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Risk Factors and Reasons for Emergency Department Visits Within 30 Days of Elective Hand Surgery: An Analysis of 3,261 Patients

J Hand Surg Asian Pac Vol. 2022 Jan 14:2250004. doi: 10.1142/S2424835522500047. Online ahead of print.

ABSTRACT

Background: The frequency of hand and elbow surgeries occurring in outpatient and elective settings is on the rise. Emergency department (ED) visits in the postoperative period are increasingly used as quality measures for surgical care. The aim of this study is to determine the number of postoperative ED visits, the primary reason for these visits, and to identify risk factors associated with these visits. Methods: We examined all elective hand and elbow procedures performed at two hospitals within a single healthcare network between 2008 and 2017. A total of 3,261 patients met the study criteria. Descriptive statistics were calculated for our population, followed by univariate and multivariate analyses, to identify risk and protective factors associated with ED visits in the first 30 days after surgery. Results: Eighty-seven of 3,261 patients presented to the ED within 30 days of their operation (2.7%). The most common reasons for ED visits were related to pain (28.7%), swelling (26.4%), and concerns for infection (20.7%). Univariate analysis indicated history of drug use, number of procedures, smoking history, and serum albumin <3.5 mg/dL as risk factors for returns to the ED. Multivariate analysis identified history of drug use, number of procedures, and serum albumin <3.5 mg/dL as independent risk factors. Smoking history failed to achieve statistical significance as an independent risk factor. Both univariate and multivariate analyses identified age >60 years as protective for postoperative ED visits. Conclusions: ED visits within the first 30 days after elective hand surgery are relatively common, despite remarkably low complication rates among these procedures. This information may help to improve risk stratification in these patients, and to aid in the development of enhanced postoperative follow-up strategies to reduce unnecessary utilization of emergency medical services. Level of Evidence: Level III (Therapeutic).

PMID:35037576 | DOI:10.1142/S2424835522500047

Multi-omic analysis in injured humans: Patterns align with outcomes and treatment responses

Cell Rep Med. 2021 Dec 21;2(12):100478. doi: 10.1016/j.xcrm.2021.100478. eCollection 2021 Dec 21.

ABSTRACT

Trauma is a leading cause of death and morbidity worldwide. Here, we present the analysis of a longitudinal multi-omic dataset comprising clinical, cytokine, endotheliopathy biomarker, lipidome, metabolome, and proteome data from severely injured humans. A "systemic storm" pattern with release of 1,061 markers, together with a pattern suggestive of the "massive consumption" of 892 constitutive circulating markers, is identified in the acute phase post-trauma. Data integration reveals two human injury response endotypes, which align with clinical trajectory. Prehospital thawed plasma rescues only endotype 2 patients with traumatic brain injury (30-day mortality: 30.3 versus 75.0%; p = 0.0015). Ubiquitin carboxy-terminal hydrolase L1 (UCHL1) was identified as the most predictive circulating biomarker to identify endotype 2-traumatic brain injury (TBI) patients. These response patterns refine the paradigm for human injury, while the datasets provide a resource for the study of critical illness, trauma, and human stress responses.

PMID:35028617 | PMC:PMC8715070 | DOI:10.1016/j.xcrm.2021.100478

Traumatic Transposition of the Ulnar Nerve Through the Distal Radioulnar Joint: A Case Report

JBJS Case Connect. 2022 Jan 12;12(1). doi: 10.2106/JBJS.CC.21.00180.

ABSTRACT

CASE: A 27-year-old woman sustained a left open distal radius fracture with dislocation of the distal radioulnar joint (DRUJ). Postoperatively after initial temporizing treatment, the patient reported numbness in an ulnar distribution and was noted to have intrinsic hand weakness. At the time of conversion to internal fixation, the ulnar nerve was found to be translocated through the DRUJ and was narrowed and felt to benefit from resection and grafting.

CONCLUSION: The combination of ulnar nerve palsy and wide displacement of the distal radius with DRUJ dislocation should raise the possibility of translocation of the ulnar nerve through the DRUJ.

PMID:35020669 | DOI:10.2106/JBJS.CC.21.00180

HHV-6 and Schizophrenia: An Unusual Presentation or an Unproven Etiology?

Prim Care Companion CNS Disord. 2022 Jan 6;24(1):21cr02944. doi: 10.4088/PCC.21cr02944.

