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PubMed1996

Community and hospital acquired Staphylococcus aureus septicaemia: 115 cases from a Dublin teaching hospital.

Despite advances in diagnostic techniques and antimicrobials, septicaemia due to Staphylococcus aureus remains a common clinical problem with a significant mortality. We retrospectively compared community and hospital acquired cases of S. aureus septicaemia occurring in our 600 bed teaching hospital over a 30 month period. Of 110 episodes 32 (29%) were community acquired and 78 (71%) hospital acquired. A likely primary source was identified in 14 (44%) of community acquired cases and in 73 (94%) of hospital acquired cases. A secondary focus of infection was more common in community acquired cases (17, 53%) than hospital acquired cases (5, 6%). Mortality was significantly higher in community acquired cases (22% vs. 6%). An association was also found between the presence of endocarditis and increased mortality, although this did not reach significance. We also compared hospital acquired septicaemia due to methicillin sensitive and methicillin resistant S. aureus found a significantly higher mortality in the methicillin resistant group (22% vs. 3%, P < 0.05). S. aureus septicaemia remains an important cause of morbidity and mortality, particularly when associated with secondary foci of infection. This study also emphasises the importance of control of methicillin resistant strains in hospital.

Bacteremia↗

PubMed1996

Prevalence of hospital-acquired infection in a Lithuanian hospital.

A prevalence survey in the biggest Lithuanian hospital was undertaken as part of the hospital infection control programme in Lithuania, in collaboration with Statens Seruminstitut, Denmark, to introduce modern methods and technologies in infection control. It aimed to test the methodology of prevalence studies identifying features of community- and hospital-acquired infections, use of clinical microbiology and antibiotics. It was found that 27.3% of all patients had an infection at the time of the survey. The prevalence rate of community-acquired infection (CAI) was 20.5% and of hospital-acquired infection (HAI), 9.2%. Almost one third of all HAI were acquired in other hospitals but still active at the time of the survey. HAIs were more prevalent in children (14.9%) than in adult patients (7.7%). The prevalence of HAI varied from 1.0% in neurological departments to 61.5% in the burns unit. Respiratory tract infections were the most common accounting up to 49.1% of all HAI and 28.3% of CAI. At the time of survey 26.0% of patients were receiving antibiotic treatment although more than one third of these were recorded as having no infection. Microbiological investigations were performed in 41.1% cases of HAI. In this hospital, the survey data indicated an array of preventive priorities which will be exploited during the current hospital infection control programme. A national prevalence study is planned using the experience gained.

Adolescent↗

PubMed2001

[The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization].

OBJECTIVES: 1) To know the impact of chronic obstructive pulmonary disease (COPD) on hospital care (visits to the emergency room and admission); and 2) to identify and describe COPD patients whose use of health care is high (COPD-HC), also assessing the costs generated by such patients. METHOD: We reviewed the files of all patients with COPD receiving care at our hospital in 1998, looking at age, sex, smoking, simple spirometry, arterial gases at rest, number of admissions, duration of hospital stay, and number of visits to the emergency room. After describing the sample, patients were stratified in three groups by use of hospital care: group A, patients not requiring hospital care; group B, patients requiring less care than the COPD-HC group; and group C, COPD-HC. The criteria used to define the COPD-HC group were 1) >= 2 admissions in one year, 2) >= 3 visits to the emergency room, without admission in one year, or 3) 1 admission and 2 visits to the emergency room for COPD exacerbation in one year. RESULTS: Three hundred twenty cases were studied, 3 women (0.9%) and 317 men (99.1%), mean age 71 9 years. One hundred twenty-six patients (39.4%) made 263 visits in 1998, accounting for 1.1% of all emergencies (n = 23,750) and 4.05% of all medical emergencies (n = 6,489). Ninety-two patients (28.7%) were admitted for exacerbation of COPD. One hundred twenty-six admissions were made over the course of the year, accounting for 9.6% of all admissions to the internal medicine wards (n = 1,309). The 39 patients (12.2%) who were classified COPD-HC generated 160 emergency visits (60.8%) and 72 admissions due to COPD (57.1%). The analysis of variation revealed statistically significant differences among the 3 groups for age, FEV1, FVC and PaO2, but not for PaCO2. COPD-HC patients had the lowest values for FEV1, FVC and PaO2 and were older. CONCLUSIONS: COPD generates high demand for hospital care. A small group of COPD patients (12.2%) accounts for nearly 60% of hospital visits for this disease. The group requiring greater care generally has more severe disease (older, more severe bronchial obstruction and hypoxemia).

