Trends In Admissions Research Articles

Trends in hospital admissions for childhood fractures in England

PurposeFractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who...

Trend of Diabetes-Related Hospital Admissions During the Transition Period From Adolescence to Adulthood in the State of California.

This study examined the incidence of diabetes-related hospital admissions and described the characteristics among youth and emerging adults with type 1 (T1D) and type 2 diabetes (T2D) in California. A retrospective study was conducted using the statewide inpatient database during the years 2014-2018. Individuals aged 13-24 years hospitalized with diabetic ketoacidosis (DKA) or severe hypoglycemia (SH) were recorded. Demographic characteristics and health measures among youth (ages 13-18) and young adults (ages 19-24) were compared. A total of 34,749 admission encounters for T1D and 3,304 for T2D were analyzed. Hospitalization rates significantly increased with age during the transition to adulthood, from 70/100,000 California population at age 17 to 132/100,000 at age 19 in T1D. Higher hospitalization rates were demonstrated in young adults than in youth in T1D, and the rate was significantly higher in Black young adults (23.9%) than in youth (12.0%) among the age-adjusted population with diabetes (P < 0.0001). More young adults admitted were on public insurance, and approximately half were from the lowest income quartile. No difference was observed in hospital length of stay; however, hospital charges were higher among young adults. Young adults were three times more likely to be admitted for severe conditions. We demonstrated a significant rise in hospital admission during the transition period in individuals with T1D. There were significantly more Black young adults who were on public insurance and had lower socioeconomic status. Our findings suggest that the health care system fails many emerging adults with diabetes, particularly for people of color, and that improving medical transition is crucial.

Inequalities in Mortality and Access to Hospital Care for Cervical Cancer-An Ecological Study.

Cervical cancer is the second most common form of cancer in the world among women, and it is estimated to be the third most frequent cancer in Brazil, as well as the fourth leading cause of death from cancer. There is a difference in cervical cancer mortality rates among different administrative regions in Brazil along with an inadequate distribution of cancer centers in certain Brazilian regions. Herein, we analyze the trends in hospital admission and mortality rates for CC between 2000 and 2012. This population-based ecological study evaluated the temporal trend in cervical cancer between the years 2000 and 2012, stratifying by Brazilian administrative regions. The North and Northeast regions had no reduction in mortality in all age groups studied (25 to 64 years); when analyzing hospitalization rates, only the age group of 50 to 64 years from the North Region did not present a reduction. During the years studied, in the South Region, the age group ranging from 50 to 54 years had the greatest reduction in mortality rates (β = −0.59, p = 0.001, r2 = 0.63), and the group ranging from 45 to 49 years had the greatest reduction in hospital admission rates (β = −8.87, p = 0.025, r2 = 0.37). Between the years 2000 and 2012, the greatest reduction in the incidence of UCC was in the South Region (β = −1.43, p = 0.236, r2 = 0.12) followed by the Central-West (β = −1, p < 0.001, r2 = 0.84), the Southeast (β = −0.95, p < 0.001, r2 = 0.88), the Northeast (β = −0.67, p = 0.080, r2 = 0.25), and, finally, by the North (β = −0.42, p = 0.157, r2 = 0.17). There was a greater reduction in mortality rates and global hospitalization rates for CC in Brazil than in the United States during the same period with exceptions only in Brazil’s North and Northeast regions.

Comparative study between admission, orthopaedic surgery, and economic trends during Covid-19 and non-Covid-19 pandemic in an Italian tertiary hospital: a retrospective review

BackgroundThe COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic—during the Italian lockdown period between 8 March and 4 May 2020—influenced orthopaedic access for traumatic events to the Emergency Department (ER).MethodsA retrospective review of the admission to the emergency room and the discharge of the trauma patients’ records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups.ResultsNo significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to − 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing.ConclusionWe detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).

