Related Hospital Admissions Research Articles

Risk stratification of emergency department patients with chest pain using d-dimer and high-sensivity C-reactive protein

Study objectives: Several recent reports in the literature have shown positive association between HS-CRP and d-dimer levels with diagnosis of acute coronary syndrome. Our study aims to find out whether these 2 markers would be useful in the risk stratification of patients presenting to the emergency department (ED) with undifferentiated chest pain. Methods: One hundred twenty-three patients, aged 25 years or older, were recruited when they presented to the ED with nontraumatic chest pain. They were evaluated and treated at the discretion of the treating physician but had additional d-dimer and HS-CRP done. Treating physicians were blinded to the results of these tests. Patients who had no history of ischemic heart disease and were diagnosed to have noncardiac chest pain underwent cardiac stress testing or other appropriate investigations to exclude cardiac ischemia and confirm their diagnoses. Final diagnoses were determined by cardiologists. These patients were followed up for mortality, ischemic events, and related hospital admissions at 1 week and 6 months after ED visit. Results: There was a nonsignificant difference in the mean HS-CRP levels of patients with acute coronary syndrome and noncardiac chest pain. However, HS-CRP level for patients with related admission within 1 week of presentation was 41.5 mg/dL compared with 3.4 mg/dL for patients who did not have related admission ( P =.01). There was no significant difference for mortality rate or related admission at 6 months. d-dimer levels of patients with angina were significantly higher than those of patients with noncardiac chest pain. They were 143.9 μg/L and 99.7 μg/L, respectively ( P =.016). Thirteen patients had acute myocardial infarction within 1 week of the presenting episode, and they had a mean d-dimer level of 154.9 μg/L compared with mean d-dimer level of 95.8 μg/L for patients who did not have acute myocardial infarction within 1 week of the presenting episode ( P =.013). Twenty-three patients had a related admission within 6 months. Their mean d-dimer level of 150.7 μg/L was significantly higher than the 91.7 μg/L for patients who did not have a related admission within 6 months ( P =.001). Conclusion: Our findings suggest that high HS-CRP level predicted a related admission within 1 week of the presenting episode, which is potentially useful in risk stratification. A patient with risk factors and atypical-sounding pain but high HS-CRP level will probably need more urgent further cardiac evaluation after acute myocardial infarction had been ruled out than a patient who had normal HS-CRP levels. A higher d-dimer level was associated with an increased risk of coronary artery disease. Patients with higher levels of d-dimer were also more likely to have acute myocardial infarction within 1 week of presentation with chest pain and have a related admission within 6 months. These patients should be evaluated as soon as possible by a cardiologist for definitive treatment. Our study numbers are too small for us to recommend a cutoff value for HS-CRP and d-dimer levels at which the clinician should be alarmed. Further studies with larger patient recruitment would help elucidate this issue.

Exploring patient-doctor partnership in white European and South Asian adults with asthma: a qualitative interview study

Background:South Asian people with asthma have a higher risk of asthma related hospital admission compared with white Europeans. There is no clear evidence of differences in severity or prevalence of asthma, prescribed drugs, asthma education or in the severity of the acute episodes amongst admitted patients in the two ethnic groups. Excess risk is only likely to be in part due to socio-economic status. Difficulties in developing an effective patient-doctor relationship has been suggested as one of the many possible explanatory factors underlying these differences in hospitalisation rates.Objectives- To examine concepts of the patient-doctor relationship held by white and south Asian people with asthma- To identify difficulties and enhancers in the development of patient-doctor relationshipsMethodsQualitative study involving in-depth interviews with patients and doctors recruited from the Chest Clinic, Ealing Hospital, Londonand GPs are recruited from the adjoining area. A literature review and pilot interviews were used to develop the initial topic guide. We plan to purposively sample approximately 20 south Asian and 20 white adults with asthma. We are conducting patient interviews in their preferred language; interviews are taped, translated into English and transcribed. Grounded techniques with deviant case analysis are being used for data analysis.Progress to datePilot interviews have been conducted and the topic guide has been developed. We have to date conducted 10 interviews with data analysis taking place concurrently. We plan to discuss the interim results at the ASM.

Therapy related hospital admission in patients on polypharmacy in Singapore: a pilot study.

