Risk Of Hospital Admission Research Articles

Impact of wildfires and PM2.5 on ST-elevation acute coronary syndrome in Rosario City: a case-crossover study

ABSTRACT We conducted a modified case-crossover study to examine whether wildfires in the Paraná River Delta departments surrounding Rosario, Argentina, during 2021–2022 increased PM₂.₅ concentrations in this city and if this rise subsequently elevated the risk of ST-elevation myocardial infarction (STEMI). We first observed that daily PM₂.₅ levels in Rosario were significantly higher on wildfire days compared to non-wildfire days (34 µg/m3 vs. 25.75 µg/m3, p < 0.01). In the case-crossover analysis, we found that the odds of STEMI were significantly higher on days when PM₂.₅ concentrations exceeded 20 µg/m3 (OR 2.2 [95% CI 1.2–4.2, p = 0.02]). Additionally, the odds of STEMI increased with higher PM₂.₅ concentrations, with a significant difference when comparing the first and fourth quartiles concentration (OR 1.76 [95% CI 1.06–2.92, p = 0.03] and OR 2.02 [95% CI 1.25–3.27, p < 0.01], respectively). In conclusion, wildfires in the surrounding departments of Rosario City in the Paraná River Delta led to elevated PM₂.₅ levels, and this increase was associated with a higher risk of STEMI hospital admissions.

Impact of time to antibiotics on clinical outcome in paediatric febrile neutropenia: a target trial emulation of 1685 episodes

Prompt antibiotic administration for febrile neutropenia (FN) is standard of care, and targets of time to antibiotics (TTA)<60min are common. We sought to determine the effect of TTA ≥60 versus <60min on adverse outcomes (intensive care unit (ICU) admission or death) in children with cancer and FN. Effect modification by a decision rule that predicts infection (AUS-rule) and bacteraemia were also investigated. The prospective, multi-centre (n=8), Australian PICNICC study dataset was analysed. To control for confounding, we used outcome regression adjusted for propensity score modelled as restricted cubic spline with two degrees of freedom. The propensity score was estimated from a logistic regression model for the exposure on the confounders, identified a priori (age, sex, severely unwell, disease, chemotherapy intensity and site). TTA was defined as time from from emergency triage to first antibiotic dose. 1685 FN episodes in 976 patients were included. Median TTA was 53min (IQR 37-77min, 1542 (92%) <120min). An adverse outcome occurred in 43 (2.6%) episodes (39 ICU; 5 deaths). The confounder-adjusted point estimate suggested a lower risk for adverse outcome associated with TTA ≥60min (RR 0.62, 95% CI 0.32-1.21), but the wide 95% CI precluded definitive judgement about strength and direction of the effect (unadjusted RR 0.52; 95% CI 0.26, 1.05). Similarly, although the point estimates were suggestive of a null association or reduced risk for adverse outcome associated with TTA ≥60min for all comparisons across bacteraemia or AUS-rule strata, the 95% CIs were imprecise. For children with FN, there was no definite evidence that TTA ≥60min from hospital triage (but within 2h), increased risk of adverse outcome or prolonged hospital admission. This study has important implications for FN TTA mandates, suggesting a more nuanced approach is required. National Health and Medical Research Council and Medical Research Future Fund.

Outpatient Medications Deimplemented by the AAP Bronchiolitis Guidelines: An Umbrella Review of Meta-Analyses.