Adult↗

PubMed2003

Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals.

INTRODUCTION: The in-hospital Utstein template for cardiopulmonary resuscitation (CPR) was assessed in four secondary hospitals (334-441 beds) which did not have systematic data collection. MATERIALS AND METHODS: The reports and outcome over a period of 12 months during the years 2000-2001 were evaluated. RESULTS: Of a total of 1690 patients that had a cardiac arrest (CA), 204 (12%) were resuscitated. Information on the collected Utstein parameters were available as follows: initial rhythm in 91%, time interval from collapse to defibrillation (in case of ventricular fibrillation or ventricular tachycardia as initial rhythm) in 90%, time interval to return of spontaneous circulation (ROSC) in 83% and duration of resuscitation in 83%. ROSC was achieved in 69 patients (34%, CI 27-41%) and 34 (17%, CI 11-23%) survived to hospital discharge. Twenty patients showed satisfactory neurological recovery (10%, CI 6-14%). Eighteen (9%, CI 5-13%) patients were alive at 12 months from the event. Factors associated with survival to hospital discharge were VF/VT (P=0.007) as the initial rhythm and shorter interval to defibrillation (P=0.046). CONCLUSION: The in-hospital Utstein template was logical but laborious and it provided tools for resuscitation management evaluation in the study hospitals. For continuous use, a slightly compressed model may be warranted. In the present material, the overall survival rate to hospital discharge was in line with previous reports but there were somewhat less neurologically satisfactory survivors. There is an evident need to improve the outcome of patients suffering CA on the wards. An important step is to reduce the time interval to defibrillation.

Aged↗

PubMedDate not supplied

Computerized hospital on-line resources allocation link (CHORAL): a mechanism to monitor and establish policy for hospital ambulance diversions.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy. In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn transmitted automatically to all other CHORAL computers. Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗

PubMed2002

A comparison in hospitalization rates between a community-based mobile emergency service and a hospital-based emergency service.

OBJECTIVES: The aims of this study were to compare the rates of inpatient admission between a mobile community-based psychiatric emergency service and a hospital-based psychiatric emergency service, and to identify the clinical characteristics of consumers more likely to be admitted to hospital. METHODS: A retrospective, quasi-experimental design was used with a 3-month cohort of all face-to-face emergency service contacts presenting at the mobile and hospital-based sites. The Health of the Nation Outcome Scales and details of the outcome following initial assessment were completed for all contacts, and each group was compared for differences in clinical characteristics and outcome. RESULTS: Hospital-based emergency service contacts were found to be more than three times as likely to be admitted to a psychiatric inpatient unit when compared with those using a mobile community-based emergency service, regardless of their clinical characteristics. Those with severe mental health disorders such as schizophrenia and major affective disorder, and experiencing problems with aggression, non-accidental self-injury, hallucinations and delusions, problems with occupation, activities of daily living, and living conditions were more likely to be admitted to hospital. Nevertheless, after controlling for clinical characteristics, site of initial assessment accounted for a substantial proportion of the variance in decisions to admit to hospital. CONCLUSIONS: Emergency psychiatric services which include a mobile component and provide a specialized multidisciplinary team approach appear to be most effective in providing services in the least restrictive environment and avoiding hospitalization.

Adult↗

PubMed1998

The Collaborative Hospital Transfusion Study: variations in use of autologous blood account for hospital differences in red cell use during primary hip and knee surgery.

BACKGROUND: Red cell use in patients undergoing Diagnosis Related Group (DRG) 209 procedures (major joint and limb reconstruction procedures of the lower extremities) has been shown to have large, unexplained interhospital variations. STUDY DESIGN AND METHODS: Abstracted records of 2590 consecutive DRG 209 patients at five university hospitals from January 1992 to December 1993 were stratified by procedure and preoperative blood deposit status. Patient characteristics and transfusion and in-hospital outcomes were compared across hospitals. RESULTS: Blood use among patients who did not preoperatively deposit blood was similar across hospitals. Significant differences were found across hospitals for total hip replacement patients in the percentage of patients preoperatively depositing blood (59-80%), percentage of patients receiving transfusion(s) (51 to > 99%), the mean number of units collected per patient (1.6-2.9), and the mean number of unused autologous units per 100 patients (1-185). No significant differences were found in the percentage of those who deposited blood and then required allogeneic units. There was little variability in length of hospital stay or in last hematocrits. Findings were similar for total knee replacement patients. CONCLUSIONS: Interhospital variations in red cell use for primary total hip and knee reconstruction are primarily due to hospital-specific differences in autologous blood collection and transfusion.

