Reason For Hospital Admission Research Articles

Body Mass Index of 92,027 patients acutely admitted to general hospitals in Denmark: Associated clinical characteristics and 30-day mortality.

BackgroundData are sparse on the range of BMI among patients acutely admitted to general hospitals. We investigated BMI values and associated patient characteristics, reasons for hospital admission, and mortality in Denmark.MethodsWe identified all persons with an acute inpatient admission 2011–2014 in Central Denmark Region and assessed BMI measurements recorded in the Clinical Information System. We used cross-sectional and cohort analyses to examine the BMI distribution and its association with demographic characteristics, comorbidities, medication use, tobacco smoking, reasons for admission, and 30-day mortality.ResultsAmong 92,027 acutely admitted patients (median age 62 years, 49% female) with a BMI measurement, 4% had a BMI (kg/m2) <18.5, 42% a BMI between 18.5 and 25, 34% a BMI between 25 and 30, and 20% a BMI ≥30. Compared with normal-weight patients, 30-day mortality was high among patients with BMI <18.5 (7.5% vs. 2.8%, age- and smoking-adjusted odds ratio (aOR) 2.4; 95% confidence interval (CI): 2.0–2.9, whereas patients with overweight (aOR 0.7; 95% CI: 0.6–0.8) and obesity class I (aOR 0.8; 95% CI: 0.6–0.9)). Compared with the total population, patients with BMI <18.5 were older (68 years median); more were female (73%); more had comorbidities (Charlson Comorbidity Index score >0 in 42% vs. 33% overall), more were current smokers (45% vs. 27% overall), and acute admissions due to respiratory diseases or femoral fractures were frequent. In contrast, patients with BMI ≥30 were relatively young (59 years median), fewer smoked (24%): type 2 diabetes, sleep disorders, cholelithiasis, and heart failure were frequent diagnoses. Prevalence of therapies for metabolic syndrome, pain, and psychiatric disorders increased with higher BMI, while patients with BMI <18.5 frequently used asthma medications, glucocorticoids, and antibiotics.ConclusionIn patients acutely admitted to general hospitals, reasons for hospital admission and associated clinical characteristics differ substantially according to BMI range. BMI <18.5 is a clinical predictor of high short-term mortality.

Einflussgrößen auf die Krankenhaussterblichkeit bei Patienten mit Sepsis – Entwicklung eines risikoadjustierten Modells auf Basis der Leistungsdaten deutscher Krankenhäuser

BackgroundInpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis. MethodsThe analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases). ResultsFollowing the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R2 value=0.27), which is an excellent result. ConclusionThe CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals.

Spironolactone to increase natriuresis in congestive heart failure with cardiorenal syndrome

Background: Signs and symptoms of volume overload are the most frequent reason for hospital admission in acute heart failure (AHF). Diuretics are mainstay treatment, but their optimal type and dose regimen remain unclear, especially in patients with cardiorenal syndrome.Methods: This prospective study aimed to include 80 AHF patients with volume overload and cardiorenal syndrome. Through a 2 × 2 factorial design, patients were randomised towards (1) combinational treatment with acetazolamide and low-dose loop diuretics versus high-dose loop diuretics; and (2) open-label oral spironolactone 25 mg OD given upfront versus at discharge. Here reported are the results of the spironolactone treatment arm after complete follow-up of 34/80 patients (since the study was stopped because of slow recruitment). The primary study end-point was incident hypokalaemia (<3.5 mmol/L) or hyperkalaemia (>5.5 mmol/L).Results: Serum potassium derangements were numerically less frequent in the upfront versus discharge spironolactone group, yet this result was underpowered due to incomplete study recruitment (hyperkalaemia: 6% vs. 11%; hypokalaemia: 13% vs. 28%, respectively; p-value = .270). Natriuresis after 24 h was higher in the upfront vs. discharge spironolactone group (314 ± 142 vs. 200 ± 91 mmol/L, respectively; p-value = .010). Relative change in plasma NT-proBNP level after 72 h was similar among both groups (−16 ± 29% vs. −5 ± 45%, respectively; p value = .393), with no difference in all-cause mortality (p-value = .682) or the combination of all-cause mortality and heart failure readmission (p-value = .799).Discussion: Spironolactone use upfront in AHF patients at high risk for cardiorenal syndrome is safe and increases natriuresis.