Does the availability of transcatheter aortic valve replacement impact inpatient outcomes after surgical aortic valve replacement? Analysis of the national inpatient sample

Abstract Background With the introduction of transcatheter aortic valve replacement (TAVR), the treatment of aortic stenosis (AS) has experienced a paradigm shift, altering patient selection for surgical aortic valve replacement (SAVR) over the past decade. What remains to be determined is the impact of a hospital's ability to offer TAVR, in the contemporary era, on inpatient outcomes following SAVR. Purpose The goal of this study was to assess inpatient mortality and the use of mechanical aortic valve replacement (mAVR) in patients undergoing SAVR at TAVR versus non-TAVR centers in the United States. Methods The National Inpatient Sample (2011–18), a probability sample of inpatient visits in the United States, was used to study trends in admissions for SAVR at TAVR and non-TAVR centers; in-hospital mortality was trended over time. Survey estimation commands were used to determine weighted national estimates. Results There were 559,365 inpatient visits for SAVR with 75.2% (95% CI 74.2%-76.2%) and 24.7% (95% CI 23.8%-25.8%) receiving bioprosthetic SAVR (bAVR) and mAVR, respectively at TAVR centers and 64.5% (95% CI 63.3%-65.6%) and 35.5% (95% CI 34.4%-36.7%) receiving bAVR and mAVR, respectively at non-TAVR centers. SAVR recipients at non-TAVR centers were older when compared to recipients at TAVR centers (68.3±0.09 vs 66.9±0.11 years p&amp;lt;0.001). Heart failure, cardiac arrhythmias, peripheral vascular disorders, complicated hypertension and diabetes, renal failure and liver disease were more common in patients undergoing SAVR at TAVR-centers. During the study period, both crude (OR = 0.78 95% CI 0.73–0.83) and adjusted (OR = 0.79 95% CI 0.73–0.86) inpatient mortality was lower amongst SAVR recipients at TAVR centers. The utilization rates of mAVR at both TAVR and non-TAVR centers decreased over time amongst all age groups (p trend &amp;lt;0.001). Conclusions Patients undergoing SAVR at TAVR centers were younger and had more co-morbidities compared to patients undergoing SAVR at non-TAVR centers. Although patients undergoing SAVR at TAVR centers had significantly more co-morbidities, inpatient mortality was lower at TAVR centers compared to non-TAVR centers. Further research is needed to determine whether the impact of a multidisciplinary cardiac approach resulted in significant differences in patient selection for SAVR, due to the availability of TAVR, influencing patient outcomes. Funding Acknowledgement Type of funding sources: None.

Trends in the use of mechanical and bioprosthetic aortic valve replacement in the era of transcatheter aortic valve replacement

Abstract Background The choice between a mechanical versus a bioprosthetic valve in aortic valve replacement (AVR) is based on life expectancy, bleeding risk and co-morbidities, since bioprosthetic AVR (bAVR) as compared to mechanical AVR (mAVR), are associated with a more rapid structural deterioration. However, refinements in bioprosthetic valves and the introduction of transcatheter aortic valve replacement (TAVR) (potential for valve-in-valve procedures), will most likely influence valve selection in the future. The impact of widespread transcatheter valve replacements, on the decision to use bAVR versus mAVR, in the contemporary era and subsequent outcomes remain to be determined. Purpose The goal of our study was to assess trends in utilization of bAVR and mAVR in the United States while, assessing in-hospital mortality over time. Methods The National Inpatient database (2009–18) was used to study trends in admissions for bAVR and mAVR and in-hospital mortality over time. Survey estimation commands were used to determine weighted national estimates. Results There were 700,896 inpatient visits for AVR with 70.1% (95% CI 69.2%-71.1%) and 29.9% (95% CI 28.9%-30.8%) visits for bAVR and mAVR, respectively. Those undergoing bAVR were significantly older, [bAVR (69.8 years) vs mAVR (62.7 years) p&amp;lt;0.001]. Heart failure, cardiac arrhythmias, hypertension, diabetes with complications and renal failure were more common in those undergoing a bAVR. Through the course of the study period, the rates of mAVR decreased across all age groups (p trend &amp;lt;0.001), including patients younger than 50 years (p trend &amp;lt;0.001). Both crude (OR = 1.20 95% CI 1.13–1.27) and adjusted (OR = 1.34 95% CI 1.25–1.44) inpatient mortality was higher amongst mAVR recipients. Conclusions In the contemporary TAVR era, the utilization of mAVR has decreased across all age groups, including those younger than 50 years old. Although mAVR recipients were healthier with significantly less co-morbidities, inpatient mortality was higher after mAVR compared to bAVR. In addition to understanding the causes accounting for the higher mortality after mAVR, future research should focus on developing TAVR friendly bAVR; possibly enhancing our ability to perform percutaneous valve-in-valve procedures in the future. Funding Acknowledgement Type of funding sources: None.