Aged↗

PubMed2001

Chiropractic hospitals in America: A case study of the Bakkum Hospital (1936-1950).

OBJECTIVE: The purpose of this article is to relate the story of the Bakkum Chiropractic Clinic and Hospital and offer evidence regarding the lost days of chiropractic hospitalization and inpatient care. DISCUSSION: The number of chiropractic facilities offering inpatient care peaked in the period between World Wars I and II. Little information is available about the vast majority of these facilities. One of them was the Bakkum Chiropractic Clinic and Hospital in Waukon, Iowa. The proprietor was Roy C. Bakkum, DC; he and his wife, Jessie H. Bakkum, DC, opened their 30-bed facility in 1936. Patients received hole-in-one chiropractic adjustments, rest, and nursing care at this facility. Dr Roy Bakkum not only envisioned chiropractors as true primary caregivers but also implemented that vision to the best of his ability. He saw chiropractic as the principal type of health care that the vast majority of people should receive, even as inpatients; instead of being the usual and customary type of hospital care, pharmaceutical and surgical intervention would be called on only as needed. Mainly because of economic pressures, the Bakkums' facility closed in 1950. CONCLUSION: The Bakkum Chiropractic Clinic and Hospital may have been fairly typical of small chiropractic facilities offering inpatient care. Like many private hospitals of various kinds, the Bakkums' facility closed in the post-World War II period, primarily because of economic and political losses. This article traces the history of one chiropractic facility to add historical context to chiropractors' long struggle to own and operate chiropractic hospitals.

Chiropractic↗

PubMed2002

Early discharge of hip fracture patients from hospital: transfer of costs from hospital to nursing home.

Hip fracture patients occupy more and more hospital beds. One of the strategies for coping with this problem is early discharge from the hospital to institutions with rehabilitation facilities. We studied whether early discharge affects outcome and costs. 208 elderly patients with a hip fracture were followed up to 4 months after the fracture. First, a group of 102 patients stayed in our hospital for the usual period (median 18 days). Then, 106 patients were assigned to a group for early discharge (median 11 days). We measured disabilities, health-related quality of life and cognition at 1 week, 1, and 4 months after hospitalization. To calculate total societal costs, inpatient days, the efforts of professionals in- and outside institutions, and interventions/examinations were recorded during this 4-month period. At 4 months, we found no differences in mortality, ADL level, complications, quality of life, and type of residence. More patients in the early discharge group were discharged to nursing homes with rehabilitation facilities (76% versus 53%), but the median total stay in hospital and nursing home was the same (26 days). Early discharge from hospital did not substantially reduce the total costs (conventional management Euro 15,338 per patient and early discharge Euro 14,281 per patient), but merely shifted them from the hospital to the nursing home.

Aged↗

PubMed1978

Bacteremic superinfections of patients with bacteremia: occurrence, bacteriology, mortality, and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972.

During the course of hospitalization of 6,414 patients with bacteremic infections identified at Boston City Hospital (Boston, Massachusetts) during 12 selected years between 1935 and 1972, 6.0% developed verified bacteremic superinfections with organisms not isolated or identified in the primary bacteremic infection. Analysis of these cases reemphasizes the increasing occurrence of serious hospital-acquired infections despite the successive introduction and intensive use of a large number of effective antibacterial agents. The bacteremic superinfections, like the primary hospital-acquired bacteremias, increased in incidence over the years, particularly since 1961; they were more frequent and were associated with a higher mortality rate and longer duration of hospital stay in the primary hospital-acquired cases than in the patients in whom bacteremia was considered to be community-acquired. The organisms in superinfections were similar to those in primary hospital-acquired bacteremias. Superinfection was more frequent among the patients who died than among the survivors.

