Trends In Admissions Research Articles

Trends in hospital admissions and mortality from diabetes mellitus in Rio Grande do Sul: historical series 2000-2020.

To analyze the trends of hospital admissions and deaths from diabetes mellitus in the 18 host municipalities of the 19 regional health coordination offices and in Rio Grande do Sul, 2000-2020. Ecological study with secondary data collected in the Hospital Information System, the Mortality Information System, and the Brazilian Institute of Geography and Statistics, from 2000-2020. Coefficients were standardized using the direct method and Prais-Winsten regression analysis. A downward trend wasfound in the coefficients of hospitalizations for diabetes mellitus in most cities and states. In 2020, for both areas, hospitalizations for diabetes mellitus were below the average of the period. The mortality trend remained stationary in almost all municipalities and in the state. There was evidence of a decrease in hospitalizations and stationary mortality by DM in most municipalities analyzed, possibly due to the policies and actions implemented in the period, despite the aging of the population.

Trends in hospital admissions and mortality from diabetes mellitus in Rio Grande do Sul: historical series 2000-2020

RESUMO Objetivo: Analisar a tendência das internações hospitalares e dos óbitos por diabetes mellitusnos 18 municípios-sede das 19 coordenadorias regionais de saúde e no Rio Grande do Sul, 2000-2020. Método: Estudo ecológico com dados secundários coletados no Sistema de Informações Hospitalares, Sistema de Informação sobre Mortalidade e Instituto Brasileiro de Geografia e Estatística, de 2000-2020. Foi realizada padronização dos coeficientes pelo método direto e análise por regressão de Prais-Winsten. Resultados: Encontrou-se tendência de diminuição dos coeficientes de internações por diabetes mellitus na maioria dos municípios e Estado. Em 2020, foram observadas hospitalizações por diabetes mellitus abaixo da média obtida no período, para ambos. A tendência de mortalidade permaneceu estacionária em quase todos os municípios e no Estado. Conclusão: Foi evidenciada diminuição das internações e mortalidade estacionária por DM na maioria dos municípios analisados, possivelmente em virtude das políticas e ações implementadas no período, apesar do envelhecimento da população.

A 365-Day Record of Maternal Admissions in Intensive Care Unit at the University of Port Harcourt Teaching Hospital in Nigeria

BACKGROUND. The intensive care unit provides critically ill patients with the necessary monitoring, care and supports to optimize their organ/system functions. Parturients are often at risk of sudden deteriorations or exacerbation of chronic illnesses from direct or indirect causes and would often require admissions into the intensive care or high dependency unit. This study is aimed at looking at the trends of maternal admissions in 365 days at the intensive care unit of a tertiary teaching hospital in Southern part of Nigeria, a country that contributes significantly to the global proportion of maternal morbidity and mortality. METHODS. The study adopted a retrospective approach. All critically ill parturients admitted and requiring organ support or close monitoring in the ICU had their files and ICU documents reviewed. The review was held from January-December 2018. RESULTS. Thirty-nine (39) parturients with a mean age (years) of 33 ± 1.3 were admitted, representing 2.9% of annual deliveries. All admissions were postnatal and came predominantly from the unbooked labour ward (51%) and the time lag from maternal deteriorations to presentation to the ICU was 72 ± 10 hours. The main indications for admissions were due to postpartum haemorrhage (33.3%), complications of hypertensive disorders of pregnancy (30.9%) and sepsis (25.6%). Nineteen (48.7%) patients died from obstetric haemorrhage, complications of hypertensive disorders of pregnancy, sepsis and pulmonary embolism. CONCLUSION. The trend of maternal admissions at this specific time frame reflects the burden of maternal critical care in our environment. It highlights the need to holistically tackle the known scourge with improved care.

Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome?