The 2014 AAP Bronchiolitis Guidelines deimplemented or recommended against the routine therapeutic use of albuterol, hypertonic saline, and epinephrine for infants and children presenting in the outpatient setting. Our objective was to perform an umbrella review of all meta-analyses that included outpatient subanalyses or network meta-analyses with medication treatment comparisons to study the clinical benefits of these deimplemented medications in the outpatient (i.e., primary care, urgent care, and emergency department) setting. Searches were performed in the databases PubMed and Scopus and the Web search engine Google Scholar on the following three topics: albuterol and bronchiolitis, epinephrine and bronchiolitis, and hypertonic saline and bronchiolitis. Article types were limited to systematic reviews and meta-analyses with outpatient subanalyses, with English language and age restrictions. The search strategy was based on the Population, Intervention, Comparator, Outcomes, Studies (PICOS) framework. The studies were uploaded to Rayyan, a Web-based platform for managing articles of systematic reviews. Citation tracking and manual review of references were performed for the included studies. The meta-analyses and network meta-analyses were reviewed for outpatient subanalyses focused on clinical responses and risk of hospital admission. A total of 6 meta-analyses for albuterol, 4 meta-analyses for epinephrine, and 11 meta-analyses for hypertonic saline were included. Our review identified evidence from predominantly low and moderate evidence meta-analyses (assessed using GRADE and AMSTAR 2) indicating that all three deimplemented medications exhibit one or more therapeutic effects and benefits for infants with the bronchiolitis syndrome in the outpatient setting. Effect sizes ranged from medium to near medium. These clinical benefits include decreased hospital admissions and lower clinical severity scores. Given the heterogeneity of patients under the umbrella term "acute bronchiolitis" and the potential for some patients to respond clinically to albuterol, hypertonic saline, and epinephrine, current evidence supports conducting therapeutic trials in infants with acute bronchiolitis in outpatient settings. However, further well-designed and adequately powered randomized controlled trials and high-quality meta-analyses are still needed.

Caesarean section and risk of infection in offspring: systematic review and meta-analysis of observational studies

ObjectiveTo compare the risk of hospital admissions with infections and infections not in hospital in children born by caesarean section with children born by vaginal birth.Data sourcesMedline, Embase, and PubMed...

Resting heart rate assessed within clinical practice demonstrates no prognostic relevance for defibrillator recipients in the German DEVICE registry

Resting heart rate (RHR) has prognostic implications in heart failure with reduced ejection fraction, where ≤ 70 bpm is targeted. Whether a RHR > 70 bpm assessed within clinical practice goes along with elevated cardiovascular risk in implantable cardioverter-defibrillator (ICD) / cardiac resynchronization therapy-defibrillator (CRT-D) recipients remains incompletely understood. A total of 1589 patients (ICD n = 1172 / CRT-D n = 417, median age 65 years, 22.6% female) undergoing ICD/CRT-D implantation or revision in the prospective German DEVICE multicenter registry were analyzed. RHR was assessed via a 12-channel electrocardiogram at enrollment. 1-year outcomes (all-cause mortality, major cardio- and cerebrovascular events (MACCE), all-cause hospital admission) were compared between patients with a RHR ≤ 70 bpm and > 70 bpm. 733 patients (46.1%) showed a RHR > 70 bpm. Median RHR was 63 (interquartile range 59; 68) bpm (≤ 70 bpm group) and 80 (75; 89) bpm (> 70 bpm group). Heart failure with reduced ejection fraction was present in 76.3%, a prior myocardial infarction in 32.4% and non-ischemic heart disease in 44.9%. One-year all-cause mortality was similar between RHR groups (≤ 70 bpm 5.4% vs. > 70 bpm 5.4%, p = 0.96), and subgroup analysis regarding patient characteristics and comorbidities revealed only a significantly higher rate of patients with dual chamber ICD in the > 70 bpm group (0.8% vs. 9.2%, p = 0.003). MACCE (5.9% vs. 6.1%, p = 0.87) and defibrillator shock rates (9.9% vs. 9.8%, p = 1.0) were similar. Higher all-cause hospital admission rates were observed in patients with > 70 bpm RHR (23.1% vs. 29.0%, p = 0.027) driven by non-cardiovascular events (6.0% vs. 11.7%, p = 0.001). In conclusion, in ICD and CRT-D recipients a RHR at admission > 70 bpm may indicate patients at increased risk of all-cause hospital admission but not of other adverse cardiovascular events or death at 1-year follow-up.

Continuity of primary care and avoidable hospitalization in a young population with asthma: a population-based cohort study

Existing evidence regarding the impact of continuity of care (COC) in asthma patients is limited, and its quality is low to moderate. This study aimed to investigate associations between relational COC within primary care and asthma-related hospitalizations in children using a robust methodology. This study is a population-based cohort study that utilized a national claims database in South Korea. The study comprised 136,296 individuals under 20 years old who were newly diagnosed with asthma between 2015 and 2016. These were classified into high, medium, and low continuity groups based on the continuity of care index (COCI). The primary outcome measure was the incidence of asthma-related hospitalizations. During a two-year follow-up period, 10,922 patients (8.01%) were hospitalized: 2520 (5.59%) in the high-continuity group, 3188 (6.98%) in the medium-continuity group, and 3867 (8.48%) in the low-continuity group. After adjusting for confounding covariates, patients in the low- and medium-continuity groups exhibited significantly higher risks of hospital admission (adjusted hazard ratio (aHR) = 1.30 [95% confidence interval = 1.24–1.37] and aHR = 1.14 [1.08–1.20], than those in the high-continuity group. Sensitivity and subgroup analyses findings were consistent. In a young population with asthma increased continuity of primary care was associated with less hospitalization.

