Total Admissions Research Articles

Volume Matters: Examining The Management Of Necrotizing Pancreatitis In The United States.

To examine the impact of hospital volume on mortality and healthcare utilization in patients admitted with necrotizing pancreatitis (NP). Over 20% of patients with acute pancreatitis develop NP, which has been associated with higher rates of procedural intervention, morbidity, and mortality. Adult patients admitted with NP were identified in the 2016-2019 Nationwide Readmissions Database 2016-2019. Hospital volume cutoffs were defined by tertiles of total NP admissions per year (low-volume [<9 admissions/year]; medium-volume [9-25 admissions/year]; high-volume [≥26 admissions/year]). Subgroup analyses were performed for NP patients undergoing procedural intervention. The primary outcome was in-hospital mortality. Multivariable logistic regression models determined the association between clinical outcomes and hospital volume. A total of 25,483 patients were identified, 14.3% of whom underwent procedural intervention, with the highest rate of intervention occurring in high-volume hospitals. The most common interventions offered at low- and medium-volume hospitals were open necrosectomy and percutaneous drainage. In contrast, high-volume hospitals had increased rates of minimally invasive surgery and endoscopic management. High-volume centers had the highest mortality rate among all patients (7.3% vs. 6.6% vs. 5.5%, P<0.001) but the lowest among the intervention-only cohort (7.5% vs. 10.4% vs. 12.0%, P<0.001). After adjusting for confounders, high-volume centers had lower odds of mortality in all patients (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.65-0.93) and in the intervention-only cohort (OR 0.64, 95% CI 0.42-0.96). High-volume hospitals were also associated with a shorter hospital stay and lower healthcare costs. Management of NP at high-volume hospitals was associated with improved survival and decreased healthcare utilization. As interventional techniques advance, following evidence-based guidelines and implementing clear referral pathways will optimize outcomes for both patients and hospital systems.

Predicting hospital admissions due to COVID-19 in Denmark using wastewater-based surveillance.

Wastewater surveillance has become a fundamental tool to monitor the circulation of SARS-CoV-2 in order to prepare timely public health responses. In this study we integrate available clinical data on hospital admissions with wastewater surveillance data and investigate if predictions of the number of hospital admissions due to COVID-19 in Danish hospitals are improved by including wastewater concentrations of SARS-CoV-2. We implement state space models to describe the relationship between the number of hospital admissions due to COVID-19, available with a three-week classification delay, and more recent numbers of total hospital admissions with COVID-19. Including wastewater concentrations of SARS-CoV-2, we consider five-week predictions of the number of hospital admissions due to COVID-19. As a result of the three-week classification delay, the predictions translate into two hindcasts, one nowcast and two forecasts. The predicted values for all time frames follow the observed numbers well. We find that log likelihood values are higher when including wastewater concentrations (across all horizons) and that lagging the wastewater observations to investigate whether changes in wastewater concentrations occur before changes in hospital admissions does not result in further improvements. Our study shows that including wastewater concentrations improve estimates of the number of hospital admissions due to COVID-19, implying that wastewater concentrations add valuable information about the underlying transmission and that the imminent development of the near-future disease burden from COVID-19 is better informed when carefully including wastewater concentrations.

P-1186. Significant Reduction in Disease Burden and a Shift in Clinical Diagnoses in Children Hospitalized with Respiratory Syncytial Virus (RSV) after Nirsevimab Implementation in Catalonia (Spain)