BACKGROUND Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes. OBJECTIVE To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study. DESIGN From January to July 2021, all adult COVID-19 patients requiring admission for more than 48 h. SETTING One primary centre and two secondary centre hospitals. PATIENTS One hundred and twenty-three ICU and 77 NON-ICU patients. INTERVENTION MR-proADM, lymphocyte subpopulations and immunoglobulins were measured within 48 h and on days 3 and 7. A Log-rank test was used to compare survival curves, using a MR-proADM cut-off value of 1.5 nmol l−1. The predictive ability for mortality was compared using the area under the curve and 95% confidence interval (CI) of different receiver-operating characteristic curves. MAIN OUTCOME MEASURES The first 48 h MR-proADM values were significantly higher in the ICU group (median value 1.10 [IQR, 0.80 to 1.73] pg ml−1 vs. 0.90 [0.70 to 1.20] pg ml−1, P = 0.020), and statistically significant changes were observed over time for MR-proADM, CD3+, CD4+ and CD56+. In univariate analysis, MR-proADM was the only biomarker that significantly predicted mortality (P = 0.006). The logistic regression model showed an odds ratio for mortality equal to 1.83 (95% CI, 1.08 to 3.37) P = 0.035 for MR-proADM, 1.37 (1.15 to 1.68) P = 0.001 for MuLBSTA and 1.11 (1.05 to 1.18) P less than 0.001 for SAPS II. CONCLUSION MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting. TRIAL REGISTRATION on clinicaltrials.gov, NCT04873388 registered on March 2020.

Trends in inpatient and post-discharge mortality among young infants admitted to Kilifi County Hospital, Kenya: a retrospective cohort study

ObjectivesTo describe admission trends and estimate inpatient and post-discharge mortality and its associated exposures, among young infants (YI) admitted to a county hospital in Kenya.DesignRetrospective cohort study.SettingSecondary level hospital.ParticipantsYI aged...

Severe Neonatal Opioid Withdrawal Requiring Pharmacotherapy: Impact of Region of Residence.

Our objective was to evaluate the trend and to assess the impact of maternal region of residence in Western New York (WNY), on severe neonatal opioid withdrawal syndrome (NOWS). Term infants' born at gestational age greater than or equal to 37 weeks with severe NOWS, defined as withdrawal resulting in the receipt of pharmacologic therapy from WNY admitted to our neonatal intensive care unit (NICU) from January 1, 2008 to December 31, 2016, were included. Severe NOWS admissions to our NICU from the following five regions were controlled with birth and insurance data: (1) Urban North, (2) Erie Coastal, (3) Niagara Frontier, (4) Southern Tier, and (5) Urban South. "Urban South" residence was associated with an increased risk of severe NOWS (adjusted odds ratio = 1.8, 97.5% confidence interval: 1.1-2.9). The trend in admission for severe NOWS doubled between 2008 to 2010 and 2014 to 2016 (p = 0.01). More infants born to maternal nonprescribed opioid users were placed in foster care at discharge (36.5 vs. 1.9%, p < 0.001). In WNY, neonates born to mothers from the "Urban South" were twice at risk of being admitted for severe NOWS. One-third of infants with severe NOWS after nonprescribed opioid use were placed in foster care. Implementing targeted strategies at the community level may help improve outcomes in NOWS. · Maternal region of residence is a risk factor for severe neonatal opioid withdrawal.. · Admissions for severe neonatal opioid withdrawal trended up from 2008 to 2010 to 2014 to 2016.. · One-third of the infants born to mothers on nonprescribed opioids were discharged to foster care..

Hospitalization Pattern for Chronic Lower Respiratory Diseases in Australia: A Retrospective Ecological Study.

