Post-hospital Data Research Articles

Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic: Challenges and lessons learned

PurposeThe purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. MethodsAn observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into 3 groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. ResultsAltogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% – 100%, 22% – 100% and 29% – 100% for groups 1 – 3. ConclusionsTo improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.

Abstract 214: A Counterfactual Machine Learning Model Study To Estimate The Impact Of Coronary Angiography For Out Of Hospital Cardiac Arrest

Background: The American Heart Association guidelines for resuscitation 2020 recommends emergency coronary angiography (CAG) in cases of out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC) with ST-segment elevation(STE) and, it is unclear how much CAG actually contributes to improved outcomes in various OHCA patient populations. The aim of this study is to estimate the impact of CAG on OHCA using a counterfactual machine learning model. Methods: We analyzed adult non-traumatic OHCA patients (43,977 cases) from June 2014 to December 2019 from the JAAM (Japan Association for Acute Medicine)-OHCA registry, which includes post-hospitalization data from 140 Japanese hospitals. We defined outcomes as favorable neurological outcomes (Cerebral Performance Categories (CPC) 1-2) and survival at 30 and 90 days. We estimated the outcome assuming that all patients had received CAG using a machine learning and counterfactual hypothetical model, and also estimated the outcome assuming that all patients had not received CAG. An average of each individual difference between the two estimations was calculated as average treatment effect (ATE) (%), which represents the effect of CAG on improving outcomes for the population. In addition, subgroup analysis was performed based on ROSC, STE and initial documented rhythm. Results: The ATE(%, 95% confidence interval) of CAG in all OHCA patients for CPC 1-2 at 30 and 90 days was 3.11% (2.92-3.30) and 1.85% (1.74-1.95), and survival at 30 and 90 days was 6.25%(5.93-6.57) and 2.20%(1.88-2.52), respectively. The subgroup analysis of ATE for CPC 1-2 at 90 days was particularly lower in the no STE group, initial pulseless electrical activity (PEA) group and initial asystole group than in the STE group and initial ventricular fibrillation(VF) group (Figure). Conclusions: In the JAAM-OHCA registry, we used a counterfactual machine learning model to estimate the effect of CAG on OHCA.

O36: DEVELOPING A TRAUMA REGISTRY IN A MIDDLE INCOME COUNTRY – BOTSWANA

Abstract Background Botswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals. Methods A cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 mainly involved stakeholder consultations on existing data collection tools. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype. Results The pre-hospital road traffic accident data is collected using hard copy forms and some of this data is transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data is also partially stored as hard copies and some data is stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals. Conclusion Electronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools. Keywords Trauma registry, Injury registry, Road Traffic Accident Trauma Registry, Road Traffic Crushes Registry, Road Accident Registry. SYSTEMATIC REVIEWS

Contemporary Status of Acute Myocardial Infarction in Korean Patients: Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers.

Background: This study aimed to present the development process and characteristics of the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC). Methods: We developed KRAMI-RCC, a web-based registry for patients with AMI. Patients from 14 RCCs were registered for more than three years from July 2016. It includes an automatic error-checking system, and user training and on-site monitoring are performed to manage data quality. Results: A total of 11,700 AMI patients were registered in KRAMI-RCC over three years (73.9% men). The proportions of patients with ST-elevation and non-ST-elevation myocardial infarction at discharge were 43.4% and 56.6%, respectively. Of the total three-year patients, 5.6% died in the hospital, and 4.4% died 12 months after discharge. The case fatality within 12 months was 9.7%. Pre-hospital care data showed delayed arrival time after onset of symptoms (median 153 min) and low transportation rate by public ambulance (25.2%). Post-hospital care data showed lower participation rate in the second rehabilitation program (16.8%). Conclusions: The recently developed KRAMI-RCC registry has been more focused on pre-hospital and post-hospital data, which will be helpful in understanding the current state of AMI disease management and in making policy decisions to reduce case fatality in Korea.

Clinical features and outcomes of discharged coronavirus disease 2019 patients: a prospective cohort study.

