Repeat Admissions Research Articles

FP2.11 - Management of Acute Sigmoid Volvulus – a 10-year retrospective review

Abstract Aims This study aims to review the management and outcomes of acute sigmoid volvulus within our Trust. Methods This was a retrospective study conducted at our NHS Trust. All adult patients presenting with SV between January 2012 and January 2022 were included. Data was collected from electronic patient records. Admission data included management (conservative only, CM, emergency surgery, ES, or planned surgery, PS), episode number, and 30-day mortality. Surgical data included ASA grade, complication rates, and bowel continuity rates. Results 219 patients (54.8% male, median age 72yrs) presented with acute SV. 87.2% patients were managed conservatively at index presentation, 44% of whom experienced recurrent SV. 27.4% patients received surgical management during follow-up (18.3% ES, 9.1% PS), none of whom experienced recurrence following surgery. The rate of ES increased linearly with total number of episodes, from 11% at index presentation to 25% at ≥5 episodes. 30-day mortality was 13.4% in the CM group, 15% in the ES group, and 0% in the PS group. Post-operative complication rate was 42.5% in the ES group and 5% in the PS group. Bowel continuity was achieved in 22.5% of ES patients and 60% of PS patients. Discussion Conservative management of SV was associated with a significant recurrence rate in our cohort. Repeat admissions were associated with an increasing incidence of ES, which was associated with worse outcomes compared with PS. We recommend all patients are considered for planned surgical intervention at index presentation to reduce recurrence and minimise the rate of emergency intervention.

A predictive model for readmission within 1-year post-discharge in patients with schizophrenia

BackgroundSchizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China.MethodsA prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model’s performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples.ResultsMultivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13–8.86), repeat admissions (aHR 3.49, 95% CI 2.08–5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34–3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04–3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model.ConclusionsA nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.

969 Assessment of Diagnostic Criteria and Treatment Approaches for Biliary Dyskinesia: A Retrospective Analysis in NHS Grampian

Abstract Aim Biliary dyskinesia is a motility disorder of the gallbladder and sphincter of Oddi which presents with biliary-type pain without a structural pathology. Diagnosis relies on the ROME IV criteria for Functional Gallbladder Disorder, but its clinical utilisation remains limited. This retrospective study evaluates the diagnostic criteria, investigations, treatment, and surgical outcomes in patients with suspected biliary dyskinesia. Method Data from 185 patients who underwent cholecystokinin cholescintigraphy between 2017 and 2022 in NHS Grampian were analysed. Information on patient demographics, Rome IV criteria, supportive investigations, treatments, complications, hospital admissions, and medication use was collected from Trakcare. Results The average patient age was 46 years, with 21.1% male and 78.9% female participants. The Rome IV Criteria was used in only 12.4% of cases. Cholecystectomy was performed in 40.5% of cases, with complications occurring in 10.6% of these surgeries. On average, patients were admitted to the hospital 1.07 times, staying for approximately 3.92 days before surgery. Notably, 30.6% of cholecystectomy patients needed readmission for unresolved symptoms, and 40.5% relied on analgesics. Conclusions Rome IV criteria was underutilised in diagnosing biliary dyskinesia. Cholecystectomy did not reliably relieve symptoms in all patients, resulting in repeat admissions. Better adherence to diagnostic criteria and clear treatment guidelines are needed.

Anxiety and Depression Symptoms Improve in Partial Hospitalization Treatment for Adolescents with and without Suicidal Thoughts and Behaviors: Leveraging Measurement-Based Care and Electronic Health Record Data