Chronic lower respiratory diseases are among the commonest causes of hospital admission worldwide. Identifying the trends in hospital admission due to chronic lower respiratory diseases is important for public health and policy makers. The aim of this study was to examine the hospitalization profile related to chronic lower respiratory diseases in Australia during the past 21 years. A retrospective ecological study was conducted using hospital admission data taken from the National Hospital Morbidity Database (NHMD). Hospital admissions data for chronic lower respiratory diseases were extracted for the period between 1998 and 2019. The Pearson Chi-square test for independence was used to estimate the variation in hospital admission rates. The hospitalization rate for chronic lower respiratory diseases rate decreased by 14.4%, from 568.90 (95%CI 565.50-572.30) in 1998 to 486.95 (95%CI 484.24-489.66) in 2019 per 100,000 persons, p<0.05. Rates of same-day hospitalization for chronic lower respiratory diseases increased by 62.7% from 1998 to 2019, while rates of overnight-stay hospital admission for chronic lower respiratory diseases decreased by 23.7% from 1998 to 2019. During the study duration, the hospitalization rates for bronchiectasis and other chronic obstructive pulmonary disease increased by 120.0% and 34.7%, respectively. The hospital admissions rates for emphysema, status asthmaticus, simple and mucopurulent chronic bronchitis, bronchitis, not specified as acute or chronic, unspecified chronic bronchitis, and asthma decreased by 94.8%, 92.6%, 70.7%, 66.3%, 46.0%, and 32.3%, respectively. The rates of hospitalization among patients aged 75 years and above increased by 3.9%, while younger age groups including those aged younger than 15 years, 15-59 years, and 60-74 years showed a reduction in the rate of hospitalization by 53%, 22.8%, and 19.7%, respectively. Overall, the hospitalization rate for chronic lower respiratory diseases is seen to have decreased over the study period. Patients with chronic obstructive pulmonary disease (COPD) and the elderly group have a higher rate of hospitalization. Future studies are needed to investigate factors associated with the increase in the rate of hospitalization among the elderly age group.

A comparative study on enrolment of scheduled caste and scheduled tribe learners in bachelor of social work programme of IGNOU in Assam before and after implementation of IGNOU fee exemption scheme under SCSP/TSP Grant

Education is a very important determinant of overall development of a community or a society. It is the responsibility of a state in democratic country like India to provide equal opportunity of qualitative educational development to all sections of the society. Distance education is mainly focused on democratization of higher education by providing a platform to disadvantageous section of people due to some unavoidable circumstances. It facilitated them; get the hands on training through distance mode without hampering the daily social responsibilities and activities of learners. IGNOU BSW programme is one of the important professional based programme for learners dealing with professional training/degree in Social Work. India’s Northeast region is popularly celebrated for its cultural diversity with sizable number of Schedule Tribe (ST) community as inhabitant of this region. Social Work Education in the Northeast region of India began only in the year 1992. The present study is carried out on 620 learners of BSW programme enrolled at IGNOU RC, Guwahati in last ten years from 2010 to 2019 with an intention to assess the impact of IGNOU fee exemption scheme in admission of Scheduled Caste (SC) and Scheduled Tribe (ST) learners in undergraduate programmes. This will enable us to know and assess the participation/ involvement of SC/ST learners in free admission scheme of IGNOU under SCSP/TSP Grant in Assam by examining their percent shares in annual admission. Apart from that we have also examined the overall general trends of admission on the basis of Area (Urban, Rural &amp; Tribal), Gender, the age profile, and marital status of learners enrolled in this programme. This study is undertaken to determine and access the fulfilment of University’s motto “reaching the unreached” in weaker section and scheduled communities of our society.

Trend of Admissions Due to Chronic Lower Respiratory Diseases: An Ecological Study.

Objective: This study aimed to examine the trend of hospital admissions related to chronic lower respiratory diseases in England and Wales between 1999 and 2020. Method: This ecological analysis used data that were made accessible to the public and were taken from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) databases in England for the time span between April 1999 and April 2020. The patients were grouped into four age groups: under 15, 15−59, 60−74, and 75 years and above. Results: In 2020, there were 432,193 chronic lower respiratory disease hospital admissions, which increased from 239,606 in 1999. The hospital admission rate increased by 57.5% (from 459.54 (95% CI 457.71−461.38) in 1999 to 723.70 (95% CI 721.55−725.85) in 2020 per 100,000 people, p < 0.5). The majority of hospital admissions for chronic lower respiratory diseases were found to be directly linked to age (more prevalent in the 75+ age group). Moreover, female hospital admission rates for chronic lower respiratory diseases grew by 85.2% between 1999 and 2020, increasing from 445.45 (95% CI 442.92−447.97) to 824.96 (95% CI 821.73−828.19) per 100,000 people. Conclusion: The rate of hospital admissions due to chronic lower respiratory diseases has sharply increased during the past two decades. COPD was the most common cause for chronic lower respiratory disease admissions. Ageing was also found to be a factor in increased hospital admissions. Future studies are warranted to identify other risk factors of hospital admissions due to chronic lower respiratory diseases and specifically COPD.