Bacterial Infections↗

PubMed1978

Duration of hospitalization for bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972.

In survivors of both community-acquired (CA) and hospital-acquired (HA) bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972, the mean hospital stay fluctuated widely from one selected year to the next, but it was generally shorter and early discharges were more frequent in the years when effective antibacterial agents were used. The greatest reduction in hospital stay occurred by 1941. The size of the fluctuations and reductions also varied with the causative organism. The average duration of hospitalization of all survivors of HA bacteremic infections after the first positive blood culture was 10.5 days longer than the total hospitalization of survivors of CA infections. The reduced length of hospital stay after 1935 is attributed to the successful use of effective antibacterial drugs, and the greater effect in CA than in HA cases is attributed to more frequent infections in the latter with organisms resistant to those drugs.

Boston↗

PubMed2006

Adverse outcomes in Belgian acute hospitals: retrospective analysis of the national hospital discharge dataset.

OBJECTIVE: The prevalence and variability of adverse outcome rates in Belgian acute hospitals is examined by using the national hospital discharge database. DESIGN: setting, and participants. Retrospective analysis based on administrative data of all Belgian acute hospitals, covering the full medical (n = 1 024 743) and surgical (n = 633 027) in-patients population for the year 2000. MAIN OUTCOME MEASURES: For 11 adverse outcomes and failure-to-rescue, the rates and variability among hospitals were studied. The all patient refined diagnostic-related groups (APR-DRG) method was used for risk adjustment. RESULTS: The prevalence of adverse outcomes was 7.12% in the medical and 6.32% in the surgical group. Rates ranged from 6.25 (deep venous thrombosis) to 32.3 (urinary tract infection) outcomes per 1000 discharges in the medical group and from 3.39 (deep venous thrombosis) to 17.6 (urinary tract infection) outcomes per 1000 discharges in the surgical group. The failure-to-rescue rate was 240 and 211 per 1000 discharges, respectively. Except for pressure ulcers and hospital-acquired sepsis, the prevalence of adverse outcomes was significantly higher (P = 0.001) in the medical group. All adverse outcome rates varied substantially among the hospitals surveyed. CONCLUSIONS: This study identifies the occurrence of adverse outcomes in a national population. It adds information to the growing body of knowledge in predominantly Anglo-Saxon countries about adverse outcomes. Striking variation exists in the risk-adjusted adverse outcome rates across Belgian acute hospitals, revealing a large potential for quality gains that encourage further action.

Adult↗

PubMed1997

Pre-hospital and hospital time delays in thrombolytic treatment in patients with suspected acute myocardial infarction. Analysis of data from the EMIP study. European Myocardial Infarction Project.

OBJECTIVES: To compare the components of the time delay involved in pre-hospital and hospital thrombolytic therapy in patients presenting with suspected acute myocardial infarction. MATERIAL AND METHODS: From October 1988 to January 1992 a total of 198 mobile emergency units in 15 European countries and Canada randomized 5469 patients to receive either pre-hospital thrombolytic treatment, followed by placebo in hospital (pre-hospital group), or pre-hospital (hospital group) in the European Myocardial Infarction Project trial. We performed a post hoc analysis of these data to correlate components of the interval between symptom onset and treatment with baseline patient characteristics. RESULTS: The delay between onset of symptoms and calling for an ambulance was significantly longer for female patients (P = 0.0001), older patients (> 65 years old; P = 0.0001), those who had experienced pain within the previous 24 h (P = 0.0001), and those with pulmonary oedema (P = 0.04). This delay was significantly shorter in patients with previous myocardial infarction (P = 0.02), those with ventricular fibrillation (P = 0.0001), and those in shock (P = 0.0001). The delay between the two injections was significantly longer for older patients (> 65 years old; P = 0.02), those with previous myocardial infarction (P = 0.03), and those in shock (P = 0.003). CONCLUSIONS: Action undertaken to reduce delays between symptom onset and treatment should focus on modifiable factors such as patients who are likely to be late callers i.e. women and those over 65 years of age.

Aged↗

PubMed1998

The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay.