To estimate the incidence of drug-related problems (DRPs)-associated hospital admission, and its correlation to polypharmacy and age. A retrospective, cross-sectional study in in-patients on polypharmacy in Singapore. Significant differences (P < 0.05) between number of medications taken and age of patients were tested with the chi-square test. The study population consisted of 347 patients (aged 16-97) on a mean of 7.4 +/- 2.1 medications. 10.8% of the study population had DRPs on admission: 71.9% of which were dominant reasons for admission, and DRPs contributed partly in the remaining cases. These DRPs were mostly avoidable, and can be broadly classified into non-compliance, adverse drug reactions, require synergistic therapy, inappropriate dose and untreated condition. 52% of these cases were made up of geriatric patients. No statistical difference was found between patients on polypharmacy and those on major polypharmacy (10 and more drugs) in having a DRP. In this study, DRPs contributing to hospital admission appeared to be avoidable. Geriatrics were more susceptible to DRPs and future efforts are required in managing medications prescribed for these patients to reduce such incidences.

Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA).

To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs. Multicenter pharmacoepidemiology survey conducted between 1988 and 1997. Eighty-one academic hospitals throughout Italy. Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods. For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire. Mean age +/- standard deviation of the patients was 70 +/- 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10-1.54), alcohol use (OR = 1.39, 95% CI = 1.20-1.60), and number of drugs (OR = 1.24, 95% CI = 1.20-1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01-2.23 for age 65-79 and OR = 1.53, 95% CI = 1.00-2.33 for age > or =80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05-1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11-1.25 for each drug increase) were the only predisposing factors. The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.

Traffic related air pollution and acute hospital admission for respiratory diseases in Drammen, Norway 1995-2000.

The aim of this study was to estimate the associations between seven ambient air pollutants [particulate matter (PM10), nitrous dioxide (NO2), sulfur dioxide (SO2), ozone (O3), benzene, formaldehyde and toluene] and acute hospital admissions for respiratory diseases in Drammen, Norway 1995-2000. Time-series analysis of counts was performed by means of generalized additive models with log link and Poisson distribution. The results showed that benzene was the pollutant having the strongest association with respiratory diseases for the total study period, the relative risk of an interquartile increase of benzene was 1.095 with 95% confidence interval: 1.031-1.163. The corresponding results were 1.049 (0.990-1.112) for formaldehyde, 1.044 (1.000-1.090) for toluene, 1.064 (1.019-1.111) for NO2, 1.043 (1.011-1.075) for SO2, 0.990 (0.936-1.049) for O3 and 1.022 (0.990-1.055) for PM10. Dividing the total study period into two 3-year periods, there was a substantial reduction in the exposure levels of the volatile organic compounds (benzene, formaldehyde and toluene) from the first to the second period. Separate analyses for the second time period showed weaker association between these pollutants and the health outcome. This study provides further evidence for short-term respiratory health effects of traffic related air pollution.

Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992-7

Objective: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years.Design: Cross sectional survey...

Moynihan 03

Aims: Laparoscopic hernia repair induces less pain and enables a quick return to normal activity, but no information is available on long-term benefits and complications. In this prospective randomized controlled trial, laparoscopic mesh hernia repair was compared with open-mesh hernia repair at 5 years' follow-up. Methods: Patients who were randomized to either transabdominal preperitoneal laparoscopic (TAPP) repair under general anaesthetic or tension-free open-mesh hernioplasty (OPEN) under local anaesthetic were recalled after a minimum of 5 years' follow-up. Patients were required to complete a validated questionnaire, which included questions on the presence of groin pain, numbness, testicular pain, recurrence or any directly related hospital admission. An objective clinical assessment of all patients was then undertaken by one of three independent assessors. Results: A total of 241 patients were reviewed (119 OPEN; 122 TAPP). Mean patient follow-up was 5.8 years. Paraesthesia was more frequently observed with OPEN than with TAPP (30 per cent versus 2 per cent; P < 0.001). Groin pain was present in 13 per cent of the patients in the OPEN group and 8 per cent of patients in the TAPP group. Severe pain (pain analogue scores over 50 per cent) was observed in only two patients, both of whom underwent OPEN repair. No statistically significant difference between TAPP and OPEN repairs was observed in the incidence of testicular pain (2 per cent versus 2 per cent), recurrence (0 per cent versus 2 per cent) and contralateral hernia (5 per cent versus 1 per cent). Conclusions: Open and laparoscopic mesh hernia repairs are both associated with good long-term results. Laparoscopic hernia repair has significant long-term clinical advantages.

First results from an intensified monitoring system to estimate drug related hospital admissions.