Effectiveness of interventions aimed at improving physical and psychological outcomes of fall-related injuries in people with dementia: a narrative systematic review

BackgroundThe annual prevalence of falls in people with dementia ranges from 47 to 90%. Falls are a common reason for hospital admission in people with dementia, and there is limited research evidence regarding the care pathways experienced by this population. In addition to immediate management of an injury, prevention of further falls is likely to be an important part of any successful intervention.This review aims to assess the effectiveness of interventions for improving the physical and psychological wellbeing of people with dementia who have sustained a fall-related injury.MethodsSystematic review methodologies were employed utilising searches across multiple databases (MEDLINE, CENTRAL, Health Management Information Consortium, EMBASE, CINAHL, Web of Science, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro)) and citation chaining. Studies including people with a known diagnosis of dementia living in the community and who present at health services with a fall, with or without injury, were included. Outcomes of interest included mobility, recurrent falls, activities of daily living, length of hospital stay, and post-discharge residence. Results were independently reviewed and quality assessed by two researchers, and data extracted using a customised form. A narrative synthesis was performed due to heterogeneity of the included studies.ResultsSeven studies were included. Interventions clustered into three broad categories: multidisciplinary in-hospital post-surgical geriatric assessment; pharmaceuticals; and multifactorial assessment. Multidisciplinary care and early mobilisation showed short-term improvements for some outcomes. Only an annual administration of zoledronic acid showed long-term reduction in recurrent falls.ConclusionsDue to high heterogeneity across the studies, definitive conclusions could not be reached. Most post-fall interventions were not aimed at patients with dementia and have shown little efficacy regardless of cognitive status. Minor improvements to some quality of life indicators were shown, but these were generally not statistically significant. Conclusions were also limited due to most studies addressing hip fracture; the interventions provided for this type of injury may not be suitable for other types of fractures or soft tissue injuries, or for use in primary care.Systematic review registrationPROSPERO CRD42016029565.

Incidence of hepatocellular carcinoma in patients with chronic liver disease due to hepatitis B or C and coinfected with the human immunodeficiency virus: A retrospective cohort study.

AIMTo assess the incidence of hepatocellular carcinoma (HCC) in chronic liver disease due to hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfected with human immunodeficiency virus (HIV).METHODSA retrospective cohort study was performed, including patients with chronic liver disease due to HBV or HCV, with and without HIV coinfection. Patients were selected in the largest tertiary public hospital complex in southern Brazil between January 2007 and June 2014. We assessed demographic and clinical data, including lifestyle habits such as illicit drug use or alcohol abuse, in addition to frequency and reasons for hospital admissions via medical records review.RESULTSOf 804 patients were included (399 with HIV coinfection and 405 monoinfected with HBV or HCV). Coinfected patients were younger (36.7 ± 10 vs 46.3 ± 12.5, P < 0.001). Liver cirrhosis was observed in 31.3% of HIV-negative patients and in 16.5% of coinfected (P < 0.001). HCC was diagnosed in 36 patients (10 HIV coinfected and 26 monoinfected). The incidence density of HCC in coinfected and monoinfected patients was 0.25 and 0.72 cases per 100 patient-years (95%CI: 0.12-0.46 vs 0.47-1.05) (long-rank P = 0.002), respectively. The ratio for the HCC incidence rate was 2.98 for HIV-negative. However, when adjusting for age or when only cirrhotic are analyzed, the absence of HIV lost statistical significance for the development of HCC.CONCLUSIONIn this study, the presence of HIV coinfection in chronic liver disease due to HBV or HCV showed no relation to the increase of HCC incidence.

P257 Surgical and hospital admission in adults newly diagnosed with inflammatory bowel disease (IBD) in the biological era in Spain: Results of the nationwide EpidemIBD study of GETECCU