The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019.

Hepatitis C virus (HCV) is a prominent liver disease that often presents with mental illness. We stratify the HCV population and review its healthcare burden on the US hospital system. The US National Inpatient Sample was used to select admissions related to HCV between 2016 and 2019. Weights were assigned to discharges, and trend analyses were performed. Strata were formed across demographics, comorbidities, psychiatric and substance use conditions, and other variables. Outcomes of interest included hospitalization incidences, mortality rates, total costs, and mean per-hospitalization costs. From 2016 to 2019, there were improvements in mortality and hospitalization incidence for HCV, as well as a decline in aggregate costs across the majority of strata. Exceptions that showed cost growth included admissions with multiple psychiatric, stimulant use, or poly-substance use disorders, and a history of homelessness. Admissions with no psychiatric comorbidities, admissions with no substance use comorbidities, and admissions with housing and without HIV comorbidity showed decreasing total costs. Along with per-capita mean costs, admissions with comorbid opioid use, bipolar, or anxiety disorder showed significant increases. No significant trends in per-capita costs were found in admissions without mental illness diagnoses. Most strata demonstrated decreases in hospitalization incidences and total costs surrounding HCV; however, HCV cases with mental illness diagnoses saw expenditure growth. Cost-saving mechanisms for these subgroups are warranted.

Examining “Mass Probation” Through an Intersectional Lens: The Intracategorical Effects of Race and Ethnicity on Women and Men’s Probation Outcomes in Kansas

Community supervision increased dramatically since the early 2000s. Similar to trends in prison admissions, the increase has not been equal across racial and ethnic groups. In addition to disparities in placement onto supervision, experiences under supervision and outcomes may also be shaped by intersecting identities. Accordingly, this study examined probation outcomes among 4,433 probation cases in 2018 in Kansas. We assess how race and ethnicity impact outcomes among women and men while controlling for criminogenic risk and need, offense, financial stability, and other factors using multilevel modeling. Results indicate that race and ethnicity were unrelated to probation outcomes for women; however, Black men were subject to the worst odds of probation outcomes. Policy and future research implications are discussed.

CARING FOR OLDER ADULTS ACROSS THE CARE CONTINUUM: EXPERIENCES OF OLDER ADULTS AND FORMAL CAREGIVERS

Abstract As individuals age, they are at risk of experiencing health challenges that can contribute to poorer health outcomes and increase health care costs. During acute care crises and through the continuum of dealing with chronic diseases, older adults rely on formal caregivers to provide care and support. Formal caregivers’ delivery of care can be challenged during difficult patient cases (e.g., providing wound care to a person exhibiting behavioral and psychological symptoms of dementia) and during high stress times, such as working through a pandemic. However, during difficult times, resilience among formal caregivers can have a positive affect on care delivery. This symposium identifies some of the health challenges experienced by aging adults, challenging experiences of nurses, levels of resilience among formal caregivers, and discusses the implications for nursing care and future research. Ms. Coates examines trends in adverse drug admissions among older adults in the United States using the 2018 Healthcare Cost and Utilization Project’s National Inpatient Sample. Dr. Hwang explores the relationship between nutrition, inflammation, and physical and mental health in aging adults with chronic leg wounds. Dr. Sefcik discusses nurses’ experiences caring for community-dwelling persons living with dementia and chronic wounds. Mr. Hathaway examines factors that contribute to resilience in staff of a continuing care retirement community during the late stage of the COVID-19 pandemic. Dr. DiMaria-Ghalili, discussant, will synthesize these findings and offer insights on designing interventions to address health challenges and recommendations for supporting formal caregivers.

