Predictive Factor For Hospitalization Research Articles

Predictive Factors of Hospitalization and Emergency Visits Among Children With Asthma.

Introduction A chronic diverse inflammatory disease, asthma affects millions of people worldwide. To control asthma, standardized care is essential. Children with asthma who receive appropriate care have lower emergency room (ER) visits and hospital stays as well as a higher quality of life than children who do not receive appropriate care. We aim to evaluate the predictive variables of hospitalization and ER visits in children with asthma. Methodology In 2022 and 2023, a cross-sectional descriptive study was carried out on children with asthma and their caregivers who were attending primary health care clinics in the eastern region of Saudi Arabia. We used the Childhood Asthma Control Test (C-ACT) to evaluate asthma control. A C-ACT score of less than 19 indicates uncontrolled childhood asthma. To investigate the relationships between the risk factors and the rate of ER visits and hospitalizations, we performed a multiple logistic descriptive analysis. Results In this study, 124 asthmatic children from primary health care centers matched the inclusion criteria. The majority of children had atopy, and their mean age was 10.8±3.4 years. Concerning the risk factors linked to ER visits and hospitalization, there is evidence that not following up with physicians, using more frequent and short-acting beta-agonists, exposure to smoke and household pets, and poor asthma control are linked to increased rates of both ER visits and hospitalizations. Conclusion Better asthma control in children and adolescents may be achieved by providing inexpensive asthma care services, more thorough parental and child education, and effective symptom management. These measures can help reduce exacerbations of asthma and the consequences that accompany them.

Positive and Negative Syndrome Scale (PANSS) predictors of hospitalization during home treatment on 1045 patients with schizophrenia in acute crisis

IntroductionSeveral factors related to the risk of requiring psychiatric hospitalization have been described in patients diagnosed with schizophrenia treated with methods other than home treatment. With regard to the symptoms, high global illness severity and positive symptoms of schizophrenia have been most frequently related to the risk of hospitalization in patients with schizophrenia. However, there are no studies describing which clinical factors increase the likelihood of being hospitalized while undergoing home follow-up.ObjectivesTo determine which of the clinical factors assessed in the PANSS predict the risk of hospitalization in patients diagnosed with schizophrenia following a home treatment program.MethodsAll patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. A comparative, bivariate analysis of each item of the PANSS and of the global results of each category was conducted on those who were hospitalized and those who were not hospitalized. Finally, a logistic regression of each category of the PANSS was done on both groups, controlling for other socio-demographic and clinical factors.ResultsA total of 1045 patients with schizophrenia were evaluated in this study. PANSS positive symptom subscale (PANSS-S), PANSS General Psychopathology, PANSS Excited Component and PANSS Global Score scored higher in patients who were finally hospitalized in a conventional acute treatment unit. Regarding the PANSS negative symptom subscale, no significant differences were found between the two groups.In patients who required hospitalization, the scores of all the PANSS positive symptom subscale (PANSS-P) items and all items on the PANSS excited component (excitement, tension, hostility, uncooperativeness and poor impulse control) were significantly higher. Some items regarding general psychopathology (Somatic concern, anxiety, guilt feelings, tension, and mannerisms) were also significantly higher in the hospitalization group. Only 3 items—blunted affect, guilt feelings and motor retardation—scored significantly higher in patients who did not require hospitalization. In the logistic regression, only the global score of the PANSS-P reached statistical significance (P = 0.001).ConclusionsPositive symptoms scored in the PANSS seem to be the most predictive factors of hospitalization regarding clinical symptoms in patients with Schizophrenia following home treatment. Other items regarding exciting symptoms and general psychopathology also showed as relevant regarding the risk of conventional hospitalization in those patients.Disclosure of InterestNone Declared

Hospitalization risk among patients with Mpox infection-a propensity score matched analysis.

Monkeypox (Mpox) is a reemerging, neglected viral disease. By May 2023, worldwide Mpox cases surpassed 87,000. Predictive factors for hospitalization with Mpox are lacking. We aim to compare clinical characteristics and outcomes in hospitalized and nonhospitalized patients with Mpox infection. A multicenter retrospective case-control cohort of patients with Mpox infection. We performed a propensity score match analysis from a global health network (TrinetX). We compare clinical characteristics and outcomes between hospitalized and nonhospitalized patients with Mpox. Of 1477 patients, 6% were hospitalized, 52% required an ED visit, and 29% received treatment at urgent care. After propensity score matching, 80 patients remained in each group. Hospitalizations were more common among Black persons (51% versus 33%, p = 0.01), people with HIV (50% versus 20%, p < 0.0001), and those with proctitis (44% versus 12.5%, p < 0.001). Independent predictive factors of hospitalization in our cohort for Mpox included people who are Black with a diagnosis of HIV, severe proctitis, pain requiring opioids, and elevated lactate dehydrogenase. Greater recognition of factors associated with increased risk of Mpox severity and hospitalization is paramount.