BackgroundCOVID-19 is a global pandemic but the follow-up data of discharged patients was barely described.AimsTo investigate clinical outcomes, distribution of quarantine locations, and the infection status of the contacts of COVID-19 patients after discharge.DesignA prospective cohort studyMethodsDemographics, baseline characteristics of 131 COVID-19 patients discharged from February 3 to 21, 2020 in Wuhan, China were collected and analyzed by reviewing the medical records retrospectively. Post-hospitalization data related to clinical outcomes, quarantine locations and close contact history were obtained by following up the patients every week up to 4 weeks.Results53 (40.05%) patients on discharge had cough (29.01%), fatigue (7.63%), expectoration (6.11%), chest tightness (6.11%), dyspnea (3.82%), chest pain (3.05%), and palpitation (1.53%). These symptoms constantly declined in 4 weeks post discharge. Transient fever recurred in 11 (8.4%) patients. 78 (59.5%) discharged patients underwent chest CT and 2 (1.53%) showed deterioration. 94 (71.8%) patients received SARS-CoV-2 retest and 8 (6.10%) reported positive. 7 (2.29%) patients were re-admitted because of fever or positive SARS-CoV-2 retest. 121 (92.37%) and 4 (3.05%) patients were self-quarantined at home or community spots following discharge, with totally 167 closely contacted persons free of COVID-19 at the endpoint of study.ConclusionsThe majority of COVID-19 patients after discharge were in the course of recovery. Readmission was required in rare cases due to suspected recurrence of COVID-19. Although no contacted infection observed, appropriate self-quarantine and regular reexamination are necessary, particularly for those who have recurred symptoms.

Developing a trauma registry in a middle-income country - Botswana.

BackgroundBotswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals.MethodsA cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 – stakeholders' consultation and trauma registry prototype was designed. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype.ResultsThe pre-hospital road traffic accident data are collected using hard copy forms and some of these data were transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data were also partially stored as hard copies and some data are stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals.ConclusionElectronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools.

1085 The Use of the Molecular Adsorbent Recirculating System (MARS) in Treatment of Cholestatic Drug Induced Liver Injury

INTRODUCTION: Cholestatic drug induced liver injury (DILI) is a subtype of DILI defined by elevated alkaline phosphatase (ALP) or bilirubin levels from exposure to a drug causing cholestasis. It is a challenging diagnosis with limited treatment options. The molecular adsorbent recirculating system (MARS) allows for hemofiltration of albumin-bound substances that can improve cholestatic hepatitis, pruritus, and hepatic encephalopathy (HE). Here we report six cases of acute cholestatic DILI treated with MARS. METHODS: Patients with cholestatic DILI who underwent MARS were identified at a single institution. Pre-MARS, post-MARS and post hospitalization data on ALP, bilirubin, INR and HE were collected. Completion of MARS therapy was defined as continuous therapy for three to five days. RESULTS: Six cases were identified, one of which progressed to acute liver failure (ALF). Hepatotoxic medications included acetaminophen, phentermine, methimazole, OxyElite and two cases of the anabolic steroid Methyl-1-etiocholenololepietiocholanolone. Mean total bilirubin prior to MARS was 34.5 mg/dl. Over the course of therapy, patients had significant improvement with an average bilirubin of 13.4 mg/dl at completion of MARS and 2.4 mg/dl at follow up. Coagulopathy was seen in the case of ALF from acetaminophen with pre-MARS INR of 1.9 and post-MARS INR of 1.7. This patient also had grade 4 HE prior to MARS with improvement to grade 0 post-MARS. ALP levels were not abnormal and did not change. Clinical improvement in pruritis and jaundice was seen in all cases. CONCLUSION: This case series highlights six patients with cholestatic DILI who had significant improvement in bilirubin, pruritis and jaundice with MARS. This improvement in cholestasis was thought to be due to filtration of bilirubin. Removal of bilirubin also improved jaundice. In conjunction with medical therapy and withdrawal of the offending agent, there was sustained improvement in bilirubin that continued even on outpatient follow up. There was also improvement in pruritis that was refractory to maximal medical therapy. It is unclear which substance is the principal pruritogen associated with cholestasis. However, MARS provided significant symptomatic relief that persisted. In the one case of cholestatic DILI causing acute liver failure, MARS resulted in resolution of HE and served as a bridge to spontaneous hepatic recovery. Our case series shows that MARS is a viable option in treating acute cholestatic liver injury refractory to medical therapy.