NO ABSTRACT

PMID:34991186 | DOI:10.4088/PCC.21cr02944

Defining Acute Traumatic Encephalopathy: Methods of the "HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma" (HeadSMART II) Study

James d'Etienne, MD - Mon, 12/27/2021 - 05:00

Front Neurol. 2021 Dec 8;12:733712. doi: 10.3389/fneur.2021.733712. eCollection 2021.

ABSTRACT

Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that "mild" forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.

PMID:34956041 | PMC:PMC8693379 | DOI:10.3389/fneur.2021.733712

Defining Acute Traumatic Encephalopathy: Methods of the "HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma" (HeadSMART II) Study

Front Neurol. 2021 Dec 8;12:733712. doi: 10.3389/fneur.2021.733712. eCollection 2021.

ABSTRACT

Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that "mild" forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.

PMID:34956041 | PMC:PMC8693379 | DOI:10.3389/fneur.2021.733712

Racial/Ethnic Distribution of Graduates from Doctorate and Masters Epidemiology Degree Programs in the United States, 2008 to 2018

Ann Epidemiol. 2021 Dec 21:S1047-2797(21)00346-X. doi: 10.1016/j.annepidem.2021.12.004. Online ahead of print.

ABSTRACT

PURPOSE: To identify trends in racial and ethnic diversity of epidemiology graduate degree recipients in the U.S. between academic years 2008 to 2018.

METHODS: National-level data from the National Center for Education Statistics was analyzed to assess the change in proportions of epidemiology degrees conferred to each racial/ethnic group - American Indian or Alaska Native; Asian, Native Hawaiian or Other Pacific Islander; Black or African American; Hispanic or Latino; White; and two or more races- over two time periods, Fall 2007- Spring 2012 (Period 1) and Fall 2012 - Spring 2018 (Period 2).

RESULTS: During Period 1, 3837 epidemiology graduate degrees were conferred, and 6960 in Period 2. Within race/ethnicity groups, there was a statistically significant increase in graduate epidemiology degrees awarded over the two time periods to students of Hispanic or Latino ethnicity, and to students reporting two or more races. The proportion of degrees awarded to non-White students in aggregate increased by 4.7 percentage points, from 33.5% to 38.2%, while awards to White students decreased by the same amount.

CONCLUSIONS: Overall, the racial/ethnic diversity of epidemiology graduates in the U.S. increased between 2008 and 2018, however, further efforts are needed to increase awards within some racial minority subgroups.

PMID:34952203 | DOI:10.1016/j.annepidem.2021.12.004

Multi-institutional intervention to improve patient perception of physician empathy in emergency care

Hao Wang, MD - Wed, 12/22/2021 - 05:00

Emerg Med J. 2021 Dec 21:emermed-2020-210757. doi: 10.1136/emermed-2020-210757. Online ahead of print.

ABSTRACT

BACKGROUND: Physician empathy has been linked to increased patient satisfaction, improved patient outcomes and reduced provider burnout. Our objective was to test the effectiveness of an educational intervention to improve physician empathy and trust in the ED setting.

METHODS: Physician participants from six emergency medicine residencies in the US were studied from 2018 to 2019 using a pre-post, quasi-experimental non-equivalent control group design with randomisation at the site level. Intervention participants at three hospitals received an educational intervention, guided by acognitivemap (the 'empathy circle'). This intervention was further emphasised by the use of motivational texts delivered to participants throughout the course of the study. The primary outcome was change in E patient perception of resident empathy (Jefferson scale of patient perception of physician empathy (JSPPPE) and Trust in Physicians Scale (Tips)) before (T1) and 3-6 months later (T2).

RESULTS: Data were collected for 221 residents (postgraduate year 1-4.) In controls, the mean (SD) JSPPPE scores at T1 and T2 were 29 (3.8) and 29 (4.0), respectively (mean difference 0.8, 95% CI: -0.7 to 2.4, p=0.20, paired t-test). In the intervention group, the JSPPPE scores at T1 and T2 were 28 (4.4) and 30 (4.0), respectively (mean difference 1.4, 95% CI: 0.0 to 2.8, p=0.08). In controls, the TIPS at T1 was 65 (6.3) and T2 was 66 (5.8) (mean difference -0.1, 95% CI: -3.8 to 3.6, p=0.35). In the intervention group, the TIPS at T1 was 63 (6.9) and T2 was 66 (6.3) (mean difference 2.4, 95% CI: 0.2 to 4.5, p=0.007). Hierarchical regression revealed no effect of time×group interaction for JSPPPE (p=0.71) nor TIPS (p=0.16).

