Record Review Research Articles

Maternity Healthcare Worker Perspectives of Severe Acute Maternal Morbidity Recording, Reporting and Case Review in Queensland, Australia.

Systematic, multi-disciplinary review of Severe Acute Maternal Morbidity (SAMM) can improve maternal outcomes. Routinely collected data, collated into the Queensland SAMM Dashboard, may facilitate local case review. We wanted to understand how SAMMs are reviewed locally and how centrally collated data supports review processes. The purpose of this survey was to assess local SAMM recording and review practices in Queensland. A cross-sectional online survey, using multiple choice and free-text response formats, sampled multi-disciplinary health care workers (HCW) involved in SAMM review in Queensland public maternity units. Responses were analysed for content, with thematic analysis performed on free-text comments. Twenty HCW responded from a mix of tertiary, regional and rural maternity facilities. HCW responses identified a lack of clarity around the terms 'maternal morbidity', 'SAMM' and 'Near-Miss'. HCW reported various approaches for recording and reviewing SAMM. The commonest structures were Root Cause Analysis and Human Error and Patient Safety incident analysis. Reviews commonly involved: patient safety teams (50%); staff involved in the case (45%); independent/external reviewers (40%) and hospital management (40%). Few responses (10%) indicated consumers were involved. 30%-80% reviewed the ACSQHC defined SAMM, 70% Near-Miss cases and up to 70% reviewed other severe maternal morbidity indicators. 20% of HCW stated lessons learned during reviews were shared with other hospitals. In Queensland, we have found variability in: HCW understanding of SAMM definitions, how cases are recorded, reviewed and improvements facilitated. A standardised approach to SAMM review and collaboration to share lessons learned may benefit maternity care.

Liposomal bupivacaine use is not associated with a higher rate of surgical site infections or multidrug-resistant infections in dogs undergoing anal sacculectomy.

To describe whether infiltration of liposomal bupivacaine (LB) is a risk factor for the development of surgical site infection (SSI) in anal sacculectomy (AS) and compare bacterial isolates from SSIs in animals that received LB and those that did not. A medical record review was performed at Colorado State University for dogs undergoing AS between August 2019 and October 2024. Data retrieved included signalment, reason for AS, anesthesia time, additional procedure performed, perioperative and postoperative antibiotic administration, use of LB, development of SSI, and bacterial isolates. The study population included 105 dogs that underwent a total of 121 ASs. In 18 of 105 cases (17.1%), SSI was noted. For the cases where LB was infiltrated intraoperatively, the rate of SSI was 17.5% (11 of 63). In cases where LB was not used, the rate of SSI was 16.7% (7 of 42). The most common bacterial isolates were Escherichia coli and Enterococcus spp. Of the 10 cultures, 8 had resistance profiles and 2 of 8 (25%) were found to have multidrug-resistant bacteria present, with no difference between the groups. This study did not show that LB was a significant risk factor for the development of SSI or multidrug-resistant infections. Incisional infiltration of LB does not seem to be associated with a higher rate of SSI or higher rates of multidrug-resistant infections in dogs undergoing AS.

Feasibility Trial of a Technology-Delivered Intervention for Opioid Use Disorder Recovery Postpartum

This randomized feasibility trial aimed to 1) assess methodology for a subsequent efficacy trial and 2) examine the usability and acceptability of Project BETTER’s hybrid technology-delivered educational intervention for pregnant people receiving medication for opioid use disorder within a perinatal addiction treatment clinic. Participants were randomized to the technology-delivered educational intervention or standard practice control (brochure). Project BETTER’s intervention offers three modules (pregnancy-to-postpartum transition, Neonatal Opioid Withdrawal Syndrome, child welfare interactions) via Computerized Intervention Authoring System (CIAS 3.0). Inclusion criteria were: ≥18 years of age, <34 weeks pregnant, currently receiving medication for opioid use disorder (MOUD), and had engaged in care ≤10 weeks during their current pregnancy. Study visits included an online survey, brief interview, and medical record review. Mean perceived helpfulness scores were compared by study condition using independent samples t-test. The screening process identified 49 potential participants, n = 31 (63%) of whom were recruited. Twenty-nine participants were randomized (intervention: n = 16, control: n = 13). Participants (n = 29) were reproductive age [M = 30.0 years (SD = 4.4)], 66% white and 31% Black with a median estimated gestational age of 24 weeks. Most participants (69%) received buprenorphine. Study completion rate was 83%. Most participants completed study components remotely. Among participants in the intervention group, 56% completed at least one module. Participants perceived the intervention to be as helpful as the brochure (intervention: 5.28 ± 0.98, control: 5.39 ± 0.56, p = 0.387) and highly acceptable. With protocol modifications, scale up to a larger clinical trial is feasible and acceptable to pregnant people receiving MOUD.