Predictors of Coronavirus Disease 2019 Hospitalization After Sotrovimab in Patients With Hematologic Malignancy During the BA.1 Omicron Surge.

Sotrovimab is an anti-spike neutralization monoclonal antibody developed to reduce the risk of coronavirus disease 2019 (COVID-19) progression and advancement to hospitalization in high-risk patients. Currently, there is limited research describing the association of sotrovimab treatment in patients with hematologic malignancy and the predictive factors of hospitalization. We performed an observational study of 156 consecutive cancer patients who received sotrovimab at Memorial Sloan Kettering Cancer Center in New York City during the BA.1 Omicron surge. We evaluated the demographic, clinical, and laboratory characteristics of the patients who had subsequent COVID-19-related hospitalization(s) compared to those who did not. Among the 156 study patients, 17 (11%) were hospitalized, of whom 4 were readmitted for COVID-19-related complications; 3 deaths were attributed to COVID-19. Results from multivariable logistic regression show that significant factors associated with hospitalization include patients on anti-CD20 therapy (adjusted odds ratio [aOR], 5.59 [95% confidence interval {CI}, 1.73-18.12]; P = .004) and with relapse/refractory disease (aOR, 5.69 [95% CI, 1.69-19.16]; P = .005). Additionally, whole genome sequencing of severe acute respiratory syndrome coronavirus 2 detected high occurrences of mutations in the spike gene associated with treatment-related resistance longitudinal samples from 11 patients treated with sotrovimab. While sotrovimab is effective at reducing COVID-19 hospitalization and disease severity in patients with hematologic malignancy when administered early, patients who received anti-CD20 antibodies showed substantial morbidity. Due to the high potential for resistance mutation to sotrovimab and increased morbidity in patients on anti-CD20 therapy, combination treatment should be explored to determine whether it provides added benefits compared to monotherapy.

Evaluating red blood cell distribution width from community blood tests as a predictor of hospitalization and mortality in adults with SARS-CoV-2: a cohort study

Background Red blood cell distribution width (RDW) has been assessed during COVID-19 patient hospitalization, however, further research should be done to evaluate RDW from routine community blood tests, before infection, as a risk factor for COVID-19 related hospitalization and mortality. Patients and methods RDW was measured as a predictor along with age, sex, chronic illnesses, and BMI in logistic regressions to predict hospitalization and mortality. Hospitalization and mortality odds ratios (ORs) were estimated with 95% confidence intervals (CI). RDW was evaluated separately as continuous and discrete (High RDW ≥ 14.5) variables. Results Four thousand one hundred and sixty-eight patients were included in this study, where 824 patients (19.8%) had a high RDW value ≥14.5% (High RDW: 64.7% were female, mean age 58 years [±22] vs. Normal RDW: 60.2% female, mean age 46 years [±19]). Eight hundred and twenty-nine patients had a hospitalization, where the median time between positive PCR and hospital entry was 5 [IQR 1–18] days. Models were analyzed with RDW (continuous) and adjusted for age, sex, comorbidities, and BMI suggested an OR of 1.242 [95% CI = 1.187–2.688] for hospitalization and an OR of 2.911 [95% CI = 1.928–4.395] for mortality (p < .001). RDW (discrete) with the same adjustments presented an OR of 2.232 [95% CI = 1.853–1.300] for hospitalization and an OR of 1.263 [95% CI = 1.166–1.368] for mortality (p < .001). Conclusions High RDW values obtained from community blood tests are associated with greater odds of hospitalization and mortality for patients with COVID-19. KEY MESSAGES RDW measures before SARS-CoV-2 infection is a predictive factor for hospitalization and mortality. RDW threshold of 14.5% provides high sensitivity and specificity for COVID-19 related mortality, comparatively to other blood tests. Patient records should be accessed by clinicians for prior RDW results, if available, followed by further monitoring.

Early damage as measured by SLICC/ACR damage index is a predictor of hospitalization in systemic lupus erythematosus (SLE).