Abstract Background RSV causes a significant burden including hospitalization in infants. Nirsevimab prophylaxis was implemented in October 2023 in Catalonia (Spain) for all children &amp;lt; 6-months-old to reduce RSV-associated morbidity. We aimed to define the impact of nirsevimab administration on clinical outcomes of hospitalized children with RSV infection. Methods We compared clinical data from RSV-associated hospitalizations in children &amp;lt; 16-years-old between October 2022 - March 2023 and October 2023 - March 2024. Respiratory samples were collected from 11 hospitals of the COPEDICAT network (https://www.copedicat.cat). Laboratory confirmation was performed by a real-time multiplex RT-PCR-based assay (Allplex Respiratory Panel Assay, Seegene, South Korea) or antigen test. Disease severity was defined by the pulmonary score and/or need for PICU care. Results We included 636 hospitalized patients (63.5% in 2022-23 and 36.5% in 2023-24), mostly with lower respiratory tract infections (97.6%). Median age in the 2022-23 season was 4.5 vs 11 months in the following season (p&amp;lt; 0.001). The proportion of children &amp;lt; 6-months-old was also significantly lower in 2023-24 (53.0% vs 31.5%, p&amp;lt; 0.001) (Figure 1). There was a 42.6% reduction in hospitalizations in 2023-24 compared with the previous season; most of the hospitalized children in the 2023-24 season had not been immunized with nirsevimab (72.5%). In 2023-24, there was a higher proportion of bronchitis (40.1% vs 27.2%, p&amp;lt; 0.001) and children treated with bronchodilators and corticosteroids (both p&amp;lt; 0.001) compared to the previous season. The number of PICU admissions decreased by half (60 vs 32), but its percentage in relation to total hospital admissions did not change significantly (14.9% vs 13.8%, p=0.58). No significant differences were found in the clinical score at admission or respiratory support. Conclusion After the introduction of nirsevimab in infants &amp;lt; 6-months-old, children admitted to catalan hospitals were older and the proportion of bronchitis was significantly higher than in the previous season. In addition, there was a reduction of almost 50% RSV-associated hospitalizations and PICU admissions compared to the previous season; most of the hospitalized children had not been immunized with nirsevimab. Disclosures Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Astra-Zeneca: Honoraria|Enanta: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi-Pasteur: Advisor/Consultant|Sanofi-Pasteur: Honoraria

Nature and prevalence of long-term conditions in people with intellectual disability: retrospective longitudinal population-based study

ObjectiveExplore the nature and prevalence of long-term conditions in individuals with intellectual disability.DesignRetrospective longitudinal population-based study.SettingPrimary and secondary care data across the population of Wales with the Secure Anonymised Information...

Hospitalization Trends and Healthcare Resource Utilization for Fecal Impactions in Pediatric Patients with Functional Constipation.

Objectives: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients. For healthcare resource utilization, we analyzed the length of hospital stays and total hospital charges, adjusted for inflation. Results: A total of 23,570 admissions due to fecal impactions in children between the years 2011 and 2019 were analyzed, contributing to 0.18% of the total pediatric admissions. Hospitalization rates nearly doubled from 2011 (0.15%) to 2019 (0.29%). The mean hospitalization charges also trended upwards from 15,234 USD in 2011 to 22,487 USD in 2019. The inflation-adjusted annual rate of increase in hospital charges during this period was 5.9% per year. Aggressive fecal disimpaction procedures (either manual or surgical) were performed in approximately 3% of these admissions. Multivariate regression showed that older children (13-18 years of age) were more likely to require aggressive disimpaction. Female children, those with Hispanic ethnicity, and those with obesity were less likely to be associated with the need for disimpaction. Conclusions: Hospitalizations for fecal impaction have increased significantly over the past decade, creating a substantial burden on healthcare resources. Our study highlights the importance of aggressive outpatient management strategies with close follow-up for fecal impactions, which will potentially minimize these hospitalizations.

Systematic review of integrated mental and physical health services for children and young people with eating and functional symptoms.

Evidence suggests that by recognising the psychosocial component of illness as equally important to the biological components, care becomes more holistic, and patients can benefit. Providing this type of care requires collaboration among health professionals, rather than working in isolation, to achieve better outcomes. However, there is a lack of evidence about the implementation of integrated health care. This review focuses on children and young people experiencing eating disorders (i.e. disorders related to feeding and eating) or functional symptom disorders (i.e. medically unexplained symptoms). The present review is part of a larger study that will inform the development of a new children's hospital in England. Both eating disorders and functional symptom disorders are conditions that may be particularly likely to benefit from an integrated approach to health care, and this review aims to investigate what service models have been used to integrate care, what factors influence their implementation, and what effects these integrated models have on access to and outcomes from care. We conducted a systematic review of studies based on children and young people with eating disorders or functional symptom disorders, investigating the effectiveness of integrated mental and physical health services versus any other type of services provided in these populations. We searched MEDLINE, EMBASE and PsycInfo® (American Psychological Association, Washington, DC, USA) electronic bibliographic databases in July 2024 without restriction on the date of publication or country of interest. We reviewed only studies written in English. We identified 2668 citations which resulted in 1939 papers eligible for title screening. Only one single-site Australian evaluation of an integrated care model from over 20 years ago was included in our review. The study reported significantly higher number of total admissions and total bed-days utilised in the integrated approach. However, the burden of care shifted from psychiatric wards to medical wards and as a result, the cost per admission and the cost per inpatient decreased. The lack of conceptual consistency about the definition of integrated care may have driven false screening and loss of some evidence. The same limitation applies in terms of the definition of functional symptom disorders. The review identified a gap in the evidence base relating to integrated secondary service provision for children and adolescents with eating disorders or functional symptom disorders in comparison with generic services. No similar studies were identified for children and young people with functional symptom disorders. Our findings align with previous evidence and show that despite the existence of studies describing aspects of integrated care, integration of physical and mental health services for children and young people with eating disorders or functional symptom disorders is underexplored and the limited available evidence is of weak quality. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.

