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Amornpojnimman T, Suwanwong P, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Predictors of hospital outcomes among patients with posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis 2022; 31:106579. [PMID: 35738219 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES We aimed to identify independent predictors of the clinical outcomes of posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS This retrospective cohort study recruited PRES patients admitted in the hospital between 2006 and 2019. The baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the groups with favourable (modified Rankin scale [mRS] score, 0-2) and unfavourable (mRS score, 3-6) clinical outcomes. Factors presenting with p-values < 0.5 in univariate analysis were analysed in the multiple logistic regression model to determine independent predictors of outcome. RESULTS Among 136 PRES patients, 22.80% experienced unfavourable outcomes (mRS score, 3-6), and the mortality rate was 7.35%. The common presenting symptoms in the unfavourable clinical outcome group were impairment of consciousness (90.32%) and seizures (67.74%). Sepsis as a hospital complication (adjusted odds ratio [aOR], 32.95; 95% confidence interval [CI], 4.44-244.22, p = 0.001), acute kidney injury as a hospital complication (aOR, 9.94; 95% CI, 1.71-57.66; p = 0.010), and impairment of consciousness (aOR, 10.85; 95% CI, 1.72-68.53, p = 0.011) were independent predictors of unfavourable outcomes. On the other hand, headache was an independent protective factor (aOR, 0.164; 95% CI, 0.03-0.91; p = 0.039). CONCLUSIONS Impairment of consciousness, sepsis as a hospital complication, and acute kidney injury were independent predictors of unfavourable clinical outcomes, whereas headache showed a preventive effect.
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Affiliation(s)
- Thanyalak Amornpojnimman
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pachara Suwanwong
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Van Goethem N, Vilain A, Wyndham-Thomas C, Deblonde J, Bossuyt N, Lernout T, Rebolledo Gonzalez J, Quoilin S, Melis V, Van Beckhoven D. Rapid establishment of a national surveillance of COVID-19 hospitalizations in Belgium. ACTA ACUST UNITED AC 2020; 78:121. [PMID: 33292566 PMCID: PMC7673251 DOI: 10.1186/s13690-020-00505-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
Background In response to the COVID-19 epidemic, caused by a novel coronavirus, it was of great importance to rapidly collect as much accurate information as possible in order to characterize the public health threat and support the health authorities in its management. Hospital-based surveillance is paramount to monitor the severity of a disease in the population. Methods Two separate surveillance systems, a Surge Capacity survey and a Clinical survey, were set up to collect complementary data on COVID-19 from Belgium’s hospitals. The Surge Capacity survey collects aggregated data to monitor the hospital capacity through occupancy rates of beds and medical devices, and to follow a set of key epidemiological indicators over time. Participation is mandatory and the daily data collection includes prevalence and incidence figures on the number of COVID-19 patients in the hospital. The Clinical survey is strongly recommended by health authorities, focusses on specific patient characteristics and relies on individual patient data provided by the hospitals at admission and discharge. Conclusions This national double-level hospital surveillance was implemented very rapidly after the first COVID-19 patients were hospitalized and revealed to be crucial to monitor hospital capacity over time and to better understand the disease in terms of risk groups and outcomes. The two approaches are complementary and serve different needs. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-020-00505-z.
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Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Epidemiology and Biostatistics, Institut de recherche expérimentale et clinique, Faculty of Public Health, Université catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Woluwe-Saint-Lambert, Belgium.
| | - Aline Vilain
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Chloé Wyndham-Thomas
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Jessika Deblonde
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Nathalie Bossuyt
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Tinne Lernout
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Javiera Rebolledo Gonzalez
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sophie Quoilin
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Vincent Melis
- Directorate Healthcare, Federal Public Service (FPS) Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Dominique Van Beckhoven
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
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Daş M, Bardakci O, Siddikoglu D, Akdur G, Yilmaz MC, Akdur O, Beyazit Y. Prognostic performance of peripheral perfusion index and shock index combined with ESI to predict hospital outcome. Am J Emerg Med 2020; 38:2055-2059. [PMID: 33142174 DOI: 10.1016/j.ajem.2020.06.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Peripheral perfusion index (PPI) and shock index (SI) are considered valuable predictors of hospital outcome and mortality in various operative and intensive care settings. In the present study, we evaluated the prognostic capabilities of these parameters for performing emergency department (ED) triage, as represented by the emergency severity index (ESI). METHODS This prospective cross-sectional study included 367 patients aged older than 18 years who visited the ED of a tertiary referral hospital. The ESI triage levels with PPI, SI, and other basic vital sign parameters were recorded for each patient. The hospital outcome of the patients at the end of the ED period, such as discharge, admission to the hospital and death were recorded. RESULTS A total of 367 patients (M/F: 178/189) admitted to the ED were categorized according to ESI and included in the study. A decrease in diastolic BP, SpO2 and PPI increased the likelihood of hospitalization and 30-day mortality. Based on univariate analysis, a significant improvement in performance was found by using age, diastolic BP, mean arterial pressure, SpO2, SI and PPI in terms of predicting high acuity level patients (ESI < 3). In the multivariable analysis only SpO2 and PPI were found to predict ESI < 3 patients. CONCLUSION Peripheral perfusion index and SI as novel triage instruments might provide useful information for predicting hospital admission and mortality in ED patients. The addition of these parameters to existing triage instruments such as ESI could enhance the triage specificity in unselected patients admitted to ED.