Hospital admissions and re-admissions in lupus patients are common occurrences that can lead to poor prognosis. We evaluated the leading causes of all-cause hospitalizations and their predictive factors in the Malaysian multi-ethnic SLE patients. This is a retrospective study involving 300 SLE patients. Demographic data and details of hospitalizations from the year 1988 until 2019 were reviewed. Baseline and latest disease activity (SLEDAI-2 K) and SLICC/ACR damage index (SDI) scores were evaluated. To be eligible for this study, their SLE diagnosis and disease duration was at least one year; this is to ensure that the baseline disease damages were measured at least after 6 months of diagnosis and subsequent disease damage indexes were captured. Majority were of Chinese ethnicity 150 (50%). The cohort's median age was 48 (18-82) years and median disease duration was 13 (1-52) years. 133 (44.3%) had SDI score of ≥1 at baseline (early damage). 69 (23%) had developed new organ damage during this study period.There were 222 (74%) patients ever hospitalized from this cohort. The main cause of hospitalization was lupus flare which included concurrent infection (n = 415 admissions, 46%), followed by elective admissions for procedures and others (n = 284 admissions, 31.5%). Admissions for treatment and disease related complications were 13.8%. 8.7% of admissions were due to infections alone. Median length of stay for SLE-related cause admissions was longer compared to non-SLE related causes. Jointly predictive factors for hospitalization were anti-phospholipid syndrome (OR 5.82), anti-Smith (OR 6.30), anti-SSA (OR 3.37), serositis (OR 14.56), neurological (OR 5.52) and high baseline SDI (OR 1.74), all p < 0.05. Early damage in lupus as measured by SDI is a predictive value of hospitalization. Optimization in managing patients with pre-existing damage is crucial to reduce hospitalization risk and subsequent complications.

Epidemiology and the Estimated Burden of Microbial Keratitis on the Health Care System in Taiwan: A 14-Year Population-Based Study

To investigate the epidemiologic characteristics of microbial keratitis and its overall burden on the health care system in Taiwan. Retrospective, population-based study. We conducted a study using claims data in the Taiwan National Health Insurance Research Database in 2000-2013, employing diagnoses, drugs, and procedure codes to define diseases and procedures. Participants were classified into groups according to the requirement of hospitalization and surgical intervention. The main outcome measures were incidence, risk factors, predictive factors for hospitalization and surgical intervention, and health care expenditure. A total of 2,071 patients were included. The overall incidence significantly increased from 8.4 in 2000 to 20.2 per 100,000 person-years in 2013. The peak age range of incidence was between 18 and 40 years, but the peak age group for health care expenditures was those older than 65 years. A total of 704 patients (33.99%) had analyzable risk factors, of which the top 3 were diabetes mellitus (DM, 11.52%), eye trauma (10.55%), and dry eye (8.72%). Older patients, those using steroid and antiglaucoma agents, and those with ocular and systemic diseases were susceptible to further hospitalization and surgical intervention for the treatment of microbial keratitis. In Taiwan, DM, eye trauma, and dry eye were key predisposing factors for microbial keratitis. Older patients (>40 years) accounted for approximately 80% of health care expenditure for the management of infectious keratitis. Special care may be required for older patients with medication-related risk factors and ocular and systemic comorbidities because they are likely to have severe diseases leading to hospitalization and surgical interventions.

Predictive factors of hospitalization in adults with pediatric-onset SCI: a longitudinal analysis.

Longitudinal survey. To investigate the prevalence and rate of hospitalization among adults with pediatric-onset spinal cord injury (SCI) and explore medical and behavioral factors associated with hospitalization. This study included 368 adults who sustained a SCI prior to age 19 and were enrolled in an ongoing longitudinal study investigating the outcomes of pediatric-onset SCI. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized outcome measures: Satisfaction with Life Scale; Short-Form 12 Health Survey; Alcohol Use Disorders Identification Test; Patient Health Questionnaire-9 Depression Scale; and Craig Handicap Assessment and Recording Technique. Overall, 61% of participants self-reported at least one hospitalization across all time points; average length of hospitalization was 14.8 days (±23.3). Individuals who were ethnic minorities as well as those with high cervical-level SCI were more likely to be hospitalized. Those who were unemployed and those with health-care coverage were more likely to be hospitalized and have longer hospitalization stays. The risk of hospitalization was higher with occurrence of pressure ulcers, urinary tract infections, pneumonia, pain and a chronic medical condition. Smoking cigarettes increased the risk of hospitalization, whereas those who engaged in exercise and were active in the community had lower odds of hospitalization. Both medical and lifestyle factors have an important role in predicting hospitalization. An increased understanding of the risk and protective factors associated with hospitalization should assist clinicians in developing strategies and prevention efforts to minimize secondary health complications and foster healthy lifestyle behaviors.

Predicting the severity of acute bronchiolitis in infants: Should we use a clinical score or a biomarker?