Use of a trigger tool to describe and screen drug-related hospital admissions in older adults: the TRIGGAge retrospective cohort study.

Drug-related hospital admissions (DRAs) can account for 5%-40% of total hospital admissions in older adults, with a significant proportion deemed preventable. To increase the detection of DRAs, in 2021, a revised trigger tool listing 21 frequent causes of admissions and medications at risk was proposed. This study aimed to describe DRAs using this trigger tool in a French acute geriatric ward and to assess the performance of the tool. This was a retrospective cohort study in a 20-bed geriatric unit including all patients hospitalised in 2023. During the first quarter of 2024, each patient's chart was adjudicated by using a two-step standardised review procedure to assess whether the admission was a DRA. The potentially at cause medications and reasons for admission were also assessed. During the study period, 483 patients were hospitalised in the acute-care geriatric ward (mean age 86.7 ± 6.15years). After adjudication, 207 admissions (43%) were identified as DRAs; 70% were considered preventable. The main causes of DRAs were falls/fractures (33%), bleeding (23%) and delirium (14%). The drugs most frequently responsible were diuretics (21%), renin-angiotensin system inhibitors (20%) and direct oral anticoagulants (15%). The overall sensitivity and specificity of the tool for detecting DRAs was 90% (95% CI 88-93) and 72% (68-76), respectively. After adjudication, the trigger tool helped detect 83% more DRAs as compared with the attending geriatrician. DRAs are frequent in a geriatric population and often preventable. Their detection may be improved by the use of a trigger tool.

AUDIT OF OBSTETRIC REFERRED CASES IN TERTIARY CARE HOSPITAL OF PESHAWAR

Objective: This study aimed to determine obstetric referral characteristics and their causes. Methods: This prospective observational study was conducted in the Gynae B unit, Khyber Teaching Hospital, Peshawar, Jan 1st, 2021 - Dec 31st, 2021. All obstetric cases referred to this hospital in the study period were included. Detailed clinical history, including the age, parity, period of gestation if antenatal, and place of referral, were recorded. A thorough general physical and obstetrical examination was performed, and required investigations were sent. The patient's treatment, including vaginal delivery, cesarean section, and conservative management, was recorded. Data analysis was done using SPSS 22.0. Results: Total obstetric admissions during the study period were 5,242; total referrals for obstetric indications were 1,678, constituting 32% of all obstetric admissions. 1241 (74%) of cases fall within the age group of 20-30, while 234 (14%) were under 20 years old and 201 (12%) were over 30 years. 588(35%) of patients were prim gravidas, 453(27%) were multi and 335(20%) were grand multigravidas. 56% of patients presented during antenatal, while 604 (36%) arrived intrapartum and 302 (18%) postpartum. The mode of transport used by the referred patients was an ambulance in 369(22%) and private vehicles in 1308(78%) cases. The most common reasons for obstetric referrals were hemorrhagic disorders, accounting for 28%, and hypertensive disorders, which made up 18%. Conclusion: Complex obstetric cases are referred to our tertiary care facility. A proper referral system is needed for tertiary care-level hospitals. The process of transferring patients between hospitals highlights the importance of teamwork. It is necessary to acknowledge that tertiary care is the only option for high-risk referrals.