COVID-19 pandemic and admission rates for and management of acute coronary syndromes in Israel

Abstract Background Since the COVID-19 pandemic outbreak several countries have reported a decrease in the number of patients admitted with non-ST elevation myocardial infarction (NSTEMI). Purpose We aimed to evaluate admission trend and outcomes of patients with NSTEMI in the COVID-19 era in a nationwide survey. Methods A prospective, multicenter, observational, nationwide study involving 13 medical centers across Israel. All NSTEMI patients admitted to intensive cardiac care units (ICCUs) over an 8-week period during the COVID-19 outbreak were compare them with NSTEMI patients admitted 2 years earlier (control period) during the Acute Coronary Syndrome Israeli Survey (ACSIS) 2018. Results There were 624 (43%) NSTEMI patients, of them 349 (56%) hospitalized during the COVID-19 era and 275 (44%) during the control period, representing a 27% increase in NSTEMI admission rate during the COVID-19 era. Approximately 76% were male, median age was 67 years (IQR 58–76). There were no differences in baseline characteristics between the two study periods. During the COVID-19 era, more patients arrived at the hospital via an emergency medical system (EMS) compared with the control period (p for trend = 0.005) Time from symptom onset to hospital admission was longer in the COVID-19 era [687.00 (IQR147–2805) vs. 178.00 (IQR 102- 407), respectively, p-value &amp;lt;0.001]. Nevertheless, time from hospital admission to reperfusion was similar in both groups. Rate of percutaneous coronary intervention was higher in the COVID-19 era group (91.3% vs. 59.7%, respectively, p&amp;lt;0.001). In-hospital mortality rate was similar in both groups (2.3% vs. 4.7%, respectively, p=0.149) as was the 30-day mortality rate (3.7% vs. 5.1%, respectively, p=0.238). Conclusions In contrast to previous reports, in Israel, admission rate of NSTEMI was increased during the COVID-19 era. With longer time from symptoms to admission, but with the same time from hospital admission to reperfusion therapy and with similar in-hospital and 30-day mortality rates. Funding Acknowledgement Type of funding sources: None.

Marijuana Use and Stress Cardiomyopathy in the Young.

BackgroundIncreased accessibility, recreational use, and regional legalization of marijuana (cannabis) have been paralleled by widespread recognition of its serious cardiovascular complications (acute myocardial infarction, stroke, sudden death) particularly in the young. We aimed to examine trends in hospital admissions and outcomes of adults with stress cardiomyopathy (SC) in temporal relation to marijuana use.Methods and resultsA search of the 2003-2011 Nationwide Inpatient Sample (NIIS) database identified 33,343 admissions for SC of which 210 (0.06%) were temporally related to marijuana use. Demographics, clinical characteristics, and outcomes of marijuana users (MU) and non-marijuana users (NMU) with SC were compared. MU were younger (44±14 vs. 66±13 years), more often male (36% vs. 8%), and had lower prevalence of hypertension (38% vs. 62%), diabetes (2.4% vs. 17.6%), and hyperlipidemia (16% vs. 52%) while more often suffered from depression (33% vs. 15%), psychosis (12% vs. 4%), anxiety disorder (28% vs. 16%), alcohol use disorder (13% vs. 3%), tobacco use (73% vs. 29%), and polysubstance abuse (11% vs. 0.3%) [all p<0.001]. In addition, MU more often suffered a cardiac arrest and required placement of a defibrillator while congestive heart failure was more frequent in NMU. Logistic regression analysis on the entire database (n=71,753,900), adjusted for known risk factors for SC, identified marijuana use as an independent predictor of SC (OR=1.83; 95% CI=1.57-2.12, p<0.0001). Among MU, older age (>48 years) was a strong predictor of any major adverse cardiac event (OR=7.8; 95% CI=2.88-21.13; p<0.0001).ConclusionsMarijuana use is linked to SC in younger individuals and is associated with significant morbidity despite being younger in age and having a more favorable cardiac risk factor profile in affected individuals.

