Reason For Hospital Admission Research Articles

Clostridium difficile infection in a Geriatric Care Unit: clinical characteristics and prognosis

Background & aims. Clostridium difficile infection (CDI) is a leading cause of nosocomial diarrhoea in elderly people. This study aimed to describe the main clinical features and prognosis at 6 months of patients affected by CDI in a Geriatric Unit. Methods. Retrospective observational study based on clinical records conducted among elderly patients admitted to a Geriatric Care Unit. Inclusion criteria were: 1) patients discharged with diagnosis of CDI, confirmed by positive fast enzyme immunoassay for detection of C. Difficile toxin B on stool sample; 2) availability of Multidimensional Prognostic Index (MPI) score, assessed during the first 48 hours after admission. Secondary analysis was performed to investigate potential risk factors for worse outcomes during hospitalization, and on the incidence of recurrences and survival in a subgroup at 6 months of follow-up. Results. Thirty-three patients enrolled (23 F, 10 M), mean age 89 years. CDI was the reason for hospital admission in 39.6% of cases, while 60.4% developed the infection during hospitalization. All patients had undergone recent antibiotic treatment and 97% had recently been hospitalized or were nursing home residents. Ninety percent of subjects had more than two comorbidities and in 85% of cases, MPI predicted a high risk of mortality. In-hospital mortality was 21% and, in the subgroup of 16 patients who completed the 6-month follow-up, 31% had at least one recurrence and 75% died. Conclusions. CDI affects oldest-old and vary frail patients, with high comorbidity and high risk of mortality, and most of them have a poor prognosis, suggesting that CDI might be considered as a frailty marker itself.

Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions.

Background Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals. Objectives The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. Methodology. A cross-sectional retrospective study consisted of 204 patients aged 18–65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility. Results As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI + β-blockers and tritherapy such as diuretics + β-blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy (p=0.0001). Conclusion During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies.

Thrombectomy after in-house stroke in the transfer population

BackgroundPatients with large-vessel occlusion (LVO) who initially present to a non-thrombectomy-capable center (“spoke”) have worse outcomes than those presenting directly to a thrombectomy-capable center (“hub”). Furthermore, patients who suffer in-hospital strokes (IHS) suffer worse outcomes than those suffering strokes in the community. Data on patients who suffer IHS at a spoke hospital is lacking. We aim to characterize this particularly vulnerable population, define their outcomes, and compare them to patients who develop IHS at a hub institution. MethodsWe retrospectively reviewed prospectively collected data from patients suffering an IHS at a spoke hospital who were then transferred to the hub hospital for endovascular therapy (EVT). We then compared outcomes of these patients under EVT after developing IHS at the hub institution. ResultsA total of 108 IHS patients met inclusion criteria: 91 (84%) at a spoke facility and 17 (16%) at the hub facility. Baseline characteristics and reason for hospital admission were comparable between the two groups. Time from imaging to IV-tPA administration (17 vs. 70 min, p = 0.01) and time to EVT (120 vs. 247 min, p = 0.001) were significantly shorter in the hub group. More patients had a 90 day-mRS of 0-3 in the hub group than the spoke group (57% vs 22%, p < 0.05). ConclusionPatients undergoing EVT after suffering IHS at a spoke hospital have significantly higher rates of poor outcomes compared to patients who suffer IHS at a hub hospital. Prolonged time delays in the initiation of IV-tPA and EVT represent areas of improvement.

A percepção de crianças escolares acerca da hospitalização: estudo com dados qualitativos