Prospects for Personnel Training for the Forestry Sector in the Regions of Russia: Arctic Context

Introduction. The development and enhancement of the management efficiency of the forestry sector in the Macroregion of the Northwest and the Arctic zone of the Russian Federation are strategically significant for the country's development, oriented towards global competitiveness. The aim of this study is to analyze the prospects for personnel training within the system of secondary vocational education for the forestry sector in the Northwest and Arctic zones of the Russian Federation. Materials and Methods. The materials for the study were statistical data from two forms of state federal reporting for 2022: No. 1-T (prof) "Information on the number and demand for workers in organizations by professional groups" and form No. SPO-1 "Information about the educational organization that carries out educational activities in educational programs of secondary vocational education." The study employed methods of descriptive statistics, economic-mathematical modeling, and comparative data analysis. Results of the Study. An extended list of 23 directions and specialties of secondary vocational education organizations training qualified personnel for the forestry complex in the Arctic Macroregion and Northwest Russia has been identified. An assessment of the provision of the economy of enterprises and organizations in the forestry sector with qualified personnel has been presented. The analysis revealed 12 entities in the macroregion whose personnel needs for mid-level specialists can be met by graduates from their own region, as well as 13 entities in the macroregion that need to train their personnel beyond the macroregion in other regions of Russia to meet the demand for qualified workers and employees. A mapping tool has been developed, comprising 85 subjects of the Russian Federation, divided into three groups based on the total admission to specialties and directions related to the forestry sector. Discussion and Conclusion. The mapping tool obtained demonstrates that the regions with the highest preparation of forestry specialists are located far from the Arctic zone and Northwest Russia. Meanwhile, the main forest resources of the macroregion's entities are unevenly distributed across their territories, concentrated mainly in the central and southern parts. The proposed mapping tool contributes to addressing the issues of personnel training for the forestry sector through the involvement of all interested actors: applicants, employers, secondary vocational education organizations, and regional executive authorities.

Popular areas of training for persons with disabilities and educational migrants when entering Russian universities

Introduction. Much attention is paid worldwide to the development of an education system that should provide quality education for each person. This is especially true for certain specific categories of citizens: people with disabilities, educational migrants. The study was aimed at determining, based on an analysis of the admission of people with disabilities and educational migrants to universities, which areas of training and specialties were the most popular among these categories. Materials and methods. The study materials were statistical data from the state federal reporting form for 2022: No. VPO-1 “Information on the organization performing educational activities under higher education programs – bachelor’s degree programs, specialist programs, master’s degree programs” for state higher education organizations in terms of full-time education at the beginning of the 2022/23 academic year. The study used methods of comparative analysis and descriptive statistics, methods of analysis and synthesis, decision theory, mathematical modeling and statistical data analysis. Results. The maximum values of the share of individuals with disabilities and educational migrants in the total admission to universities corresponded to different regions and federal districts: for individuals with disabilities, it was the North Caucasus Federal District, for educational migrants – St. Petersburg, Sevastopol, Leningrad and Tver regions. The analysis identified 11 most popular areas of training for individuals with disabilities and 16 for educational migrants. Five integrated groups of specialties and areas of training (UGSN) could be considered the universal all-Russian choice of areas of training and specialties upon admission to universities for these categories: 31.00.00 – Clinical Medicine; 09.00.00 – Informatics and Computer Engineering; 44.00.00 – Education and Pedagogical Sciences; 38.00.00 – Economics and Management; 40.00.00 – Jurisprudence. For each category of applicants, admission formulas had been compiled, which represented the ratio of the number of UGSN from the corresponding fields of science. Discussion and conclusion. A comparative analysis of the general admission to universities showed that for individuals with disabilities, the leading areas of admission were UGSN from the field of sciences – sciences about society, while for educational migrants these were engineering, technology and technical sciences. In both categories, the second most popular area of science was health care and medical sciences. The third position was occupied by sciences from the first places of the opposite categories. The least interest among individuals with disabilities was paid to UGSN of engineering areas, where training and further work activity were associated with greater difficulties.

