Rate Of Serious Outcomes Research Articles

Characterization of pediatric beta-adrenergic antagonist ingestions reported to the National Poison Data System from 2000-2020.

When ingested by children, small quantities of beta-adrenergic antagonists (BAA) are described as dangerous, and even potentially lethal ("one pill can kill"). We characterize demographics, clinical characteristics, and the rate of serious outcomes amongst pediatric patients with reported BAA ingestions. Retrospective review of United States patients < 20-years-old with reported single-agent BAA ingestions presenting to a healthcare facility between January 2000 and February 2020 for whom a poison control center (PCC) was consulted. Data was abstracted from the National Poison Data System (NPDS). Medical outcomes were assessed by the NPDS scale of no effect, minor effect, moderate effect, major effect, and death. All relevant NPDS fatality narratives were reviewed. 35,436 reported exposures were identified. 29,155 (82.3%) were < 6-years-old, of which 29,089 (99.8%) were unintentional. 25 patients (< 0.1%) < 6-years-old had major effects. 2,316 (8.8%) of patients with no/mild effects were admitted to a critical care unit. Of all cases, 1,460 (4.1%) had hypotension and 1,403 (4.0%) had bradycardia. 119 (0.3%) developed hypoglycemia. The only four fatalities resulted from intentional ingestions in patients > 10-years-old who sustained cardiac arrest in the pre-hospital setting. Reported BAA ingestions in this multi-year national pediatric cohort caused infrequent toxicity, and no fatalities resulted from an unintentional ingestion. The frequency of bradycardia, hypotension, and hypoglycemia were low. While severely poisoned patients require aggressive treatment, 8.8% of patients were admitted to a critical care unit despite having no or mild effects, which suggests an opportunity to reduce resource utilization.

Clinical characteristics and factors for serious outcomes among outpatients infected with the Omicron subvariant BF.7.

To evaluate clinical characteristics and identify risk factors associated with severe outcomes in outpatients infected with the Omicron subvariant BF.7,data werecollected from outpatients diagnosed with Corona Virus Disease 2019 from December 19, 2022 to January 5, 2023. Clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with serious outcomes. Variables with a p < 0.10 in the univariate analysis were included in the multivariate model.Our study analyzed 770 patients, of whom 380 (49.4%) were male, with a median age of 59. The most common symptoms reported were cough (71.2%), fever (64.7%), and sore throat (37.7%). Fever lasted an average of 5.93 ± 3.37 days for the general population and 10.64 ± 7.12 days for impaired-immunity patients. Most cases were mild (68.7%), followed by moderate (27.1%). Severe cases accounted for 2.2%, with 0.5% critically ill. Serious outcomes occurred in 4.2% of cases, with 11 deaths during follow-up. Underlying-diseases patients had a higher rate of serious outcomes. Factors associated with serious outcomes included receiving a three-dose vaccination (odds ratio [OR] = 0.324, 95% confidence interval [CI]: 0.113-0.932, p = 0.037), male gender (OR = 2.890, 95%CI: 1.107-7.548, p = 0.030), age (OR = 1.060, 95%CI: 1.024-1.097, p = 0.001), and chest tightness or dyspnea at the time of visit (OR = 4.861, 95%CI: 2.054-11.507, p < 0.001).Our study found that cough, fever, and sore throat were the most common symptoms reported by patients. Receiving a three-dose vaccination was protective, while male gender, age, and chest tightness or dyspnea were identified as risk factors for serious outcomes.

Benefits of a Single Dose of Betamethasone in Imminent Preterm Labour.