Abstract 4136932: Impact of Different Socioeconomic Metrics on Heart Failure-Related Admission and Short-Term Outcomes in Maryland

Introduction: Annually, over 500,000 Americans are hospitalized due to heart failure (HF), marking it as a major contributor to morbidity and mortality. It also poses a significant financial burden and leads to considerable losses in productivity. Objective: This study investigates the predictive accuracy of different socioeconomic metrics on the risk and outcomes of HF in Maryland. Methodology: A retrospective analysis of the Maryland State Inpatient Database (2016-2020) was conducted to assess the predictive accuracy of race/ethnicity, insurance status, household median income, and neighborhood poverty level (measured by the Distressed Communities Index) on the risk of heart failure-related hospital admissions and outcomes. Multivariate logistic regression models were also used to adjust for confounders. Result: During the study period, a total of 389,220 cases of HF were reported in the Maryland SID. The majority of these patients were white (56.8%) and female (51.1%), with a median age of 73 years (interquartile range [IQR] 62-82 years). The in-hospital mortality rate was 5.1%, while rates of atrial fibrillation, cardiac arrest and prolonged hospital stay were 34.4%, 0.3%, and 48.4%, respectively. Multivariate analysis revealed a substantial area under the ROC curve (AUC) indicating good model performance: 0.88 for predicting HF, 0.64 for atrial fibrillation, 0.64 for cardiac arrest 0.57 for prolonged hospital stays, 0.63 for mortality. Subgroup analyses showed variable predictiveness by race (AUC = 0.4378), payment method (AUC = 0.5754), income quartile (AUC = 0.5202), and deprivation composite score (AUC = 0.4751). Patients with private insurance had the highest risk of stress cardiomyopathy (odds ratio [OR] = 1.98; 95% confidence interval [CI] 1.70-2.29). Socioeconomic metrics, including neighborhood distress, showed varying predictive accuracy for the HF-related admissions and selected short-term outcomes, with the highest predictive accuracy for neighborhood distress on the risk of HF (AUC = 0.50, std: 0.006), atrial fibrillation (AUC = 0.48, std: 0.0007), cardiac arrest (AUC = 0.51, std: 0.007), and prolonged hospital stays (AUC = 0.53, std: 0.0005) and mortality (AUC = 0.50, std: 0.0015). Conclusion: Neighborhood poverty level demonstrates significant predictive power for assessing the risk of HF-related hospital admissions and the short-term outcomes among Maryland residents, exceeding factors like insurance and race/ethnicity.

Abstract 4117414: Risk Factors Associated with Cardiac Hospital Admissions in Cancer Patients Treated with Immune Checkpoint Inhibitors

