or timing. These findings support the potential utility of a centralised notification and outbreak management system for CPE positive patients.

Hospitalization Events Among Adolescents and Adults With Sickle Cell Disease in a Tertiary Care Center in Central India.

Sickle cell disease (SCD) is an inherited red blood cell disorder, wherein mutation causes the substitution of glutamic acid to valine at the sixth position of the β-globin chain. These include sickle cell anemia (homozygous sickle mutation), sickle-beta thalassemia, and hemoglobin SCD. The clinical manifestations of SCD are protean. Individuals with SCD suffer from both acute and chronic complications, which include recurring episodes of pain commonly called vaso-occlusive crisis (VOC) - acute chest syndrome (ACS); aseptic necrosis of the bone; micro-infarction of the spleen, brain, and kidney; infections; stroke; and organ damage affecting every part of the body. SCD necessitates frequent hospitalizations because of severe complications, which pose a significant burden on caregivers and economic strain on healthcare systems. The pattern of hospital admission with SCD varies in different parts of the world. This study aimed to determine the causes of hospitalization among adolescent and adult patients with SCD and to determine factors associated with their hospital stay. The study was a hospital-based prospective observational study comprising adolescent and adult patients diagnosed with SCD, aged 15-45 years, who were hospitalized in the Department of General Medicine at All India Institute of Medical Sciences in Raipur from August 2021 to August 2022. According to our study, the primary reason for hospitalization was a painful crisis, accounting for 63% of cases, followed by infection (17%), ACS (11%), and acute hemolytic crisis (9%). Notably, we did not observe any significant differences between genders and causes of admission (p > 0.05). Joint pain (p = 0.005), back pain (p = 0.001), and chest pain (p = 0.001) were more frequently reported by adults over the age of 19. In addition, our analysis of the duration of hospital stays and various factors revealed that patients admitted for infections had a significantly longer mean hospital stay duration (p = 0.040). Acute painful crises were the primary cause of hospital admission among individuals with SCD; many patients also encountered infections and ACS. Furthermore, patients who experienced infections and VOC had a lengthier duration of hospital stay. Therefore, it is essential to provide them with comprehensive instructions on various preventive measures against infections and the factors that trigger painful crises.

An Analysis of New York Data: Fluctuations in Hospital Capacity Are Driven by Variability in Elective Admissions and Discharge Activity.

Background Hospital overcrowding compromises patient safety. The contribution of variability in admissions and discharges to overall hospital capacity needs to be quantified. This study describes the statewide day-to-day fluctuation in the volume of hospitalized patients, the variability and pattern of hospital admissions and discharges throughout the week, and the contribution of Emergency Department (ED) vs. elective (non-ED) admissions and discharges to the overall variability in the system across the week. Methodology This is a retrospective analysis of the New York State Statewide Planning and Research Cooperative System database, in which all New York healthcare facilities submit patient-level data monthly. The study period was from January 01 to December 31, 2015. Outcomes included total volumes of admissions and discharges and length of stay sorted by patient origin (ED vs. non-ED admits (elective)) and service type (medicine vs. surgery) by day of the week. Results We studied 1,692,090 hospital admissions. Admissions were highest on Mondays and Tuesdays and steadily decreased throughout the week. There was little variability in the ED admissions throughout the week. Surgical elective admissions had significant variability throughout the week, with higher admissions at the beginning of the week. There was a significant difference (p < 0.01) between admissions on weekdays vs. weekends. Discharges increased from Monday to Friday, with a dramatic drop on the weekends, for both ED and elective pathways. Systemwide, on Monday, hospitals were 21% above the mean volume, and on Fridays, hospitals were 32% below the mean volume. Conclusions Overall hospital capacity shows dramatic variability throughout the week, driven primarily by elective admissions and discharges from any source throughout the week. Because elective admissions are schedulable, hospitals can reduce variability by smoothing scheduling. Increased weekend discharges will also improve capacity.