An intensified monitoring system was set up to identify drug related hospital admissions and estimate population-based incidences for commonly prescribed medications. Pharmacovigilance-centres systematically screened nonelective admissions to emergency rooms or departments of internal medicine for drug related hospitalizations (DRH). Clinical pharmacologists used standardized causality assessment. Service areas of each acute care hospital were defined by 5 digit postal codes that covered 60% of all admissions. Drug dispensing information was available through claims processed by regional pharmacy computing centres. Quarterly incidences were estimated by dividing the number of events by the number of treated patients. 435 DRHs were reported during five quarters. The incidence of ADRs leading to admissions varied for specific drug groups from 1.5/10 000 treated patients to 24/10 000. Quarterly variation of incidences was moderate except for insulin and calcium antagonists. 95% confidence intervals overlap for all quarters within each group. Incidences are sensitive to changes in the definition of the source population. Our pharmacovigilance monitoring system allows comparisons of population-based incidences of drug-related hospitalizations among drugs and over time. It provides important information for risk management and monitoring outcomes of pharmaceutical quality management programmes.

Acute pulmonary toxicity of particulate matter filter extracts in rats: coherence with epidemiologic studies in Utah Valley residents.

Epidemiologic reports by C.A. Pope III et. al. demonstrated that in the Utah Valley, closure of an open-hearth steel mill over the winter of 1987 was associated with reductions in respiratory disease and related hospital admissions in valley residents. To better examine the relationship between plant-associated changes in ambient particulate matter (PM) and respiratory health effects, we obtained total suspended particulate filters originally collected near the steel mill during the winter of 1986 (before closure), 1987 (during closure), and 1988 (after plant reopening). PM subcomponents were water-extracted from these filters and Sprague-Dawley rats were intratracheally instilled with equivalent masses of extract. Data indicated that 24 hr later, rats exposed to 1986 or 1988 extracts developed significant pulmonary injury and neutrophilic inflammation. Additionally, 50% of rats exposed to 1986 or 1988 extracts had increased airway responsiveness to acetylcholine, compared to 17 and 25% of rats exposed to saline or the 1987 extract, respectively. By 96 hr, these effects were largely resolved except for increases in lung lavage fluid neutrophils and lymphocytes in 1986 extract-exposed rats. Analogous effects were observed with lung histologic assessment. Extract analysis using inductively coupled plasma-mass spectroscopy demonstrated in all three extracts nearly 70% of the mass appeared to be sodium-based salts derived from the glass filter matrix. Interestingly, relative to the 1987 extract, the 1986/1988 extracts contained more sulfate, cationic salts (i.e., calcium, potassium, magnesium), and certain metals (i.e., copper, zinc, iron, lead, strontium, arsenic, manganese, nickel). Although total metal content was (3/4) 1% of the extracts by mass, the greater quantity detected in the 1986 and 1988 extracts suggests metals may be important determinants of the pulmonary toxicity observed. In conclusion, the pulmonary effects induced by exposure of rats to water-based extracts of local ambient PM filters were in good accord with the cross-sectional epidemiologic reports of adverse respiratory health effects in Utah Valley residents.

Effect of an older sibling and birth interval on the risk of childhood injury

Objective—Certain family structures have been identified as putting children at high risk for injury. To further define children at highest risk, we set out to explore the effect of an...

ASSOCIATION BETWEEN THE CHANGE IN NUTRITIONAL STATUS IN RESPONSE TO TUBE FEEDING AND THE OCCURRENCE OF INFECTIONS IN CHILDREN WITH A SOLID TUMOR

In 32 children with a solid tumor, the association between the change in weight for height, in response to 4 weeks of tube feeding during the intensive phase of treatment, and the occurrence of leukopenia, leukopenic infections, and nonleukopenic infections in a period thereafter (4-10 weeks) was studied. Factors possibly influencing the change in weight for height during the first 4 weeks of tube feeding were also assessed. A statistically significant negative correlation (rho = 0.59; p < .001) was found between the change in z-score of weight for height in response to the first 4 weeks of tube feeding, and the occurrence of nonleukopenic infections between 4 and 10 weeks. A reduced occurrence of nonleukopenic infections resulted in a significant reduction of the number of days of infection related hospital admission (rho = .45; p = .009), which, besides providing advantages for the patient, also had economical benefits. The change in weight for height in response to tube feeding was mainly influenced by the incidence of therapy-induced vomiting (r = .45; p = .02) and by the amount of energy provided by tube feeding (r = .47; p = .007). Based on these findings, it is recommended that naso-gastric tube feeding be used in children with a solid tumor during the early intensive phase of treatment, and that one should aim for a considerable increase in weight for height during the first 4 weeks of administration, since this has been shown to reduce the number of nonleukopenic infections in a subsequent period. The increase in weight for height may be improved by providing an optimal antiemetic protocol, which will increase energy uptake, and an energy-enriched formula, which will increase energy intake.