Aims: i) To assess the frequency of surgery and hospital admission in an inception cohort of adults newly diagnosed with IBD; ii) to describe the characteristics and indications for surgical interventions; iii) and to know the causes for hospital admissions. Prospective and population-based nationwide study in Spain. Adult patients diagnosed with IBD -Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC)- during 2017 in the 17 Spanish regions has been included and followed-up for 12 months after diagnosis. Data were captured in a web-based database (AEG-REDCap). Up to October 31st 2017, 2,404 patients from 122 centres covering approximately 50% of the Spanish population have been included. Of them, 53% were males, with mean age 40 years. In total, 49% had UC, 46% CD, and 5% IC. About 15% of patients had a family history of IBD. In CD patients, 53% had ileal and 26% ileocolonic location, and 13% perianal disease; 8% of patients had stenosing and 7% fistulising behaviour at the time of diagnosis. In UC patients, 30% had extensive colitis and 36% left-sided colitis at diagnosis. Median follow-up was 6 months (range 0–10 months). Eighty-five patients (3.5%) underwent 107 surgical procedures. Median time to first surgery was 0 months (range 0–4 months). As regards the first surgical procedure, 67% were urgent and 60% entailed abdominal surgery (15.3% for stenosis, 13% for abdominal abscess and 22.4% for perforation). Rates of surgery were higher in CD than in UC (7 vs. 0.6%, p < 0.01). CD patients with inflammatory behaviour had lower rates of surgery than those with strictures or fistula (5%, 11%, and 25%, respectively, p < 0.01). Surgery was also more frequent among CD patients with perianal disease than in those without it (28 vs. 4.3%, p = 0.01). Other variables, such as family history of IBD, or smoking habit were not associated with the need for surgery. A total of 648 patients (27%) were admitted to hospital during follow-up (10% of them had more than 1 admission) with disease diagnosis as major driver (93%). Median time from diagnosis to admission was 0 months (range 0–9 months). Reasons for hospital admissions are summarised in Table 1. In this large nationwide inception cohort in the biological era, a substantial proportion of patients underwent surgery, which was urgent in over two thirds of cases, and CD with aggressive manifestations as the main drivers. One third of patients were hospitalised -most of them at disease diagnosis- in the first months of follow-up

480 a ground-shaking case limb-shaking as an unusual presentation of tias

TIA is a very common reason for hospital admission, and typically presents with focal neurologic deficits including vision loss, limb weakness, and aphasia. Limb-shaking is a rare manifestation of TIA, and can easily be confused with a seizure. Distinction is critical, as Limb-Shaking TIAs are the result of severe carotid artery stenosis causing insufficient brain perfusion. In some rare instances, TIAs may be triggered by orthostatic situations. We present a case of repetitive Limb-Shaking TIAs secondary to critical left ICA steno-occlusive disease, and discuss the clinical manifestations, physiology, diagnosis, and management of this condition. A 65-year-old Caucasian female with a past medical history of hypertension, hyperlipidemia, pre-diabetes, migraine headaches, and tobacco use presented with frequent TIAs for 4 months. She reported weakness, numbness, and involuntary non-rhythmic shaking of her right arm and leg, disturbances in her left visual fields consisting of flashing lights, and diaphoresis for 4 months. Episodes would last less than 1 min and occur 1–2 times daily. Carotid ultrasound showed complete occlusion of left ICA, and 20%–30% narrowing of the right ICA. She was referred to vascular surgery, and started on 81 mg of Aspirin daily which resulted in decreased frequency episodes. Approximately 2 weeks later, she began to notice increased frequency of episodes up to 4 times daily, mainly occurring after standing from a supine position, or after walking long distances. The patient was subsequently noted to have postural tachycardia without postural hypotension. Due to concern for haemodynamic failure with activity, patient was placed on strict bed rest. CT angiography of the brain and neck matched ultrasound findings. EEG showed high amplitude, sharp contoured waves in the left temporal region without epileptiform phenomena. Additionally, MRI brain showed cerebral atrophy, bilateral small chronic ischaemic changes, and small subacute cerebral infarcts in the frontal lobes and left parietal lobe. Cervico-cerebral angiography revealed critical stenosis of the left ICA origin, and more than 80% stenosis of the right ICA origin. Patient was subsequently transferred to a different hospital for endarterectomy.