Temporal trends in admissions for atrial fibrillation and severe bleeding in England: an 18-year longitudinal analysis

Objective. Temporal trends in admissions for atrial fibrillation (AF) and severe bleeding associated with AF vary worldwide. We aimed to explore their temporal trends in England and their relation to the introduction of DOACs in 2014 in the UK. Design. This longitudinal ecological study utilised aggregated data that was extracted from the Hospital Episode Statistics database, which captured annual admissions for AF and severe bleeding associated with AF between 2001 and 2018. Trends in admissions over the study period and across age groups, gender and regions in England were assessed. Results. In total, there were 11,292,177 admissions for AF and 324,851 admissions for severe bleeding associated with AF. There was a steady rise in admissions for AF from 2001 to 2017 (204,808 to 1,109,295; p for trend<.001). A similar trend was observed for severe bleeding (4940 to 30,169; p for trend <.001), but the increase dropped slightly between 2013 and 2014 and continued thereafter. Conclusions. There was a rise in admissions for AF and severe bleeding in England between 2001 and 2018. There is little evidence that the slight drop in admissions for severe bleeding between 2013 and 2014 may have been caused by the introduction of DOACs in 2014. Contributors to these trends need urgent exploration.

Changes in epidemiology and care strategies at the Norwegian National Burn Centre over 35 years (1986–2020)

IntroductionWe evaluated trends in admissions, % TBSA (total body surface area) burnt, age, and outcomes over a 35-year period at the national burn centre in Norway. MethodsRelevant data were extracted from the departmental quality registry covering all acute admissions for burns during 1986–2020. ResultsIn 1986–2020 there were 2.889 admissions for burns (67.6 % males), with a 110 % increase in 2016–20 when compared to 1986–90. Admissions of children <2 years increased by 400 %. In 2011–20, 66.5 % of patients were transferred from other hospitals.The median area injured declined markedly, from 16.5% TBSA in 1986–90 to 4.5% TBSA in 2016–20.Changes in care included an increased focus on non-delayed referrals and transfers, an explicit intent to achieve early excision within 48 h, and a transition from a highly frequent to a less frequent dressing changes scheme.Mortality declined from 10.9 % to 3.0 %. In 2011–20 the mortality among actively treated patients was 2.4 %. For patients with Baux scores 80–119, mortality declined from 36.0 % (1991–2010) to 18.2 % (2011–20) (P < 0.001). DiscussionSince 1986, more patients have been referred to the burn centre, many of younger ages and with more minor burns. Survival of patients with Baux scores 80–119 increased significantly.

593: PRE-COVID, COVID, AND POST-COVID TRENDS OF RSV AND INFLUENZA ACROSS GEOGRAPHIC REGIONS IN THE USA

Introduction: Admissions to Pediatric Intensive Care Units (PICUs) for respiratory illnesses, particularly RSV and Influenza (INF), have decreased during the COVID-19 pandemic. The differences in trends for RSV and INF admissions to PICUs across different regions in the U.S. are unknown. Changes in these trends before (2014-19), during (2019-20), and towards the end of the pandemic (2021-22), and utilization patterns across regions have not been evaluated. This analysis aimed at addressing these questions. Methods: 874,066 USA PICU cases from the Virtual Pediatric Systems database (myvps.org), from Q1-2014 to Q2-2022, were used to study RSV and INF in patients < 18 years. The geographic regions according to U.S. Census definition included Mid-West (MW), Northeast (NE), South (S), and West (W). RSV and INF were defined by ICD-9 and ICD-10 codes. After removing low-risk patients (PRISM III POD < 0.004) the cohort size was 492,642. Segmented regression analysis (Muggeo 2016) was used to fit the trends in yearly rates for RSV and INF. Least-squares linear fits were applied to data segments before and after breakpoints (change in slope) to determine the correlation coefficients of each segment. Fisher’s Z-transform was used to investigate significant differences between segments before and after their respective breakpoints. Utilization amongst regions was done by ANCOVA analysis, and Bonferroni corrected p-values for the most prevalent procedures in the cohorts. Results: All regions showed an increase in RSV and INF between 2014-19, but decreasing during 2020-21. In 2021-22 all regions showed an increase trend in INF, but RSV increased only in MW and S compared to NE and W. Further analysis using RSV segmented regression revealed: MW, NE, and W breakpoints (positive to negative) in: 2018, 2019, and 2019, respectively. For INF, breakpoints for MW, NE, S, and W were detected in: 2019, 2020, 2019, and 2019, respectively. CPAP use in W was greater than S (p< 0.02). All other procedure comparisons had p-values>0.05. Conclusions: RSV and INF increased in all regions during pre-COVID. RSV and INF decreased in all regions during COVID. INF increased in all the regions towards the end of pandemic. RSV increased in MW and S near the end of the pandemic. Differences in use of CPAP for RSV were found between W and S.