Clinical pharmacy interventions by community pharmacists during the dispensing process.

To evaluate the professional contact between the community pharmacist and general practitioner during the dispensing process on issues other than the legality or simple clarification of the prescription. Fourteen community pharmacists from five adjacent localities completed details of each clinical pharmacy intervention during 1 week of each month for a period of 1 year. Each week of the month was randomly selected. When a community pharmacist had to contact the prescriber, during the dispensing of a prescription, the following data were recorded: brief patient details, the prescribed drug therapy, the reason for intervention, the outcome and the time taken. The main outcome measures were the type and nature of each intervention, the BNF category of the drug involved and the time taken. A multidisciplinary clinical panel assessed the potential of each intervention to alter the outcome of the patient's clinical management and to prevent a drug related hospital admission. These assessments were ranked between 0 and 10 (100% confident). During a period covering 1 week per month over 1 year, 1503 clinical pharmacy interventions were made out of 201 000 items dispensed. When normalized for the dispensing volume of each community pharmacy the lower the number of items dispensed then the greater was the percentage of interventions (P=0.013). The clinical panel decided that between 19 (0.01% of the total items dispensed) and 242 (0.12%) interventions may have prevented a drug-related hospital admission, 71 (0.04%) to 483 (0.24%) could have prevented harm whilst 103 (0.05%) to 364 (0.18%) had the potential to improve the efficacy of the intended therapeutic plan. The panel also decided that 748 (0.37%) interventions improved the clinical outcome and could have saved a visit to or by the general practitioner. Conclusion Clinical pharmacy provided by a community pharmacist during the dispensing process has the potential to provide a valuable contribution to health care.

Associations between alcohol related hospital admissions and alcohol consumption in Victoria: Influence of socio-demographic factors

ObjectiveTo examine the cross-sectional ecologic associations between apparent per-capita alcohol consumption, alcohol-related hospital admission rates, and the distributions of socio-demographic factors for people residing in 76 Local Government Areas (LGAs) in Victoria, during the 1995-1996 fiscal year. MethodVisitor-adjusted per-capita alcohol consumption was obtained from wholesale sales data from the Liquor Licensing Commission Victoria. Alcohol-related hospital admission rates were extracted from the Victorian Inpatient Minimum Dataset, and adjusted by the appropriate aetiologic fractions. Summary socio-demographic measures were derived from the 1996 Census. Their associations were analysed using multiple linear regression. ResultsPer-capita alcohol consumption ranged from 4 to 14 litres absolute alcohol/ year and alcohol-related hospital admission rates ranged from 5 to 25 per 10,000 residents/year (external-cause diagnoses) and 8-37 per 10,000 residents/ year (disease diagnoses). Higher levels of per-capita consumption were associated with higher admission rates (r=0.45 for external cause diagnoses, M5.66 for disease diagnoses, and r=0.70 for all diagnoses), each per-capita increase of one litre/year corresponding to increased admission rates of 0.6, 1.5 and 2.1 per 10,000 person-years, respectively. Further adjustments by summary socio-demographic measures reduced, but did not modify, the associations between per-capita consumption and admission rates. Conclusions and ImplicationsSummary measures of sales-based per-capita alcohol consumption and socio-demographic environments may provide useful indicators of alcohol-related morbidity in Victorian communities.

Cost of hospitalizations for heart failure: Sodium retention versus other decompensating factors

Objective: To determine the cost of heart failure–related hospital admissions and to compare the cost of admissions for sodium retention with the cost of admissions for other decompensating factors. Design: Retrospective, non-experimental, cost analysis. Setting: Midwestern university-affiliated, tertiary care, medical center. Sample: Two hundred seven heart failure–related admissions, 117 (57%) of which were for sodium retention leading to volume overload. Outcome Measures: Cost of hospitalization. Procedure: Data obtained from the patient and financial records of patients hospitalized for heart failure in 1992 were analyzed using the ratio of cost-to-charge accounting procedure. Results: The total cost was $2,442,720 for the 207 heart failure–related admissions; the average cost was $12,400 per admission. Approximately half of the cost of the hospitalizations was expended in the 4 cost centers comprising routine and critical care services, which incorporate room charges and nursing care. Another one third of the cost was for supplies, medications, and laboratory tests. Admissions as a result of sodium retention had lower costs than admissions as a result of other factors. Conclusion: The cost of hospitalization for heart failure is high. Routine services, supplies, medications, and laboratory tests used by these patients contribute to the high cost of care. Improved outpatient management strategies are necessary to reduce hospital admissions as a result of sodium retention. (Heart Lung® 1999;28:102-9)

Patients' experiences of healing a venous ulcer were described as “forever healing” which affected their activities and treatment

Chase SK, Melloni M, Savage A. A forever healing: the lived experience of venous ulcer disease. J Vasc Nurs1997 Jun; 15 : 73 –8. [OpenUrl][1][CrossRef][2][PubMed][3] Question How do patients experience...