Hospitalization causes and outcomes in HIV patients in the late antiretroviral era in Colombia

BackgroundAntiretroviral therapy (ART) has modified the natural history of HIV-infection: the incidence of opportunistic infections (OIs) has decreased and mortality associated to HIV has improved dramatically. The reasons for hospitalization have changed; OIs are no longer the most common reason for admission. This study describes the patient population, admission diagnosis and hospital course of HIV patients in Colombia in the ART era.MethodsPatients admitted with HIV/AIDS at six hospitals in Medellin, Colombia between August 1, 2014 and July 31, 2015 were included. Demographic, laboratory, and clinical data were prospectively collected.Results551 HIV-infected patients were admitted: 76.0% were male, the median age was 37 (30–49). A new diagnosis of HIV was made in 22.0% of patients during the index admission. 56.0% of patients of the entire cohort had been diagnosed with HIV for more than 1 year and 68.9% were diagnosed in an advanced stage of the disease. More than 50.0% of patients had CD4 counts less than 200 CD4 cells/μL and viral loads greater than 100,000 copies. The main reasons for hospital admissions were OIs, tuberculosis, esophageal candidiasis and Toxoplasma encephalitis. The median hospital stay was 14 days (IQR 8–23). Admission to the intensive care unit (ICU) was required in 10.3% of patients and 14.3% were readmitted to the hospital; mortality was 5.4%.ConclusionsSimilar to other countries in the developing world, in Colombia, the leading cause of hospitalization among HIV-infected patients remain opportunistic infections. However, in-hospital mortality was low, similar to those described for high-income countries. Strategies to monitor and optimize the adherence and retention in HIV programs are fundamental to maximize the benefit of ART.

Comparison of clinical findings between dogs with suspected anaphylaxis and dogs with confirmed sepsis

OBJECTIVE To compare clinical signs, laboratory test results, and imaging findings between dogs with suspected anaphylaxis and dogs with sepsis. DESIGN Retrospective case-case study. ANIMALS 10 dogs with suspected anaphylaxis and 22 dogs with confirmed sepsis that met the criteria for systemic inflammatory response syndrome. PROCEDURES Medical records for dogs in each group were reviewed and data extracted regarding signalment; reason for hospital admission; physical examination findings; results of CBC, serum biochemical analysis, coagulation testing, cytologic examination, and microbial culture; and imaging reports. RESULTS All dogs in the anaphylaxis group fulfilled the criteria for systemic inflammatory response syndrome. Dogs in both groups had gastrointestinal signs, lethargy, mentation change, and bleeding abnormalities. Dogs with suspected anaphylaxis had a significantly higher eosinophil count and serum alanine aminotransferase activity and lower blood pH than dogs with sepsis. Dogs with sepsis had a significantly higher band neutrophil count, serum globulins concentration, and serum alkaline phosphatase activity and lower serum glucose concentration. Dogs in both groups had intracavitary free fluid and ultrasonographic findings of thickened intestines, gas or fluid-filled intestines, and a thickened gallbladder wall. CONCLUSIONS AND CLINICAL RELEVANCE Clinical signs, laboratory values, and imaging findings may be similar in dogs with sepsis or anaphylaxis. Given the marked difference in prognosis and treatment, early differentiation is important. Anaphylaxis should be considered if a septic nidus cannot be identified, and supportive care should be considered for such patients.

Acute heart failure: Epidemiology and socioeconomic burden

AbstractAcute heart failure (AHF) is defined as the rapid development or change in symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. AHF is the first reason for hospital admission in individuals aged 65 or more. Despite therapeutic advances, it remains a syndrome with particularly ominous prognosis, with an in‐hospital mortality rate of 4–7%, a 2‐ to 3‐month postdischarge mortality of 7–11% and a 2‐ to 3‐month readmission rate of 25–30%. In addition, AHF is the single most important determinant of the huge healthcare expenditure related to heart failure, as it accounts for nearly 70% of the total heart failure‐related cost.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/5608946/Activity.aspx

Enfermedad invasiva por Streptococcus pyogenes: ingresos durante 6 años

Introduction and objectiveThe last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital. Material and methodsRetrospective study in a Pediatric hospital, of all in-patients with final diagnosis of ID due to SGA during 6 years (2009-2014).To consider ID, SGA had to be isolated in sterile samples; in patients with fascitis necroticans in skin samples or in any sample in patients with the diagnostic of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of these criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash.Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected. ResultsFifty-two (52) cases were included (12/10,000 of all inpatients); 3 years-old was the medium age (p25-75: 1.4-6.9 years); 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis.Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8-15 days). Three patients presented sequels and one patient died. ConclusionThe ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections, and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations.