S879 Race Stratified Trends in Hospitalizations for Inflammatory Bowel Disease Flare: A Retrospective Cohort Study

Introduction: Inflammatory bowel disease (IBD) describes a state of chronic, intermittent gastrointestinal inflammation, and remains a significant cause of inpatient morbidity. This study provides data on the nationwide trend of hospitalizations for IBD in the United States, after stratification by race. Given the significance that socioeconomic factors play on access to health care, we aim to examine the influence of household income on trends of hospitalizations for IBD in each of the major ethnic groups. Methods: The Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) was sourced for data involving adult hospitalizations for patients admitted with IBD (2005 to 2014). ICD-9 codes were used to query patients, and analysis of trend data was conducted using the Cochran-Mantel-Haenszel χ2 test of linear association. P values < 0.05 were considered statistically significant. The main outcome was percent change in number of admissions over the study period, stratified by race. Our secondary outcome analyzed race stratified trends in the percent of patients belonging to the four quartiles of family income. Analysis was done using SPSS software. Results: 232,910 adults were admitted from 2005 to 2014 with a primary diagnosis of IBD; UC (N= 81,232; 34.9%) CD (N= 151,678; 65.1%). Over the study period, White (CAU) patients with IBD were the single cohort with a decreasing trend in the number of admissions, and a decrease in percent change from 2005 to 2014 (%Δ = -7.55%). All other races had increasing trends in admissions and an increase in percent change of admissions. African American’s (AA: %Δ = +32.3%), Hispanic’s (HSP: % Δ = +29.3), Asians Native American, and others (%Δ = +27.8). Linear by linear association was significant (p ≤ 0.001) for all aforementioned trends (Figure 1, Table 1). By the study's end, AA patients had the greatest proportion of their cohort belonging to the poorest quartile of household income (Q1; AA: 47.2%, HSP: 35.70% CAU: 20.9%), and entered this quartile at the quickest rate (Figure 2). Conclusion: Healthcare disparity remains a complicated and costly burden. Research has shown the patients belonging to lower socioeconomic classes have limited access to healthcare, reduced health literacy, and environmental realities that contribute to increased morbidity and mortality. Our findings of increasing IBD-related hospitalizations and a greater percentage of minority patients in the poorest quartile highlight the impact of socioeconomic determinants.Figure 1.: (a, b): Display of the trend in IBD-related admissions stratified by race as proportions of the total number of IBD patients admitted (2005-2014). Linear by linear association was significant (p ≤ 0.001) for all aforementioned trends.Figure 2.: (a, b, c): Display of the yearly trend in patients belonging to one of the four quartiles of family income. (Q1) $1 - $45,999, (Q2) $46,000 - $58,999, (Q3) $59,000 - 78,999, (Q4) $79,000+Table 1.: Temporal trends in IBD-related admissions stratified by race proportions. Linear by linear association was significant (p ≤ 0.001) between groups.