Characterization of Dermatologic Disease and Challenges in Care of Incarcerated Patients.

Incarcerated individuals face many health care challenges, including limited sanitation, limitations of formularies, and difficulty obtaining routine medical care. This study characterizes skin conditions in incarcerated individuals in the Harris Health System in Houston, Texas. We performed a retrospective health record review on incarcerated inpatients and outpatients between 2011 and 2022, collecting data on diagnostic workups, diagnoses, and interventions. Skin and soft tissue infections and drug reactions (42.9%) were the most common inpatient conditions, compared with papulosquamous and eczematous diseases (34.8%) and neoplasms (31.5%) in outpatients. Many patients demonstrated challenges in management directly related to their incarceration. Overall, the distribution of skin conditions in the incarcerated population shares similarities with that of the general population. Dermatologists should overcome resource limitations, educate patients and jails, and promote improved jail protocols for this vulnerable population.

A Situational Analysis and an Untapped Opportunity for Tackling Challenges Associated with Coverage of Tuberculosis Preventive Treatment: A Multi-Centric Study in India.

To assesses the coverage, adherence, reasons for non-initiation and non-completion of tuberculosis preventive treatment (TPT) among household child contacts (HHCC) of pulmonary tuberculosis (TB). This cross-sectional study was conducted across eight sites in India. Estimated sample size was 200 per site. Information was collected through record review and house-to-house visits of HHCCs of notified pulmonary TB cases during January to March 2022. Coverage and adherence was assessed by proportion of eligible HHCC initiated and completed TPT, respectively. Of 2554 HHCCs eligible for TPT, initiation and completion rate was 34% and 22%, respectively. Across the sites the median time to conduct home visit was 14 d (IQR 9, 22) and TPT initiation was 7 d (IQR 1, 21). Reasons for the non-initiation were no information provided by paramedical workers (82%), information provided by paramedical workers but TPT was not given (19%), parents felt it's not important (9%), and fear of side-effects (3%). Reasons for non-completion were: TPT received for less than six months (from healthcare providers) (54%), advised for the lesser duration TPT by the doctors (4%), parents felt completion was not important (32%), parents' fear of side-effects or myth (5%), and HHCC complained of side-effect (0.7%). Inadequate emphasis on home visits leads to TPT initiation in only one-third and completion in less than one-fourth of eligible HHCCs. This poor coverage was primarily due to the health system related issues. Rarely reported TPT side-effects highlighted its safety.

Outcomes of Sepsis–Associated Acute Kidney Injury

Background Acute kidney injury (AKI) is common in tropical countries. Most common cause of AKI in India is sepsis. AKI is known to progress to acute kidney disease (AKD). Long-term follow-up of sepsis associated AKI is pivotal for identifying factors influencing progression. Materials and Methods We conducted a case record review of patients admitted between January 2022 and January 2023 to assess the outcomes of sepsis-AKI and the factors associated with the transition to chronic kidney disease (CKD). Results Of a total of 2600 renal intensive care admissions, 451 were diagnosed with sepsis-AKI. About 8.8% (40 cases) completely recovered within the first week (AKI recovered), and the remaining 91.1% cases (AKD) were followed up for 1 week to 1 year. The mortality rate between this period was about 45.7% (188 patients). On the assessment of survivors (223 patients), complete renal recovery was noted in 160 patients, and 28.3% (63 patients) transitioned to CKD. Elderly age, high SOFA score, and multiorgan failure were associated with higher progression to CKD (P &lt; 0.05). Conclusion AKI patients need a follow-up period of at least 1 year, as delayed recovery is common. Sepsis-associated AKI progresses to CKD in about 28% of patients with risk factors being old age, presence of comorbidities, severe sepsis with multiorgan involvement, and high SOFA score.

End-of-life (EOL) outcomes and healthcare utilization for patients with hepatocellular carcinoma (HCC) who received immune checkpoint inhibition (ICI).