CONCLUSION: An educational intervention with the addition of text reminders designed to increase empathic behaviour was not associated with a change in patient-perceived empathy, but was associated with a modest improvement in trust in physicians.

PMID:34933917 | DOI:10.1136/emermed-2020-210757

Multi-institutional intervention to improve patient perception of physician empathy in emergency care

Emerg Med J. 2021 Dec 21:emermed-2020-210757. doi: 10.1136/emermed-2020-210757. Online ahead of print.

ABSTRACT

BACKGROUND: Physician empathy has been linked to increased patient satisfaction, improved patient outcomes and reduced provider burnout. Our objective was to test the effectiveness of an educational intervention to improve physician empathy and trust in the ED setting.

METHODS: Physician participants from six emergency medicine residencies in the US were studied from 2018 to 2019 using a pre-post, quasi-experimental non-equivalent control group design with randomisation at the site level. Intervention participants at three hospitals received an educational intervention, guided by acognitivemap (the 'empathy circle'). This intervention was further emphasised by the use of motivational texts delivered to participants throughout the course of the study. The primary outcome was change in E patient perception of resident empathy (Jefferson scale of patient perception of physician empathy (JSPPPE) and Trust in Physicians Scale (Tips)) before (T1) and 3-6 months later (T2).

RESULTS: Data were collected for 221 residents (postgraduate year 1-4.) In controls, the mean (SD) JSPPPE scores at T1 and T2 were 29 (3.8) and 29 (4.0), respectively (mean difference 0.8, 95% CI: -0.7 to 2.4, p=0.20, paired t-test). In the intervention group, the JSPPPE scores at T1 and T2 were 28 (4.4) and 30 (4.0), respectively (mean difference 1.4, 95% CI: 0.0 to 2.8, p=0.08). In controls, the TIPS at T1 was 65 (6.3) and T2 was 66 (5.8) (mean difference -0.1, 95% CI: -3.8 to 3.6, p=0.35). In the intervention group, the TIPS at T1 was 63 (6.9) and T2 was 66 (6.3) (mean difference 2.4, 95% CI: 0.2 to 4.5, p=0.007). Hierarchical regression revealed no effect of time×group interaction for JSPPPE (p=0.71) nor TIPS (p=0.16).

CONCLUSION: An educational intervention with the addition of text reminders designed to increase empathic behaviour was not associated with a change in patient-perceived empathy, but was associated with a modest improvement in trust in physicians.

PMID:34933917 | DOI:10.1136/emermed-2020-210757

High End-of-Life Health Care Utilization in a Contemporary Cohort of Head and Neck Cancer Patients Treated with Immune Checkpoint Inhibitors

J Palliat Med. 2021 Nov 30. doi: 10.1089/jpm.2021.0323. Online ahead of print.

ABSTRACT

Background/Objective: End-of-life health care utilization (EOLHCU) is largely uncharacterized among patients with recurrent/metastatic head and neck squamous cell carcinomas (RMHNSCC), particularly now that immune checkpoint inhibitors (ICI) have been introduced to the treatment landscape. We examined this in a single-institution, retrospective study. Design/Settings: We utilized a database of deceased, ICI-treated RMHNSCC patients to obtain demographic and EOLHCU data, the latter of which included advanced care plan documentation (ACPD) and systemic therapy or emergency room (ER)/hospital/intensive care unit (ICU) admission within 30 days of death (DOD). This was compared with a cohort of deceased thoracic malignancy (TM) patients in an exploratory analysis. Multivariate analysis was performed to examine for association between patient factors (such as age, Eastern Cooperative Oncology Group (ECOG) performance status, or smoking status) and overall survival (OS); associations between the said patient factors and EOLHCU were also evaluated. This study was conducted at an academic, tertiary center in the United States. Results: The RMHNSCC patients (n = 74) were more likely to have ACPD (p < 0.01), an emergency department visit (p < 0.01), and/or hospital admission (p < 0.01) within 30 DOD relative to the TM group. There was no difference in ICU admissions, ICU deaths, or systemic therapy at end of life (EOL). The OS declined in association with ECOG performance status (PS) and smoking. No association was observed between patient factors and any EOLHCU metric. Conclusions: At our center, patients with ICI-treated RMHNSCC have higher rates of both ACPD and EOLHCU, suggesting high symptom burden and representing opportunities for further study into supportive care augmentation.

PMID:34847733 | DOI:10.1089/jpm.2021.0323

Percutaneous image-guided cryoablation of spinal metastases: A systematic review

J Clin Neurosci. 2021 Nov 25:S0967-5868(21)00556-7. doi: 10.1016/j.jocn.2021.11.008. Online ahead of print.