S137 Trends in Admissions, Outcomes and Financial Burden of C. difficile Infection-Related Hospitalizations: A Nationwide Analysis

S137 Trends in Admissions, Outcomes and Financial Burden of C. difficile Infection-Related Hospitalizations: A Nationwide Analysis

TRENDS AND OUTCOMES OF BRONCHIECTASIS–RELATED HOSPITALIZATION IN THE UNITED STATES FROM 2015 TO 2018

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: The burden of bronchiectasis on health system is not well known due to lack of data on prevalence and trends of the disease. This study was aimed to determine the age- and gender-adjusted national trends in bronchiectasis-related hospitalizations in the United States using the largest nationally representative database. METHODS: We performed a cross-sectional study of the National Inpatient Sample database for all adult patients (≥ 18 years old) with bronchiectasis as the principal diagnosis from October 1, 2015 to December 31, 2018. We analyzed the age- and gender-adjusted longitudinal trends in hospital admissions, in-hospital mortality, hospital charges, and hospital length of stay. RESULTS: Between 2015 to 2018, the number of bronchiectasis-related hospitalizations and in-hospital mortality has remained stable. The proportion of diabetes patients among bronchiectasis has significantly decreased from 2015 to 2018, from 20.93% to 10.91% (p<0.001). Moreover, the number of patients with bronchiectasis managed at teaching tertiary hospitals has significant increased from 73.8% to 78.3% (p=0.008). There was no significant increase in hospital charges and hospital length of stay. CONCLUSIONS: Analyses of temporal changes in bronchiectasis showed stable hospitalizations and in-hospital mortality among patients with bronchiectasis, with a decrease in proportion of co-morbid condition of diabetes. CLINICAL IMPLICATIONS: Further studies should be conducted exploring the relationship of diabetes and bronchiectasis to aid understanding of the disease process and provide optimal care. DISCLOSURES: No relevant relationships by Jeeyune Bahk, source=Web Response No relevant relationships by Jennifer Fung, source=Web Response No relevant relationships by Kam Sing Ho, source=Web Response

Trends in inpatient admissions and emergency department visits for heart failure in adults with versus without diabetes in the USA, 2006–2017

IntroductionHeart failure (HF) is a major contributor to cardiovascular morbidity and mortality in people with diabetes. In this study, we estimated trends in the incidence of HF inpatient admissions and...

THE BURDEN OF PULMONARY EMBOLISM ON ETHNIC MINORITIES IN THE UNITED STATES: ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE DATABASE FROM 2015-2018

TOPIC: Pulmonary Vascular Disease TYPE: Original Investigations PURPOSE: Defining national prevalence and trends of pulmonary embolism (PE) may help in evaluating the role of preventive measures and management strategies to minimize PE related mortality. This study was conducted to determine the age- and gender-adjusted national trends in PE-related hospitalizations in the U.S. using the largest nationally representative database. METHODS: We performed a cross-sectional study of the National Inpatient Sample database for all adult patients (≥ 18 years old) with PE as the principal diagnosis from October 1, 2015 to December 31, 2018. We analyzed the age- and gender-adjusted longitudinal trends in hospital admissions, in-hospital mortality, hospital charges, and hospital length of stay. RESULTS: Between 2015 to 2018, PE-related hospitalizations and in-hospital mortality increased. There was a significant increase in admissions of Afro-American and Hispanic patients (p=0.007, p=0.009, respectively). Hospitalizations increased in the uninsured but decreased in private payers (p=0.005, p=0.008, respectively). The number of patients with PE managed at teaching tertiary hospitals significantly increased (p<0.001). There was a significant decrease in proportion of co-morbid condition of diabetes among PE patients, whereas that of coronary artery disease (CAD), chronic kidney disease (CKD), and cerebrovascular disease (CVD) have increased from 2015-2018 (p<0.01). Moreover, hospital charges of PE patients were significantly increased (p<0.001). CONCLUSIONS: Analyses of temporal changes in PE showed stable hospitalization rates and hospital mortality in patients with pulmonary embolism. There was a significant increase in PE incidence in African-American and Hispanic population, with significant comorbidities, and no insurance coverage, with an increment in hospital charges. CLINICAL IMPLICATIONS: The observed increase in PE incidence in ethnic minorities with significant comorbidities and no insurance coverage raises concerns with respect to decreased access to health care being responsible for an increased risk of PE in these groups, and the resulting observed increase in hospital costs. DISCLOSURES: No relevant relationships by Jeeyune Bahk, source=Web Response No relevant relationships by Kam Sing Ho, source=Web Response No relevant relationships by David Steiger, source=Web Response