Objetivo: Compreender a percepção da criança escolar frente à hospitalização. Métodos: Trata-se de um estudo qualitativo, realizado em um hospital pediátrico público de referência para a 21ª Macrorregião de Saúde Juazeiro do Norte, Ceará. A pesquisa foi realizada entre os meses de fevereiro a novembro de 2017. A população do estudo foram 10 crianças escolares. Os dados foram coletados por meio de uma entrevista semiestruturada e analisados por através da análise de conteúdo. Resultados: A partir da análise dos dados emergiram duas categorias temáticas: percepção da criança escolar acerca da internação, e a visão da criança diante da hospitalização. A partir destas pôde-se compreender a visão e/ou opinião da criança sobre a hospitalização e os motivos relacionados à mesma, os sentimentos e experiências vivenciados pelas crianças durante este episódio, a percepção destas quanto ao ambiente hospitalar, atividades e procedimentos desenvolvidos durante este período, e a atenção advinda dos profissionais da saúde. Considerações finais: Conclui-se, a partir do estudo, que as crianças percebem e entendem os motivos da internação hospitalar, e que apesar de relacionarem a hospitalização somente com a realização de procedimentos invasivos e dolorosos, elas compreendem a necessidade destes para a recuperação de sua saúde.

Prognosis of patients with sickle cell disease and COVID-19: a French experience

Prognosis of patients with sickle cell disease and COVID-19: a French experience

Clinicoradiographic data and management of children with Chiari malformation type 1 and 1.5: an Italian case series.

The widespread use of imaging has increased Chiari malformation (CM) diagnosis. CM shows clinical heterogeneity that makes management controversial. We aimed to evaluate the occurrence and clinical and radiographic presentation of children with CM-1 and CM-1.5, reporting possible differences according to age and management. We retrospectively reviewed 46 children diagnosed with CM-1 or CM-1.5, between 2006 and 2019 at our institute. We evaluated for each subject: reason for hospital admission, clinical presentation, age at diagnosis, extent of cerebellar tonsillar herniation (CTH) and type of treatment when carried out. Affected children were assigned to three age groups. In some patients, a clinical follow-up was carried out. Mean age at diagnosis was 7.61years. Mean CTH was 8.72mm. Syringomyelia was found in 10.9%. Twenty-six individuals (56.5%) were symptomatic. The most frequent symptom was headache (34.8%). There were no statistically significant differences between the age groups with regard to the amount of CTH (p = 0.81). Thirteen children (28.3%) underwent surgical treatment. CTH was significantly higher in the surgical group (p < 0.01). Twenty-three patients (50%) performed a 3-year mean follow-up, 17 of whom had no surgery treatment. CTH was stable in 58.8%, reduced in three and increased in three, without any change in symptoms. Only one child showed a worsening in herniation and symptoms, then requiring surgery. Frequency and type of symptoms were consistent with those reported in the literature. Conservative approach is a viable option for minimally symptomatic patients, most of whom did not show clinical worsening at follow-up.

Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain

IntroductionThe severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals’ current service needs during this pandemic. The aim of this study was to provide an overview of the impact of the pandemic, and its corresponding State of Emergency, on a tertiary traumatology emergency service. MethodsAn observational study was performed at a tertiary hospital within the Spanish National Health System. Four different periods were studied, including the first 20 days of Spain's current State of Emergency, from March 14 to April 02, 2020 (Period 4). This period was compared to the 20-day period prior to the State of Emergency (Period 3), and to matching periods in the two previous years (Periods 1 and 2). A total of 6,565 patient visits were analyzed: 1909 in Period 1 (29.1%), 2161 in Period 2 (32.9%), 1983 in Period 3 (30.2%), and 512 in Period 4 (7.8%). Variables collected included patient age and sex, insurance type, discharge destination and reason for hospital admission. ResultsThe patients’ mean age was 55.1 years old (Standard Deviation (SD): 22.1), and 51.8% were women (3495/6565). During the COVID-19 pandemic, there were significant reductions in total visits to the trauma emergency department, workplace accidents, traffic accidents and number of hospital admissions, particularly during Period 4. However, no statistically-significant differences were found in the number of osteoporotic hip fractures admitted between the four periods. The numbers of hospital admissions for osteoporotic hip fracture were 42 during Period 1, 41 during Period 2, 43 during Period 3 and 36 during Period 4. ConclusionsWhile most traumatological presentations decreased in frequency over the course of the outbreak, the number of osteoporotic hip fractures remained stable. Thus, contingency plans in times of crisis need to be carefully targeted, and to keep in mind certain public health issues that do not decrease, despite a State of Emergency, like osteoporotic hip fractures.