Beyond diagnosis: investigating hospital referral impact on biological treatment initiation, hospital admission, and surgery patterns in inflammatory bowel disease – a Danish population based study

Objectives Early biological treatment in patients with inflammatory bowel disease (IBD) is important in disease control. Previous studies have suggested that patients with IBD from Non-Academic Hospitals were less likely to receive biologics. The aims of this study were (1) to use the granular data in the clinical database, GASTROBIO, to study detailed differences in time from IBD diagnosis to first administration of biologics, hospital admission, and surgery in patients referred to Academic Hospitals versus to Non-Academic Hospitals, and (2) to explore differences in disease extent, behavior, and indication for biological treatment. Material and methods This was a retrospective cross-sectional descriptive population-based quality study of patients with IBD initiating biologics in the North Denmark Region between 2016 and 2018. Data from GASTROBIO were extracted, namely demographic data, time of diagnosis, biological treatments with indications, hospital admission, and surgery. Results Of the 146 patients included, 84 were from the Academic and 62 from the Non-Academic Hospitals. No significant differences in median time from diagnosis to (1) treatment, (2) hospital admission or (3) IBD surgery between the groups were observed. A higher percentage of patients with luminal Crohn’s disease were treated with biologics at the Academic Hospital (78% and 66%). Conclusions Based on the findings of this population-based study, we found no evidence that the referral area had a significant impact on the duration from diagnosis to the initiation of biological treatment, hospital admissions, or surgery. However, the data suggested that fewer patients with luminal Crohn’s disease were referred to biologics from Non-Academic Hospitals.

The Vax effect: Role of global vaccination initiatives in pandemic control and impact in Dehradun during COVID-19

COVID-19 was one of the most contagious diseases spread throughout the world and caused by the Corona virus. Its cellular and molecular profiling was performed on individuals suffering from Covid-19-like sickness in Dehradun. During this investigation, 100 random samples were taken from patients. Real Time PCR amplification of suspected cases of Covid-19 was done where 68% of the cases were positive. The proportions and patterns of positive cases and hospital admissions for covid-19 in the third wave in Dehradun were significantly different when compared to the first and second waves. This disparity was caused by a number of factors, including changes in lifestyle, natural immunological ability to cope with recent waves of natural infections, and the most important factor, which was that more than 83% of people over the age of 18 years had received the first or both doses of the vaccine. The Covid-19 vaccines were so effective due to which there was a very low rate of serious infection, hospitalization, and mortality.

Pattern of hospital admissions and costs associated with acute rheumatic fever and rheumatic heart disease in Australia, 2012-2017.

ObjectiveThis study aims to describe the pattern and trends in acute rheumatic fever (ARF)/rheumatic heart disease (RHD)-related hospitalisations and costs for Australians aged <65 years.MethodsThis retrospective linked data study measured trends in hospitalisations and costs for ARF, RHD and complications of ARF/RHD in Northern Territory, South Australia, Western Australia, Queensland and New South Wales between 1 July 2012 and 30 June 2017. Persons with ARF/RHD were identified from RHD registers and/or hospital records.ResultsOver the 5-year study period, 791 children, aged <16years (86.3% Indigenous), and 2761 adults, aged 16-64years (44.8% Indigenous), were hospitalised for ARF, RHD or associated complications. On average there were 296 paediatric admissions per year, increasing 6.1% annually (95% CI: 2.4-9.6%, P=0.001) and 1442 adult admissions per year, increasing 1.7% annually (95% CI: 0.1-3.4%, P=0.03). Total 5-year costs were AU$130.6m (AU$17.6m paediatric, AU$113.0m adult). Paediatric costs were mostly for ARF-related admissions whereas adult costs mostly involved valvular surgery. Emergency admissions and air ambulance transfers were common, particularly for non-metropolitan residents.ConclusionsSuccessful ARF/RHD prevention would deliver significant hospital cost savings. Investment in primary and specialist health care in regional areas may reduce emergency admissions and regional transfers, further reducing hospital burden.