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Affiliation(s)
- Murat Daş
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Okan Bardakci
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey.
| | - Duygu Siddikoglu
- Department of Biostatistic, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Gökhan Akdur
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Musa Caner Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Okhan Akdur
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Yavuz Beyazit
- Department of Internal Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
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Driessen SRC, Wallwiener M, Taran FA, Cohen SL, Kraemer B, Wallwiener CW, van Zwet EW, Brucker SY, Jansen FW. Hospital versus individual surgeon's performance in laparoscopic hysterectomy. Arch Gynecol Obstet 2016; 295:111-117. [PMID: 27628752 PMCID: PMC5225188 DOI: 10.1007/s00404-016-4199-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
Purpose To compare hospital versus individual surgeon’s perioperative outcomes for laparoscopic hysterectomy (LH), and to assess the relationship between surgeon experience and perioperative outcomes. Methods A retrospective analysis of all prospective collected LHs performed from 2003 to 2010 at one medical center was performed. Perioperative outcomes (operative time, blood loss, complication rate) were assessed on both a hospital level and surgeon level using Cumulative Observed minus Expected performance graphs. Results A total of 1618 LHs were performed, 16 % total laparoscopic hysterectomies and 84 % laparoscopic supracervical hysterectomies. Overall outcomes included mean (SD±) blood loss 108.9 ± 69.2 mL, mean operative time 95.4 ± 39.7 min and a complication occurred in 76 (4.7 %) of cases. Suboptimal perioperative outcomes of an individual surgeon were not always detected on a hospital level. However, collective suboptimal outcomes were faster detected on a hospital level compared to individual surgeon’s level. Evidence of a learning curve is seen; for the first 100 procedures, a decrease in operative time is observed as individual surgeon experience increases. Similarly, the risk of conversion decreases up to the first 50 procedures. Conclusion An individual outlier (i.e., surgeon with consistently suboptimal performance) will not always be detected when monitoring outcome measures only on a hospital level. However, monitoring outcome measures on a hospital level will detect suboptimal performance earlier compared to monitoring only on an individual surgeon’s level. To detect performance outliers timely, insight into an individual surgeon’s outcome and skills is recommended. Furthermore, an experienced surgeon is no guarantee for acceptable surgical outcomes.
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Affiliation(s)
- Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, INF 440, 69115, Heidelberg, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Bernhard Kraemer
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Christian W Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Erik W van Zwet
- Department of Medical Statistics, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. .,Department BioMechanical Engineering, Delft University of Technology, PO Box 5, 2600 AA, Delft, The Netherlands.
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Huang CY, Chen YT, Wu LA, Liu CJ, Chang SC, Perng DW, Chen YM, Chen TJ, Lee YC, Chou KT. Sleep apnoea patients have higher mortality when confronting sepsis. Eur J Clin Invest 2014; 44:38-45. [PMID: 24117403 DOI: 10.1111/eci.12187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/04/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sleep is essential for the maintenance of an intact immune function. Patients with sleep apnoea experience frequent sleep interruption due to apnoea-related arousals, possibly adversely impacting their immunity and affecting their outcomes when confronting sepsis. This case-control study aimed to compare the outcomes of sepsis patients with and without sleep apnoea. METHODS From 2000 to 2009, 168 sleep apnoea patients who were first admitted for sepsis were identified from the Taiwan National Health Insurance Research Database. Also, 672 sepsis patients without sleep apnoea, who were matched by age, gender and Charlson's comorbidity index scores, served as controls. Hospital outcomes of the two groups were compared. Binary logistic regression was employed for multivariate analysis. RESULTS The mortality rates of sepsis patients with and without sleep apnoea were 60.1% and 47.9%, respectively (P = 0. 005). After multivariate adjustment, sleep apnoea (OR: 1.805, 95% CI: 1.227-2.656, P = 0.003), presence of shock (OR: 3.600, 95% CI: 2.144-6.046, P < 0.001) and number of organs with dysfunction (OR: 1.591, 95% CI: 1.087-2.329, P = 0.017) were found to be independently associated with mortality. Sleep apnoea patients who needed continuous positive airway pressure treatment had an even higher risk of mortality. CONCLUSIONS Sepsis patients with sleep apnoea may have poorer hospital outcomes than those without sleep apnoea.