ABSTRACT Partial hospitalization programs (PHPs) offer an alternative to inpatient care for youth with acute psychiatric needs. PHP treatment is effective for adults, but fewer studies have examined adolescent programs. In the current study, we describe a large sample of adolescents enrolled in a PHP and evaluate symptom change over treatment. Demographic information, insurance, treatment length, readmission status (i.e. repeat admissions), the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Columbia Suicide Severity Rating Scale (C-SSRS) were extracted from electronic health records. The sample (N = 1237, ages 12–18) was predominantly female assigned at birth (70%), White (84%), and non-Hispanic/Latine (92%). Approximately 25% of the adolescents reported suicidal thoughts and behaviors (STBs) and 8% were readmissions. Anxiety and depression symptoms decreased significantly over the course of treatment (p < .001). Female patients reported more severe symptoms than males (p’s < 0.001), and patients who identified as racial and/or ethnic minorities reported higher anxiety and depression (p’s < 0.05) over treatment. Past month STBs was associated with higher anxiety (p = .003) and depression (p < .001) symptoms at admission, though these youth experienced similar symptom reduction. Readmission status did not predict symptoms at admission or change over treatment. This naturalistic study suggests that PHP treatment reduces anxiety and depression symptoms for adolescents with STBs and those with repeat admissions. Demographic factors impacted symptom severity and suggested that patients identified as racial and/or ethnic minorities may experience barriers to accessing treatment. Treatment needs and considerations for adolescents in PHPs are discussed.

Rapid access nurse-led atrial fibrillation clinics reduce hospital readmissions

Abstract Background Atrial Fibrillation (AF) is the most common cardiac arrhythmia and in the UK accounts for about 1.5% of healthcare expenditure mainly through recurrent hospital admissions (1). The European Society of Cardiology 2020 AF guidelines (2) provides a clear framework of all the different components required to provide good patient-centred integrated AF management of which very little is done well within an emergency inpatient setting. Purpose We have developed a nurse led Rapid Access AF (RAAF) clinic aiming to prevent repeat admissions and improve patients overall AF care. Methods All patients discharged from our institution's emergency department (ED) or acute medical ward with a primary diagnosis of atrial fibrillation are suitable for the Rapid Access AF clinic. At the clinic the patients are given patient education, advise about risk factor modification, access to an "AF hotline" and a simple initial management plan should symptoms worsen with advise about when to attend the emergency department. Patients are then reviewed at a weekly multidisciplinary meeting with the local AF doctors where longer term strategies are made. The clinics have been operating now for 2 years and we have audited the 3 months from January to March 2022 with further follow up at 6 months. Results 41 out of 64 patients presenting to the emergency department with AF were admitted. However, whether in the ED or subsequent medical ward, treatment as a whole was very simple AF management, similar to that of outpatient care ( e.g. in ED Beta Blockers 34%, Digoxin 16%, oral Flecainide 5%, IV Amiodarone 12.5%, direct current cardioversion 1.5%, no clear AF treatment 16%, anticoagulation in patients with CHADSVASC 2+ 92%). 36 out of 64 patients were discharged to RAAF clinic and were seen on average 22 days post discharge. Readmission rates were 11% vs 32% at 30 days in patients discharged to RAAF compared to standard care and 14% vs 60% at 6 months. Conclusion Patients admitted to hospital with a primary diagnosis of AF are at high risk of early readmission. A rapid access AF clinic is effective at significantly reducing hospital readmission rates whilst also providing more holistic integrated AF management.

Population-based estimates suggest middle meningeal artery embolization for subdural hematomas could significantly expand the scope of neurovascular therapies

BackgroundThis study quantifies the impact of middle meningeal artery embolization (MMAE) for subdural hematomas (SDHs) by estimating a target population.MethodsA population-based study at a tertiary hospital, the main SDH facility...

Effects of PM2.5 and Its Components on Disease Severity in Patients with Schizophrenia and the Mediating Role of Thyroid Hormones.