1008. Implementation of Clinical Pathway for Management of Fever in Nursing Home Residents in Singapore

Abstract Background Ageing population is a major health care problem all over the world. In Singapore, as of 2020, senior citizen (65 years and above) consists of 15.2 % of total population. By 2030, one in five Singaporeans will be more than 65 years old. Thus, nursing home (NH) is an important pillar of a health care system. Nursing home staff are in the front line to manage common infections. However, the inexperience and the lack of guidance have led to inappropriate transfer to acute hospitals. Infectious Diseases Community Program (IDCP) is the project to enhance partnerships with NHs. We work with NHs to develop, adapt, and implement appropriate processes related to infection control, prevention, and management. One of our objectives is the enhancement of assessment and appropriate evaluation of fever. The aim is to reduce the inappropriate admissions to acute hospitals. Methods Fever and desaturation pathway (figure 1) was developed by IDCP team. Six participating NHs adopted the pathway and trained their staff. The study was approved by NHG domain specific review board (DSRB). Hospital records were reviewed. We compared the rate of inappropriate admission from 2015-2017 which serve as a baseline and 2019-2020. The wash-out period was 2018 when NHs were implementing the pathway. Inappropriate admission is defined as &amp;lt; ! 1. Admission is against advanced care planning / preferred plan of care or 2. Criteria in the pathway are not met on admission, 48 hours later and no other medical reason for admission. Figure 1 Results Total number of fever transfers was 950 in 2015-2017 and 688 in 2019-2020. Number of inappropriate admissions was 115 in 2015-2017 and 50 in 2019-2020. Inappropriate admission was 12.11% in 2015-2017 and 7.27 % in 2019-2020 (table 1). Figure 2 shows the rate of inappropriate admissions of six participating NHs from 2015-2020. There is a decreasing trend after the pathway has been implemented in 2018. Table 1 Figure 2 Conclusion Adopting fever and desaturation pathway has reduced the rate of inappropriate admission in six participating NHs in Singapore. However, there is an increasing trend in inappropriate admission in 2020. This could be due to the lack of isolation facility in the NHs during the COVID-19 pandemic. We are continuing the implementation of the pathway to the rest of the NHs in the western region of Singapore. Disclosures All Authors: No reported disclosures.

Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century.

Diabetic foot disease (DFD) is a leading cause of hospital admissions and amputations. Global trends in diabetes-related amputations have been previously reviewed, but trends in hospital admissions for multiple other DFD conditions have not. This review analysed the published incidence of hospital admissions for DFD conditions (ulceration, infection, peripheral artery disease [PAD], neuropathy) and diabetes-related amputations (minor and major) in nationally representative populations. PubMed and Embase were searched for peer-reviewed publications between 1 January 2001 and 5 May 2022 using the terms 'diabetes', 'DFD', 'amputation', 'incidence' and 'nation'. Search results were screened and publications reporting the incidence of hospital admissions for a DFD condition or a diabetes-related amputation among a population representative of a country were included. Key data were extracted from included publications and initial rates, end rates and relative trends over time summarised using medians (ranges). Of 2527 publications identified, 71 met the eligibility criteria, reporting admission rates for 27 countries (93% high-income countries). Of the included publications, 14 reported on DFD and 66 reported on amputation (nine reported both). The median (range) incidence of admissions per 1000 person-years with diabetes was 16.3 (8.4-36.6) for DFD conditions (5.1 [1.3-7.6] for ulceration; 5.6 [3.8-9.0] for infection; 2.5 [0.9-3.1] for PAD) and 3.1 (1.4-10.3) for amputations (1.2 [0.2-4.2] for major; 1.6 [0.3-4.3] for minor). The proportions of the reported populations with decreasing, stable and increasing admission trends were 80%, 20% and 0% for DFD conditions (50%, 0% and 50% for ulceration; 50%, 17% and 33% for infection; 67%, 0% and 33% for PAD) and 80%, 7% and 13% for amputations (80%, 17% and 3% for major; 52%, 15% and 33% for minor), respectively. These findings suggest that hospital admission rates for all DFD conditions are considerably higher than those for amputations alone and, thus, the more common practice of reporting admission rates only for amputations may substantially underestimate the burden of DFD. While major amputation rates appear to be largely decreasing, this is not the case for hospital admissions for DFD conditions or minor amputation in many populations. However, true global conclusions are limited because of a lack of consistent definitions used to identify admission rates for DFD conditions and amputations, alongside a lack of data from low- and middle-income countries. We recommend that these areas are addressed in future studies. This review was registered in the Open Science Framework database ( https://doi.org/10.17605/OSF.IO/4TZFJ ).

