Anaemia under-reporting in a hospital setting in Italy

Background

Anaemia is a common occurrence in the general population, affecting nearly one in three people worldwide, with peaks in the elderly and those with chronic diseases or micronutrient deficiency.

If recognised, anaemia can often be treated through micronutrient administration, thus an early recognition of the disorder has a significant return in terms of Public Health and of investment.

Methods

Hospitalisation records from a large sample of ordinary admissions over a year (2016) were retrospectively analysed, in order to assess the impact of hospital stay on anaemia prevalence, defined according to WHO criteria. Prevalence was estimated by both haemoglobin levels and anaemia-related description codes (ICD9CM) at discharge.

Furthermore, the main diagnoses associated with loss of haemoglobin were investigated, using binary logistic regression.

Results

Over the 15,624 ordinary admissions, we found the prevalence rate of anaemia was 47.2% at hospital admission, increasing to 63.9% at discharge.

During hospital stay, a mean reduction of 0.323 g/dl (SD ± 1.39) haemoglobin was recorded, in particular those with neurological, circulatory, and haematological diseases (p < 0.001). By comparing the two diagnostic criteria, a great under-reporting occurred in 85.3% patients with haemoglobin levels predictive for anaemia at hospital discharge.

Conclusions

Our results highlight the importance of correctly identifying anaemia in the hospital setting as a main Public Health concern. Since haemoglobin loss is recorded during hospital stay, we propose measuring haemoglobin levels not only at admission, but also at discharge, and to enhance proper ICD9CM code inclusion in discharge records. The achievement of both these good practices would have a double effect: to properly inform all the stakeholders and to allow more than half hospital patients, those with haemoglobin levels predictive for anaemia but without specific ICD9CM code at discharge, to be cured in the proper setting.

Key messages

Anaemia often remained misidentified during hospitalisation, thus inducing a decrease in mean inpatients haemoglobin levels and a consequent increase of anaemia prevalence at discharge. Despite this worsening during hospital stay, a significant underreporting was recorded: 85.3% patients with Hb levels predictive for anaemia at hospital discharge had no specific ICD9CM code.

Risk of fall among the hospitalized over-49 population. A retrospective cohort study in a hospital

Background

Despite the copious efforts made to prevent the problem, inpatient falls remain one of the most common adverse events in hospitals, with high risks in term of morbidity and mortality rates, as well as high costs for the healthcare system. This study aims to evaluate the inpatient falls incidence rate in a hospital in Rome, Italy.

Methods

A retrospective cohort study has been set out based on data collected by a Risk Management Unit concerning the falls of patients over 49 years, which happened in the hospital between 1st July 2008 and 30th June 2013. Data collected from the incident report forms were inserted in a database and analyzed using the statistical program SPSS, 20.0 Illinois version.

Results

During the period observed, 516 falls were reported. Patients who fell had a mean age of 68.8 years (SD ± 16.2). The falls are distributed for these age groups: 109 (21.1%) in 50-64; 129 (25%) in 65-74; 181 (35.1%) in 75-84; 97 (18.8%) in > 84. Fall incidence rate was calculated on the overall number of hospital admissions in the observed period (N = 35,812) (1.44 per 100 hospital admissions IC95% 1.32-1.56). Most of the patients were men (333; 64.5%) and older than 75 (53.9%). Inpatient falls were more frequent in the medicine wards (incidence rate 2.2 per 100 hospital admissions, IC95% 1.85-2.55,). The 51.6% of falls happened during the night shift. Severe outcome resulted in 13.6% of falls. Most of the falls (52.3%) happened within three days from the hospital admission. At multivariate analysis, a period of 2-3 days from hospital admission is the main risk factor to determine severe outcomes such as death or cranial trauma (p = 0.02; OR 2.87 IC95% 1.16-7.09).

Conclusions

The study contributes to measure the phenomenon in older adults and age group 50-64, identifying a specific indicator to properly measure inpatient falls incidence rate in the elderly. The study gives indications on the main risk factors related to this adverse event and on prevention strategies.

Key messages

Falls in hospital is an important adverse event not only in the elderly. The first period of three days from the hospital admission constitutes the main risk factor for the falls.

[Vaccination against measles, mumps and rubella in a Roma people camp in Rome, Italy]

The immunization strategy aimed to the elimination of Measles and the prevention of Congenital Rubella failed to reach the planned objectives in Europe; in Italy the renewed National Elimination Plan (PNEMoRc 2010-2015) has been recently approved. The evaluation of a preventive intervention to avoid the spread of measles in a Roma people camp confirm the importance of specific vaccination in high risk populations, like nomads, in which low coverage rates are responsible for the maintenance of the disease.