560 Background: ICI is standard of care treatment for advanced HCC. EOL outcomes for patients with HCC who receive ICI prior to death are unknown. We examine relationships between EOL outcomes, healthcare utilization, and receipt of ICI for patients with advanced HCC referred to our tertiary center. Methods: Patients with advanced HCC evaluated at our center on or after January 1, 2020 and who died by March 29, 2024 were included. Patients were identified using diagnostic codes for liver cancer and HCC, and subsequently verified by manual review of the electronic health record. Demographic data, Child-Pugh (CP) status, and treatment history were collected. Primary EOL outcomes include: documentation of advance directives and goals of care (GOC) conversations, location of death, palliative care referral, hospice referral, days in hospice, and code status. Secondary healthcare utilization outcomes include: systemic therapy receipt, emergency department (ED) visits, hospitalization, and intensive care unit (ICU) admissions within 14, 30, and 90 days of death. Outcomes were stratified by ICI or non-ICI as last therapy received and p-values were derived using Pearson’s chi-square test for equality of proportions. Results: Of 221 evaluated patients, 71 died and met criteria for analysis. Baseline characteristics include mean age 64.1 years, 70.8% male, 71.8% received systemic treatment (median 1 line, range [1-7]), 54.1% CPA, 37.5% CPB, and 8.3% CPC at the time of last treatment. No statistically significant differences in primary EOL outcomes were detected when stratified by receipt of ICI or non-ICI as last therapy. Median days enrolled in hospice were not statistically significant between groups (24.5 days [non-ICI] vs 10 days [ICI]; p = 0.39). A higher proportion of patients who received ICI as last therapy had increased healthcare utilization across all outcomes (see Table). Conclusions: Patients with advanced HCC receiving ICI as their last treatment before death compared to those receiving non-ICI had similar EOL outcomes but higher healthcare utilization. This may be due to increased real-world use of ICI in CPB patients. Further investigation into risk stratification to predict high healthcare utilizers could guide decision-making and conversations around ongoing use of ICI, particularly near the EOL. Healthcare utilization outcomes stratified by receipt of ICI. Outcome Before Death n = 71 90 days 30 days 14 days Therapy within Total: Last therapy ICI 33/71 (46.5%)69.7% 18/71 (25.4%)66.7% 6/71 (8.5%)33.3% ED visit Total: Last therapy ICI 29/71 (40.8%)58.6% 27/71 (38.0%)55.6% 22/71 (30.1%)59.1% Hospitalization Total: Last therapy ICI 32/71 (45.1%)59.4% 30/71 (42.3%)56.6% 29/71 (40.8%)58.6% ICU admission Total: Last therapy ICI 6/71 (8.5%)66.7% 6/71 (8.5%)66.7% 6/71 (8.5%)66.7%

REM Sleep Behavior Disorder Diagnostic Code Accuracy and Implications in the Real-World Setting.

Isolated REM sleep behavior disorder (iRBD) carries increased risk of neurodegenerative parkinsonian disorder or dementia (NPD) but is difficult to accurately screen for in the community. Health care data offer the opportunity to identify large numbers of iRBD cases among outpatients. We aimed to determine the positive predictive value (PPV) of an RBD International Classification of Disorders (ICD) code for actual iRBD based on manual review of the electronic health record (EHR), examine risk of NPD diagnosis, and explore whether a statistical model developed using selected EHR data can identify individuals with the RBD ICD code who have high probability for actual iRBD. In this retrospective cohort study, a search of the EHR at a single health care system was conducted to identify outpatients who received the ICD9 or ICD10 RBD code in 2011-2021. The EHR for each case was manually reviewed. Secondary RBD cases were excluded. Remaining cases were classified as no iRBD or actual iRBD (possible, probable, or definite). Incident cases of NPD were identified. PPV of presence of the RBD ICD code for actual iRBD was calculated. Cumulative incidence of NPD with death as a competing event was compared in those with vs without iRBD. Least absolute shrinkage and selection operator (LASSO) regression was used to build a prediction model for iRBD, and the model was validated in an independent data set. Among 1,130 cases with the RBD ICD code, 499 had secondary causes of RBD. For the remaining 628 cases, EHR review indicated no iRBD in 168 (26.8%). PPV of the RBD ICD code was 73.25%. Over a median follow-up of 4.7 years, compared with the no iRBD group, the iRBD group had a higher risk of NPD (subdistribution hazard ratio = 10.4 [95% CI 2.5-43.1]). The LASSO prediction model for iRBD had an area under the receiver operating characteristic curve of 0.844 (95% CI 0.806-0.880). PPV of an RBD ICD code is moderate. In the real-world setting, patients with iRBD had a high risk of incident diagnosis of NPD over 4.7 years. Results indicate feasibility of using statistical models developed using EHR data to accurately predict iRBD.