Background: Immune checkpoint inhibitors (ICIs) are highly effective anti-cancer treatments for several cancers. However, treatment with ICIs is associated with metabolic perturbations, accelerated atherosclerosis, and increased risks of adverse cardiovascular events. In this study, we aimed to determine risk factors associated with cardiac hospital admissions in patients treated with ICIs for their cancer. Methods: Retrospective data was collected for all patients treated with ICIs between 1 January 2010 and 1 January 2020 through the Hunter New England Local Health District (HNELHD), Australia. Patient medical history and demographics were collected through electronic medical records. Outcome data was obtained from the HNELHD Institutional Cardiac and Stroke Outcomes Unit database. Cardiac admission was defined as cardiac disease based on hospital administration ICD-10 codes. Binary logistic regression was used for multivariate analysis and performed through SPSS version 28. Results: A total of 1,080 patients were included in the final analysis. Mean age of patients was 66.9 ± 11.7 years, with the majority male sex ( n =685; 63.4%). Primary cancer diagnosis of patients treated with ICIs included melanoma ( n =417; 38.7%), and cancer of the lung ( n =327; 30.3%). Nivolumab monotherapy was the most used first-line ICI treatment ( n =475; 44.0%) followed by pembrolizumab monotherapy ( n =428; 39.6%). A total of 266 (24.6%) patients had at least one cardiac hospital admission. On univariate analysis, pre-existing cardiovascular disease (CVD) ( p &lt;0.001), diabetes mellitus ( p &lt;0.001), chronic kidney disease ( p &lt;0.001), and prior CVD medications ( p &lt;0.001) were associated with cardiac hospitalisation. On multivariate analysis, prior history of heart failure ( p &lt;0.001), hypertension ( p =0.003), ischaemia, and peripheral vascular disease ( p =0.049) were independently associated with an increased risk of cardiac hospital admission. Conclusions: In cancer patients treated with ICIs, pre-existing CVD risk factors increases the risk of cardiac-associated hospitalisations. Adequate CVD risk modification and monitoring during treatment with ICIs may be necessary to reduce cardiac hospitalisations.

Identifying and Predicting Risk for Hospital Admission among Patients with Parkinsonism.

Patients with parkinsonism are more likely than age-matched controls to be admitted to hospital. It may be possible to reduce the cost and negative impact by identifying patients at highest risk and intervening to reduce hospital-related costs. Predictive models have been developed in nonparkinsonism populations. The aims were to (1) describe the reasons for admission, (2) describe the rates of hospital admission/emergency department attendance over time, and (3) use routine data to risk stratify unplanned hospital attendance in people with parkinsonism. This retrospective cohort study used Clinical Practice Research Datalink GOLD, a large UK primary care database, linked to hospital admission and emergency department attendance data. The primary diagnoses for nonelective admissions were categorized, and the frequencies were compared between parkinsonism cases and matched controls. Multilevel logistic and negative binomial regression models were used to estimate the risk of any and multiple admissions, respectively, for patients with parkinsonism. There were 9189 patients with parkinsonism and 45,390 controls. The odds of emergency admission more than doubled from 2010 to 2019 (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.96, 2.76; P-value for trend <0.001). Pneumonia was the most common reason for admission among cases, followed by urinary tract infection. Increasing age, multimorbidity, parkinsonism duration, deprivation, and care home residence increased the odds of admission. Rural location was associated with reduced OR for admission (OR 0.79; 95% CI 0.70, 0.89). Our risk stratification tool may enable empirical targeting of interventions to reduce admission risk for parkinsonism patients.

Influence of therapy exposures on specific late morbidities, prescription drug purchases, and mortality in aging male survivors of childhood cancer: A registry-based study.

Childhood cancer treatments predispose to late health problems and premature death. Our aim was to use national registry data to study associations between cancer therapy exposures and late health outcomes in aging male childhood cancer survivors (CCS). The study comprised 200 male CCS (survival ≥5 years) treated with conventional cancer therapy at a single institution in 1964-2000 and 1000 matched population controls. Analyses involved registry-based data on prescription drug purchases, reimbursements for chronic conditions, hospital admissions, and deaths that occurred ≥5 years after the cancer diagnosis. Mean age of CCS was 45.4 years. Compared to population controls, CCS had a higher risk for hospital admissions due to cardiovascular diseases and late mortality, both of which increased after age 40 years. CCS also had a higher risk for purchases of antihypertensives and lipid-lowering drugs within the last year of the study. Heart radiation ≥10 Gy was associated with hospitalizations due to cardiovascular diseases (HR 4.14, 95%CI 1.81-9.48), purchases of antihypertensives (OR 3.05, 95%CI 1.32-7.36), and purchases of lipid-lowering drugs (OR 2.93, 95%CI 1.08-7.73). Testosterone deficiency developed typically during pediatric follow-up, and it was associated with testicular radiation ≥20 Gy (HR 41.2, 95%CI 15.4-110) but not with alkylating agents. Of patients treated with testicular radiation ≥20 Gy, 91% had purchased testosterone within the last year. Reassuringly, CCS had no excess risk for purchases of opioids, anxiolytics, antiepileptics, or antidepressants. These findings emphasize the need for risk-based follow-up. Middle-aged male CCS are at an increased risk of premature cardiovascular morbidity and excess mortality.