Burns Across Seasons: Seasonal Effect on the Mechanism of Burn Injuries in Pediatric Patients Requiring Hospitalization

Background: Burn injuries are a major cause of trauma in pediatric patients, comprising 17–25% of total burn admissions and ranking among the five most deadly childhood injuries. Seasonal variations significantly influence burn mechanisms due to changes in environmental conditions and activities. Scald injuries peak during colder months with increased use of hot water and heating appliances, while warmer months see more contact and electrical burns from outdoor activities and power surges. Despite the high burden in developing nations, limited research explores these seasonal patterns. Objectives: This study aimed to investigate the seasonal relationship with burn injury mechanisms in pediatric patients under 13 years of age. Specifically, it sought to identify seasonal variations in burn types, quantify hospitalizations across seasons, and assess associated hospital stay durations. Methods: A prospective analytical cross-sectional study was conducted at Mayo Hospital Lahore/KEMU from December 2023 to August

A Retrospective Analysis of Assault Admissions at a Regional Medical College in Jharkhand: Examining Factors that Impact Patient Outcome

Abstract Background: Assault admissions pose a significant burden on healthcare systems worldwide. Understanding factors influencing surgical intervention for assault victims can improve resource allocation and patient care. This study aims to analyze a large dataset of assault admissions at a regional medical college to identify factors associated with surgical management. Methods: We conducted a retrospective analysis of admissions at Sheikh Bhikhari Medical College (SBMCH), Hazaribag, Jharkhand India, between Jan 2023 and December 2023. We reviewed data for over 4,000 admissions and identified 1,339 cases admitted due to assault-related injuries. Logistic regression analysis was used to investigate the association between potential predictors (age category, length of stay, time of admission, and gender) and the likelihood of requiring surgical intervention. SPSS v29.0 was used while a p value of &lt;0.05 was considered as of statistical significance. Result: Assault admissions constituted approximately 30% of the total admissions during the study period. Time of admission significantly impacted the need for surgery. Patients admitted later (off-hours/) had slightly higher odds of requiring referrals. Gender also emerged as a significant predictor. Age category and length of stay did not show statistically significant associations with surgical intervention. Conclusion: This study highlights the high prevalence of assault admissions and the potential influence of time of admission and gender on surgical management. Additionally, the high referral rate to higher centers suggests a need for increased access to neurosurgical services within the region. The challenge of patients leaving against medical advice (LAMA) warrants further investigation. Future research should explore specific injury types requiring surgery and potential gender differences in assault injuries.

Foot and Ankle Trauma: Epidemiology Before, During, and Post COVID-19 Pandemic in a Level I Trauma Center: A 5-Year Experience and Data Analysis.

Background: Foot and ankle injuries are one of the leading orthopedic causes of emergency department (ED) admissions. The purpose of this study was to analyze, through 5 years of data collection, differences in number and type of admissions, as well as the severity of foot and ankle trauma to the ED in the pre-pandemic period, during the COVID-19 emergency, and in the post-pandemic period. This study aims to assess epidemiological and clinical data. Methods: Five years of data were collected on admissions to the ED at the Fondazione Policlinico Universitario A. Gemelli using an electronic database. The system allowed the use of a numeric code assessed at triage ranging from 1 to 5, where 1 indicated a patient with compromised vital functions, and it continued in decreasing criticality. Data were extensively analyzed and extrapolated to obtain epidemiological and clinical evaluation. Results: Data from 3787 patients, including 1945 males with a mean age of 41.4 years, were collected. Data were evaluated in the three different periods. In the pre-pandemic period, 2228 ED admissions were recorded, including 1138 males with a mean age of 37.4 years and a mean of 2.79 admissions per day. Codes 3 and 4 reported in the ED triage were 4.8% and 90.1%, respectively; the average surgical treatment was 5.6%. During the COVID period, the total number of admissions was 981, with 501 males with an average age of 43.8 years and a mean of 1.30 admissions per day. Codes 3 and 4 were 22.5% and 72.7%, respectively; the average surgical treatment was 10.4%. In the post-COVID period, 578 admissions were, including 306 males with a mean age of 43.2 years, and a daily access rate of 1.58 patients. Codes 3 and 4 reported in the ED triage were 25.4% and 70.8%, respectively; the average surgical treatment was 8.6%. Conclusions: During the pandemic period due to COVID-19 a substantial decrease in total admissions per day in the ED was noted, but an increase in more complex codes occurred, as evidenced by the percentage increase in surgical admissions compared to total admissions during the pandemic; the mean age of users gradually increased. Total hospitalization data remained stable in the post-pandemic period, likely due to the global impact of the pandemic. COVID-19 radically and concretely changed people's living habits and priorities for accessing the ED.