Defining cause of death in a contemporary cohort with ANCA-associated vasculitis (AAV): A comparison of electronic health record and death certificate data.

Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) face excess mortality compared with the general population. Mortality in clinical epidemiology research is often examined using death certificate diagnosis codes; however, the sensitivity of such codes in AAV is unknown. We performed a retrospective cohort study using the Mass General Brigham AAV Cohort, including patients with AAV who died between 2002 and 2019. Causes of death were determined by electronic health record (EHR) review (reference gold standard) and via cause of death diagnosis codes on death certificates. We calculated the sensitivity of death certificate diagnosis codes for AAV. Of 684 patients in the registry, 184 died, 92 (52 %) of whom had adequate EHR data available determine cause of death and 72 (40 %) of whom had both EHR and death certificate data available. Death due to AAV, infection, cardiovascular disease, and cancer occurred in 8 %, 29 %, 5 %, and 18 %, respectively, when ascertained by manual review, as opposed to 0 %, 11 %, 25 %, and 21 %, as determined by death certificates. The sensitivity of AAV diagnosis codes for AAV was 16.6 % (95 % CI: 10.5, 22.6) among all patients with death certificate data available. In a contemporary cohort of patients with AAV, infection was the most common cause of death, while death due to AAV itself was rare. We found a high degree of discordance between causes of death determined by manual review and death certificate diagnosis codes. Mortality research on AAV should include linkage to medical records data to reduce potential bias.

Liver cancer in Saudi Arabia: A registry-based nationwide descriptive epidemiological and survival analysis.

Liver cancer is a major worldwide health concern characterized by increasing rates of occurrence. It ranks as the sixth most prevalent form of cancer and is the third highest contributor to cancer-related fatalities globally. This study aimed to describe the epidemiology of liver cancer in Saudi Arabia and to analyze the factors associated with it. This retrospective medical record review included all the patients diagnosed with a liver cancer from January 2014 to December 2020. The incidence data were obtained and collected from the Saudi Cancer registry. The net survival percentage was obtained in global cancer observatory website of the International Agency for Research on Cancer. There were 3066 occurrences of liver cancer among Saudi Nationals during the years 2014 and 2020. The majority of patients consisted of males, accounting for 2105 individuals, which represents 68.7 % of the total. The predominant morphologies are Hepatocellular carcinoma (2520, 82.2 %), choliangocarcinoma (267, 8.7 %), Adenocarcinoma (5.1 %), and malignant neoplasm (3.4 %). The age-standardized incidence rate for males between 2014 and 2020 varied from 4.0 per 100,000 to 4.8 per 100,000, whilst for females it ranged from 1.5 per 100,000 to 2.4 per 100,000. The age-standardized incidence rate among Saudi nationals is 4.7 cases per 100,000, while the age-standardized mortality rate is 4.6 deaths per 100,000. Liver cancer is a significant global health problem, marked by its high occurrence and typically poor survival rates. By emphasizing risk factors, it enhances the implementation practices that may help to provide appropriate care to maximize favourable outcomes.

Pregnancy-Associated MyocardialInfarction in Alberta: A Population-Based Study.

Cardiac disease is the leading cause of maternal mortality in developed countries, and myocardial infarction (MI) is an important cause of pregnancy-associated morbidity and mortality. These infrequent, but very serious, events are not optimally described in the medical literature. This study describes a 15-year consecutive, retrospective cohort of confirmed pregnancy-associated MIs (PAMIs) identified in Alberta, Canada (2003-2017). Utilizing a provincial administrative database, a cohort of women with PAMI were identified using a validated algorithm. Additional cases were identified by reviewing provincial maternal mortality records. Medical record review was conducted on each case with further details obtained via linkage with a provincial coronary heart disease registry. Available angiographic images were also reviewed. Forty-three cases of PAMI were identified in Alberta between 2003 and 2017, providing a crude incidence of ∼5.64/100,000 births. Rates of PAMI increased over the study period. Of the identified MIs, 16.3% occurred antepartum (mean gestational age of 18weeks), while 30.2% were peripartum and 53.4% occurred within 6months postpartum (at a mean of 7.8weeks after delivery). The most common mechanism of PAMI was spontaneous coronary artery dissection (44.2%) and this mechanism predominated postpartum. Coronary artery disease was a frequent antepartum cause of MI, whereas demand ischemia was the leading cause of peripartum MI. Maternal mortality was approximately 9%. PAMI is an increasing cause of maternal morbidity and mortality in Alberta. Clinicians should have a high index of suspicion for PAMI and ensure optimal management of this dangerous complication of pregnancy.