Impact of COVID-19 Lockdown on Emergency Department Visits, Hospital Admissions, and Mortality in Northern Jordan: An Interrupted Time Series Analysis

Background: The Jordanian healthcare system was significantly affected by the COVID19 pandemic, as lockdowns and infections strained the healthcare system. The impact of the ensuing national lockdown on emergency department visits, hospital admissions, and mortality is unclear. Purpose: To assess the impact of COVID-19 lockdown on the pattern of emergency department visits, hospital admissions, and mortality at a major hospital in northern Jordan. Methods: An electronic database belonging to King Abdullah University Hospital was used for a retrospective analysis, and the data was accessed in 2022. All patients who visited the emergency department before, during, and after the lockdown in 2020 and 2019 were analyzed using an interrupted time-series analysis. Descriptive statistics were calculated for categorical variables, followed by the Wilcoxon Signed-Ranks Test to detect mean differences. Results: ED visits decreased by 53.5% during the lockdown period and by 22% after the lockdown period compared to the same periods a year before. During lockdown, hospital admissions rose significantly from 11.8% in 2019 to 17.1% in 2020, with 23.96% critical care unit admissions. Post-lockdown, ED admissions increased from 11.3% in 2019 to 16.3% in 2020, with critical care admissions rising to 30.10%, and the mortality rate increased by 50%. Conclusion: The study concluded a decrease in hospital admissions and emergency visits during lockdown, but an increase in mortality rates. Future planning should focus on optimizing care for lifethreatening emergencies, improving national emergency preparedness, and developing Hospital Readiness Checklists for effective response to emergencies like COVID-19. Implications for Nursing: Nursing has faced challenges and changes due to the COVID19 lockdown. Patient admissions decreased after the 2020 lockdown, impacting nursing practice, mental health, and patient care. Nurses should be adapted to telehealth services, maintain care remotely, and address nurses’ mental health issues. Virtual tools should be utilized to connect with patients. Keywords: Jordan, COVID-19, Lockdown, Emergency department, Hospital admissions, Interrupted time series analysis.

Unraveling determinants of severe anaphylaxis — A cluster analysis from a large national hospitalization database

BackgroundUnderstanding potential risk factors and phenotypes at-risk of anaphylaxis can tailor public health actions to prevent avoidable deaths. Therefore, our aim was to explore patterns of hospital admissions diagnosed with anaphylaxis in France from 2012 to 2021, across different age groups, using the national French hospital database and to evaluate potential determinants to propose phenotypes at-risk, with a particular view to severe cases. MethodsThis is a descriptive study, using data from the French Program for the Medicalization of Information Systems, from 2012 to 2021. We included all patients hospitalized for anaphylaxis using International Classification of Diseases (ICD)-10 codes listed as a primary diagnosis. Potential risk factors were selected according to corresponding ICD codes, available as secondary data of hospitalization. Severe anaphylaxis (SA) was defined based on the need of admissions in intensive care units. To explore the patterns and characteristics, we employed cluster analysis using the clustering large applications algorithm. Charlson comorbidity index (CCI) was used to evaluate comorbidities. ResultsDuring the 9-year study period, 78,453 patients had 86,654 admissions due to anaphylaxis for all-causes. Most of the cases were non-severe anaphylaxis (93.7%), 5.9% were SA, and 0.4% evolved to fatal anaphylaxis (FA). Rate of admissions for SA was 0.08/100,000/year. Seasonal trend of cases of anaphylaxis due to Hymenoptera venoms were shown. Increased severity and risk of death were significantly higher in the elderly. Food-induced anaphylaxis is more frequent in childhood, but SA occurred at adolescence and early adulthood. The CCI was higher in SA and FA. By applying the clustering algorithm CLARA, we identified 3 clusters distributed according to the severity. ConclusionMore than providing a snap shot of potential risk factors for anaphylaxis in France, we were able to suggest phenotypes of anaphylaxis of different severities and to propose actions based on our findings. Although further research is needed in the field, we strongly believe that the data presented may contribute to public health advancements to ensure quality of care of patients suffering from anaphylaxis.

1799. Patients Who Inject Drugs (PWID) and Unstable Housing are Associated with Invasive Group A Strep Infection: A retrospective collaboration between two large, quaternary care hospital systems in Philadelphia