Drug Related Hospital Admissions of Elderly Patients

Drug Related Hospital Admissions of Elderly Patients

Relation of measures of asthma severity and response to treatment to outcome in acute severe asthma.

It would be helpful if patients with asthma who require admission to hospital for an acute attack could be identified. The relation between the severity of an attack of asthma as determined by admission assessment and the eventual outcome was studied in 52 asthmatic patients aged 14 to 44 years and admitted to an asthma emergency room. The patient's history, including medication and previous admissions to hospital, was recorded and a clinical assessment, including a full inspiratory and expiratory flow-volume loop, was performed on four occasions: on admission, at two hours and at 12-18 hours after the start of a standardised treatment, and two weeks later on an outpatient basis. Patients who were discharged and who had an uneventful follow up at the two week assessment were defined as good responders. Patients who had to be admitted to hospital after 12 to 18 hours or were readmitted during the two weeks, or both, were defined as poor responders. Thirty eight patients were good responders and 14 were poor responders (seven admitted at 12 to 18 hours, seven returned to hospital). All four patients with a raised arterial carbon dioxide tension (PaCO2) (> or = 6 kPa) and the three with cyanosis were in the poor responder group, and this group had lower peak expiratory flow (PEF) values (21% v 30% predicted) on admission. There was, however, considerable overlap in PEF between the two groups and no clinical measure was able to distinguish between the good and the poor responders reliably. Poor responders had a history of more chronic systemic steroid administration, regular use of inhaled beta agonists, and asthma related hospital admissions. Nearly all the subjects showing a good response to standardised treatment had a PEF > 75% predicted and an FEV1 > 65% predicted 12 to 18 hours after the start of treatment. Prediction of outcome at admission was not possible in individual patients. A history of poor long term control of asthma, a PEF < 30% of predicted, a PaCO2 > or = 6 kPa, the presence of cyanosis, and lack of early response to treatment indicated a group of asthmatic patients who are less likely to respond to conventional emergency treatment over a short period.

Drug related admissions to medical wards: a population based survey.

1. In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2. Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3. The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Noncompliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4. The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5. Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention

Three hundred and thirty-three consecutive patients in a medical ward were evaluated in a high-intensity monitoring scheme for drug events as a cause of hospitalization. Taking into consideration only 'definite' and 'probable' drug events, we found 36 cases (10.8%) of all admissions to be drug-related hospitalizations (DRH). Of these, 8.1% were adverse drug reactions and 2.7% were therapeutic failures due to ineffective dosage. In 8 cases (2.4%) the drug event could definitely have been avoided, and a further 13 cases (3.9%) were considered to have been potentially avoidable if appropriate measures had been taken by the health service. In 19 cases (53%) the referring physician was unaware of the drug-related problem. Those patients admitted because of a drug event were taking significantly more drugs than other individuals. The avoidable drug events pointed to the primary health care physicians as the appropriate targets for preventive measures in terms of intensified drug education. The study demonstrated that a reliable estimate of the DRH rate requires active data collection by a qualified health service worker in close collaboration with the patient's family doctor in cases of suspected DRH.

Infections and sickle cell disease in Eastern Saudi Arabian children.

The rate and pattern of infections in 144 Saudi Arabian children with sickle cell disease (SCD) and matched normal control subjects are reported. All diagnoses of SCD were made at birth by means of screening blood from the umbilical cord. The children were prospectively followed up from birth to 4 years of age. Severe bacterial infections occurred in none of the children with SCD; one of the control children developed pneumococcal meningitis. Acute gastroenteritis was significantly more common among patients with SCD. For the first year of life, patients with SCD had significantly more infections than did the control children; but the reverse was true in the group that was 37 to 48 months of age. Considering all types of infections for all age groups, no difference was noted between patients with SCD and control subjects in terms of infection rate or related hospital admission. There were no deaths caused by infection in this series. We conclude that Saudi Arabian infants and young children of oasis origin with SCD are not at increased risk of infections compared with healthy children of the same age.