Odontogenic Infections are More Frequent and More Severe during COVID-19 Pandemic

The COVID-19 pandemic has created a global decrease in access to routine healthcare. This public health crisis has led to limited access to healthcare during the COIVD-19 pandemic due to public perception of quarantine regulations, loss of jobs and health insurance, and fear of contracting the virus from visiting healthcare providers (Anderson et al, 2021). Thus, a delay in treatment occurs for a multitude of medical and dental problems, leading to a challenge to the medical community due to emergent situations. This includes an increase in the number of people developing more severe deep space infections of the head and neck. A 2018 systematic review found that of all deep neck space infections, there was a 36% incidence of a dental-related source (Pardal-Pelaez et al, 2018), placing the burden of management often on those in the oral and maxillofacial community.When a patient with these severe infections needs treatment, they utilize the already-strained resources of the hospital, including operating room time and ICU beds. Although several vaccines are now available to some populations, epidemiologists agree there is a long way from the end of the acute impact of COVID-19 on the healthcare system.The authors' service had perceived an increase of admissions for severe head and neck infections over the past year since the pandemic began. This retrospective study reviews the admissions and treatment of severe head and neck infections during the time period of January 2020 to January 2021 compared to the past 2 years to verify this increase and examine the specific causes of this potentially life-threatening problem.Data were gathered via general chart review of patient admitted for deep space infections from January 2018 to January 2021 at Emory University and Grady Memorial in Atlanta, GA. The surgical patient population was identified through the use of ICP and CPT codes.This study looks at variables including demographics and medical comorbidities, severity of infection, COVID-19 status, cultures, length of stay, and necessity for ICU care, as well as outcomes and complications and need for reoperation. Early analysis of this preliminary data shows an 8% increase in deep neck space infections treated from 2018 to 2019, and a 19.8% increase from 2019 to 2020. This clear upward trend of admissions for deep neck space infections over the past year indicate more needs to be done to try to keep patients out of the hospital and safe.

Are changes in practice a cause of the rising burden of bronchiolitis for paediatric intensive care units?

Bronchiolitis, a characteristic entity of viral-induced respiratory disease in children younger than 2 years, is among the most pressing diseases affecting global child health. Although bronchiolitis causes major morbidity and mortality in low-income and middle-income countries, its case fatality rate has decreased to less than 1% in high-income countries with access to paediatric intensive care units (PICUs). With seasonal outbreaks, particularly due to respiratory syncytial virus (RSV), bronchiolitis puts a tremendous pressure on PICUs and their transfer teams. Annual admission numbers to PICUs have been increasing over the past 2 decades, as consistently reported in studies from Australia, New Zealand, Europe, Canada, and the USA (table). 1 Schlapbach LJ Straney L Gelbart B et al. Burden of disease and change in practice in critically ill infants with bronchiolitis. Eur Respir J. 2017; 491601648 Crossref PubMed Scopus (58) Google Scholar , 2 Linssen RS Teirlinck AC van Boven M et al. Increasing burden of viral bronchiolitis in the pediatric intensive care unit; an observational study. J Crit Care. 2021; (published online July 22.)https://doi.org/10.1016/j.jcrc.2021.07.009 Crossref PubMed Scopus (2) Google Scholar , 3 Pelletier JH Au AK Fuhrman D Clark RSB Horvat C Trends in bronchiolitis ICU admissions and ventilation practices: 2010–2019. Pediatrics. 2021; 147e2020039115 Crossref PubMed Scopus (9) Google Scholar , 4 Garland H Gunz AC Miller MR Lim RK High-flow nasal cannula implementation has not reduced intubation rates for bronchiolitis in Canada. Paediatr Child Health. 2020; 26: e194-e198 Crossref PubMed Google Scholar , 5 Linssen RS Bem RA Kapitein B et al. Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units. Eur J Pediatr. 2021; (published online April 23.)https://doi.org/10.1007/s00431-021-04079-y Crossref PubMed Scopus (4) Google Scholar

Neurological impairment and disability in children in rural Kenya.