Long-Term Outcomes of Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Use Among Patients on Maintenance Dialysis

Despite an elevated risk of sudden cardiac death among dialysis patients, implantable cardioverter defibrillators (ICDs) have not been shown to improve mortality and are associated with high complication rates. Subcutaneous (S-)ICDs may reduce the risk of complications for eligible dialysis patients, but safety and benefits versus transvenous (TV-)ICDs are unknown. To compare long-term outcomes between dialysis patients receiving S-ICD versus TV-ICDs. We performed a retrospective analysis of ICD implants among Fee-For-Service Medicare beneficiary dialysis patients in the National Cardiovascular Data Registry ICD Registry. Outcomes were ascertained from Medicare claims data. We compared survival outcomes, hospital admissions, and ICD- associated and dialysis vascular access-associated complications, between eligible S-ICD and single chamber TV-ICD recipients using stabilized inverse probability of treatment weighting. We identified 529 dialysis patients receiving S-ICDs and 842 receiving single chamber TV-ICDs who met the inclusion criteria. S-ICD recipients were younger, more often Black, and had a higher burden of cardiac disease and prior dialysis access interventions. After propensity weighting, there was no difference in the risk of death (HR 1.12, 95% CI 0.96-1.30), hospital admission (HR 1.01, 95% CI 0.88-1.16), bacteremia/sepsis (HR 1.01, 95% CI 0.80-1.26), device reoperation (HR 1.06, 95%CI 0.59-1.89) and subsequent dialysis access interventions (HR 1.12, 95% CI 0.86-1.46). In this representative longitudinal cohort study of dialysis patients, compared with TV-ICD, S-ICD was not associated with decreased risks of death, hospitalization, device complications, and dialysis access interventions.

Perinatal health in a cohort of children conceived after assisted reproduction in the UK: a population-based record-linkage study

ObjectiveTo compare the risk of hospitalisation for conditions originating in the perinatal period between children conceived via assisted reproductive technology and those that are naturally conceived, differentiating by treatment type.Study...

Sarcopenia and Frailty in Stroke and Cardiovascular Disease

Sarcopenia is a progressive skeletal muscle disorder involving an accelerated loss of muscle mass and function. Frailty is characterized by a decline in the functioning of multiple physiological systems and an increased vulnerability to stressors. The incidence of these pathological conditions increases with age and is often accompanied by various acute or chronic disorders. The presence of sarcopenia or frailty in patients with other diseases is associated with poor outcomes. For example, frailty is highly prevalent in patients with heart failure and is linked to an increased risk of hospital admission and mortality. Among stroke patients, pre-stroke frailty is frequently observed and is associated with higher mortality, extended hospitalization, and stroke recurrence. Furthermore, the risk of sarcopenia and frailty is high in stroke survivors. Poststroke frailty is associated with increased mortality, hospital admissions, and stroke recurrence. Managing sarcopenia and frailty after stroke is crucial for improving patient outcomes. Multidisciplinary support, including aggressive rehabilitation, nutritional support, and continuous rehabilitation during the chronic stage, is important. As Japan is a super-aging country, effective management of sarcopenia and frailty, alongside disease treatment, is essential for further improving patient prognosis.

Housing tenure and acute lower respiratory tract infection admissions in two Scottish birth cohorts