INTRODUCTION: Since their inception, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS) have been suggested as measures of the quality of trauma care. In concept, they are designed to accurately assess injury severity and predict expected outcomes. ICISS, an injury severity methodology based on International Classification of Diseases, Ninth Revision, codes, has been demonstrated to be superior to ISS and TRISS. The purpose of the present study was to compare the ability of TRISS to ICISS as predictors of survival and other outcomes of injury (hospital length of stay and hospital charges). It was our hypothesis that ICISS would outperform ISS and TRISS in each of these outcome predictions. METHODS: "Training" data for creation of ICISS predictions were obtained from a state hospital discharge data base. "Test" data were obtained from a state trauma registry. ISS, TRISS, and ICISS were compared as predictors of patient survival. They were also compared as indicators of resource utilization by assessing their ability to predict patient hospital length of stay and hospital charges. Finally, a neural network was trained on the ICISS values and applied to the test data set in an effort to further improve predictive power. The techniques were compared by comparing each patient's outcome as predicted by the model to the actual outcome. RESULTS: Seven thousand seven hundred five patients had complete data available for analysis. The ICISS was far more likely than ISS or TRISS to accurately predict every measure of outcome of injured patients tested, and the neural network further improved predictive power. CONCLUSION: In addition to predicting mortality, quality tools that can accurately predict resource utilization are necessary for effective trauma center quality-improvement programs. ICISS-derived predictions of survival, hospital charges, and hospital length of stay consistently outperformed those of ISS and TRISS. The neural network-augmented ICISS was even better. This and previous studies demonstrate that TRISS is a limited technique in predicting survival resource utilization. Because of the limitations of TRISS, it should be superseded by ICISS.

Adult↗

PubMedDate not supplied

Does evening removal of urinary catheters shorten hospital stay among general hospital patients? A randomized controlled trial.

OBJECTIVE: Literature indicates that removing urinary catheters at midnight facilitates earlier discharge among urology patients, but the effect of evening removal on the general patient population is unknown. The objective of this study was to investigate whether removing a urinary catheter at 22.00 hours compared to 06.00 hours among a general hospital population would lead to earlier hospital discharge. DESIGN: Randomized controlled trial. SETTING AND SUBJECTS: The study was conducted in a large tertiary hospital in Brisbane, Australia. Two hundred and ten general surgical and medical patients who had an indwelling catheter as part of their routine care were included. RESULTS: Length of hospital stay after catheter removal was not significantly affected by the timing of its removal among general hospital patients: mean hours morning 186.1; mean evening 209.3, (P = .309). In a cohort of surgical patients, the hospital stay was shorter in the evening removal group (mean hours morning 186.1; mean evening 209.3), but this result was not statistically significant (P = .127). Patients in the evening group were more likely to have a longer time period between catheter removal and the first postcatheter void, mean hours morning, 3.76 vs evening, 4.89 (t = -2.59, CI - 1.99 to -0.27). Timing of removal of the urinary catheter had no effect on the volume of the first void, mean volume morning, 214.7 mL vs evening, 221.4 mL. Twenty-five (12.1%) patients were recatheterized, but the rate of recatheterization between groups was similar. There were no differences in postdischarge problems between groups. CONCLUSION: Among general hospital patients, removing an indwelling urinary catheter at 22:00 hours does not shorten the length of stay and is effective in increasing the time to first void.

Australia↗

PubMed2006

Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) Study.

BACKGROUND: Little is known about physical activity levels in patients with coronary artery disease (CAD) who are not engaged in cardiac rehabilitation. We explored the trajectory of physical activity after hospitalization for CAD, and examined the effects of demographic, medical, and activity-related factors on the trajectory. DESIGN: A prospective cohort study. METHODS: A total of 782 patients were recruited during CAD-related hospitalization. Leisure-time activity energy expenditure (AEE) was measured 2, 6 and 12 months later. Sex, age, education, reason for hospitalization, congestive heart failure (CHF), diabetes, and physical activity before hospitalization were assessed at recruitment. Participation in cardiac rehabilitation was measured at follow-up. RESULTS: AEE was 1948+/-1450, 1676+/-1290, and 1637+/-1486 kcal/week at 2, 6 and 12 months, respectively. There was a negative effect of time from 2 months post-hospitalization on physical activity (P<0.001). Interactions were found between age and time (P=0.012) and education and time (P=0.001). Main effects were noted for sex (men more active than women; P<0.001), CHF (those without CHF more active; P<0.01), diabetes (those without diabetes more active; P<0.05), and previous level of physical activity (those active before hospitalization more active after; P<0.001). Coronary artery bypass graft patients were more active than percutaneous coronary intervention (PCI) patients (P=0.033). CONCLUSIONS: Physical activity levels declined from 2 months after hospitalization. Specific subgroups (e.g. less educated, younger) were at greater risk of decline and other subgroups (e.g. women, and PCI, CHF, and diabetic patients) demonstrated lower physical activity. These groups need tailored interventions.