STUDY OF COMORBIDITIES IN ALZHEIMER'S DISEASE PATIENTS REQUIRING INPATIENT CARE

Patients of Alzheimer's disease (AD) who required hospital admission and inpatient care were studied for comorbidities, reason for hospital admission and clinical outcome. Patients diagnosed with AD were prospectively followed up and those who required hospital admission were included in the study (n = 30). Clinical records were reviewed to identify comorbidities and reason for admission. Patients were followed up for six months after discharge to study hospital readmission and death. Commonest presenting symptoms of the subjects in the emergency room were pain (43.3%), fever (26.7%), breathlessness (23.3%), altered sensorium (10%) and gastrointestinal bleeding (7%). Known comorbidities included hypertension (50%), chronic kidney disease (16.7%), chronic obstructive pulmonary disease (13.3%) and diabetes (13.3%). Following admission, reason for admission included sepsis (26.7%), acute exacerbation of chronic obstructive pulmonary disease (13.3%), heart failure (10%), hyponatremia (10%) and analgesic induced gastrointestinal bleeding (7%). Four patients (13.3%) were diagnosed with malignancy (bronchogenic carcinoma, non-Hodgkin's lymphoma and metastatic carcinoma with unknown primary). On six month follow up, mortality was 10% and all the patients who died were diagnosed with malignancy. One patient required readmission following discharge in the follow up period.

Day-care unit for rigid panendoscopy of the upper aerodigestive tract: A study of 436 procedures

ObjectivesTo assess the role of day-care management of upper aerodigestive tract (UADT) panendoscopy and to study criteria for conventional hospital admission and reasons for conversion. Patients and methodsRetrospective study, from January 2011 to May 2013. Inclusion criteria UADT panendoscopy for carcinoma assessment. Study variables, age, gender, tumor location, reason for panendoscopy, TNM stage, previous external radiotherapy, home-to-hospital distance and Apfel, Detsky and ASA scores. A day-care and a conventional admission group were compared using Fisher's test for ASA score, student's test for age and Pearson's chi2 test for the other variables. ResultsFour hundred and thirty-six panendoscopies were performed: 252 in day-care, including 4 cases of conversion and 184 with conventional admission. There were no significant differences between groups for age, gender, tumor location, TNM stage, reason for panendoscopy, previous external radiotherapy, home-to-hospital distance or Apfel score. A significant difference was observed for ASA score (P<0.0001) and Detsky score (P=0.03). In 39% of cases, the reason for hospital admission without criteria defined by the French Society of Anesthesia and Intensive Care Medicine (SFAR) and French Health Authority (HAS) was the patient's refusal of day care. In 10% of conventional admissions, day-care was not implemented because of psychosocial factors. ConclusionDay-care management is appropriate for UADT panendoscopy in selected patients. The reasons for the high rate of patient refusal should be studied.

Potentially avoidable hospitalizations in patients with advanced cancer.

e18275 Background: Cancer patients and their clinicians often wish to avoid preventable hospital admissions, but efforts to understand the predictors of avoidable hospitalizations are lacking. We sought to examine reasons for hospital admissions in patients with advanced cancer, identify potentially avoidable hospitalizations (PAH), and explore predictors of PAH. Methods: We prospectively enrolled hospitalized patients with advanced cancer from 9/2014 - 11/2014 as part of a longitudinal data repository to define symptom burden in this population. Upon admission, we assessed patients’ symptom burden (Edmonton Symptom Assessment System [ESAS]; scored 0-10). We created a summated ESAS physical symptom variable. We used consensus-driven medical record review to identify the primary reason for each hospital admission and categorize it as PAH or not based on of an adaptation of Graham’s criteria for PAH. We used mixed multivariable logistic regression analyses to identify predictors of PAH. Results: We assessed 477 hospital admissions in 200 consecutively admitted patients (mean age = 64.6; 47% female; 67% married). Over half of admissions came through the emergency department (56%). The most common reasons for admissions were fever/infection (30%), symptoms (26%), and planned admission for chemotherapy or procedure (10%). We identified 149 (31%) as PAH. Among these PAH, 45 (30%) were readmissions due to failure of timely outpatient follow-up (within 7 days of discharge) and 44 (30%) were due to premature discharge from prior hospitalization. In a mixed logistic regression model, being married (odds ratio [OR] 0.48 [0.28-0.81]; p &lt; 0.01) was associated with lower likelihood of PAH, while higher physical symptom burden (OR 1.02 [1.00-1.04]; p = 0.04) was associated with greater likelihood of PAH. Conclusions: We identified that a substantial proportion of hospitalizations in patients with advanced cancer are potentially avoidable, often related to failure of timely outpatient follow-up and premature hospital discharge. Our results demonstrate that patients’ symptom burden predicts PAH, thus underscoring the need to address patients’ symptoms in order to reduce preventable hospital admissions.