Studies have indicated the different effects of PM2.5 components on human health. However, specific components that influence the severity of disease in schizophrenia patients and their underlying mechanisms remain unclear. Therefore, a repeated measures study for schizophrenia was constructed based on Anhui Mental Health Center. We collected information, including demographics and thyroid hormones (TH) levels, on repeat admissions of schizophrenia patients during 2017-2020, assessing their illness severity by positive and negative symptom scales (PANSS). Concentrations from the nearest component monitoring station in the 3 months before admission were assigned as the participant's exposure level. We assessed the effects of PM2.5 components individually and in combination on schizophrenia and explored the mediating role of THs. Results indicated that benzo[a]pyrene, sulfate, nitrate, chloride, ammonia, cadmium, chromium, lead, selenium, and thallium exposure were associated with increased PANSS scores, with more significant results observed in males. Mixed exposure to PM2.5 components was found to be associated with increased PANSS scores and decreased free triiodothyronine (FT3). Mediation analysis suggested that the reduction in FT3 might mediate the association between the PM2.5 components and PANSS scores. The findings emphasize the impacts of PM2.5 components on schizophrenia and the potential value of focusing on changes in THs.

Comparison of percutaneous coronary intervention versus medication in dialysis patients with coronary artery disease

Abstract Background There is a lack of evidence for the optimal management of dialysis patients complicated with coronary artery disease (CAD). Based on the favorable results from patients with normal or near-normal kidney function, percutaneous coronary intervention (PCI) has extended to patients on maintenance dialysis. However, it is unknown whether this extrapolation is accurate. Purpose We sought to investigate the benefits of PCI in dialysis patients with CAD. Methods Between January 2015 and June 2021, 455 617 consecutive cardiac catheterizations from 30 cardiac centers in China were reviewed retrospectively through medical records. Patients with normal coronary anatomy, those who did not receive dialysis therapy or received dialysis for less than 3 months, those who received coronary artery bypass grafting, repeat admissions, and those with less than one year of follow-up were excluded. Patients were followed up via telephone interviews or clinic visits until June 2022. The primary outcome of interest was 1-year all-cause mortality, and the secondary outcome of interest was 1-year cardiac death. Cox proportional hazards regression model was used to assess the association of PCI with outcomes. Inverse probability of treatment weighting was used to control for imbalances in patient characteristics. Results Of 1 119 patients who met the final criteria, 799 (71.4%) received PCI. The mean age was 61.9±10.6 years, and 828 (74.0%) were male. Compared with medically treated patients, patients in the PCI group were more likely to present with a high Gensini score, be with multivessel diseases, and receive dual antiplatelet and statin therapy. Overall, 201 (16.4%) all-cause deaths were documented, with 153 (13.7%) cardiac deaths. Patients treated with PCI experienced significantly lower cumulative rates of 1-year all-cause deaths (15.5% vs. 24.1%, log-rank p&amp;lt;0.001) as well as cardiac deaths (11.5% vs. 19.1%, p&amp;lt;0.001). Multivariate analyses showed that PCI was independently associated with a lower risk of either all-cause deaths (hazard ratio 0.48, 95% confidence interval 0.36-0.64, p&amp;lt;0.001) or cardiac mortality (hazard ratio 0.45, 95% confidence interval 0.30-0.61, p&amp;lt;0.001). These findings were further confirmed in the inverse probability of treatment weighting cohort. Conclusion This cohort study found that in real-world practice, among dialysis with CAD, use of PCI was associated with significantly lower risks for 1-year all-cause death or cardiac mortality compared with medical management. Further prospective studies are needed to confirm these findings.

Admissions for Bronchiolitis at Children’s Hospitals Before and During the COVID-19 Pandemic