Abstract 346: A Trial of Pre-discharge Point of Care Ultrasound for Acute Decompensated Heart Failure

Background: Acute decompensated heart failure (ADHF) is a primary reason for hospital admission and readmission in the elderly. Prior studies have demonstrated that sonographic pulmonary B-lines and large inferior vena cava (IVC) diameter with reduced collapsibility may accurately predict ADHF readmission. Ultrasound is a readily available bedside tool that can be used to assess a patient’s volume status, which can be difficult to assess under certain clinical conditions. The purpose of this project is to determine if a pre-discharge focused lung and IVC ultrasound exam can be used to predict readmission in a veteran patient population. Methods: This is a single-center study conducted at the Miami Veterans Affair Medical Center (VAMC). Only patients with a primary diagnosis of ADHF admitted to a hospitalist team through the emergency room will be considered. Exclusion criteria include: pre-existing structural lung disease; primary right-sided heart failure; severe tricuspid regurgitation; or hospice status. A single operator will evaluate all included patients for B-lines and IVC dimension within 24 hours of admission and discharge. Ultrasound results, without management recommendations, will be given to hospitalists to use at their discretion to support clinical decision-making. Patients will be categorized based on positive or negative ultrasound findings. The primary outcome of interest is 30-day readmission rate. Secondary outcomes include 90-day readmission, all-cause mortality, length of stay, and changes in weight or renal function. Chi-square and Mann-Whitney testing will be used to analyze categorical and continuous variables, respectively. Kaplan-Meier survival curves will be generated for both patient cohorts. Results/Anticipated Results: Through quarter 3 of fiscal year 2019, the Miami VAMC had 215 unique admissions for ADHF. The average 30-day readmission rate per quarter was 18.44% (total 40 of 215). Study enrollment is ongoing. We anticipate that many patients may demonstrate discrepancy of volume status between their clinical and ultrasound exams, and that patients found to have B-lines and/or large IVCs with poor collapsibility will have worse outcomes. Conclusion: Decreasing readmissions for acute decompensated heart failure is a priority for both patients and physicians. Persistent volume overload has been associated with increased risk for readmission. Ultrasound may be a useful augmentation to the physical exam to determine a patient’s volume status to further guide inpatient treatment, predict prognosis, and determine readiness for discharge.

A Population-Based Study Evaluating Sex Differences in Patients Presenting to Emergency Departments With Syncope.

This study sought to determine whether sex-specific differences in management and outcomes of syncope patients exist. Syncope is a common presentation to the emergency department (ED) and reason for hospital admission. Patients≥18 years of age, presenting to the ED with a primary diagnosis of syncope in Alberta, Canada, from January 1, 2007 to December 12, 2015 were included. ED records were linked to hospital records to identify patients admitted versus discharged from the ED. Outcomes included 30-day and 1-year all-cause mortality. Multivariable mixed-effect logistic regression assessed the association between sex and outcomes. Of the 63,274 ED syncope patients, 33,986 (53.7%) were women and 29,288 (46.3%) were men (p<0.01). Compared with men, women were younger (51.6 ± 23.8 years for women vs. 55.1 ± 20.9 years for men; p<0.001), less likely to arrive by ambulance (48.4% women vs. 51.7% men; p<0.001), and had fewer comorbidities (67.9% women vs. 61.8% men with Charlson comorbidity score=0; p<0.001). Overall, 12.6% women and 16.8% men were admitted to hospital (p<0.001). Regardless of discharge status, women had lower mortality rates (30-day admitted: 2.9% women and 4.4% men; p<0.001; discharged: 0.2% women and 0.4% men; p<0.001; and 1-year admitted: 12.6% women and 16.1% men; p<0.001; discharged: 2.4% women and 3.7% men; p<0.001). After adjusting for confounders, men were associated with 1.4-fold higher odds of death at 1 year. This was unchanged regardless of discharge status. Although women are more likely than men to present to the ED with syncope, they are less likelytobeadmitted to hospital. Mortality rates are lower for women, regardless of discharge status.