Abstract Background Invasive infections involving Group A Streptococcus (iGAS), defined as infections beyond simple skin and soft tissue infection or pharyngitis, are rising nationally. We report an increase in incidence of iGAS at two urban, quaternary care health systems that contain 6 hospitals in the city of Philadelphia. Methods All blood, sterile fluid, and tissue cultures that yielded Streptococcus pyogenes were identified using the laboratory information systems at the Temple University Health System and the University of Pennsylvania Health System. Two cohorts were compared: cases diagnosed between January 1, 2019 and December 31, 2019, and between January 1, 2021 to December 31, 2021. We excluded 2020 data to avoid analysis of disease incidence when hospital admission patterns may have been highly biased due to COVID-19 pandemic. Electronic health records were reviewed and data pertaining to demographics, month of infection, culture site, HIV status, HCV status, housing status, and injection drug use were abstracted. Descriptive statistics were used to summarize findings. Results In 2021, there were 301 unique cases of iGAS (148 involving bacteremia) compared to 169 in 2019 (with 70 cases of bacteremia). This represented an overall increase in iGAS of 178% and a 211% increase in cases involving bacteremia. Of the cases in 2021, 210 (69.8%) were PWID compared to only 54 (32%) in 2019, a 388% increase. In 2021, 7.5% of patients had a diagnosis of HIV compared to 8.9% in 2019, but a large percentage did not have an HIV test (37% in 2019 and 19% in 2021). HCV Antibody positivity was 52.3% in 2021 versus 26.6% in 2019. Housing instability was recorded in 151 cases (50.2%) in 2021 and 31 (18.3%) in 2019, a 487% increase. Table 1 Demographic and clinical characteristics of iGAS cases in 2019 and 2021 Table 2 Age and Sex data in PWID Conclusion From 2019 to 2021, there was an increase in iGAS infections among an adult population in a large metropolitan city. We noted a 178% total increase in iGAS during our study period, with a 388% increase among PWID and 487% increase among those unstably housed. As the overdose crisis continues, public health practitioners and medical providers should be aware of the increase in iGAS when providing empiric treatment for PWID with infections and utilize local and national resources to report and manage cases. Disclosures Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant

The Effect of Nationwide Lockdown in India on the Epidemiology of Injuries During the First Wave of COVID-19

Background. The pattern of hospital admissions and medical care changed during the COVID pandemic.&#x0D; The aim of the study to describe the nature of patients attending the orthopedic emergency department of a level 1 trauma center in terms of number and proportion based on demographic characteristics and the nature of the injury before the lockdown, during the lockdown, and during the unlocking period of the nationwide lockdown for controlling the COVID-19 pandemic in India.&#x0D; Methods. We conducted a longitudinal study from 01.01.2020 to 31.12.2020. Patients attending the orthopedic emergency were grouped based on cause, type, and site of injury. The median number observed each day with IQR. The distribution of the same was compared between the prelockdown with lockdown period and the lockdown period with a phased unlocking period.&#x0D; Results. A total of 10513 patients were included. There was a statistically significant reduction in the proportion of patients needing inpatient care between the prelockdown phase and lockdown phase (p = 0.008). However, this was not seen between lockdown and postlockdown periods (p = 0.47). The proportion of road traffic accidents dropped from 26% to 15% during this time (p0.001). The proportion of contusions was reduced and that of soft tissue injuries increased (p0.001). The proportion of lower limb injuries decreased from the prelockdown phase to the lockdown phase, and that of spinal injury patients increased (p = 0.007). The proportion of patients with contusions increased and soft tissue injuries decreased during this period (p0.001). Lower limb injuries and road traffic accidents increased, and spinal injuries were reduced (p0.001).&#x0D; Conclusion. The lockdown for controlling the spread of the pandemic affected the demographic and epidemiological aspects of injuries attending the orthopedic emergency department of a level 1 trauma center in a developing country. There was a decrease in the proportion of females and children attending the ED during the lockdown. The number of road traffic accedents s decreased during the lockdown. The number of patients with contusions attending the trauma center during the lockdown decreased, but there was an increase in the number of patients with spine injuries. We suggest that improvement in triage facilities, wider use of telemedicine, and increasing the stock of PPEs are essential for tackling such situations in the future.