The COVID-19 pandemic has been associated with a transient decrease in bronchiolitis hospitalizations compared with prepandemic patterns, but current effects remain unknown. To analyze changes in patterns of bronchiolitis admissions at US children's hospitals during the 2020-2023 bronchiolitis seasons compared with the 2010-2019 seasons. This retrospective cross-sectional study used data from 41 US children's hospitals in the Pediatric Health Information System database. Bronchiolitis has winter-predominant seasonality, so hospitalizations were grouped according to bronchiolitis season (from July through June). This study included all patients aged younger than 2 years admitted with a diagnosis of bronchiolitis between July 1, 2010, and June 30, 2023. Bronchiolitis seasons from July through June between 2010-2011 and 2019-2020 were classified as the prepandemic era, and seasons between 2020-2021 and 2022-2023 were classified as the pandemic era. Data analysis was performed from July 1, 2010, through June 30, 2023. Admission date. The primary outcome was number of hospitalizations for bronchiolitis by season and month. Monthly admission counts from the prepandemic era were transformed into time series and used to train seasonal ensemble forecasting models. Forecasts were compared to monthly admissions during the pandemic era. In this study, there were 400 801 bronchiolitis admissions among 349 609 patients between July 1, 2010, and June 30, 2023. The median patient age was 6 (IQR, 2-12) months; 58.7% were boys and 43.7% were White. Hospitalizations increased gradually during the prepandemic era (median, 29 309 [IQR, 26 196-34 157]), decreased 69.2% (n = 9030) in the 2020-2021 season, and increased 75.3% (n = 51 397) in the 2022-2023 season. Patients in the pandemic era were older than those in the prepandemic era (median, 7 [IQR, 3-14] vs 6 [2-12] months; P < .001). Intensive care unit (ICU) admissions increased from 32.2% (96 245 of 298 535) in the prepandemic era to 36.7% (37 516 of 102 266) in the pandemic era (P < .001). The seasonality of bronchiolitis admissions changed during the pandemic era. Admissions peaked in August 2021 (actual 5036 vs 943 [95% CI, 0-2491] forecasted) and November 2022 (actual 10 120 vs 5268 [95% CI, 3425-7419] forecasted). These findings were unchanged in sensitivity analyses excluding children with complex chronic conditions and excluding repeat admissions. In a sensitivity analysis including all viral lower respiratory tract infections in children aged younger than 5 years, there were 66 767 admissions in 2022-2023 vs 35 623 (31 301-41 002) in the prepandemic era, with the largest increase in children aged 24 to 59 months. The findings of this cross-sectional study suggest that bronchiolitis hospitalizations decreased transiently and then increased markedly during the COVID-19 pandemic era. Patients admitted during the pandemic era were older and were more likely to be admitted to an ICU. These findings suggest that bronchiolitis seasonality has not yet returned to prepandemic patterns, and US hospitals should prepare for the possibility of atypical timing again in 2023.

Chronic hepatitis B in hospitalized rheumatologic patients: problems of screening and reactivation of infection

Objective: to evaluate the completeness of screening for hepatitis B virus (HBV) infection in HBsAg-positive patients admitted to a rheumatology hospital and to follow the history of HBV reactivation/seroversion during antirheumatic therapy. Material and methods. The results of initial and repeated (if applicable) hospitalizations were analyzed in 80 patients with rheumatic diseases (RD), including 55 (69%) women and 25 (31 %) men, with Australian surface antigen (HBsAg), admitted to the V.A. Nasonova Institute of Rheumatology from January 1, 2020 to July 20, 2022 (30 months). Results and discussion. The total number of hospitalizations to the clinic during the observation period, including repeat admissions, was 13,681. The number of hospitalizations in 80 patients with HBV infection during the observation period, including repeat admissions, was 144, of which for systemic vasculitis – 6 (8 %), other systemic connective tissue diseases – 16 (20 %), osteoarthritis and post-traumatic changes of joints – 14 (15 %), inflammatory joint diseases – 42 (54 %). Cases of HBV reactivation/seroverion, both in anamnesis and during observation, were detected in 9 (11 %) patients, and most frequently (n = 5) they were registered during methotrexate therapy. Conclusion. HBV infection in patients with RD leads to significant difficulties in the selection of drug therapy, due to the risk of reactivation of the infection. The results obtained indicate incomplete screening of patients with RD for HBV infection during the preclinical phase. Further investigation is needed to develop clear recommendations for the management of patients with RD infected with HBV.

Mean Length of Stay of Orthopedic Trauma Patients Admitted in the In- tensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sec- tional Study.