Background: A complete course of prenatal corticosteroids reduces the possibility of morbimortality and neonatal respiratory distress syndrome (RDS). Occasionally, it is not possible to initiate or complete the maturation regimen, and the preterm neonate is born in a non-tertiary hospital. This study aimed to assess the effects of a single dose of betamethasone within 3 h before delivery on serious outcomes (mortality and serious sequelae) and RDS in preterm neonates born in tertiary vs. non-tertiary hospitals. Materials and methods: Preterm neonates who were <35 weeks and ≤1500 g, treated during a period of five years in a level IIIC NICU, were included in this retrospective cohort study. Participants were divided into groups as follows: NM, non-matured; PM, partial maturation (one dose of betamethasone up to 3 h antepartum). They were further divided based on their place of birth (NICU-IIIC vs. non-tertiary hospitals). The morbimortality rates and the severity of neonatal RDS were evaluated. Results: A total of 76 preterm neonates were included. A decrease in serious outcomes was found in the PM group in comparison to the NM group (OR = 0.2; 95%CI (0.07–0.9)), as well as reduced need for mechanical ventilation (54% vs. 68%). The mean time between maternal admission and birth was similar in both cohorts. The mean time from the administration of betamethasone to delivery was 1 h in the PM cohort. With regard to births in NICU-IIIC, the PM group performed better in terms of serious outcomes (32% vs. 45%) and the duration of mechanical ventilation (117.75 vs. 132.18 h) compared to the NM group. In neonates born in non-tertiary hospitals with PM in comparison to the NM group, a trend towards a reduced serious outcome (28.5% vs. 62.2%) and a decreased need for mechanical ventilation (OR = 0.09; 95%CI (0.01–0.8)) and maximum FiO2 (p = 0.01) was observed. Conclusions: A single dose of betamethasone up to 3 h antepartum may reduce the rate of serious outcomes and the severity of neonatal RDS, especially in non-tertiary hospitals.

Validation of the Canadian syncope risk score in a large prospective international multicenter study

Abstract Background Management and risk stratification of patients with syncope in the emergency department (ED) is often challenging. In an effort to support ED physicians in disposition decisions, the Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes. Methods The CSRS was developed in a Canadian multicenter study and contains nine predictors: predisposition to vasovagal syncope, heart disease, systolic pressure &amp;lt;90 or &amp;gt;180mmHg in the ED, troponin level &amp;gt;99th percentile, abnormal QRS axis, QRS duration &amp;gt;130ms, QTc interval &amp;gt;480ms and an ED diagnosis of vasovagal or cardiac syncope. Patients can achieve a CSRS score between −3 and +11 points. We validated the CSRS in a large prospective international multicenter study recruiting patients 40 years or older presenting to the ED with a syncopal event within the last 12 hours. Recruitment centers contained smaller provincial hospitals, as well as big University Hospitals in eight countries on three continents. Primary outcome measure were 30-day serious arrhythmic and non-arrhythmic adverse events, as defined by the authors of the original score. Results 1581 patients were eligible for this analysis. The population in this validation cohort was older (mean age 68 vs 54 years) and had a considerably higher rate of serious outcomes compared to the derivation cohort (n=186 (11.8%) vs n=147 (3.6%)). The area under the receiver operating characteristic curve (AUC) for the CSRS was 0.88 (95% confidence interval (CI) 0.86–0.91) and significantly higher compared to the validated OESIL score (AUC 0.75, 95% CI 0.71–0.78, p&amp;lt;0.001). Calibration curve analysis showed an underestimation of risk in patients with a low CSRS and an overestimation in patients with a high CSRS. The rate of observed serious outcomes within 30d increased from 0.8% in the very low risk group (CSRS equal to or below −2) to 48% in the (very) high risk group (CSRS equal to or above 4, Hazard ratio 79.4, 95% CI 11.1–570.9). A Kaplan-Meier plot was used to visualize rates of serious outcomes in three different risk groups (Figure). Conclusion This is the first validation of the Canadian Syncope Risk Score in a large international syncope cohort. The prognostic discrimination of the CSRS for 30-day serious outcomes was very good in our validation cohort and comparable to that of the Canadian derivation study. Despite suboptimal calibration, prognostic analysis showed a high rate of serious outcomes in the CSRS (very) high risk group and a low rate of serious outcomes in the very low risk group. Allowing the clinical judgement of the ED physician in the form of suspected syncope etiology to be a part of the score seems to largely contribute to the high performance of the CSRS. Additional validation studies might be needed to further increase the accuracy of the CSRS in different patient populations with a different incidence of outcomes in settings outside of Canada. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation; Swiss Heart Foundation

Flattening the curve in 52 days: characterisation of the COVID-19 pandemic in the Principality of Liechtenstein - an observational study.