Spatial distribution of unscheduled hospital admissions for chronic obstructive pulmonary disease in the central area of Asturias, Spain

BackgroundChronic obstructive pulmonary disease (COPD) is one of the major causes of mortality worldwide and also reports high morbidity rates and the global burden COPD has continued to rise over the last several decades. The best-known COPD risk factors are tobacco smoke and air pollution, but genetics, age, sex, and socioeconomic status are additional factors. This study aimed to assess the spatial distribution of unscheduled COPD hospital admissions of men and women in the central area of Asturias during 2016–2018 and identify trends, spatial patterns, or clusters in the area.MethodsUnscheduled COPD hospital admissions in the central area of Asturias were registered, geocoded, and grouped by census tracts (CTs), age, and sex. Standardized admission ratio, smoothed relative risk, posterior risk probability, and spatial clusters between relative risks throughout the study area were calculated and mapped.ResultsThe spatial distribution of COPD hospital admissions differed between men and women. For men, high-risk values were located primarily in the northwestern area of the study, whereas for women the cluster pattern was not as clear and high-risk CTs also reached central and southern areas. In both men and women, the north-northwest area included the majority of CTs with high-risk values.ConclusionsThe present study showed the existence of a spatial distribution pattern of unscheduled COPD hospital admissions in the central area of Asturias that was more pronounced for men than for women. This study could provide a starting point for generating knowledge about COPD epidemiology in Asturias.

Evaluating disparities by social determinants in hospital admission decisions for patients with COVID-19 quaternary hospital early in the pandemic.

The COVID-19 pandemic has highlighted significant disparities in hospital outcomes when focusing on social determinants of health. Better understanding the drivers of these disparities is not only critical for COVID-19 care but also to ensure equitable treatment more generally. In this paper, we look at how hospital admission patterns, both to the medical ward and the intensive care unit (ICU), may have differed by race, ethnicity, and social determinants of health. We conducted a retrospective chart review of all patients who presented to the Emergency Department of a large quaternary hospital between March 8 and June 3, 2020. We built logistic regression models to analyze how race, ethnicity, area deprivation index, English as a primary language, homelessness, and illicit substance use impacted the likelihood of admission while controlling for disease severity and timing of admission in relation to the start of data collection. We had 1302 recorded Emergency Department visits of patients diagnosed with SARS-CoV-2. White, Hispanic, and African American patients made up 39.2%, 37.5%, and 10.4% of the population respectively. Primary language was recorded as English for 41.2% and non-English for 30% of patients. Among the social determinants of health assessed, we found that illicit drug use significantly increased the likelihood for admission to the medical ward (odds ratio 4.4, confidence interval 1.1-17.1, P = .04), and that having a language other than English as a primary language significantly increased the likelihood of ICU admission (odds ratio 2.6, confidence interval 1.2-5.7, P = .02). Illicit drug use was associated with an increased likelihood of medical ward admission, potentially due to clinician concerns for complicated withdrawal or blood-stream infections from intravenous drug use. The increased likelihood of ICU admission associated with a primary language other than English may have been driven by communication difficulties or differences in disease severity that our model did not detect. Further work is required to better understand drivers of disparities in hospital COVID-19 care.

A comparative study to determine the impact of double lockdown on hospital visits, admissions, and patient outcomes in a tertiary care hospital

Background: Unlike COVID 19 lockdown, very little is known about the impact of non-COVID 19 lockdown and two lockdowns (post abrogation of article 370 and post COVID 19) in series on health-care delivery system. Aims and Objectives: The aim of the study was to look for the impact of two lockdowns, separately and in combination, on health-care delivery system. Materials and Methods: Data of patients visiting the pediatric outpatient department, pattern of hospital admissions and patient outcomes 1 month and 6 months before and after two lockdowns were recorded and compared within a lockdown and with each other. Results: Fall in Outpatient visits and its persistence even after 6 months was more pronounced for post COVID 19 Lockdown or lockdown 2 (–73%VS–43% and +195VS–61%). There was a statistically significant difference between admissions rates 1 month before and after lockdown 1 (post article 370 abrogation) as well as 1 month before and after lockdown 2 (P= 0.001; P&lt; 0.0001). For the same time period, admission rates were significantly different for respiratory and gastrointestinal illnesses during the two lockdowns (&lt;0.0001). Also, there was a significant difference between admissions rates 6 month before and after lockdown 1 and 6 months before and after lockdown 2 (P&lt; 0.00001; P&lt;=0.02). There was a significant difference between hospital admission rates 1 month after lockdown 1 and lockdown 2 (&lt;0.0001). There was also significant difference between clinical spectrum of admitted patients 1 month and 6 months after the two lockdowns (&lt;0.03–&lt;0.0001). Conclusion: Both Lockdowns had a significant negative impact on healthcare delivery system. However, post COVID-19 lockdown had a much stronger impact.