Clostridioides difficile infection and testing rates in South Africa: A multicentre study, 2017-2020.

To describe Clostridioides difficile infection (CDI) rates and testing practices, at three tertiary/quaternary hospitals in South Africa (SA) for the period 2017 to 2020. A retrospective laboratory record review of all C. difficile testing at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Tygerberg Hospital (TBH) and Inkosi Albert Luthuli Central Academic Hospital (IALCH) was performed. Clinical records of patients with rCDI were reviewed to determine recurrent CDI (rCDI) rates. The median primary CDI rates per 10000 patient-days (PD) were 5.3at CMJAH, 1.8at TBH, and 0.3at IALCH. In 2020, all hospitals reported an increase in primary CDI rates compared to 2019. The median testing rates per 10000 PD were 39at CMJAH, 14at TBH, and 4at IALCH. The median age of patients with primary CDI was 33 years (IQR: 22-45 years). The rCDI rates ranged from 2 to 5 per 100 incident episodes. Significant variations in CDI and testing rates were observed across the three hospitals. An increase in CDI rates was noted at all centres during the 2020 SARS-CoV-2 outbreak. Advanced age was not prevalent in the cohort, and rCDI rates were relatively low. These findings highlight the need for systematic surveillance of healthcare-onset CDI across SA hospitals.

Financial toxicity in patients with newly diagnosed hepatocellular carcinoma.

538 Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related deaths and has been associated with significant patient (pt) financial liability, however no study has yet examined pt-reported measures of financial toxicity (FT) in this population. We sought to assess pt-reported FT in newly diagnosed HCC and to identify pt-, disease-, and treatment-related factors associated with FT. Methods: Pts with HCC were recruited prior to treatment initiation during their initial visit at a multidisciplinary liver cancer clinic at a tertiary care center between January 2023-May 2024. The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT), a validated survey for assessing financial distress in pts with cancer (range, 0-44; lower scores reflect worse financial wellness), was completed by participants during their initial visit. Sociodemographic (age, sex, race, ethnicity, primary language, insurance status, employment status, marital status, highest education completed, household income, living arrangement, home zip code), clinical (Barcelona Clinic Liver Cancer stage, performance status, age-adjusted Charlson comorbidity index, albumin-bilirubin score, presence and etiology of chronic liver disease, Child-Pugh grade, MELD-Na score), and planned treatment (surgery, liver-directed therapy, systemic therapy, clinical trial enrollment) characteristics were evaluated by questionnaires or medical record review. The EORTC QLQ-HCC18 was used to assess pt-reported quality of life (QOL). Area Deprivation Indices were calculated using pts’ home zip codes. Mean COST-FACIT scores were compared using two-sided t test for binary variables and one-way ANOVA for non-binary variables. Results: Among 47 pts enrolled, 35 (74%) completed the COST-FACIT survey. Younger age (&lt;65 vs ≥65 yrs; mean, 20.3 vs 27.8; p=0.05), non-English primary language (non-English vs English; mean, 16.2 vs 26.7; p=0.04), less completed education (high school or earlier vs college or beyond; mean, 23.3 vs 32.0; p=0.02), and worse self-reported QOL (EORTC QLQ-HCC18 score ≥cohort median vs &lt;cohort median; mean, 21.4 vs 29.2; p=0.02) were significantly associated with worse FT. Although not statistically significant, Hispanic ethnicity (Hispanic vs not Hispanic; mean, 16.1 vs 26.4; p=0.07), lack of employment (not employed vs retired vs employed; mean, 15.5 vs 29.4 vs 24.3; p=0.07), and no plan for liver-directed therapy (no vs yes; mean, 17.9 vs 26.7; p=0.07) trended towards worse pt-reported FT. Conclusions: Among pts with newly diagnosed HCC, significantly higher pt-reported FT is associated with younger age, non-English primary language, less completed education, and worse QOL. Efforts are underway to longitudinally follow our study cohort to assess the course of self-reported FT over 1-year follow-up as well as its associations with treatment response and survival.