Acute psychiatric involuntary admissions in a general hospital after suicidal behavior. A 2-year follow-up

IntroductionPatients with a plan, access to lethal means, recent social stressors and symptoms suggestive of a psychiatric disorder should be hospitalized immediately. Sometimes involuntary hospital admission is used to avoid a suicidal behavior, taking into account that after a suicide attempt 25% of people repeat attempt and 10% die by suicide.Objectives/aimsTo know hospital admission due to suicide attempts, and how many of them were involuntary.MethodA 2-year retrospective study (2014–2015) of all cases admitted after suicidal behavior in an acute psychiatric ward in a general hospital in Gijón (Spain). Reasons for hospital admission were registered, including suicide attempts. And also if admissions were involuntary.ResultsThe total number of admissions to the psychiatric unit in 2014–2015 was 2376. Admissions due to suicide attempts were 427; 300 of them were involuntary admissions. There were a total of 347 involuntary admissions these two years; among them, due to suicide attempt: 300.ConclusionsMost of involuntary admissions in the psychiatric unit of the hospital studied followed a suicide attempt, as a prevention of repeated suicidal behavior. Obvious high risk of repeat suicide attempt generates an urgency to make an accurate assessment and create a safe treatment plan and determine to retain suicidal patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Improving the prognostic value of blunt abdominal trauma scoring systems in children

Purpose Blunt abdominal trauma (BAT) is a frequent reason for hospital admission and a significant cause of death in children older than 2 years of age. Mechanisms causing abdominal injuries are predominantly motor vehicle accidents, falls, and intentional injuries. Blunt trauma accounts for 90% of pediatric injuries. There are many scoring systems that are designed to monitor victims of BAT and to predict victims who may require conservative management and those who may require surgical intervention. None of these scoring systems is perfect and fulfill the data for accurate prediction of the prognosis of these victims. We assessed three different clinical scoring systems and their prognostic properties alone and after their modification by adding a plain, erect, abdominal radiographic film to improve their prognostic values. Patients and methods We included all patients presenting with BAT older than 2 years and younger than 18 years. All children were subjected to three different trauma scoring systems. We evaluated all children using Pediatric Trauma Score, Clinical Abdominal Score System, and Blunt Abdominal Trauma in Children. We then added plain, erect, abdominal radiographic films to these systems. Results A total of 250 children with BAT were subjected to three different scoring systems. Among them, 58% were boys and 42% were girls. The cause for BAT in two hundred and two cases was car accidents, falling from heights in seven, and kicks and abuse in 41 cases. The mean time until hospital arrival was 2 h. The mean age was 15 years. The mean time for every scoring system was 5 min. Radiographic imaging showed positive signs of trauma (air under diaphragm, elevated copula of diaphragm) in 45 patients. Conclusion Adding a simple radiographic film in the erect position of the abdomen and lower chest markedly improved the prognostic value of the different scoring systems included. Keywords : children, scoring systems, trauma

Aboriginal and non-aboriginal Australian former prisoners\u2019 patterns of morbidity and risk of hospitalisation