Healthcare utilization by children with neurological impairments and disabilities in rural Kenya: a retrospective cohort study combined with secondary analysis of audit data

Background: There is a paucity of data on healthcare utilization by children with neurological impairments (NI) in sub-Saharan Africa. We determined the rate, risk factors, causes, and outcomes of hospital admission and utilization patterns for rehabilitative care among children with NI in a defined rural area in Kenya. Methods: We designed two sub-studies to address the primary objectives. Firstly, we retrospectively observed 251 children aged 6–9 years with NI and 2162 age-matched controls to determine the rate, causes and outcomes of hospitalization in a local referral hospital. The two cohorts were identified from an epidemiological survey conducted in 2015 in a defined geographical area. Secondly, we reviewed hospital records to characterize utilization patterns for rehabilitative care. Results: Thirty-four in-patient admissions occurred in 8503 person-years of observation (PYO), yielding a crude rate of 400 admissions per 100 000 PYO (95% confidence interval (Cl): 286–560). The risk of admission was similar between cases and controls (rate ratio=0.70, 95%CI: 0.10–2.30, p = 0.31). The presence of electricity in the household was associated with reduced odds of admission (odds ratio=0.32, 95% Cl: 0.10–0.90, p &lt; 0.01). Seizures and malaria were the main causes of admission. We confirmed six (0.3%) deaths during the follow-up period. Over 93% of outpatient paediatric visits for rehabilitative care were related to cerebral palsy and intellectual developmental delay. Health education (87%), rehabilitative exercises (79%) and assistive technology (64%) were the most common interventions. Conclusions: Surprisingly, the risk of hospitalization was not different between children with NI and those without, possibly because those with severe NI who died before this follow-up were under seclusion and restraint in the community. Evidence-based and tailored rehabilitative interventions are urgently required based on the existing secondary data.

Hospitalizations at United States Children's Hospitals and Severity of Illness by Neighborhood Child Opportunity Index

To describe the association between neighborhood opportunity measured by the Child Opportunity Index 2.0 (COI) and patterns of hospital admissions and disease severity among children admitted to US pediatric hospitals. Retrospective, cross-sectional study of 773 743 encounters for children <18years of age admitted to US children's hospitals participating in the Pediatric Health Information System database 7/2020-12/2021. The proportion of children from each COI quintile was inversely related to the degree of neighborhood opportunity. The difference between the proportion of patients from Very Low COI and Very High COI ranged from +32.0% (type 2 diabetes mellitus with complications) to -14.1% (mood disorders). The most common principal diagnoses were acute bronchiolitis, respiratory failure/insufficiency, chemotherapy, and asthma. Of the 45 diagnoses which occurred in ≥0.5% of the cohort, 22, including type 2 diabetes mellitus, asthma, and sleep apnea had higher odds of occurring in lower COI tiers in multivariable analysis. Ten diagnoses, including mood disorders, neutropenia, and suicide and intentional self-inflicted injury had lower odds of occurring in the lower COI tiers. The proportion of patients needing critical care and who died increased, as neighborhood opportunity decreased. Pediatric hospital admission diagnoses and severity of illness are disproportionately distributed across the range of neighborhood opportunity, and these differences persist after adjustment for factors including race/ethnicity and payor status, suggesting that these patterns in admissions reflect disparities in neighborhood resources and differential access to care.

Seasonal Effects on Hospitalizations Due to Mood and Psychotic Disorders: A Nationwide 31-Year Register Study.