Aircrew Life Support Equipment Experiences in Canadian Military Operational Women Pilots

INTRODUCTION: Women continue to remain a minority among Canadian Armed Forces (CAF) operational pilots, equaling &lt;2% in 2000 and &lt;6% in 2022. Limited sex- and gender-specific research on aeromedical support needs has been completed on this population. This initial manuscript examines aircrew life support equipment (ALSE) and musculoskeletal issues within a larger data set. METHODS: This hypothesis-generating, mixed-methods, epidemiological study used a community-based participatory research approach, involving semi-structured interviews with women who were current CAF members and had ever served as operational pilots. Interviews included aviation occupational interest and medical questionnaires, as well as medical record reviews, which were analyzed descriptively and thematically. RESULTS: Demographics included 51 of 88 (58%) of CAF operational women pilots from 15 different platforms, with a mean service time of 20 yr (range from 8–41 yr) and mean total flying hour estimation of 2400 h (range of 500–8500 h). At least one piece of ALSE did not fit properly in 82% of subjects, and 52% of this group reported prolonged health impacts. Almost all subjects had musculoskeletal issues, with 35% resulting in a flying impairment. DISCUSSION: This snapshot looks at sex- and gender-specific aeromedical experiences of operationally trained CAF women pilots, which can be used to guide research, policy, training, and education to improve their aeromedical experiences specifically with ALSE. Sex- and gender-based analysis and optimization could help improve equipment procurement and prevent unnecessary injury and illness in female pilots due to their ALSE. Thorgrimson J, Breeck K. Aircrew life support equipment experiences in Canadian military operational women pilots. Aerosp Med Hum Perform. 2025; 96(2):116–120.

Pre-Assault Diagnoses Associated with Post-Assault Emergency Department Visits After Recent Sexual Assault

ABSTRACT Characteristics associated with individuals who frequent the emergency department at higher rates have been well established; however, factors associated with greater emergency department visits following a recent sexual assault are largely unknown. The current study evaluated the associations between pre-assault factors such as substance use and physical injuries, assault characteristics such as genital injury, non-genital injury, alcohol or drug use involvement, intimate partner involvement, and emergency department visits one-year after a sexual assault medical forensic exam (SAMFE). The current study included a medical record review of 123 individuals who received a SAMFE at a hospital in the United States. Demographic variables, characteristics of the sexual assault, pre-sexual assault diagnoses, frequency of SAMFEs, and post-SAMFE emergency department visits were examined. A negative binomial regression was used to examine these factors on post-SAMFE emergency department visits. Results indicated that alcohol or drug use during an assault was associated with fewer emergency department visits post-SAMFE. Substance use and physical injury disorders pre-SAMFE were positively associated with post-SAMFE emergency department visits. Findings provide important insight for prevention strategies to potentially increase access to mental and physical health care post-assault to reduce the risk of repeated emergency department visits among recent survivors of sexual assault.

Evaluating the brain injury guidelines (BIG) in an Australian trauma centre: A retrospective cohort analysis.

The Brain Injury Guidelines (BIG) were developed to improve resource utilisation for patients with traumatic brain injury (TBI). The original BIG have never been validated outside the USA. The unique challenges facing Australian healthcare warrant validation of the BIG in this setting. This study aimed to evaluate the current standard of TBI management, safety of the BIG, and hypothetical resource savings resulting from their implementation. A single institution, retrospective cohort study. Patients were identified by searching the database of radiology reports for computerised tomography (CT) studies, for patients presenting to the Princess Alexandra Hospital emergency department (ED) from 1 January 2018 to 1 January 2023. Chart review of the medical record was performed and patients were classified into BIG1, BIG2 or BIG3 based on neurological examination, intoxication, antiplatelet/anticoagulant use, and CT findings. The primary outcome was the need for neurosurgical intervention. Secondary outcomes were worsening neurological examination within 24h of admission, progression on repeat head CT (RHCT) and post-discharge ED visits and 30-day readmissions. The guidelines were considered to fail if any BIG1 or BIG2 patient required neurosurgical intervention or ICU admission. 878 patients were included, of which 106 (12.1%) were BIG1, 113 (12.9%) BIG2, and 659 (75.1%) BIG3. Subdural and subarachnoid haemorrhage were the most common intracranial haemorrhage (ICH) in all groups. No BIG1 or BIG2 patient showed neurological deterioration or required intervention. Radiological progression was seen in 7% and 3.4% of RHCT for BIG1 and BIG 2 patients respectively; in no case did this change management. There was 1 (0.9%) post-discharge ED visit in the BIG1 group. There were no 30-day readmissions in the BIG1 or BIG2 group. All patients needing intervention or readmission were BIG3. Current practice is not in line with the BIG, with excessive intervention performed in 97.2% of BIG1 patients and 96.5% of BIG2 patients. Agreement between the assigned and verified therapeutic plan was perfect (k=1.00), meaning no patient failed the BIG. Adoption of the BIG could have saved 101 RHCT, 208 neurosurgical consultations and 189 inpatient days. The BIG are safe in Australia and would significantly improve healthcare resource utilisation. Current practice regularly deviates from the BIG, suggesting significant resource saving to be realised. Future studies should prospectively validate the BIG so widespread adoption can be supported and implemented. Integration with allied health, long-term outcomes and potential modifications to the BIG remain to be explored.