Abstract Introduction Early-life acute lower respiratory tract infections (LRTI) have been associated with increased morbidity and mortality. Despite young children spending much of their time at home, the contribution of home ownership status, on LRTI hospital admissions is unknown. Objectives To estimate the association between housing tenure and the odds of LRTI hospitalization in children &amp;lt;2 years in two birth cohorts. Methods De-identified Scottish birth records were linked to maternal Census data (2001 and 2011) and to hospital admission data to construct two birth cohorts (Cohort 1 (C1), born 2000-2002; Cohort 2 (C2), 2010-2012). Using logistic regression we estimated the association of housing tenure (owned, social rented, private rented, rent-free) with the odds of LRTI hospital admission, before and after adjustment for maternal age, residential area, and maternal qualification level. Results Over the 2-year follow-up, there were 14,833 LRTI admissions in 12,527 children (10,832 children had 1 LRTI admission and 1,695 &amp;gt;1 LRTI admission). 75.6 % of all LRTI admissions were due to bronchiolitis. In C1 and C2, 4.0% and 5.3% children, respectively, had one or more LRTI admission. Compared to children living in owned housing, the odds of LRTI admission were higher in children living in social rented housing (C1: Odds ratio=1.40, 95% confidence interval: 1.31-1.49; C2: 1.23, 1.16-1.31), private rented (C1:1.24, 1.11,1.39; C2: 1.14, 1.06-1.21), and rent-free housing (C1: 1.53, 1.35,1.74; C2: 1.04, 0.80-1.36) after confounder adjustment. Conclusions We found an association between non-owned housing and higher odds of LRTI admission which was more marked in C1 than in C2. Further research is warranted to unpick the mechanisms underlying the association between housing tenure and LRTI admission. Interventions to prevent LRTI admissions could usefully target children living in non-owned housing. Key messages • This study demonstrates the value of administrative and health data linkage in improving our understanding of how socio-environmental factors might impact children’s respiratory health. • Children living in social and private rented housing (compared to owned housing) have a higher risk of LRTI hospital admission and could benefit the most from LRTI-lowering interventions.

Risk and causes of hospital admission in patients with atrial fibrillation on treatment with oral anticoagulants

Abstract Background Atrial fibrillation (AF) is associated with an increased risk of hospitalisation, although the main reasons for hospital admission and the role of antiarrhythmic drugs are not clarified. Objective The aim of our study was to assess the incidence rate and the factors associated with all-cause, cardiovascular and AF-related causes of hospitalisation in patients suffering from AF. Methods This is a prospective single-centre ongoing study (ATHERO-AF cohort) which included 2782 patients affected by non-valvular AF on oral anticoagulants. The primary endpoints were all-cause, cardiovascular and AF-related hospitalisation. Cardiac hospitalizations were defined as (non-AF) arrhythmias, acute coronary syndromes, heart failure (HF), systemic embolism, hypertensive urgency, vascular/cardiac surgery. The AF-related hospitalisation was defined as a recurrence of AF in paroxysmal pattern or as a high-rate symptomatic AF episode in persistent/permanent patterns. Multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratio (HR) with 95% Confidence interval (95%CI) for each factor in relation to risk of hospitalisation. Results Overall, 43.5% of patients were women with a mean age of 74.6±9.1year. Patients were followed for a mean of 31±26.8 months. We registered 1205 (12.1%/year) hospitalisations for any reason, 533 (5.7%/year) for cardiovascular causes and 180 (2.0%/year) were AF-related hospitalisations (Central illustration). Among the anti-arrhythmic drug use, we highlighted that flecainide and propafenone were associated with AF-related hospitalisations in paroxysmal and in persistent/permanent patterns (HR 1.861, 95%CI 1.116-3.101 and HR 1.947, 95%CI 1.069-3.548, respectively). Amiodarone (HR 3.012, 95%CI 1.835-4.943) and verapamil or diltiazem (HR 2.067, 95%CI 1.117-3.825) were associated with an increased risk of AF-related hospitalisations in persistent/permanent AF pattern. Furthermore, cancer was associated (HR 1.802, 95%CI 1.057-3.070) with increased risk of hospitalisation due to AF-related causes. Conversely, beta-blockers and digoxin were not associated with increased risk of hospital admission. Conclusions Hospitalisations of patients with AF are frequent for both cardiovascular and non-cardiovascular causes. Among the AF-related ones, the use of antiarrhythmic drugs emerged as associated with increased risk of hospitalisations, hypothesizing their poor effect in preventing AF episodes. For these reasons, we suggest carefully considering their use, reserving them for symptomatic patients with frequent AF recurrences.Central Illustration

Machine Learning techniques for predicting inpatient probability and LOS from EU Injury Database