AimTo investigate geographical change over time in the burden of neurological impairments in school‐aged children in a demographic surveillance area.MethodWe investigated changes in neurological impairment prevalence in five domains (epilepsy and cognitive, hearing, vision, and motor impairments) using similar two‐phase surveys conducted in 2001 (n=10 218) and 2015 (n=11 223) and determined changes in location‐level prevalence, geographical clustering, and significant risk factors for children aged 6 to 9 years (mean 7y 6mo, SD 1y) of whom 50.4% were males. Admission trends for preterm birth, low birthweight (LBW), and encephalopathy were determined using admission data to a local hospital.ResultsOverall prevalence for any neurological impairment decreased from 61 per 1000 (95% confidence interval [CI] 48.0–74.0) in 2001 to 44.7 per 1000 (95% CI 40.9–48.6) in 2015 (p<0.001). There was little evidence of geographical variation in the prevalence of neurological impairments in either survey. The association between neurological impairments and some risk factors changed significantly with year of survey; for example, the increased association of adverse perinatal events with hearing impairments (exponentiated coefficient for the interaction=5.94, p=0.03). Annual admission rates with preterm birth (rate ratio 1.08, range 1.07–1.09), LBW (rate ratio 1.08, range 1.06–1.10), and encephalopathy (rate ratio 1.08, range 1.06–1.09) significantly increased between 2005 and 2016 (p<0.001).InterpretationThere was a significant decline in the prevalence of neurological impairments and differential changes in the associations of some risk factors with neurological impairments over the study period. Limited geographical variation suggests that similar interventions are appropriate across the defined area.

Emergency Care Sensitive Conditions in Brazil: A Geographic Information System Approach to Timely Hospital Access

BackgroundThe benefits of treatment for many conditions are time dependent. The burden of these emergency care sensitive conditions (ECSCs) is especially high in low- and middle-income countries. Our objective was to analyze geospatial trends in ECSCs and characterize regional disparities in access to emergency care in Brazil. MethodsFrom publicly available datasets, we extracted data on patients assigned an ECSC-related ICD-10 code and on the country’s emergency facilities from 2015-2019. Using ArcGIS, OpenStreetMap, and WorldPop, we created catchment areas corresponding to 180 minutes of driving distance from each hospital. We then used ArcGIS to characterize space-time trends in ECSC admissions and to complete an Origin-Destination analysis to determine the path from household to closest hospital. FindingsThere were 1362 municipalities flagged as “hot spots,” areas with a high volume of ECSCs. Of those, 69.7% were more than 180 minutes (171 km) from the closest emergency facility. These municipalities were primarily located in the states of Minas Gerais, Bahia, Espiríto Santo, Tocantins, and Amapá. In the North region, only 69.1% of the population resided within 180 minutes of an emergency hospital. InterpretationsSignificant geographical barriers to accessing emergency care exist in certain areas of Brazil, especially in peri-urban areas and the North region. One limitation of this approach is that geolocation was not possible in some areas and thus we are likely underestimating the burden of inadequate access. Subsequent work should evaluate ECSC mortality data. FundingThis study was funded by the Duke Global Health Institute Artificial Intelligence Pilot Project.

Trends in radiotherapy inpatient admissions in Germany: a\xa0population-based study over a\xa010-year period