ABSTRACT

Percutaneous cryoablation (PCA) is a minimally invasive technique that has been recently used to treat spinal metastases with a paucity of data currently available in the literature. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective or retrospective studies concerning metastatic spinal neoplasms treated with current generation PCA systems and with available data on safety and clinical outcomes were included. In the 8 included studies (7 retrospective, 1 prospective), a total of 148 patients (females = 63%) underwent spinal PCA. Tumors were located in the cervical (3/109 [2.8%], thoracic (74/109 [68.8%], lumbar (37/109 [33.9%], and sacrococcygeal (17/109 [15.6%] regions. Overall, 187 metastatic spinal lesions were treated. Thermo-protective measures (e.g., carbo-/hydro-dissection, thermocouples) were used in 115/187 [61.5%] procedures. For metastatic spinal tumors, the pooled mean difference (MD) in pain scores from baseline on the 0-10 numeric rating scale was 5.03 (95% confidence interval [CI]: 4.24 to 5.82) at a 1-month follow-up and 4.61 (95% CI: 3.27 to 5.95) at the last reported follow-up (range 24-40 weeks in 3/4 studies). Local tumor control rates ranged widely from 60% to 100% at varying follow-ups. Grade I-II complications were reported in 9/148 [6.1%] patients and grade III-V complications were reported in 3/148 [2.0%]) patients. PCA, as a stand-alone or adjunct modality, may be a viable therapy in appropriately selected patients with painful spinal metastases who were traditionally managed with open surgery and/or radiation therapy.

PMID:34840092 | DOI:10.1016/j.jocn.2021.11.008

Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting

James d'Etienne, MD - Fri, 11/26/2021 - 05:00

Open Access Emerg Med. 2021 Nov 19;13:503-509. doi: 10.2147/OAEM.S334495. eCollection 2021.

ABSTRACT

OBJECTIVE: Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting.

METHODS: We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores.

RESULTS: We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05).

CONCLUSION: Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.

PMID:34824553 | PMC:PMC8610774 | DOI:10.2147/OAEM.S334495

Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting

Hao Wang, MD - Fri, 11/26/2021 - 05:00

Open Access Emerg Med. 2021 Nov 19;13:503-509. doi: 10.2147/OAEM.S334495. eCollection 2021.

ABSTRACT

OBJECTIVE: Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting.

METHODS: We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores.

RESULTS: We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05).

CONCLUSION: Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.

PMID:34824553 | PMC:PMC8610774 | DOI:10.2147/OAEM.S334495

Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting

Chet Schrader, MD - Fri, 11/26/2021 - 05:00

Open Access Emerg Med. 2021 Nov 19;13:503-509. doi: 10.2147/OAEM.S334495. eCollection 2021.

ABSTRACT

OBJECTIVE: Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting.

METHODS: We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores.

RESULTS: We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05).

CONCLUSION: Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.

PMID:34824553 | PMC:PMC8610774 | DOI:10.2147/OAEM.S334495

Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting

Open Access Emerg Med. 2021 Nov 19;13:503-509. doi: 10.2147/OAEM.S334495. eCollection 2021.

ABSTRACT

OBJECTIVE: Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting.

METHODS: We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores.

RESULTS: We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05).

CONCLUSION: Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.

PMID:34824553 | PMC:PMC8610774 | DOI:10.2147/OAEM.S334495

Development and validation of a prediction model for estimating one-month mortality of adult COVID-19 patients presenting at emergency department with suspected pneumonia: a multicenter analysis

Andrew Shedd, MD - Tue, 11/23/2021 - 05:00

Intern Emerg Med. 2021 Nov 23:1-10. doi: 10.1007/s11739-021-02882-x. Online ahead of print.