Maternal morbidity: a longitudinal study of women’s health during and up to 22 months after pregnancy in Jamaica

ABSTRACT Our study evaluated factors associated with ill-health in a population-based longitudinal study of women who delivered a singleton live-born baby in a 3-month period across Jamaica. Socio-demographics, perception of health, chronic illnesses, frequency and reasons for hospital admission were assessed. Relationships between ill-health and maternal characteristics were estimated using log-normal regression analysis. Of 9,742 women interviewed at birth, 1,311 were assessed at four stages, 27.7% of whom reported ill-health at least once. Hospitalization rates were 20.9% during pregnancy, 6.1% up to 12 months and 0.5% up to 22 months after childbirth. Ill-health, reported by 11% of women, was less likely with better education (RR=0.62, 95%; 0.42-0.84). Hospital admission was associated with higher socio-economic status (RR=1.33, 95% 1.04-1.70) and Caesarean section [CS] (RR=1.57, 95%; 1.21-2.04). One in three (33.7%) women reported chronic illnesses, and the likelihood increased with age, parity and delivery by elective CS (RR=1.44, 95%; 1.20-1.73). In multivariable analyses, ill-health was more likely with chronic illness (RR=2.06, 95%; CI: 1.71-2.48) and hospital admission from 12 to 22 months after childbirth (RR=1.54, 95% CI: 1.12-2.12). Ill-health during pregnancy and after childbirth represent a significant burden of disease and requires a standardised comprehensive approach to measuring and addressing this disease burden.

Postpartum Opioid Use: Can We Reduce It Safely?

Delivery of an infant is the number one reason for hospital admission in the U.S., where most mothers recovering from a delivery (whether cesarean or

ETIOLOGY AND PREVALENCE OF URINARY TRACT INFECTIONS AMONG PREGNANT WOMEN IN A TERTIARY CARE HOSPITAL IN KOTA REGION

Background: UTI’s are more common during pregnancy because of changes in the urinary tract and has been reported among 20% of the pregnant women with significant reason for hospital admission. It has several adverse outcomes not only on the mother but also on the fetus like chronic renal failure, pyelonephritis, preeclampsia, anemia, fetal mortality and premature delivery.&#x0D; Patients and methods: The aim of this study was to determine the prevalence and etiologyof UTI among 120 pregnant women attending the ANC of GMC Kotaduring the study period from January 2017 to June 2017.UTI was diagnosed by growth of at least 105 CFU/ml of a urinary tract pathogen in a culture of a midstream urine sample. The isolated bacteria were identified by biochemical tests.&#x0D; Results: Of the 120 urine samples examined in this study,34 (28.33%) were found to contain significant bacteriuria. Of the variables examined, Highest prevalence was observed in 21-25 years age group (50%), multipara (44.11%), and in 3rd trimester (55.88%). The bacterial pathogens isolated were most commonly Escherichia coli (55.88%), Klebsiella sps(20.6%), Pseudomonas sps(8.82%), Proteus sps(5.88%), Enterobacter sps(5.88%), Enterococcus sps(2.94%).&#x0D; Conclusion: The prevalence rate of urinary tract infection (UTI) during pregnancy is high. So it is important to do routine screening of all pregnant women for significant bacteriuria to reduce the complications on both maternal and fetal health. The study also recommends health education on personal sanitary hygiene.

What Predicts Hospital Admissions in Community-Dwelling People With Parkinsonism?

Previous studies have looked at the reasons for hospital admission in people with parkinsonism (PwP), yet few have looked at factors that precipitate admission. People with parkinsonism with a diagnosis of idiopathic Parkinson disease of Hoehn and Yahr stage III-V and those with Parkinson plus syndromes were assessed for motor and nonmotor symptoms, quality of life, and functional performance. Logistic regression was used to investigate predictors of hospital admission over the subsequent 2 years. Overall, 162 patients consented to be part of the study. Seventy-one PwP (43.8%) had at least 1 hospital admission, and 17 (10.5%) patients had 3 or more admissions to hospital. Poorer cognition, more nonmotor symptoms, poorer quality of life, slower timed-up-and-go test scores, and abnormal swallow predicted a subsequent hospital admission. Our study emphasizes the importance of nonmotor symptoms in predicting admission. A cost-benefit analysis of early intervention to prevent admission should be considered.