The principality of Liechtenstein had its first COVID-19 case at the beginning of March 2020. After exponential growth, the pandemic&rsquo;s first wave was contained, with the last case being diagnosed 52 days after the initial occurrence. To characterise the COVID-19 pandemic in Liechtenstein. All patients diagnosed in Liechtenstein were followed up until recovery and again 6&ndash;8 weeks after symptom onset. They were contacted every 2 days to record their clinical status until the resolution of their symptoms. The diagnosis of COVID-19 was based on clinical symptoms and molecular testing. Household and close workplace contacts were included in the follow-up, which also comprised antibody testing. In addition, public health measures installed during the pandemic in Liechtenstein are summarised. During the first wave, 5% of the population obtained a reverse transcriptase polymerase chain reaction test. A total of 95 patients (median age 39 years) were diagnosed with COVID-19 (82 who resided in Liechtenstein), resulting in an incidence in Liechtenstein of 0.211%. One patient, aged 94, died (mortality rate 1%). Only 62% of patients could retrospectively identify a potential source of infection. Testing the patients&rsquo; household and close workplace contacts (n = 170) with antibody tests revealed that 25% of those tested were additional COVID-19 cases, a quarter of whom were asymptomatic. Those households which adhered to strict isolation measures had a significantly lower rate of affected household members than those who didn&rsquo;t follow such measures. The national public health measures never restricted free movement of residents. Masks were only mandatory in healthcare settings. The use of home working for the general workforce was promoted. Gatherings were prohibited. Schools, universities, certain public spaces (like sports facilities and playgrounds), childcare facilities, nonessential shops, restaurants and bars were closed. Social distancing, hygienic measures, solidarity and supporting individuals who were at risk were the main pillars of the public health campaigns. The close collaboration of all relevant stakeholders allowed for the complete workup of all COVID-19 patients nationwide. A multitude of factors (e.g., young age of the patients, low-threshold access to testing, close monitoring of cases, high alertness and adherence to public health measures by the population) led to the early containment of the first wave of the pandemic, with a very low rate of serious outcomes. Antibody testing for SARS-CoV-2 revealed a substantial proportion of undiagnosed COVID-19 cases among close contacts of the patients.

Laxative Use Does Not Preclude Diagnosis or Reduce Disease Severity in Clostridiodes difficile Infection.

To optimize utility of laboratory testing for Clostridiodes difficile infection (CDI), the 2017 Infectious Diseases Society of America-Society for Healthcare Epidemiology of America (IDSA-SHEA) clinical practice guidelines recommend excluding patients from stool testing for C. difficile if they have received laxatives within the preceding 48 hours. Sparse data support this recommendation. Patients with new-onset diarrhea (≥3 bowel movements in any 24-hour period in the 48 hours before stool collection) and a positive stool C. difficile nucleic acid amplification test were enrolled. Laxative use within 48 hours before stool testing, severity of illness (defined by 4 distinct scoring methods), and clinical outcomes were recorded. 209 patients with CDI were studied, 65 of whom had received laxatives. There were no significant differences in the proportion of patients meeting severe CDI criteria by 4 severity scoring methods in patients receiving versus not receiving laxatives (66.2% vs 56.3%, respectively; P = .224) by IDSA-SHEA, the primary scoring system. Similar rates of serious outcomes attributable to CDI, including death, intensive care unit admission, and colectomy, were observed in the laxative and no laxative groups. Our study found similar rates of severe CDI and serious CDI-attributable clinical outcomes in CDI-diagnosed patients who did or did not receive laxatives. Precluding recent laxative users from CDI testing, as proposed by the IDSA-SHEA guideline, carries a potential for harm due to delayed diagnosis and treatment.

109 Clinical Benefit of Hospitalization for Older Adults With Syncope

We sought to compare the clinical outcomes associated with hospital admission versus outpatient management for older adults with syncope and an unremarkable emergency department (ED) evaluation. We conducted a multicenter, prospective, observational study of older adults (age 60 and over) with syncope for whom no clear diagnosis was made in the ED. Demographic clinical, and laboratory variables were collected on all patients. Patients with a serious diagnosis found in the ED were excluded. All patients regardless of disposition were followed out to 30 days for occurrence of a serious adverse event (eg, cardiac arrhythmia, myocardial infarction). The rate of serious outcomes for admitted and discharged cohorts were compared using propensity score matching. We enrolled 2,493 older adults with syncope and no clear ED diagnosis from 2013 to 2016. Mean age was 73 years (SD: 8.9 years), 51% were female. Overall, the incidence of serious outcomes at 30 days was 6.3% (95% CI 5.3-7.2%). The incidence of serious outcomes was 7.3% (95% CI 6.2-8.5%) for admitted patients and 3.0% (95% CI 1.7-4.4%) for discharged patients representing an unadjusted difference of 4.3% (95% CI 2.5-6.1%). After propensity score matching, there was no significant difference in 30-day serious outcomes after the index ED visit between the 2 groups (Risk difference=1.9%, 95% CI: -0.3 - 4.1%). There were no measurable differences in clinical variables after matching between the 2 groups. In our large sample of older adults with syncope and no clear ED diagnosis, hospital admission for diagnostic reasons was not associated with improvement in clinical outcomes at 30 days.