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Affiliation(s)
- Chien-Yu Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
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CHIABI A, NGUEFACK S, MAH E, NODEM S, MBUAGBAW L, MBONDA E, TCHOKOTEU PF, DOH FRCOG A. Risk factors for birth asphyxia in an urban health facility in cameroon. Iran J Child Neurol 2013; 7:46-54. [PMID: 24665306 PMCID: PMC3943072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The World Health Organization (WHO) estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic sequelae. The purpose of this study was to identify the risk factors of birth asphyxia and the hospital outcome of affected neonates. MATERIALS & METHODS This study was a prospective case-control study on term neonates in a tertiary hospital in Yaounde, with an Apgar score of < 7 at the 5th minute as the case group, that were matched with neonates with an Apgar score of ≥ 7 at the 5th minute as control group. Statistical analysis of relevant variables of the mother and neonates was carried out to determine the significant risk factors. RESULTS The prevalence of neonatal asphyxia was 80.5 per 1000 live births. Statistically significant risk factors were the single matrimonial status, place of antenatal visits, malaria, pre-eclampsia/eclampsia, prolonged labor, arrest of labour, prolonged rupture of membranes, and non-cephalic presentation. Hospital mortality was 6.7%, that 12.2% of them had neurologic deficits and/or abnormal transfontanellar ultrasound/electroencephalogram on discharge, and 81.1% had a satisfactory outcome. CONCLUSION The incidence of birth asphyxia in this study was 80.5% per1000 live birth with a mortality of 6.7%. Antepartum risk factors were: place of antenatal visit, malaria during pregnancy, and preeclampsia/eclampsia. Whereas prolonged labor, stationary labor, and term prolonged rupture of membranes were intrapartum risk faktors. Preventive measures during prenatal visits through informing and communicating with pregnant women should be reinforced.
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Affiliation(s)
- Andreas CHIABI
- Yaounde Gynaeco-Obstetric and Pediatric Hospital,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Seraphin NGUEFACK
- Yaounde Gynaeco-Obstetric and Pediatric Hospital,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Evelyne MAH
- Yaounde Gynaeco-Obstetric and Pediatric Hospital,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | | | - Lawrence MBUAGBAW
- Centre for the Development of Best Practices in Health, Yaounde Central Hospital, Avenue Henri Dunant, PO Box 87, Messa, Yaoundé, Cameroon
| | - Elie MBONDA
- Yaounde Gynaeco-Obstetric and Pediatric Hospital,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Pierre-Fernand TCHOKOTEU
- Yaounde Gynaeco-Obstetric and Pediatric Hospital,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Anderson DOH FRCOG
- Yaounde Gynaeco-Obstetric and Pediatric Hospital,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
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Behroozian R, Bayazidchi M, Rasooli J. Systemic Inflammatory Response Syndrome and MELD Score in Hospital Outcome of Patients with Liver Cirrhosis. Middle East J Dig Dis 2012; 4:168-72. [PMID: 24829652 PMCID: PMC3990117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/25/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The evidence saying that the rate of Systemic Inflammatory Response Syndrome (SIRS) is high in patients with advanced cirrhosis and portal hypertension, this could have negative outcome on patients prognosis. METHODS This prospective study included 109 cirrhotic patients who were admitted to Imam Khomeini Hospital, affiliated with Orumieh University of Medical Sciences, during 2011-2012. The presence of SIRS and the model for end stage liver disease (MELD) were assessed on admission and during the hospital stay. SIRS was considered positive if patients had two or more of the following: temperature of >38ºC or <36ºC; heart rate >90 beats/min; respiratory rate >20/min or PaCO2 <32 mmHg or the use of mechanical ventilation; WBC >12000/mm(3) or <4000/mm(3) or more than 10% immature neutrophil count. MELD was calculated as: MELD = 3.8 [Ln serum bilirubin (mg/dl)] +11.2 [Ln INR] +9.6 [Ln serum creatinine (mg/dl)] +6.4. Hospital outcome was defined as death or hospital discharge. RESULTS A total of 109 cirrhotic patients between the ages of 14 to 84 (mean: 54.6 ±18.4) years were included. There were 65 (59%) male patients. Of the 109 patients, 76 (69.8%) were SIRS-negative and 33 (30.2%) were SIRS-positive. The mean calculated MELD score for all patients was 15.5. There was a correlation noted between SIRS and high serum creatinine levels (p=0.01) and between SIRS and a high MELD score (p=0.00). During follow-up 19 (17.4%) patients died. SIRS was correlated with death (p<0.00) on multivariate analysis, SIRS was independently associated with hospital death. CONCLUSION SIRS is a relatively frequent event in cirrhotic patients admitted to referral centers. It is closely related to the severity of liver disease as shown by the MELD score. SIRS independently and adversely affects the in-hospital outcome in patients with liver cirrhosis.
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Affiliation(s)
- Ramin Behroozian
- 1Department of Gastroenterology, Emam Hospital, Orumieh University of Medical Sciences, Orumieh, Iran
,Corresponding Author:Ramin Behroozian, MD Department of Gastroenterology, Emam Hospital, Orumieh University of Medical Sciences, Orumieh, Iran
| | - Mehrdad Bayazidchi
- 1Department of Gastroenterology, Emam Hospital, Orumieh University of Medical Sciences, Orumieh, Iran
| | - Javad Rasooli
- 1Department of Gastroenterology, Emam Hospital, Orumieh University of Medical Sciences, Orumieh, Iran
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