Clinical significance of toxin EIA positivity in patients with suspected Clostridioides difficile infection: systematic review and meta-analysis.

The laboratory diagnosis of Clostridioides difficile infection (CDI) is controversial. Nucleic acid amplification tests (NAAT) and toxin enzyme immunoassays (EIA) are most widely used, often in combination. However, the interpretation of a positive NAAT and negative toxin immunoassay (NAAT+/EIA-) is uncertain. PubMed and EMBASE were searched for studies reporting clinical outcomes in NAAT+/EIA- versus NAAT+/EIA+ patients. Forty-six studies comprising 33,959 patients were included in this meta-analysis. All-cause mortality (RR 0.96, 95% CI 0.80-1.15), attributable mortality (RR 0.61, 95% CI 0.20-1.91), fulminant CDI (RR 0.83, 95% CI 0.57-1.20), radiographic evidence of CDI (RR 0.87, 95% CI 0.65-1.16), total CDI complications (RR 0.95, 95% CI 0.59-1.53), colectomies (RR 0.78, 95% CI 0.34-1.79), and ICU admission (RR 1.04, 95% CI 0.84-1.30) did not significantly differ between NAAT+/EIA- and NAAT+/EIA+ patients. However, rates of recurrent (RR 0.62, 95% CI 0.50-0.77) or severe (RR 0.74, 95% CI 0.63-0.88) CDI were significantly lower in NAAT+/EIA- patients than in NAAT+/EIA+ patients. The pooled prevalence of NAAT+/EIA- patients who were treated with antibiotics for CDI was 73.4% (pooled proportion 0.72, 95% CI 0.52-0.88). NAAT+/EIA- patients have lower rates of recurrence and are at reduced risk for severe CDI compared with NAAT+/EIA+ patients but have a risk of CDI-related complications and mortality comparable to that of NAAT+/EIA+ patients. Toxin results cannot rule in or rule out CDI, and the decision whether to treat symptomatic NAAT+/EIA- patients for CDI should be based on clinical presentation and not on the toxin result.IMPORTANCEClostridioides difficile infection (CDI) is a common cause of healthcare-associated infections and the leading cause of antibiotic-associated diarrhea. However, the laboratory diagnosis of CDI, primarily done by nucleic acid amplification test (NAAT) and enzyme immunoassay (EIA), is controversial, especially in patients who test positive by NAAT but negative by EIA. In this systematic review, we compared the clinical outcomes of NAAT+/EIA- versus NAAT+/EIA+ patients and found that the two groups have similar risk of mortality and CDI-related complications. However, NAAT+/EIA- patients had significantly lower rates of recurrence and severe CDI than NAAT+/EIA+ patients, and most NAAT+/EIA- patients received CDI therapy. Toxin testing can help to predict the likelihood of CDI recurrence or severe infection, but the toxin result should not be a determining factor in the administration of CDI therapy. The decision on whether to treat NAAT+/EIA- patients should be based on clinical assessment.

Sepsis Epidemiology and Outcomes in Pediatric Intensive Care Unit of Alkhadra Hospital, Tripoli, Libya

Despite the various interventions and therapies that have been implemented to improve the quality of life for children with sepsis, the prevalence and death rates continue to increase. This issue is a major public health problem that requires the continuous improvement of the guidelines and the identification of new strategies. The aim of the study was to identify the prevalence and outcomes of severe sepsis among children admitted to the Pediatric Intensive Care Unit (PICU). This study was conducted in PICU of Alkhadra Hospital in 2023 as a hospital-based retrospective study. All children who were admitted to the PICU from 2017 to 2022 were included. Data was collected from hospital file records, which included the following: age of patient, gender, comorbidities of patients, and source of admission; origin of sepsis; type of PICU admission; primary site of infection; organ dysfunction present at screening; and patient outcomes. Of the 1284 total admissions to the PICU, 128 patients (9.96%) met the definition of sepsis. Most patients (78.9%) were less than 6 years old. Respiratory problems and congenital malformations were the most common co-morbidities, with reported rates of 18.8% and 10.2%, respectively. The emergency department was the most common source of admission (67.2%). Nearly all patients had good overall performance, whereas (21.1%) of the patients were in a coma. 77.3% discharged during the study, and 22.7% died. Although decreasing the incidence through preventive measures is ideal, early recognition and treatment of sepsis will decrease both short- and long-term complications and related mortality of at-risk infants and children.