PurposeTo examine seasonal patterns of hospital admissions due to mood and psychotic disorders and to investigate whether the admission rates show variation according to the seasonal daylength (photoperiods).Patients and MethodsA retrospective nationwide register-based cohort of all psychiatric admissions (N=978,079) during 1987–2017 in Finland was utilized. The smoothed time-series of adjusted ratio of observed and expected (O/E) daily counts were estimated to examine seasonal variation. The mean O/E with 95% confidence intervals (CI) was used to study the admission rates by photoperiods. The calendar days were classified into the 71-day photoperiods based on the daylength (long/summer, short/winter, equal/spring, equal/fall) and the pace of change in daylength (slowly/rapidly increasing/decreasing daylength).ResultsManic episodes peaked in summer during the long (mean O/E=1.10, 95% CI=1.06–1.13) and slowly decreasing (1.09, 1.06–1.13) photoperiods and had a nadir in winter during the slowly increasing (0.93, 0.89–0.98) photoperiod. Admissions for unipolar depressive (UPD) episodes peaked in autumn and in spring at the end of the rapidly decreasing (1.03, 1.02–1.04) and increasing (1.03, 1.01–1.04) photoperiod, and dropped in summer during the long and slowly decreasing (0.95, 0.94–0.96) photoperiods. Bipolar depressive (BPD) and mixed episodes signaled excess admissions in autumn and in spring. Admissions for schizophrenia were higher than expected from summer to early-autumn, during the long and slowly decreasing photoperiods (1.02, 1.02–1.03), and lower than expected in other seasons, especially in mid-spring during the rapidly increasing photoperiod (0.98, 0.98–0.99).ConclusionThe study indicates the seasonality and photoperiodicity of mental disorders, especially for manic episodes. The seasonal pattern is similar between schizophrenia and manic episodes, and between UPD, BPD, and mixed episodes.

Hospital admissions of spontaneous subarachnoid hemorrhage during the COVID-19 pandemic: Southeastern Turkey experience

Objective: This study aimed to determine if the coronavirus disease 2019 (COVID-19) pandemic had any impact on admission patterns for subarachnoid hemorrhage (SAH) during 1st and 2nd waves and in-between in a tertiary institution in southeastern Turkey. Methods: Three periods were determined during the pandemic: First and second peaks (April 1-May 1, 2020 and November 18-December 18, 2020, respectively) and the slowdown period (July 5-August 4, 2020) where the daily new cases hit its lowest. We retrospectively collected data of the patients with SAH who were admitted to our institution within these periods during 2020 (the pandemic) and 2019 (the year before the pandemic). Demographic data, time between symptom onset and admission, Glasgow Coma Scale (GCS), Fisher score, World Federation of Neurosurgical Societies (WFNS), presence of intracerebral hemorrhage, intraventricular hemorrhage, hydrocephalus, type of SAH (aneurysmal vs non-aneurysmal) were recorded and compared between the pandemic and pre-pandemic periods. Results: The number of admissions in first peak, slowdown, and second peak during the pandemic was 11, 15, and 17, respectively. They did not differ significantly from corresponding periods in 2019 (17, 7, and 10, respectively) (all P&gt;0.05). The mean time from onset to admission to hospital was similar between pandemic and 2019 (ranging between 0.40-2.00 days in 2020 compared to ranging between 1.12-2.29 days in 2019). The rate of cases with worse neurological condition on admission turned out to be lower during the first peak of the pandemic compared to previous year (9.1% vs 29.4%, P=0.029), but showed no difference in the remaining two periods. The incidence of accompanying pathologies (intracerebral hemorrhage, intraventricular hemorrhage, and hydrocephalus) was also similar between the periods in 2020 and their counterparts in 2019. Rate of non-aneurysmal cases ranged between 11.1%-45.5% in 2020 compared to 10.0%-57.1% in 2019 (all P&gt;0.05). Conclusion: The study showed that hospital admission patterns for SAH was not affected by COVID-19 pandemic in the southeastern Turkey, unlike other reports. This may be due to different behavioral characteristics of the study population and capability of health care system to cope with high number of patient admissions.

COVID-19-related school closures and patterns of hospital admissions with stress-related presentations in secondary school-aged adolescents: weekly time series.

This study examines health service indicators of stress-related presentations (relating to pain, mental illness, psychosomatic symptoms and self-harm) in adolescents of secondary school age, using Hospital Episode Statistics data for England. We examined weekly time series data for three academic years spanning the time before (2018-2019) and during the COVID-19 pandemic (2019-2020 and 2020-2021), including the first lockdown when schools were closed to the majority of pupils. For all secondary school children, weekly stress presentations dropped following school closures. However, patterns of elevated stress during school terms re-established after reopening, with girls aged 11-15 showing an overall increase compared with pre-pandemic rates.