Krebs von den Lungen 6 antigen (KL‐6) has been shown to be a useful biomarker of the severity of Respiratory syncytial virus bronchiolitis. To assess the correlation between the clinical severity of acute bronchiolitis, serum KL‐6, and the causative viruses, 222 infants with acute bronchiolitis presenting at the Pediatric Emergency Department of Estaing University Hospital, Clermont‐Ferrand, France, were prospectively enrolled from October 2011 to May 2012. Disease severity was assessed with a score calculated from oxygen saturation, respiratory rate, and respiratory effort. A nasopharyngeal aspirate was collected to screen for a panel of 20 respiratory viruses. Serum was assessed and compared with a control group of 38 bronchiolitis‐free infants. No significant difference in KL‐6 levels was found between the children with bronchiolitis (mean 231 IU/mL ± 106) and those without (230 IU/mL ± 102), or between children who were hospitalized or not, or between the types of virus. No correlation was found between serum KL‐6 levels and the disease severity score. The absence of Human Rhinovirus was a predictive factor for hospitalization (OR 3.4 [1.4–7.9]; P = 0.006). Older age and a higher oxygen saturation were protective factors (OR 0.65[0.55–0.77]; P < 0.0001 and OR 0.67 [0.54–0.85] P < 0.001, respectively). These results suggest that in infants presenting with bronchiolitis for the first time, clinical outcome depends more on the adaptive capacities of the host than on epithelial dysfunction intensity. Many of the features of bronchiolitis are affected by underlying disease and by treatment. J. Med. Virol. 86:1944–1952, 2014. © 2013 Wiley Periodicals, Inc.

Predictive Factors of Hospitalization in Children With Acute Asthma at a University Emergency Care Unit

This study analyzed the factors that predicted the hospitalization of children with asthma following standardized treatment in emergency care unit (ECU). This retrospective study examined data collected from the clinical records of children, 14 years or younger, who were diagnosed with asthma (often with bronchopneumonia, pneumonia, or other illnesses) and treated at the ECU of Santo André from January 2005 to December 2009. The following data were analyzed: month and year of care, child's age and sex, period of observation, and need for hospitalization. A pediatrician confirmed the clinical diagnoses of all participants. The children were first given clinical treatments and were then admitted to ECU for follow-up assessment. The number of hospital admissions was analyzed, and correlations were found with regard to this variable and child age (χ(2) = 166.9; P = 0.00001), the presence of associated illnesses (χ(2) = 63.8; P < 0.00001), and the observation period length (χ(2) = 11.4; P = 0.009). The number of hospital admissions was not correlated with child sex (χ(2) = 0.013; P = 0.9) or time of year (χ(2) = 15.8; P = 0.1). The 3-day observation period was not significant (P = 0.4) with regard to the remainder of the variables in the multiple logistic regression analysis. Age, mainly children younger than 1 year, the presence of associated illnesses, and the observation period length predicted the hospitalization of children with asthma following treatment in ECU. Sex and seasonality did not affect the need for hospitalization.

Can we consider day-case laparoscopic cholecystectomy for acute calculous cholecystitis? Identification of potentially eligible patients

BackgroundDay-case laparoscopic cholecystectomy has not yet been validated for acute cholecystitis. We sought to identify a subgroup of acute cholecystitis patients having been hospitalized overnight after laparoscopic cholecystectomy but who could have been eligible for day-case surgery. MethodsWe identified patients treated for acute cholecystitis with laparoscopic cholecystectomy in our university medical center between May 1, 2010, and May 31, 2012, and who lacked contraindications for day-case surgery. In a second step, we assumed that patients hospitalized for <3 d would have been eligible for day-case surgery. We then compared patients hospitalized for ≤3 d with those hospitalized for >3 d in terms of demographic data, laboratory test results, and surgical procedures. ResultsThe study population comprised 86 men and 82 women (median age: 57 y; age range: 18–90 y). Contraindications for day-case surgery were identified preoperatively in 23% of the cases (39 of 168) and intraoperatively in another 23% of the cases. The proportion of patients hospitalized for <3 d was 41% (69 of 168) when considering the intention-to-treat population and 57% (51 of 90) when considering patients with no contraindications to day-case surgery. Forty percent of the patients hospitalized for ≥3 d (16 of 39) suffered from postoperative pain that was poorly controlled by oral analgesics. Abdominal drainage was the only predictive factor for hospitalization <3 d (odds ratio [95% confidence interval] = 0.13 [0.02–0.71]; P = 0.01). ConclusionsDay-case laparoscopic may be feasible in selected patients with mild or moderate acute calculous cholecystitis. Our present results may be of use in designing a study of day-case surgery for acute calculous cholecystitis and related changes in the management of these patients.

Predicting Hospitalization in Children with Acute Asthma

BackgroundAcute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. ObjectiveTo identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. MethodsThe study population was composed of children aged 5–18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1st and 4th hours. ResultsOf the 304 patients (median age: 8.0 years [interquartile range: 6.5–9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1st hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1st hour (κ = 0.577). ConclusionAttack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1st hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice.

Predictive Factors for Hospitalization After Outpatient Reduced-Intensity Conditioning (RIC) Allogeneic Hematopoietic Progenitor Cell Transplantation (AHPCT)

Predictive Factors for Hospitalization After Outpatient Reduced-Intensity Conditioning (RIC) Allogeneic Hematopoietic Progenitor Cell Transplantation (AHPCT)