Exploring the Association of Area of Deprivation Index (ADI) and cardiovascular risk factors in South Florida

IntroductionCardiovascular disease (CVD) is the leading cause of death in the United States. Major risk factors include hypertension, obesity, hyperlipidemia, and diabetes mellitus. While these cardiovascular risk factors are well-documented, further high-quality research is needed to examine their relationship with the Area Deprivation Index (ADI) in South Florida. As a measure of neighborhood socioeconomic disadvantage, ADI considers factors such as income, education, employment, and housing. This study investigates the association between ADI and cardiovascular risk factors in South Florida, a region characterized by unique health challenges and disparities.AimThis study aims to explore the odds ratio of having cardiovascular risk factors such as hypertension, obesity, hyperlipidemia, and diabetes mellitus in relation to neighborhood demographics in South Florida.MethodsA retrospective quantitative electronic health record review was conducted on patients who visited a primary care health system in South Florida from January 2022 to December 2022. The study population included 96,242 unique patients. Cardiovascular risk factors were identified using ICD-10 codes, and ADI was calculated using the patients' zip code plus four. Logistic regression, odds ratios, and Cochran-Armitage tests were used to evaluate the associations between ADI and the prevalence of cardiovascular risk factors.ResultsThe most common cardiovascular risk factor was obesity (64.24%), followed by hyperlipidemia (38.84%), hypertension (25.90%), and diabetes (10.04%). ADI was significantly higher in patients with obesity (Mean = 41.99), hypertension (Mean = 43.08), and diabetes (Mean = 44.99) compared to those without these conditions. Logistic regression analysis revealed that individuals in the highest ADI quartile were more likely to have obesity (OR = 1.16; 95% CI [1.16–1.20]), hypertension (OR = 1.47; 95% CI [1.40–1.54]), and diabetes (OR = 1.81; 95% CI [1.70–1.93]).ConclusionThis study highlights the significant association between higher ADI and the prevalence of obesity, hypertension, and diabetes in South Florida. The findings suggest that socioeconomically deprived neighborhoods are at higher risk for these cardiovascular conditions. These results underscore the need for community nurses and primary care providers to provide targeted public health interventions and resource allocation to address health disparities and improve cardiovascular health outcomes in socioeconomically disadvantaged communities.

EMS Agency Characteristics and Adverse Events in Pediatric Out-of-Hospital Cardiac Arrest Among 49 U.S. EMS Agencies

ABSTRACT OBJECTIVES Pediatric out-of-hospital cardiac arrest (OHCA) impacts 15,000-25,000 children annually in the U.S. The objective of this study was to determine if specific Emergency Medical Services (EMS) agency factors such as pediatric volume and preparedness factors, including hours of required pediatric training, pediatric emergency care coordinator (PECC), or pediatric informational resources are associated with improved quality of care or adverse events for pediatric OHCA. METHODS We conducted a retrospective chart review of EMS clinical records and EMS agency survey among 5 agencies in the Portland OR, Pittsburgh PA, Milwaukee WI, San Bernardino CA, Atlanta GA, and Dallas TX regions. We reviewed medical records of children who experienced an EMS-treated OHCA between 2013-2019 using a validated structured chart review tool to identify adverse safety events (ASEs). Agencies who contributed medical records completed a survey that described elements of pediatric preparedness and organizational structure relevant to pediatric care. We first conducted a descriptive analysis of agency and patient characteristics, followed by an evaluation of the association of agency factors that we hypothesized could improve pediatric care and reduce the occurrence of ASEs. RESULTS Twenty-two agencies with a total of 659 OHCA patient encounters completed the survey. The Broselow system was used by 81% of agencies, local protocol guides were used in 86% of agencies. Forty-five percent of agencies had a designated pediatric emergency care coordinator (PECC). Agencies reported a similar number of hours for pediatric and neonatal simulation (1.3 hrs, 1.5 hrs respectively) and skills training (2.0 hrs, 2.5 hrs, respectively) annually. We found that younger patient age significantly increased the risk of an ASE. In both univariate and multivariate analyses, several hypothesized variables were not associated with decreased risk of an ASE, including pediatric and neonatal skills/simulation training hours, conducting pediatric-specific quality reviews, and having an identified PECC. CONCLUSIONS In this large medical record review of EMS-treated pediatric OHCA cases, pediatric training, pediatric care coordination, and conducting pediatric quality reviews were not associated with reduced ASEs. Additional research is needed to understand how EMS agencies can improve the quality of care for pediatric OHCA, especially for infants.