ABSTRACT

There are only a few models developed for risk-stratifying COVID-19 patients with suspected pneumonia in the emergency department (ED). We aimed to develop and validate a model, the COVID-19 ED pneumonia mortality index (CoV-ED-PMI), for predicting mortality in this population. We retrospectively included adult COVID-19 patients who visited EDs of five study hospitals in Texas and who were diagnosed with suspected pneumonia between March and November 2020. The primary outcome was 1-month mortality after the index ED visit. In the derivation cohort, multivariable logistic regression was used to develop the CoV-ED-PMI model. In the chronologically split validation cohort, the discriminative performance of the CoV-ED-PMI was assessed by the area under the receiver operating characteristic curve (AUC) and compared with other existing models. A total of 1678 adult ED records were included for analysis. Of them, 180 patients sustained 1-month mortality. There were 1174 and 504 patients in the derivation and validation cohorts, respectively. Age, body mass index, chronic kidney disease, congestive heart failure, hepatitis, history of transplant, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and national early warning score were included in the CoV-ED-PMI. The model was validated with good discriminative performance (AUC: 0.83, 95% confidence interval [CI]: 0.79-0.87), which was significantly better than the CURB-65 (AUC: 0.74, 95% CI: 0.69-0.79, p-value: < 0.001). The CoV-ED-PMI had a good predictive performance for 1-month mortality in COVID-19 patients with suspected pneumonia presenting at ED. This free tool is accessible online, and could be useful for clinical decision-making in the ED.

PMID:34813010 | PMC:PMC8609507 | DOI:10.1007/s11739-021-02882-x

Development and validation of a prediction model for estimating one-month mortality of adult COVID-19 patients presenting at emergency department with suspected pneumonia: a multicenter analysis

James d'Etienne, MD - Tue, 11/23/2021 - 05:00

Intern Emerg Med. 2021 Nov 23:1-10. doi: 10.1007/s11739-021-02882-x. Online ahead of print.

ABSTRACT

There are only a few models developed for risk-stratifying COVID-19 patients with suspected pneumonia in the emergency department (ED). We aimed to develop and validate a model, the COVID-19 ED pneumonia mortality index (CoV-ED-PMI), for predicting mortality in this population. We retrospectively included adult COVID-19 patients who visited EDs of five study hospitals in Texas and who were diagnosed with suspected pneumonia between March and November 2020. The primary outcome was 1-month mortality after the index ED visit. In the derivation cohort, multivariable logistic regression was used to develop the CoV-ED-PMI model. In the chronologically split validation cohort, the discriminative performance of the CoV-ED-PMI was assessed by the area under the receiver operating characteristic curve (AUC) and compared with other existing models. A total of 1678 adult ED records were included for analysis. Of them, 180 patients sustained 1-month mortality. There were 1174 and 504 patients in the derivation and validation cohorts, respectively. Age, body mass index, chronic kidney disease, congestive heart failure, hepatitis, history of transplant, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and national early warning score were included in the CoV-ED-PMI. The model was validated with good discriminative performance (AUC: 0.83, 95% confidence interval [CI]: 0.79-0.87), which was significantly better than the CURB-65 (AUC: 0.74, 95% CI: 0.69-0.79, p-value: < 0.001). The CoV-ED-PMI had a good predictive performance for 1-month mortality in COVID-19 patients with suspected pneumonia presenting at ED. This free tool is accessible online, and could be useful for clinical decision-making in the ED.

PMID:34813010 | PMC:PMC8609507 | DOI:10.1007/s11739-021-02882-x

Development and validation of a prediction model for estimating one-month mortality of adult COVID-19 patients presenting at emergency department with suspected pneumonia: a multicenter analysis

Dahlia Hassani, MD - Tue, 11/23/2021 - 05:00

Intern Emerg Med. 2021 Nov 23:1-10. doi: 10.1007/s11739-021-02882-x. Online ahead of print.

ABSTRACT

There are only a few models developed for risk-stratifying COVID-19 patients with suspected pneumonia in the emergency department (ED). We aimed to develop and validate a model, the COVID-19 ED pneumonia mortality index (CoV-ED-PMI), for predicting mortality in this population. We retrospectively included adult COVID-19 patients who visited EDs of five study hospitals in Texas and who were diagnosed with suspected pneumonia between March and November 2020. The primary outcome was 1-month mortality after the index ED visit. In the derivation cohort, multivariable logistic regression was used to develop the CoV-ED-PMI model. In the chronologically split validation cohort, the discriminative performance of the CoV-ED-PMI was assessed by the area under the receiver operating characteristic curve (AUC) and compared with other existing models. A total of 1678 adult ED records were included for analysis. Of them, 180 patients sustained 1-month mortality. There were 1174 and 504 patients in the derivation and validation cohorts, respectively. Age, body mass index, chronic kidney disease, congestive heart failure, hepatitis, history of transplant, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and national early warning score were included in the CoV-ED-PMI. The model was validated with good discriminative performance (AUC: 0.83, 95% confidence interval [CI]: 0.79-0.87), which was significantly better than the CURB-65 (AUC: 0.74, 95% CI: 0.69-0.79, p-value: < 0.001). The CoV-ED-PMI had a good predictive performance for 1-month mortality in COVID-19 patients with suspected pneumonia presenting at ED. This free tool is accessible online, and could be useful for clinical decision-making in the ED.