Abstract TP302: Life After Thrombectomy

Background: Multiple randomized clinical trials have shown the benefits of thrombectomy in the treatment of acute stroke after 90 days; a recent study showed extended benefit in the functional outcomes of the original cohort of randomized patients. However, data on real-world experience on long-term outcomes, including recurrent vascular events and risk factor controls, is lacking. Aim: To study long-term clinical outcomes, risk factor modification, medication compliance, and recurrent events in patients undergoing thrombectomy in a community-based setting. Methods: Retrospective data was collected on 143 cases performed between 2013 and 2017 in a non-academic medical center. Long-term follow-up was performed by reviewing hospital and clinic records of available patients. Results: At the time of discharge, 79% of the 143 thrombectomy patients survived, 11% had died, and 10% went to hospice. Post-hospitalization data, ranging from 30-days to 3 years, was available in 83 patients. A majority of the survivors (81%) were living with family at home. Within that time frame, cardiovascular events occurred in 39% of patients, with 5 deaths (6%). Only 7% (6/83) of patients had a recurrent stroke; most of them were lacunar. Two patients had repeat thrombectomies, and one was treated with IV tpa. Seventy-nine percent (66/83) continued to be on anti-platelet agents. A surprising number (34/83) of long-term survivors continued to smoke and drink heavily (20/83). Only 78% of patients had regular medical care. Twenty-percent of survivors were depressed and 20% were demented. Conclusions: Although thrombectomy helps reduce disability and benefits stroke survival, there is a high incidence of cardiovascular and cerebrovascular events afterwards, due to poor control of risk factors, inadequate medical follow-up, and lack of lifestyle changes. Thrombectomy is a costly procedure; to be cost-effective in the long-term, it is imperative that the survivors are not left without proper medical surveillance and secondary prevention strategies.

Predictors of psychosocial outcomes for patients with mood disorders: the effects of self-help group participation.

This study examined the predictors of psychosocial outcomes (daily functioning and management of illness) for people with mood disorders. After controlling for demographic, severity of illness, and social support predictor variables, the study evaluated whether participation in self-help groups would predict improved psychosocial outcomes. Post-hospitalization data were examined for 144 mood disorder patients using hierarchic multiple regression. More education predicted improved daily functioning; self-help involvement and education predicted management of illness. The implications of these findings for providing recovery-oriented rehabilitation services are discussed.

The evolving clinical status of patients after a myocardial infarction: The importance of post-hospital data for mortality prediction

Studies predicting mortality after myocardial infarction (MI) usually rely on in-hospital data, and combine patients admitted for the first MI with recurrent MI patients. Since treatment decisions are often made or modified at the first outpatient clinic visit, this study was designed to evaluate the importance of post-hospital data on mortality prediction after a first myocardial infarction (MI). An inception cohort of patients enrolled in the Beta-Blocker in Heart Attack Trial ( n = 2830) was included. Forty-three variables (including in-hospital and post-hospital data) were evaluated using stepwise logistic regression. Ten variables were independently associated with 1-year mortality: five used in-hospital data (history of hypertension, hypercholesterolemia, congestive heart failure [CHF], ventricular tachycardia, and age); and five variables depended on post-hospital data collected at the first outpatient visit (CHF after discharge, New York Heart Association functional class, heart rate, pulmonary rales, and smoking). Two predictive systems were developed that partitioned patients into one of four classes with distinct mortality risks: a composite system using the 10 in- and post-hospital variables, and a system using only the 5 in-hospital variables. Mortality risk for the composite system classes ranged from 0.6 to 20.0% (I [ n = 861], 0.6%; II [ n = 1151], 2.3%; III [ n = 698], 4.3%; IV [ n = 120], 20.0%). In contrast, the range of mortality risk using the in-hospital data only system was less (1 to 8.3%). Most importantly, a distinct gradient within each class of the in-hospital data only system was created by the addition of the post-hospital data. This study demonstrates that risk stratification after an acute first MI is improved by the addition of post-hospital data.