Abstract Background Unlike statistical inference Machine Learning (ML) makes repeatable predictions without prior assumptions about the underlying relationships among variables. The Full Data Set (FDS) of the EU-IDB (European Injury DataBase) consent to explore risk of hospitalization due to injuries using many predictors. The Length Of Stay of patients in hospital (LOS) is a relevant proxy of complexity of treatment and resources consumption. Methods The IDB-FDS provides more than 3.800.000 ED records, in years 2008-19 for 19 Countries. LASSO (Least Absolute Shrinkage and Selection Operator) cross-validated linearized regression technique (linear for LOS) was used for variable selection and parameter regularization. Inpatients are those admitted or transferred to hospital. Days of hospitalization were used for LOS. A cross-validated Generalized Linear Model was performed on 5 folds randomly sampled assigning 80% of records to training and 20% to testing samples. Results The strongest predictors of hospital admission risk, selected by the model were in order of importance: EUROCOST-39 diagnoses categories, Age Group, Intent, Mechanism Of Injury, Activity When Injured, Transport Injury Event, Sex Of Patient, Place Of Occurrence. EUROCOST-39 represents 61,9% of explained variability and age group 19,4%. The strongest predictors of LOS were substantially the same: EUROCOST-39 86,2% of explained variability and age group 8,6%. Conclusions The main part of variability in the ML model is explained by diagnoses reclassified according to a disability standardization method. For instance, in the maximum training sample risk of hospitalization ranges from odd 0,76% for hand/fingers sprain up to 154,02% for brain concussion. In the median sample LOS ranges from 0,45 days for strain of hand/fingers up to 11,65 for multi-trauma. A combination of more disabling injury, older age and mechanism of injury (i.e. threat to breathing) increases enormously the risk of hospitalization and LOS. Key messages • Machine Learning techniques applied on EU-IDB can provide identification of relevant risk factors of hospital admission from injuries for targeting preventive measures and organizing health care. • Artificial Intelligence consents to analyse big amount of data as dimension or analytical detail of information for identifying patterns and predictors of specific indicators for injuries or diseases.

Risk factors for neonatal admission from the beginning of pregnancy in Northeast Spain.

Maternal health and gestational control are crucial to improving the newborn's prognosis. This study analyses demographic and obstetric factors at the beginning of pregnancy related to neonatal health, assessing their impact on the risk of hospital admission and prematurity. Observational retrospective study conducted in Northeast Spain with data of 9560 newborns between February 2017 and February 2022. The following have been evaluated as risk factors for hospital admission: nulliparity, multiple gestation, fertilisation techniques, foreign maternal origin, maternal age, smoking and residential location, dividing the sample according to gestational age. Hypothesis testing and logistic regression were performed. Nulliparity, fertilisation techniques and multiple gestation represent a risk factor for neonatal admission (OR 22.48, 4.04 and 3.34, respectively), especially in premature newborns <32 weeks of GA (OR: 30.71, 10.71 and 22.76, respectively). Foreign maternal origin also adds risk of admission, both in term newborns (OR 1.26; CI: 1.10-1.43) and in premature babies <32 weeks of GA (OR 1.61; CI: 1.09-2.38). Tobacco does not present a significant risk of neonatal admission. The multivariate analysis model confirms the influence of the following factors in all the studied groups: nulliparity, multiple gestation and foreign maternal origin. Nulliparity and multiple pregnancies are both main risk factors for neonatal admission and premature delivery. The use of fertilisation techniques and the foreign origin of the mother significantly associate increased risk of admission and neonatal prematurity. These findings underscore the need for a comprehensive approach to prenatal care to improve neonatal prognosis and promote long-term health in risk populations.

Antibody levels versus vaccination status in the outcome of older adults with COVID-19.

BACKGROUNDDespite the currently prevailing, milder Omicron variant of COVID-19, older adults remain at elevated risk of hospital admission, critical illness, and death. Loss of efficacy of the immune system, including reduced strength, quality, and durability of antibody responses, may render generalized recommendations on booster vaccinations inadequate. There is a lack of data on the efficacy of antibody levels in older adults and on the utility of vaccination status versus antibody levels as a correlate of protection. It is further unclear whether antibody levels may be used to guide the timing of booster vaccinations in older adults.METHODSWe conducted a prospective multicenter cohort study comprising hospitalized patients with COVID-19. Anti-SARS-CoV-2 spike antibodies were measured on hospital admission. The primary endpoint was in-hospital mortality. Patients were stratified by age, antibody levels, and vaccination status. Multiple logistic regression and Cox regression analyses were conducted.RESULTSIn total, 785 older patients (≥60 years of age [a]) and 367 controls (<60a) were included. After adjusting for confounders, risk of mortality, ICU admission, endotracheal intubation, and oxygen administration was 4.9, 2.6, 6.5, and 2.3 times higher, respectively, if antibody levels were < 1,200 BAU/mL (aOR, 4.92 [95%CI, 2.59-9.34], P < 0.0001; aOR, 2.64 [95%CI, 1.52-4.62], P = 0.0006; aOR, 6.50 [95%CI, 1.48-28.47], P = 0.013; aOR, 2.34 [95%CI, 1.60-3.343], P < 0.0001). Older adults infected with the Omicron variant were approximately 6 times more likely to die if antibody levels were < 1,200 BAU/mL (aOR, 6.3 [95% CI, 2.43-16.40], P = 0.0002).CONCLUSIONAntibody levels were a stronger predictor of in-hospital mortality than vaccination status. Monitoring antibody levels may constitute a better and more direct approach for safeguarding older adults from adverse COVID-19 outcomes.