ObjectiveWith the increasing complexity of oncological therapy, the number of inpatient admissions to radiotherapy and non-radiotherapy departments might have changed. In this study, we aim to quantify the number of inpatient cases and the number of radiotherapy fractions delivered under inpatient conditions in radiotherapy and non-radiotherapy departments.MethodsThe analysis is founded on data of all hospitalized cases in Germany based on Diagnosis-Related Group Statistics (G-DRG Statistics, delivered by the Research Data Centers of the Federal Statistical Office). The dataset includes information on the main diagnosis of cases (rather than patients) and the performed procedures during hospitalization based on claims of reimbursement. We used linear regression models to analyze temporal trends. The considered data encompass the period from 2008 to 2017.ResultsOverall, the number of patients treated with radiotherapy as inpatients remained constant between 2008 (N = 90,952) and 2017 (N = 88,998). Starting in January 2008, 48.9% of 4000 monthly cases received their treatment solely in a radiation oncology department. This figure decreased to 43.7% of 2971 monthly cases in October 2017. We found a stepwise decrease between December 2011 and January 2012 amounting to 4.3%. Fractions received in radiotherapy departments decreased slightly by 29.3 (95% CI: 14.0–44.5) fractions per month. The number of days hospitalized in radiotherapy departments decreased by 83.4 (95% CI: 59.7, 107.0) days per month, starting from a total of 64,842 days in January 2008 to 41,254 days in 2017. Days per case decreased from 16.2 in January 2008 to 13.9 days in October 2017.ConclusionOur data give evidence to the notion that radiotherapy remains a discipline with an important inpatient component. Respecting reimbursement measures and despite older patients with more comorbidities, radiotherapy institutions could sustain a constant number of cases with limited temporal shifts.

Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study

Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years. Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017-20. We also examined baseline characteristics, mortality, and trends in patients who were admitted with DKA. There were 8553 admissions coded with DKA during the first wave, 8729 during the post-first wave, and 10 235 during the second wave. Compared with preceding years, DKA admissions were 6% (95% CI 4-9; p<0·0001) higher in the first wave of the pandemic (from n=8048), 6% (3-8; p<0·0001) higher in the post-first wave (from n=8260), and 7% (4-9; p<0·0001) higher in the second wave (from n=9610). In the first wave, DKA admissions reduced by 19% (95% CI 16-21) in those with pre-existing type 1 diabetes (from n=4965 to n=4041), increased by 41% (35-47) in those with pre-existing type 2 diabetes (from n=2010 to n=2831), and increased by 57% (48-66) in those with newly diagnosed diabetes (from n=1072 to n=1681). Compared with prepandemic, type 2 diabetes DKA admissions were similarly common in older individuals and men but were higher in those of non-White ethnicities during the first wave. The increase in newly diagnosed DKA admissions occurred across all age groups and these were significantly increased in men and people of non-White ethnicities. In the post-first wave, DKA admissions did not return to the baseline level of previous years; DKA admissions were 14% (11-17) lower in patients with type 1 diabetes (from n=5208 prepandemic to n=4491), 30% (24-36) higher in patients with type 2 diabetes (from n=2011 to n=2613), and 56% (47-66) higher in patients with newly diagnosed diabetes (from n=1041 to n=1625). During the second wave, DKA admissions were 25% (22-27) lower in patients with type 1 diabetes (from n=5769 prepandemic to n=4337), 50% (44-56) higher in patients with type 2 diabetes (from n=2608 to n=3912), and 61% (52-70) higher in patients with newly diagnosed diabetes (from n=1234 to n=1986). Our results provide evidence for differences in the numbers and characteristics of people presenting with DKA during the COVID-19 pandemic compared with in the preceding 3 years. Greater awareness of risk factors for DKA in type 2 diabetes and vigilance for newly diagnosed diabetes presenting with DKA during the COVID-19 pandemic might help mitigate the increased impact of DKA. None.

National Trends In ED Visits, Hospital Admissions, And Mortality For Medicare Patients During The COVID-19 Pandemic.

Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. Using data on all traditional Medicare beneficiaries in the US from October 1, 2018, to September 30, 2020, we examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not. We found reductions in ED visits that were largest by the first week of April 2020 (52percent relative decrease), with volume recovering somewhat by mid-June (25percent relative decrease). These reductions were of similar magnitude in counties that were and were not designated as COVID-19 hot spots. There was an early increase in hospitalizations and in the relative risk for thirty-day mortality, starting with the first surge of the pandemic, peaking at just over a 2-percentage-point increase. These results suggest that patients were presenting with more serious illness, perhaps related to delays in seeking care.