Adult↗

PubMed2004

Driscoll Children's Hospital respiratory syncytial virus database: risk factors, treatment and hospital course in 3308 infants and young children, 1991 to 2002.

BACKGROUND: Treatment of respiratory syncytial virus (RSV) lower respiratory tract infection has historically been one of the most frequent reasons for admission to Driscoll Children's Hospital. OBJECTIVE: The objective of this study was to examine the relationship of risk factors for a severe and complicated disease course to the treatment and hospital length of stay. METHODS: Subjects were identified through a retrospective review of the medical records of all patients discharged with a diagnosis of RSV lower respiratory tract infection during 9 of the 11 RSV seasons between July 1, 1991 and June 30, 2002. The RSV seasons from 1991-1992 to 1994-1995 were compared with the RSV seasons from 1995-1996 to 2001-2002 with regard to treatment and hospital course. RESULTS: There were a total of 3308 admissions. Compared with patients with no risk factors, higher percentages of patients with age <6 weeks, history of prematurity, congenital heart disease and neurologic disease were admitted to the pediatric intensive care unit (PICU) and required mechanical ventilation (P < 0.001). Also the hospital length of stay was longer for patients with each of these individual risk factors (P < 0.001). The hospital length of stay and the percentages of patients admitted to the PICU and requiring on mechanical ventilation increased as the number of risk factors increased from zero to 3 or more (P < 0.001). Of patients with 3 or more risk factors, the average hospital length of stay was 13.5 days; 67% were admitted to the PICU, and 47% required mechanical ventilation. Ribavirin use decreased in patients with each of the individual risk factors (P < 0.001) as well as in patients with one or more risk factors (P < 0.001). At the same time the PICU admission rate increased from 6.1% to 11.2% (P < 0.001). CONCLUSIONS: Patients with three or more risk factors were at very high risk for having a severe or complicated disease course associated with admission to the PICU, placement on mechanical ventilation and a longer hospital length of stay.

Antiviral Agents↗

PubMed2004

Severity of injury and mortality associated with pediatric blunt injuries: hospitals with pediatric intensive care units versus other hospitals.

OBJECTIVE: To a) compare in-hospital mortality rates for pediatric (age <13 yrs) patients with blunt injuries in the New York State Trauma Registry based on hospital type (dedicated pediatric intensive care unit [PICU] and designated trauma centers and noncenters that do not have a dedicated PICU) for the purpose of determining whether there is a reduction in mortality at a specialty hospital and b) determine the extent to which high-risk patients are admitted to specialty hospitals. DATA SOURCE: Inpatient data for the years 1994-1998 in the New York State Trauma Registry. STUDY SELECTION: A total of 8,180 pediatric inpatients who suffered blunt injury were selected to examine where patients were treated (PICU, regional trauma center without PICU, area trauma center without PICU, or noncenter without PICU) as a function of injury severity. DATA EXTRACTION: Data were extracted for inpatients aged <13 yrs who suffered blunt injury. DATA SYNTHESIS: The injury severity of inpatients treated at PICUs and regional centers without PICUs was significantly higher than at other hospitals. Risk factors that were independently related to survival of pediatric trauma inpatients were age <5 yrs, motor component of one to five, abnormal systolic blood pressure relative to age, and International Classification of Disease, Ninth Revision-Based Injury Severity Score. Of the total 136 deaths, 133 were among the patients <5 yrs old, motor score <6, and age-related abnormal systolic blood pressure. A total of 66.8% of these patients were treated at PICUs, and 9.9% were treated at regional centers without PICUs. No statistically significant differences in risk-adjusted mortality rates were found by hospital type, but rates at PICUs were lower than for other types of hospitals except for noncenters without PICUs, whose patients were considerably less severely injured. CONCLUSIONS: There is significant triaging of the most seriously injured pediatric trauma inpatients to PICUs, and there is evidence that this policy is effective.

Child↗