Sleep-related problems and suicide behavior and ideation among Black and White trauma-exposed psychiatric inpatients

ObjectiveSleep-related problems (SRPs) are associated with increased risk for suicide-related behavior and death. Given that Black adults report greater SRPs as compared to White adults, the purpose of the current study was to examine sleep problems, suicide-related psychiatric admission, and suicide ideation, in Black and White trauma-exposed adults. MethodSuicide-related behavior (i.e., intent, plan, and/or behavior) as reason for hospital admission was obtained via medical records review for 172 Black and White adults who were admitted to an acute-care psychiatric facility; all participants completed validated measures of sleep quality and suicide ideation. ResultsAdjusted logistic regression analyses revealed that sleep-related daytime dysfunction (AOR = 4.32, p < .05) and poor sleep quality (AOR = 3.64, p < .05) were associated with significantly increased odds that Black participants were admitted for suicide-related psychiatric care. Poorer sleep quality (AOR = 2.10, p < .05) was also associated with increased odds of suicide-related admission among White participants. However, shorter sleep duration was marginally associated with suicide ideation in Black participants only. ConclusionsSRPs may be related to suicide-related behavior and ideation differently for vulnerable Black and White adults. More research is needed to understand potential race group differences and mechanisms by which SRPs increase risk for suicide crisis across racial groups.

Evaluation of the Prescription Pattern of Antimicrobial Agents in Hospitalised Paediatric Patients in a Tertiary Care Hospital of Kathmandu, Nepal

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Infectious diseases are one of the most frequent reasons for hospital admission for children and antimicrobials are commonly used to treat them. There is higher prevalence of irrational prescriptions of antimicrobials in such population. This study was conducted to survey the pattern of antimicrobial prescription in Paediatric inpatient.&#x0D; Material and Methods: This was retrospective, descriptive, observational study. The data was collected from prescription records. The paediatric population included in the study was categorised into three age groups. A total of 87 prescriptions were studied and the information was recorded in performa. Data were recorded in MS Excel and Graph Pad Prism version 6 was used for analysis.&#x0D; Results: The number of male child was outnumbered by female child. The average age of the patient on antimicrobial prescription was 5.34 ± 2.18 years. The mean duration of hospital stay was 6.17 ± 2.01 days. The common indications for antimicrobial prescriptions were upper respiratory tract infections, diarrhoeal illness, urinary tract infections, enteric fever, etc. The antimicrobials prescription rate was 1.33. Oral route was found to be commonly used than parenteral route. The generic prescription rate was 33.6%. The most common drug prescribed was ceftriaxone followed by amoxicillin + clavulanic acid, ciprofloxacin, metronidazole and amikacin. The 62.5% of antimicrobials were prescribed from National Essential List of Medicines.&#x0D; Conclusion: This study highlights the prescription pattern of antimicrobial agents in hospitalised Paediatric population in a tertiary care hospital.&#x0D; &#x0D; &#x0D; &#x0D;

25-hydroxyvitamin D and health service utilization for asthma in early childhood

IntroductionAsthma is the most common chronic illness of childhood and a common reason for hospital admission. Studies suggest that low vitamin D levels may be associated with health service utilization (HSU) for childhood asthma.&#x0D; Objectives and ApproachThe primary objective was to determine if vitamin D serum levels in early childhood were associated with HSU for asthma including: a) total HSU, b) hospital admissions, c) emergency department visits and d) outpatient sick visits. Secondary objectives were to determine whether vitamin D supplementation in pregnancy or childhood were associated with HSU for asthma. Prospective cohort study of children participating in the TARGet Kids! practice based research network. HSU was determined by linking each child's provincial health insurance number to health administrative databases. Multivariable quasi Poisson and logistic regression were used to evaluate the associations.&#x0D; Results2926 healthy children ages 0-6 years had 25-hydroxyvitamin D data available and were included in the primary analysis. Mean (IQR) 25-hydroxyvitmain D level was 84 nmol/L (65-98 nmol/L), 218 and 1267 children had 25-hydroxyvitamin D levels &lt;50 nmol/L and &lt;75 nmol/L, respectively. In the adjusted models, there were no associations between 25-hydroxyvitamin D (continuously or dichotomized at 50 and 75 nmol/L), vitamin D supplementation in pregnancy or childhood and HSU for asthma.&#x0D; Conclusion/ImplicationsHigher vitamin D blood values do not appear to be associated with HSU for asthma in this population of healthy urban children.