The epidemiology of pediatric oncology and hematopoietic cell transplant admissions to U.S. intensive care units from 2001-2019.

Children with cancer or hematopoietic cell transplant (HCT) frequently require ICU care. We conducted a retrospective cohort study using Healthcare Cost and Utilization Project's State Inpatient Databases from 21 U.S. states from 2001-2019. We included children <18 years with oncologic or HCT diagnosis and used ICD-9-CM and ICD-10-CM codes to identify diagnoses, comorbidities, and organ failures. We used generalized linear Poisson regression and Cuzick's test of trend to evaluate changes from 2001-2019. Among 2,157,991 total pediatric inpatient admissions, 3.9% (n=82,988) were among oncology patients and 0.3% (n=7,381) were among HCT patients. ICU admission prevalence rose from 13.6% in 2001 to 14.4% in 2019 for oncology admissions and declined from 23.9% to 19.5%, for HCT admissions. Between 2001-2019, the prevalence of chronic non-oncologic comorbidities among ICU patients rose from 44.3% to 69.1% for oncology patients (RR 1.60 [95% CI 1.46-1.66]) and from 41.4% to 81.5% (RR 1.94 [95% CI 1.61-2.34]) for HCT patients. The risk of Multiple Organ Dysfunction Syndrome more than tripled for oncology (9.5% to 33.3%; RR 3.52 [95% CI 2.97-4.18]) and HCT (12.4% to 39.7%; RR 3.20 [95% CI 2.09-4.89]) patients. Mortality decreased most for ICU patients with acute myeloid leukemia (AML) (14.6% to 8.5%) and oncology-related HCTs (15.5% to 9.2%). Critically ill pediatric oncology and HCT patients are increasingly medically complex with greater prevalence of chronic comorbidities and organ failure, but mortality did not increase. Pediatric ICUs may require increased financial and staffing support to care for these patients in the future.

Predictors of cost of admission for robot-assisted pedicle screw placement.

The authors investigated the predictors of cost of admission (CoA) for robot-assisted pedicle screw placement to assess the value of robotic systems in spine operations. Demographic, operative, and postoperative variables were retrospectively collected from 506 patients undergoing robot-assisted spine surgery utilizing the ExcelsiusGPS robot at two high-volume tertiary care centers from 2017 to 2023. Perioperative parameters were evaluated against total hospital admission cost utilizing the Kruskal-Wallis and Wilcoxon rank-sum tests followed by multivariable linear regression. The majority of patients were female (53.6%), 50-80 years of age (77.7%), and White (73.9%); had at least 1 comorbidity (58.1%); and presented with an average functional preoperative Frankel grade (57.5%). The mean CoA was $69,458 ± $47,910. On univariable analysis, demographic data including sex, age, race, and Frankel grade were not associated with CoA. The presence of a comorbidity, however, was associated with increased CoA (p < 0.001). Intraoperatively, one-third of the operations (31.8%) were revisions from prior operations and were subsequently associated with increased CoA (p = 0.021). Thoracic-level operations constituted roughly one-quarter of the cohort (24.1%) and were also associated with increased CoA (p < 0.001). Intraoperative durotomies occurred in 7.7% of patients, leading to increased CoA (p = 0.003). Extended surgical durations also demonstrated elevated CoA (p < 0.001). Postoperatively, the median length of stay (LOS) was 3 days, and an LOS of greater than 3 days was one of the primary drivers of cost (p < 0.001). Postoperative complications occurred in just 6.3% of the cohort but were also associated with increased CoA (p < 0.001). On multivariable analysis, LOS, number of screws placed, operative duration, and postoperative complications were the primary predictors of increased CoA. Understanding the drivers of cost in robot-assisted pedicle screw placement is crucial to elucidate the value associated with the use of robotic systems in spine surgery. These results indicate that patient and surgical complexity influence cost and that robotic systems may augment management in spine surgery. Further investigation is warranted to determine the long-term benefits and cost-effectiveness of new technologies compared with traditional techniques in spine surgery.