P-1169. Disseminated Pediatric Coccidioidomycosis at an Academic Center in Southern Arizona (2013 - 2023)

Abstract Background There have been few reviews of pediatric disseminated coccidioidomycosis, particularly regarding presentation. A better understanding of this may enable more timely diagnosis and improve management in children. Methods We identified 157 children with coccidioidomycosis seen in the pediatric infectious diseases practice at University of Arizona – Banner University Medical Center in Tucson, AZ, between 2013 – 2023. Criteria included: age under 18, seen by a pediatric infectious diseases specialist, with a diagnosis of coccidioidomycosis in the consultation note. This study includes the subset of children with a diagnosis of disseminated coccidioidomycosis. Cases were excluded if the electronic medical record did not document at least one of the following supporting diagnostics: positive coccidioidal IgM or IgG by EIA, culture positive for Coccidioides, or histopathological findings characteristic of coccidioidomycosis. Demographic, laboratory, and radiologic data as well as clinical characteristics were collected from review of the electronic medical record. Results Among 157 patients, 28 (17.8%) had disseminated disease. Median age at diagnosis was 11.7 years (range 7 months to 17 years of age). 64% were male. Musculoskeletal disease was the most common extrapulmonary organ system involved (15 patients), followed by skin (11), central nervous system (4), abdominal organs and viscera (2), pericardium (1) and bloodstream (1). Sixteen (57%) had no comorbidities. The chest radiograph was normal in 10 of 26 (38%) where it was performed. Seventeen (61%) had a negative coccidioidal EIA IgG serology, and 3 patients (11%) had negative IgM and IgG serologies on presentation. Only 3 (11%) had an elevated absolute eosinophil count (above 600/µL). Conclusion Disseminated coccidioidomycosis affects children of all ages and can involve many different organ systems, particularly musculoskeletal, skin, and central nervous system. It should be considered in the appropriate clinical setting even in patients with negative coccidioidal serologies, normal chest x-rays, normal eosinophil counts, or no underlying illness. Disclosures All Authors: No reported disclosures

The Association of Race, Rurality, and Neighborhood Disadvantage with Disease Severity at Initial Presentation in Cervical Spondylotic Myelopathy: A Cohort Study.

Retrospective Cohort Study. To examine the impact of neighborhood-level socioeconomic factors on the delay of care and severity of disease among DCM patients at initial presentation. Degenerative Cervical Myelopathy (DCM) is the most common etiology for spinal cord dysfunction among adults worldwide. Previous literature has suggested that social determinants of health including neighborhood-level socioeconomic status such as Area of Deprivation Index (ADI) may impact spine surgery outcomes in DCM. We performed a single-institution retrospective analysis of all patients undergoing spine surgery for the treatment of DCM from 2010 to 2022. Patients were identified using CPT and ICD9/10 codes. Data was collected via review of the electronic medical record. ADI was extracted from patients addresses. Multivariate and univariate analysis was used to assess the relationship between socioeconomic variables and myelopathy characteristics. A total of 490 patients (Mean age: 60.3±11.3y) were identified. Residence in rural areas was associated with higher Nurick score (OR 2.48,P=0.011), and lower mJOA score (OR 2.51, P=0.014) at presentation, and longer times to presentation (HR 0.48, P=0.003). Having high ADI was independently associated with shorter times to presentation (HR 1.46,P<0.001), but predicted higher Nurick score (OR 1.6, P=0.021) and lower mJOA score (OR 1.86,P=0.002). Unemployment was associated with longer times to presentation (HR 0.66,P<0.001), higher Nurick score (OR 4.5,P<0.001), and lower mJOA score (OR 4.51, P<0.001), while race was not. This is the first single institution study investigating the influence of neighborhood-level measures such as ADI on presentation status and disease burden in patients with DCM. High ADI predicts shorter disease duration but more severe DCM symptoms. Rural residence, unemployment, and non-private insurance were independently associated with prolonged and more severe DCM symptoms while race was not. 3.