Introduction: Audit of intensive care unit admissions is an important tool in monitoring and improving quality of health service provided. Length of stay in the intensive care unit provides key information to health care service providers regard- ing the burden of major orthopedic trauma and helps in improving treatment policies. Hence, this study aims to find out the mean length of stay among orthopedic trauma patients admitted in the intensive care unit of a tertiary care center. Methods: A descriptive cross-sectional study was carried out among orthopedic trauma patients admitted to the intensive care unit between January 1, 2022, and December 31, 2022, following ethical clearance from institutional review commit- tee of B.&amp;B. Hospital Gwarko, Lalitpur, Nepal (reference no: B&amp;BIRC-23-09). All orthopedic trauma patients admitted in the intensive care unit were included. Clinical records with missing information and patients who had repeat admissions due to other issues were excluded. Data were collected retrospectively. Convenient sampling method was used. Point estimate and 95% confidence interval were calculated. Results: Mean length of stay of orthopedic trauma patients admitted in intensive care unit was 4.68±5.01 days (3.89- 5.47, 95% confidence interval). Mean age of the patients was 42.07±21.76 years, and 118 (76.62%) were males and 36 (23.38%) were females. Conclusion: The mean length of stay of orthopedic trauma patients admitted in the intensive care unit of a tertiary care center was lower to that reported in other international studies. Keywords: Intensive Care Units, Length of Stay, Multiple Trauma

Laparoscopic cholecystectomy prevents readmissions. A 9-year review of acute pancreatitis in pregnancy in an Australian tertiary center

BackgroundAcute pancreatitis in pregnancy (APIP) is a rare but potentially life-threatening condition, affecting women at any gestation. The aim of this review is to investigate the demographics, etiology, management, and outcomes of pancreatitis in pregnant women in a major tertiary hospital in Queensland. MethodsData was collected from the hospital medical records of all patients diagnosed with APIP from 01/01/2012 until 30/04/2021 at the Mater Hospital, Brisbane. Descriptive statistical measures were employed. Spearman’s rank correlation was used to challenge different risk factors for readmission. Results26 patients met the inclusion criteria, with 38 admissions during the study period. Biliary pancreatitis was the most common etiology (n = 14, 53.8%). 42.5% of admissions were managed operatively (n = 15). 38.5% of patients had more than one admission (n = 10). Undergoing a laparoscopic cholecystectomy on index admission correlated with a significantly lower chance of repeat admission (rs= -.48, p = .013, CI = - .737 to -.102). ConclusionThis is the first study of this condition in an Australian institution. It demonstrates that in patients with acute biliary pancreatitis, operative management can be safely employed at any trimester and laparoscopic cholecystectomies should be performed in the index admission to reduce the risk of readmission to hospital.

Risk Factors for Hospital Re-admission for Diabetes Related Foot Disease: A Prospective Cohort Study

Diabetes related foot disease (DFD) is a common reason for admission to hospital, but the predictive factors for repeat admission are poorly defined. The primary aim of this study was to identify rates and predictive factors for DFD related hospital re-admission. Patients admitted to hospital for treatment of DFD at a single regional centre were recruited prospectively between January 2020 and December 2020. Participants were followed for 12 months to evaluate the primary outcome of hospital re-admission. The relationship between predictive factors and re-admission were examined using non-parametric statistical tests and Cox proportional hazard analyses. The median age of the 190 participants was 64.9 (standard deviation 13.3) years and 68.4% were male. Forty-one participants (21.6%) identified themselves as Aboriginal or Torres Strait Islander people. One hundred participants (52.6%) were re-admitted to hospital at least once over 12 months. The commonest reason for re-admission was for treatment of foot infection (84.0% of first re-admission). Absent pedal pulses (unadjusted hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26 - 2.85), loss of protective sensation (LOPS) (unadjusted HR 1.98; 95% CI 1.08 - 3.62), and male sex (unadjusted HR 1.62; 95% CI 1.03 - 2.54) increased the risk of re-admission. After risk adjustment, only absence of pedal pulses (HR 1.92, 95% CI 1.27 - 2.91) and LOPS (HR 2.02, 95% CI 1.09 - 3.74) significantly increased the risk of re-admission. Over 50% of patients admitted to hospital for treatment of DFD are re-admitted within one year. Patients with absent pedal pulses and those with LOPS are twice as likely to be re-admitted.

Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome.

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.

Treatment of anterior cutaneous nerve entrapment syndrome using an ultrasound-guided transverse abdominis plane block

Introduction: Anterior cutaneous nerve entrapment syndrome (ACNES) is increasingly being considered to be a common cause of abdominal pain. Unfortunately, ACNES is a condition that is frequently overlooked and misdiagnosed resulting in chronic abdominal wall pain, unnecessary investigations, procedures, and repeat admissions. Patients diagnosed with ACNES present with well-localized abdominal pain, a positive Carnett’s sign, somatosensory disturbance of the surrounding skin and symptomatic relief secondary to a trigger point injection. Current treatment strategies include modification of physical activity, simple analgesia, trigger point injections, chemical neurolysis, pulsed radiofrequency, and anterior neurectomy. Despite the plethora of treatment modalities, it is evident that a majority of patients will only experience temporary pain relief. Case Series: We describe two cases in which ultrasound-guided transverse abdominal plane blocks have successfully provided long-term symptomatic relief in patients diagnosed with ACNES. The first being a 45-year-old female and the second is a 52-year-old male who both presented with ACNES which were successfully treated with an ultrasound-guided transverse abdominal plane (TAP) block with 20 mL of 0.25% Marcaine and 4 mg of Dexamethasone. Conclusion: We provide evidence supporting the use of an ultrasound-guided TAP block for long-term symptomatic relief in patients with ACNES. However, further research is required to assess its efficacy.

A Real-World Cost-Effectiveness Study Evaluating Imaging Strategies for the Diagnostic Workup of Renal Colic in the Emergency Department.

Introduction Both non-contrast Computed Tomography (CT) and ultrasound (US) are used for the diagnosis of renal colic in the emergency department (ED). Although US reduces radiation exposure, its diagnostic accuracy is inferior to that of CT. In this context, data regarding the cost and organizational impact of these strategies represent essential elements in the choice of imaging; however, they remain poorly documented. Aim of the study The aim of this study was to compare the costs and effectiveness of diagnostic workup by US and CT for patients consulting with renal colic in the ED. Methods We conducted a monocentric real-life retrospective study of patients consulting for a renal colic in an ED between 1 July 2018 and 31 December 2018. We estimated length of stay (LOS), total hospital costs at 60 days including ED, and initial and repeat admissions. Patients with initial US in the ED were compared to patients with initial CT using inverse probability weighting of the propensity score calculated from demographic variables, vital parameters, and clinical presentation. We calculated the incremental cost effectiveness ratio as the difference in costs by the difference in LOS. The variability of the results was assessed using non-parametric bootstrapping. Results In this study, of the 273 patients included, 67 were patients assessed with US and 206 with CT. The average costs were €1159 (SD 1987) and €956 (SD 1462) for US and CT, respectively, and the ED LOS was 8.9 [CI 95% 8.1; 9.4] and 8.7 [CI 95% 7.9; 9.9] hours for US and CT, respectively. CT was associated with a decreased LOS by 0.139 [CI 95% -1.1; 1.5] hours and was cost-saving, with a €199 [CI 95% -745; 285] reduction per patient. Conclusion When imaging is required in the ED for suspected renal colic as recommended, there is real-life evidence that CT is a cost-effective strategy compared to US, reducing costs and LOS in the ED.