PMID:34813010 | PMC:PMC8609507 | DOI:10.1007/s11739-021-02882-x

Development and validation of a prediction model for estimating one-month mortality of adult COVID-19 patients presenting at emergency department with suspected pneumonia: a multicenter analysis

Intern Emerg Med. 2021 Nov 23. doi: 10.1007/s11739-021-02882-x. Online ahead of print.

ABSTRACT

There are only a few models developed for risk-stratifying COVID-19 patients with suspected pneumonia in the emergency department (ED). We aimed to develop and validate a model, the COVID-19 ED pneumonia mortality index (CoV-ED-PMI), for predicting mortality in this population. We retrospectively included adult COVID-19 patients who visited EDs of five study hospitals in Texas and who were diagnosed with suspected pneumonia between March and November 2020. The primary outcome was 1-month mortality after the index ED visit. In the derivation cohort, multivariable logistic regression was used to develop the CoV-ED-PMI model. In the chronologically split validation cohort, the discriminative performance of the CoV-ED-PMI was assessed by the area under the receiver operating characteristic curve (AUC) and compared with other existing models. A total of 1678 adult ED records were included for analysis. Of them, 180 patients sustained 1-month mortality. There were 1174 and 504 patients in the derivation and validation cohorts, respectively. Age, body mass index, chronic kidney disease, congestive heart failure, hepatitis, history of transplant, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and national early warning score were included in the CoV-ED-PMI. The model was validated with good discriminative performance (AUC: 0.83, 95% confidence interval [CI]: 0.79-0.87), which was significantly better than the CURB-65 (AUC: 0.74, 95% CI: 0.69-0.79, p-value: < 0.001). The CoV-ED-PMI had a good predictive performance for 1-month mortality in COVID-19 patients with suspected pneumonia presenting at ED. This free tool is accessible online, and could be useful for clinical decision-making in the ED.

PMID:34813010 | DOI:10.1007/s11739-021-02882-x

Premature cognitive decline in specific domains found in young veterans with mTBI coincide with elder normative scores and advanced-age subjects with early-stage Parkinson's disease

PLoS One. 2021 Nov 17;16(11):e0258851. doi: 10.1371/journal.pone.0258851. eCollection 2021.

ABSTRACT

IMPORTANCE: Epidemiologists report a 56% increased risk of veterans with (+) mild traumatic brain injury (mTBI) developing Parkinson's disease (PD) within 12-years post-injury. The most relevant contributors to this high risk of PD in veterans (+) mTBI is unknown. As cognitive problems often precede PD diagnosis, identifying specific domains most involved with mTBI-related PD onset is critical.

OBJECTIVES: To discern which cognitive domains underlie the mTBI-PD risk relationship proposed in epidemiology studies.

DESIGN AND SETTING: This exploratory match-controlled, cross-sectional study was conducted in a medical school laboratory from 2017-2020.

PARTICIPANTS: Age- and IQ-matched veterans with (+) and without mTBI, non-veteran healthy controls, and IQ-matched non-demented early-stage PD were compared. Chronic neurological, unremitted/debilitating diseases, disorders, dementia, and substance use among others were excluded.

EXPOSURE: Veterans were or were not exposed to non-penetrating combat-related mTBI occurring within the past 7-years. No other groups had recent military service or mTBI.

MAIN OUTCOMES / MEASURES: Cognitive flexibility, attention, memory, visuospatial ability, and verbal fluency were examined with well-known standardized neuropsychological assessments.

RESULTS: Out of 200 volunteers, 114 provided evaluable data. Groups significantly differed on cognitive tests [F (21,299) = 3.09, p<0.0001]. Post hoc tests showed veterans (+) mTBI performed significantly worse than matched-control groups on four out of eight cognitive tests (range: p = .009 to .049), and more often than not performed comparably to early-stage PD (range: p = .749 to .140).

CONCLUSIONS AND RELEVANCE: We found subtle, premature cognitive decline occurring in very specific cognitive domains in veterans (+) mTBI that would typically be overlooked in a clinic setting, This result potentially puts them at-risk for continual cognitive decline that may portend to the eventual onset of PD or some other neurodegenerative disease.

PMID:34788310 | DOI:10.1371/journal.pone.0258851

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