Epidemiology and Clinical Outcomes of Respiratory Viral Infections at a Single Tertiary Centre in Alberta, Canada

BackgroundRespiratory viral infections (RVI) are commonly seen in hospitalized patients. While many studies have examined outcomes with influenza, fewer studies have examined outcomes of community and hospital acquired infections of other respiratory viruses.MethodsData were prospectively collected from adult (age>17 years) inpatients with a positive result from respiratory viral multiplex panel testing during consecutive viral respiratory seasons from November 2014 to April 2017 at our facility. Ambulatory patients were excluded. Clinical outcomes including ICU admission requiring intubation, overall mortality and respiratory virus infection-related mortality was assessed at 30 days post infection.ResultsA total of 731 inpatients with positive results were identified. Influenza A was the most commonly detected virus (44%) followed by respiratory syncytial virus (RSV)(14%) and rhinovirus/enterovirus (13%). Rates of RSV and human metapneumovirus infections displayed significant yearly variability. There were no significant differences in rates of ICU admission requiring intubation (16.8% vs. 14.3% P = 0.35) between infections caused by influenza A and B and other respiratory viruses. In addition, mortality related to respiratory infections between these groups was also similar (5.7% Influenza vs. 4.5% non-Influenza P = 0.46). Ninety-five (15%) of identified patients had hospital acquired respiratory viral infections. Influenza A was the most commonly isolated hospital acquired infection (39%). Rates of ICU admission requiring intubation (22.6% vs. 14.6%, P = 0.06) and respiratory infection-related mortality (7.4% vs. 4.8%, P = 0.14) were higher in hospital acquired RVI but did not meet statistical significance. Less than half (45%) of all patients testing positive for influenza received antiviral treatment (oseltamivir). Respiratory infection-related mortality was not significantly different between those who were treated and those who were not treated (5.5% vs. 4.4%, P = 0.64).ConclusionWhile influenza remains the most common community and hospital acquired respiratory viral infection in inpatients at our facility, half of infections were attributed to other respiratory viruses and these resulted in similar rates of serious outcomes including ICU admission and mortality.Disclosures All authors: No reported disclosures.

Comparison on the long-term outcomes post percutaneous coronary intervention or coronary artery bypass grafting for bifurcation lesions in unprotected left main coronary artery

Objective: To compare the long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention(PCI) with drug-eluting stents (DES) for bifurcation lesions in unprotected left main coronary artery (ULMCA). Methods: A total of 663 consecutively patients with unprotected left main bifurcation disease (defined as stenosis≥50%) who received either drug-eluting stents (DES) implantation (n=316) or underwent CABG (n=347) between January 2003 and July 2009 in Beijing Anzhen Hospital were enrolled retrospectively in this study.The endpoints of the study were death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization). To reduce the bias between two compared groups , our study applid propensity score matching by logistic regression.Cumulative survival rate was calculated by Kaplan-Meier method.Multiple regression analyses, hazard ratio(HR) and 95%CI were tested by Cox proportional hazard models with the CABG group as the reference category. Results: The median follow-up was 7.2 years (interquartile range 5.1 to 8.3 years) in the overall patients.Unadjusted analysis showed that MACCE rate (PCI 44.5% vs. CABG 45.7%, P=0.036), the rate of repeat revascularization (PCI 33.7% vs. CABG 19.5%, P<0.001), the composite rate of serious outcomes (cardiac death, MI or stroke) (PCI 20.4% vs. CABG 34.3%, P=0.032), stroke rate (PCI 3.7% vs. CABG 23.5%, P<0.001) were significantly different for patients undergoing PCI or CABG. Death rate (PCI 13.0% vs. CABG 18.9%, P=0.12) and MI rate (PCI 11.3% vs. CABG 6.1%, P=0.108) were similar between PCI and CABG group.After adjusting covariates with multivariate Cox hazard regression model, there was no significant difference in rates of death (P=0.286), MI(P=0.165) and the composite rate of serious outcomes (cardiac death, MI or stroke) (P=0.305) between the two groups. Patients in PCI group suffered significant higher rates of MACCE(P=0.011), mainly driven by the significant higher rates of repeat revascularization(HR=2.46, 95%CI 1.662-3.642, P<0.001). However, stroke rate was still significantly higher in CABG group than in PCI group(P=0.001)after multivariate adjusting. After propensity score matching (PSM), there was no more significant difference for all covariates in the matched cohorts (202 pairs). Further PSM analysis showed that overall findings were consistent with multivariate Cox hazard regression model except for MI (PCI 12.7% vs. CABG 3.8%, P=0.039). Conclusions: During a follow-up up to 8.3 years, the survival rate is similar between the PCI and the CABG group in patients with unprotected left main bifurcation disease.The rate of repeat revascularization is significantly higher whereas stroke rate is significantly lower in the PCI group compared to CABG group.After propensity score matching, PCI group not only had a significant higher rate of repeat revascularization, but also had significantly higher risk of MI in the matched cohorts; while they did not seem to translate into any disparity of mortality in ULMCA bifurcation disease patients.Accordingly, PCI for ULMCA disease can be used as a reasonable treatment option alternative to CABG.