Preventing risk of placement breakdown and hospital admission in the management of distressed behaviour in dementia care: A qualitative case study with family and care-home staff.

Objectives: Behaviours such as hitting-out and declining personal care are commonly exhibited by people living with dementia and are associated with care-giver stress and anxiety and care home placement breakdowns. Traditionally, pharmacological approaches have been used to manage behaviour; however, research indicates limited effectiveness. National guidelines recommend use of non-pharmacological interventions as first line treatment for distress, but further research is required to elucidate the components that lead to improved care for people living with dementia. This study aims to explore what works, examining case studies in which a non-pharmacological clinical intervention, the Newcastle Model, was used to understand and manage distressed behaviour in dementia care within care home settings. Method: A qualitative case study design was used. Three cases were selected from the Edinburgh Behaviour Support Service for their success in preventing care home placement breakdown during a distressed behaviour intervention in NHS Scotland. Family members and staff involved in the interventions within these cases were interviewed (N = 6). Thematic analysis was used to analyse data. Findings: All participants reported positive outcomes from the intervention. Three key themes were identified, each with subthemes. Participants described a supportive, non-judgmental environment which allowed them to integrate knowledge about dementia and tailor interventions to the specific needs of the individual living with dementia. There was also a sense of family and staff coming together to unite with shared goals. A preliminary model of all of themes and their interactions is presented. Conclusion: The study supports use of biopsychosocial, formulation-led approaches in the understanding and treatment of complex behavioural presentations in community care settings. It suggests that clinicians should endeavour to facilitate safe and open environments for care home staff and family members, in order to promote attribution change and person-centered care, and to help mediate differences and conflict between staff and family members.

Physical health challenges faced by elders with severe mental illness: population-based retrospective cohort study.

Severe mental illness (SMI), which includes schizophrenia, schizoaffective disorder and bipolar disorder, has profound health impacts, even in the elderly. To evaluate relative risk of hospital admission and length of hospital stay for physical illness in elders with SMI. To construct a population-based retrospective cohort observed from April 2007 to March 2016, data from a case registry with full but de-identified electronic health records were retrieved for patients of the South London and Maudsley NHS Foundation Trust, the single secondary mental healthcare service provider in south-east London. We compared participants with SMI aged >60 years old with the general population of the same age and residing in the same areas through data linkage by age-, sex- and fiscal-year-standardised admission ratios (SARs) for primary diagnoses at hospital discharge. Furthermore, we compared the duration of hospital stay with an age-, sex- and cause-of-admission-matched random group by linear regression for major causes of admission. In total, records for 4175 older people with SMI were obtained, relating to 10 342 admission episodes, showing an overall SAR for all physical illnesses of 5.15 (95% CI: 5.05, 5.25). Among the top causes of admission, SARs ranged from 3.87 for circulatory system disorders (ICD-10 codes: I00-I99) to 6.99 for genitourinary system or urinary conditions (N00-N39). Specifically, the diagnostic group of 'symptoms, signs and findings, not elsewhere classified' (R00-R99) had an elevated SAR of 6.56 (95% CI: 6.22, 6.90). Elders with SMI also had significantly longer hospital stays than their counterparts in the general population, especially for digestive system illnesses (K00-K93), after adjusting for confounding. Poorer overall physical health and specific patterns were identified in elders with SMI.