Hospitalisation patterns for respiratory diseases in Australia: an ecological study

ObjectivesThe objective of this study is to examine the hospitalisation profile for respiratory diseases in Australia between 1998 and 2019.DesignAn ecological study.SettingA population study that involved all private and public...

Risk factors and outcomes in paediatric acute febrile encephalopathy: a cross-sectional study from a tertiary care centre in North India

Background: Acute Febrile Encephalopathy (AFE) is a frequent cause of emergency admissions in children, particularly in India, where it poses a significant public health challenge due to high morbidity and mortality rates. This study aims to bridge some of these gaps by analyzing the clinical features, incidence, and mortality-associated risk factors in pediatric AFE cases in a hospital-based setting in North India. Methods: This hospital-based cross-sectional study was conducted over one year (January 2020 to December 2020) in the Pediatric Intensive Care Unit (PICU) of Indira Gandhi Medical College and Hospital, Shimla. The study included all pediatric patients aged 1 to 18 years admitted to the PICU with clinical evidence of AFE, fulfilling specific inclusion criteria. Data were collected on patient demographics, clinical presentation, and relevant investigations. Key risk factors, such as shock, need for ventilatory support, Glasgow Coma Scale (GCS) scores, and Multiple Organ Dysfunction Syndrome (MODS), were assessed for their association with mortality. Results: Out of 2,832 pediatric admissions, 550 children were admitted to the PICU, and 69 met the inclusion criteria for AFE, resulting in an AFE incidence of 12.5% in the PICU and 2.4% of total hospital admissions. The study observed a slight male preponderance (56.5% male, 43.4% female) and found that the most affected age group was 10 to 18 years (43%). The overall mortality rate among AFE patients was 26%, contributing to 13.7% of the total PICU mortality. Significant risk factors associated with mortality included late hospital presentation (mortality rate of 50% in patients presenting after 7 days of symptom onset), ventilatory support (69.6% mortality), shock (44.4% mortality), MODS (47.6% mortality), Disseminated Intravascular Coagulation (DIC) (100% mortality), and GCS &lt;8 (56.5% mortality). Conclusion: AFE remains a significant contributor to pediatric morbidity and mortality, particularly in resource-limited settings. The study identifies key risk factors such as shock, ventilatory support, DIC, MODS, and low GCS, which are strongly associated with increased mortality. Early recognition and timely intervention are critical to improving outcomes.

A Systematic Review of the Costs of Drug-Associated Acute Kidney Injury and Potential Cost Savings with Nephrotoxin Stewardship Prevention Strategies.

There is a scarcity of information related to the financial impact of acute kidney injury (AKI), and even more so the economics of drug-associated AKI (D-AKI). Our goal was to provide a comprehensive summary of the economic burden of D-AKI by evaluating the costs of D-AKI compared to not developing AKI and cost savings associated with nephrotoxin stewardship approaches. Following the PRISMA guidelines, a literature search was conducted using PubMed to identify articles from database inception through November 2023. The main outcomes included AKI incidence, resource use, and cost of nephrotoxin stewardship programs/D-AKI event or no event. Key findings were summarized based on whether the study compared the cost of D-AKI vs. no AKI or identified potential cost savings associated with a nephrotoxin stewardship method to prevent D-AKI or worsening D-AKI. All costs were adjusted to USD2023. Twenty-five studies met the inclusion criteria. Eight studies compared the cost of D-AKI to no AKI. Total admission costs of patients who developed D-AKI ranged from $47,696 to $173,569. Nineteen studies implemented nephrotoxin stewardship with 12 substituting a less nephrotoxic drug; five using therapeutic drug monitoring and two altering drug dosing to limit exposure. Overall, these prevention strategies ranged from $5,171 to $364,973 in total medical cost savings and $17 to $942 in total cost savings per patient-day. The in-hospital economic impact of D-AKI is substantial. Implementing nephrotoxin stewardship strategies to reduce D-AKI is associated with cost savings. Institutions should adopt strategic and efficient nephrotoxin stewardship programs to optimize patient care and reduce costs.