Emergency General Surgery—A Misnomer?

Emergency general surgery (EGS) is defined as the urgent assessment and treatment of nontrauma, general surgical emergencies involving adults. Acute surgical emergencies often represent the most common reason for hospital admission with diagnoses, including bowel obstruction and appendicitis. EGS is a growing surgical subspecialty that includes both operative and nonoperative management of acutely ill patients. We sought to assess the burden of nonoperative care in EGS patients at our academic medical center. This study was conducted by retrospective analysis of prospectively collected data from patients entered into the Duke EGS Registry between July 1, 2016 and September 10, 2017. Fifty-six per cent (n = 771) of patients in the Duke EGS Registry (n = 1377) were managed nonoperatively as compared with 44 per cent (n = 606) who were managed operatively. Nonoperative management of disease represents a large subset of EGS and, therefore, needs further investigation to improve processes, outcomes, and standardization of care.

Invasive disease by Streptococcus pyogenes: Patients hospitalized for 6 years

Introduction and objectiveIn the 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 analyse the epidemiology and the clinical features of ID due to SGA in a tertiary paediatric hospital. Material and methodsThis was a retrospective study of all in-patients with final diagnosis of ID due to SGA during 6 years (2009–2014) in a paediatric hospital.To consider ID, SGA had to be isolated in sterile samples, in patients with fasciitis necroticans in skin samples or in any sample in patients with the diagnosis of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of the following 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) and 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.

Accurate determination of energy requirements in hospitalised patients with parenteral nutrition.

The prescription of parenteral nutrition (PN) in hospitalised patients requires an estimation of the energy requirements. Most studies employing prediction equations (PEs) to estimate energy requirements have focused on critically ill patients. The present study aimed to evaluate several PEs of the resting energy expenditure (REE) to identify the most accurate equation for estimating the REE required for PN. This cross-sectional and descriptive study included patients hospitalised with medical or surgical diagnoses, making them candidates for PN. Epidemiological data, the reason for hospital admission, nutritional screening results, characteristics of the PN administered and REE by indirect calorimetry (IC) were recorded and, subsequently, PEs were calculated. In total, 116 patients were recruited with a mean (SD) age of 56.7 (13.8) years and body mass index of 21.3 (4.25) kg m-2 . The diagnosis was medical in 52% of patients and surgical in 48%. The mean (SD) REEs of patients, according to IC, were: 6.11 (1.18) MJ [1461 (281) kcal]; and according to PEs: Mifflin, 5.07 (1.05) MJ [1212 (252) kcal]; Owen, 5.43 (0.72) MJ [1298 (172) kcal]; Harris-Benedict, 5.38 (0.85) MJ [1285 (204) kcal]; Ireton-Jones, 6.20 (1.69) MJ [1481 (403) kcal]; and short equation, 6.12 (0.92) MJ [1464 (220) kcal]. A comparison of the results obtained for the REE by IC and with PEs indicated that the short equation had less bias than the other equations, with an accuracy of 54% CONCLUSIONS: In hospitalised patients who receive PN, determination of the REE should ideally be made by IC. PEs are acceptable but not exact and so their estimation could overfeed or underfeed the patient.

Suctioning Clinic- Using inpatient resources to create an outpatient care model for bronchiolitis

Purpose Bronchiolitis is the leading reason for hospital admission for children < 2 years old. A frequent reason for admission is dehydration due to poor oral intake secondary to significant upper airway congestion. Our care model uses inpatient resources to help prevent admissions through early interventions and good suctioning techniques. Method Children four weeks to 24 months old are initially evaluated during an acute visit by a community physician and they are approved for the Suctioning Clinic. To be eligible a child must be medically stable, though at potential risk for …