Positive association between serious psychiatric outcomes and complications of diabetes mellitus in patients with depressive disorders.

Depression and diabetes are closely biologically and behaviorally intertwined. We examined the impact of comorbid diabetes mellitus on the incidence of serious psychiatric outcomes among patients with depression. We used claims data from the Korean Health Insurance Review & Assessment Service database of patients who were diagnosed with depression within one year of an index prescription for antidepressants between January 2007 and June 2008. We investigated the association between the comorbidity of diabetes mellitus and serious psychiatric outcomes of depression, such as psychiatric hospitalization, psychiatric emergency room visits, and suicide attempts. Among 200,936 patients with depression, 74,160 (36.9%) had diabetes mellitus, including 57,418 (28.6%) with complications. The incidence of serious psychiatric outcomes was 3.3% in patients with depression without diabetes and 6.7% in patients with depression and diabetes mellitus. Patients with depression and diabetes mellitus complications showed higher rates of serious outcomes than that did those without diabetes mellitus complications (odds ratio, 1.19; 95% confidence interval, 1.11-1.13). Similarly, depressed patients with micro and macrovascular diabetic complications were more likely to experience serious outcomes than those without diabetes mellitus complications (odds ratio, 2.2; 95% confidence interval, 2.07-2.34). Our results showed that comorbid diabetes mellitus can increase the risk of serious outcomes of depression, such as suicide and hospitalization, and thus may alter the antidepressants prescription patterns and healthcare service use among patients with depressive disorders.

Outcomes of Community-dwelling Seniors Vary by Type of Emergency Department

The specific objectives were: 1) to compare the characteristics and 6-month outcomes of community-dwelling seniors in Quebec, Canada, who visited three different emergency department (ED) types and 2) to explore whether the differences in outcomes by ED type were seen among subgroups of seniors. The three types of ED were most specialized, less community-oriented (n = 12); moderately specialized, less community-oriented (n = 28); and least specialized, more community-oriented (n = 28). Administrative databases were used to create a cohort of 223,120 seniors who visited these 68 EDs during a 14-month period. Using a multilevel approach, the following patient characteristics were compared across ED types: sociodemographic (age, sex, urban vs. rural residence, proximity to ED); medical diagnoses and comorbidity burden; and utilization of hospital and physician services during the 16 months before the index ED visit. Cox regression analysis was used to model the relationships between ED type and two 6-month outcomes, adjusting for patient characteristics: 1) serious outcomes (death, acute or long term-care admission) among all individuals who made an index visit and 2) outpatient ED visits (without hospital admission) among those discharged either from the ED or hospital. Interactions between ED type and patient age, sex, urban-rural residence, and comorbidity burden were explored. Compared to patients treated at the least specialized EDs, those at the most specialized EDs were more often urban-dwelling, resided outside the health service area of the ED, and had the highest disease burden and prior specialist utilization. Those treated at the moderately specialized EDs were intermediate between these two groups. During the 6 months after the ED visit, the rate of serious outcomes was higher and the rate of outpatient ED visits was lower for the most specialized compared to the least specialized EDs, even after adjustment for patient characteristics. The differences in these outcomes by ED type were attenuated among older patients and those with greater comorbidity. More vulnerable community-dwelling seniors tend to be treated in more specialized EDs, which have worse linkages to community services. Improved linkages between more specialized EDs and the community (physicians, home care, and other services) and increased access to community services may improve outcomes in this population. Seniors treated at more specialized EDs were more likely to experience serious outcomes, but were less likely to make a return outpatient ED visit.