Five-Year Trend of Adolescent Hospitalizations and Deaths in Thailand: A Secondary National Data Health Situation Analysis.

Adolescence is a critical phase for achieving human potential, serving as the foundation for later health. In 2010, the major causes of hospital admissions and deaths in Thai adolescents were related to preventable causes, specifically engagement in high-risk behaviors such as unprotected sexual intercourse, substance use and unsafe driving. We retrieved data from 1,761,667 adolescent (10-17years) hospital admissions and 6362 deaths between 2015 and 2019 from the National Health Security Office database. Trends of hospital admissions and deaths, length of stay and medical expenses by sex, age: early (10-13years) and middle adolescents (14-17years), and geographical regions were analyzed by ICD-10 disease group and single diagnosis. Hospital admissions increased in relation to the same age population from 2015 to 2019. Trends of the top 3 diagnoses shifted between disease groups from 2015 to 2019. Pregnancy retreated from the first (17.8%) to the third rank (12.2%), and arthropod-borne viral fevers advanced from the third (13.1%) to the first rank (17.1%). Injury and poisoning remained at the second rank (14.5-14.4%). Females were admitted more than males, but males had significantly longer hospital stays. Early adolescents were admitted less than middle adolescents and their hospital stay was significantly shorter. Trends of the top 3 diagnoses for deaths by disease groups remained stable: injury and poisoning (41.2%), neoplasms (10.2%), and respiratory infections (9.5%). The average direct health care cost utilized on adolescent health care was 3813 million Baht (115.54 million US Dollars) per year. Considering the top 3 disease groups, injury and poisoning had the highest average cost per hospital admission and net cost per year consuming 26.4% of the total cost. Our study highlights the cause of hospital admissions and deaths in Thai adolescents, which are mainly preventable. Adolescent health care will improve with more investment in prevention through policy, service, and education reform.

Temporal Trends in Stroke Hospitalizations, Treatment Modalities, and Mortality

Stroke remains a leading cause of morbidity and is the second leading cause of death globally1 despite advances in treatment and prevention over the past decade. In this issue of Neurology ®, Kelly et al.2 use administrative data on acute stroke hospitalizations among adults aged 18 years or older in Germany between 2014 and 2019 to describe updated trends in stroke admissions, treatment modalities, and mortality nationally. Using population-level data from the Federal Statistics Office in Germany, study authors calculated frequencies of hospitalizations for acute stroke over a 6-year period. Study authors then evaluated demographic and clinical characteristics of stroke cases and evaluated trends in the utilization of interventions such as carotid stenting, systemic thrombolysis, and thrombectomy. They also calculated proportions of stroke cases in which in-hospital death occurred, followed by logistic regression models to investigate predictors of in-hospital mortality.

Trends in Thoracic Aortic Aneurysm Hospital Admissions, Interventions, and Mortality in England between 1998 and 2020: An Observational Study

To assess trends in thoracic aortic aneurysm (TAA) hospital admissions, interventions, and aneurysm related mortality (ARM) in England, and examine the impact of endovascular repair on mortality for the years 1998 to 2020.