Study of reasons for relapse in patients with bipolar I disorder with repeat admissions and its correlation with substance use

Background: Mood disorder is one of the common causes, for which psychiatric consultations are sought. A better understanding of the factors that lead to repeated admissions, increased relapse rates, and concurrent substance dependence is necessary for the development of interventions that may reduce the likelihood of adverse effects in patient with bipolar I disorder. Aims and Objectives: The aims of this study were as follows: (1) To study the correlation between the reasons for relapse and substance use with various sociodemographic factors in patients having bipolar I disorders and (2) to find out the correlation between reasons for relapse, substance use, and severity of illness. Materials and Methods: This was a cross-sectional single interview study, in which 67 consecutive patients having bipolar I disorder and admitted in psychiatry ward were admitted on the basis of a pre-defined inclusion and exclusion criteria. The details about psychiatric, relapse-related symptoms, substance use-related symptoms, as well as other aspects of clinical profile were taken. Results: Out of 67 patients, 51 (76.1%) were male and 16 (23.8%) were female. Mean age of the participants was 30.43 years (S.D.=9.05). Sleep disturbance was seen in all patients (67) and was also the most common symptom. It was followed by psychomotor disturbances in 60 (89.5%) of the patients. Among 67 patients included in the study, substance use was seen among 28 (41.7%) of the patients. Substance use was significantly associated with age of the patients and occupation (P=0.03 each). The age group of more than 30 years (57.7%) had significantly higher substance use compared to those &lt;30 years (31.7%). Conclusion: Concurrent substance use is associated with increased risk of relapse and readmissions in cases of patients with bipolar I disorders. A thorough history is necessary to rule out substance use in these cases.

Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa.

We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. Level III, cohort study.

A Re-Audit Assessing the Standardisation of Admission Blood Tests for Patients on Norbury House (PICU)

AimsAssess if variation exists for routine blood tests performed on admission, evaluate compliance with MPFT guidelines when performing routine admission blood tests, compare results with the previous audit completed in October/November 2020 and identify strategies to improve and standardise admission blood tests.MethodsRetrospective blood result data were collected for all admissions to Norbury House (PICU) at St George's Hospital in Stafford over a two month period. For the original audit, this was between October and November 2020, following which a staff education programme raised awareness of trust guidelines regarding admission blood tests. This was then re-audited in May and June 2021 to assess its impact. Patients transferred from acute wards were included but repeat admissions were omitted. Data analysis was completed through Microsoft Excel.Results17 patients were included in the audit in October and November 2020 while 13 patients were included for the May and June 2021 audit. As per trust guidelines, the number of patients having the appropriate admission blood tests increased to 69% in 2021. Certain mandatory blood tests were requested far more regularly such as TFTs increasing from 71% in 2020 to 100% in 2021. Other vital blood tests on admission also increased substantially, such as Glucose increasing from 6% of admissions in 2020 to 69% in 2021 and Prolactin increasing from 77% in 2020 to 100% in 2021. All mandatory blood tests either increased in frequency or maintained a 100% completion rate, with the exception of Calcium which decreased slightly from 94% in 2020 to 92% in 2021.In the 2020 audit, unnecessary blood tests were requested for 88% of patients which was reduced substantially to just 21% of admissions in the 2021 audit. The total number of unnecessary tests also greatly reduced from 23 tests in total in 2020 to 3 in 2021.ConclusionIt is vital that patients being admitted to the PICU have the appropriate blood tests completed on admission, as they may be prescribed psychotropic medication that impacts their physical health and may have been self-neglecting prior to admission. Although the audit shows that the interventions completed following the last review have been hugely successful in improving compliance with trust guidelines and reducing waste of NHS resources, there is still significant room for improvement through the continual education of staff. This should then be re-audited again in Spring 2022 to ensure that the improvement continues.

A case report a delayed diagnosis of tracheomalacia resulting in prolonged steroid therapy, repeated hospital admissions and CT scans

A 30-year-old patient was admitted with shortness of breath and cough. Previous electronic entries state a history of asthma and hay fever. Repeated clerking by junior doctor states admission for treatment of likely exacerbation of asthma. The patient failed to fully improve with repeated courses of oral corticosteroids, regular nebulisers and oral antibiotics. The patient failed to improve even after several repeated admissions for similar admissions. On each admission she was subjected to CT scan and steroid courses, and at one point even had the authenticity of her symptoms questioned. Eventually she was found to have a case of tracheomalacia. Unfortunately, despite the eventual diagnosis, the patient has suffered side effects due to the delayed diagnosis and repeated treatment courses.