BackgroundPeople who have been in custody are more likely to experience multiple, long standing health issues. They are at high risk of illness and injury post release and experience poor access to health services both of which contribute to high rates of recidivism. The study was conducted to examine Aboriginal and non-Aboriginal former prisoners’ risk of hospitalisation and rehospitalisation in the five years post release from custody and identified the common reasons for hospitalisations.MethodsCommon reasons for hospital admission were identified by conducting descriptive analysis of linked data, related to former prisoners, from NSW Ministry of Health and Corrective Services NSW. This relied upon admitted patient data for 1899 patients. Of this cohort, 1075 people had been admitted to hospital at least once and remained out of custody over a five year period. The independent variables we studied included age, sex, and whether or not the person was Aboriginal. We conducted univariate and multivariate analysis on the following dependent variables: number of admissions over five years after release; more than one admission; days between custody and first hospitalisation; and days between first and second hospitalisation.ResultsMental and behavioural disorders, injuries and poisoning, and infectious or parasitic diseases were the three most common reasons for admission. Aboriginal and non-Aboriginal former prisoners had a broadly similar pattern of reasons for admission. Yet Aboriginal former prisoners were more likely than non-Aboriginal former prisoners to have a shorter mean interval between hospital admission and readmission (187 days compared to 259 days, t = 2.90, p-0.004).ConclusionsDespite poorer health among Aboriginal people, there were broadly similar patterns of reasons for admission to hospital among Aboriginal and non-Aboriginal former prisoners. There may be a number of explanations for this. The cohort was not a representative sample of the NSW prison population. There was an overrepresentation of individuals with cognitive disability (intellectual disability, acquired brain injury, dementia, fetal alcohol spectrum disorder) in the study population, which may have impacted on this group accessing hospital health care. Alternatively perhaps there were fewer presentations to hospital by Aboriginal former prisoners despite a greater need.The shorter interval between hospital admission and readmission for Aboriginal former prisoners may suggest the need for better follow up care in the community after discharge from hospital. This presents an opportunity for primary health care services to work more closely with hospitals to identify and manage Aboriginal former prisoners discharged from hospital so as to prevent readmission.

Estimation of the Demand for Hospital Care After a Possible High-Magnitude Earthquake in the City of Lima, Peru.

A probabilistic model was designed that included the following variables: demand for hospital care; time of arrival at the hospitals; type of medical treatment; reason for hospital admission; and the need for specialized care like hemodialysis, blood transfusions, and surgical procedures. The values for these variables were obtained through a literature search of the databases of the MEDLINE medical bibliography, the Cochrane and SciELO libraries, and Google Scholar for information on earthquakes over the last 30 years of over magnitude 6.0 on the moment magnitude scale. If a high-magnitude earthquake were to occur in Lima, it was estimated that between 23,328 and 178,387 injured would go to hospitals, of which between 4,666 and 121,303 would require inpatient care, while between 18,662 and 57,084 could be treated as outpatients. It was estimated that there would be an average of 8,768 cases of crush syndrome and 54,217 cases of other health problems. Enough blood would be required for 8,761 wounded in the first 24 hours. Furthermore, it was expected that there would be a deficit of hospital beds and operating theaters due to the high demand. Sudden and violent disasters, such as earthquakes, represent significant challenges for health systems and services. This study shows the deficit of preparation and capacity to respond to a possible high-magnitude earthquake. The study also showed there are not enough resources to face mega-disasters, especially in large cities. Bambarén C , Uyen A , Rodriguez M . Estimation of the demand for hospital care after a possible high-magnitude earthquake in the City of Lima, Peru. Prehosp Disaster Med. 2017;32(1):106-111.

Annals for Educators - 20 September 2016.

Annals for Educators - 20 September 2016.

Avaliação do estado nutricional em pacientes idosos oncológicos internados em um hospital de alta complexidade do Norte do Rio Grande do Sul

Aims: To assess the nutritional risk in hospitalized oncological elderly patients.Methods: Retrospective study conducted with oncological elderly patients hospitalized at the São Vicente de Paulo Hospital, in Passo Fundo, Rio Grande do Sul, Brazil. Patients with cancer who underwent anthropometric and subjective evaluation by the Mini Nutritional Assessment Reduced Forms were selected. Data were collected from the research form used by the National Cancer Institute, including clinical evaluation, type of cancer, reason for hospital admission and length of stay.Results: A total of 70 elderly patients with cancer, of both genders, with a mean age of 72.94±6.93 years, were evaluated. All patients with pancreatic cancer had weight loss. Patients with lung cancer and pancreatic cancer had the highest percentage of severe weight loss (greater than 10% of usual weight in the last six months), 57.1% and 40% respectively, while the majority of breast cancer cases had no weight loss. Body mass index and calf circumference diagnosed greater proportion of normal weight (55.7% and 65.7%, respectively), unlike the Mini Nutritional Assessment Reduced Forms, that identified higher rates of malnutrition or nutritional risk (84.4%).Conclusions: Most hospitalized oncological elderly were found to be eutrophic by the anthropometric indicators body mass index and calf circumference, while a higher proportion of these patients were classified as malnourished or at nutritional risk by the Mini Nutritional Assessment Reduced Forms, as well as by the percentage of weight loss. Patients with lung and pancreas cancer had the most severe weight loss. These results confirm the importance of using different parameters to assess the nutritional status of elderly with cancer.