Academic literature on the topic 'Poor outcomes after hospital admission'
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Journal articles on the topic "Poor outcomes after hospital admission"
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Kim, Hyo Joon, Kurz Michael, Jung Hee Wee, Joo Suk Oh, Won Young Kim, In Soo Cho, Mi Jin Lee, Dong Hun Lee, Yong Hwan Kim, and Chun Song Youn. "Coagulation measures after cardiac arrest (CMACA)." PLOS ONE 18, no. 1 (January 6, 2023): e0279653. http://dx.doi.org/10.1371/journal.pone.0279653.
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Background During cardiac arrest (CA) and after cardiopulmonary resuscitation, activation of blood coagulation and inadequate endogenous fibrinolysis occur. The aim of this study was to describe the time course of coagulation abnormalities after out-of-hospital CA (OHCA) and to examine the association with clinical outcomes in patients undergoing targeted temperature management (TTM) after OHCA. Methods This prospective, multicenter, observational cohort study was performed in eight emergency departments in Korea between September 2018 and September 2019. Laboratory findings from hospital admission and 24 hours after return of spontaneous circulation (ROSC) were analyzed. The primary outcome was cerebral performance category (CPC) at discharge, and the secondary outcome was in-hospital mortality. Results A total of 170 patients were included in this study. The lactic acid, prothrombin time (PT), activated partial thrombin time (aPTT), international normalized ratio (INR), and D-dimer levels were higher in patients with poor neurological outcomes at admission and 24 h after ROSC. The lactic acid and D-dimer levels decreased over time, while fibrinogen increased over time. PT, aPTT, and INR did not change over time. The PT at admission and D-dimer levels 24 h after ROSC were associated with neurological outcomes at hospital discharge. Coagulation-related factors were moderately correlated with the duration of time from collapse to ROSC. Conclusion The time-dependent changes in coagulation-related factors are diverse. Among coagulation-related factors, PT at admission and D-dimer levels 24 h after ROSC were associated with poor neurological outcomes at hospital discharge in patients treated with TTM.
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Guo, Rui, Ruiqi Chen, Chao You, Lu Ma, Hao Li, and Yuan Fang. "Glucose Levels and Outcome After Primary Intraventricular Hemorrhage." Current Neurovascular Research 16, no. 1 (May 13, 2019): 40–46. http://dx.doi.org/10.2174/1567202616666190131164108.
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Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.
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Song, Yue, Changqiang Yang, and Hua Wang. "Free Triiodothyronine Is Associated with Poor Outcomes after Acute Ischemic Stroke." International Journal of Clinical Practice 2022 (February 3, 2022): 1–6. http://dx.doi.org/10.1155/2022/1982193.
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Aims. It is unclear whether thyroid hormones are associated with functional outcomes after ischemic stroke. We aimed to investigate the impact of serum levels of thyroid hormones at admission on functional outcomes at 3 months after acute ischemic stroke. Methods. A total of 480 consecutive patients with ischemic stroke who were admitted to our hospital within 48 h of onset were enrolled. The levels of thyroid hormones, including thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine, were measured at admission, and functional outcomes were assessed at 3 months using the modified Rankin Scale (mRS), with scores ranging from 0 to 6. Poor outcome was defined as mRS score ≥3. Results. FT3 levels at admission were considerably lower in patients with poor outcomes than in those with good outcomes at 3 months (3.53 ± 0.70 pmol/L vs. 4.04 ± 0.68 pmol/L; P < 0.001 ). Lower FT3 levels were observed in patients with higher mRS scores. Multivariable logistic regression analysis revealed that FT3 levels were significantly associated with a risk of poor outcomes at 3 months, independent of conventional risk factors such as age, National Institutes of Health Stroke Scale score, and recanalized therapy. In addition, patients in FT3 levels in the lowest quartile had a 2.56-fold higher risk of poor outcomes than those with FT3 levels in the highest quartile (odds ratio = 2.56, 95% confidence interval = 1.15–5.69, P = 0.021 ). The sensitivity and specificity of FT3 level ≤3.69 pmol/L for predicting poor outcomes were 62.70% and 72.03%, respectively. Conclusion. Our study suggests that FT3 levels at admission are significantly and independently associated with a risk of poor outcomes after ischemic stroke and that lower FT3 levels can be considered as a prognostic biomarker for poor outcomes at 3 months.
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Keeble, Eilís, Helen C. Roberts, Christopher D. Williams, James Van Oppen, and Simon Paul Conroy. "Outcomes of hospital admissions among frail older people: a 2-year cohort study." British Journal of General Practice 69, no. 685 (July 15, 2019): e555-e560. http://dx.doi.org/10.3399/bjgp19x704621.
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Background‘Frailty crises’ are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty.AimTo determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status.Design and settingTwo populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 hours) and those following longer inpatient stays.MethodData for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data.ResultsMortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail.ConclusionIndividuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a ‘secondary prevention’ approach to frailty crises targeting individuals who are discharged from hospital.
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Gielen, Anneke, Kristine Koekkoek, Marijke van der Steen, Martijn-Looijen Looijen, and Arthur van Zanten. "Evaluation of the Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality." Western Journal of Emergency Medicine 22, no. 5 (September 2, 2021): 1132–38. http://dx.doi.org/10.5811/westjem.2021.6.50657.
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Introduction: Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. We aimed to evaluate associations between the initial EWS and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS). Methods: We performed a retrospective cohort study of adult patients admitted to a general hospital ward between July 1, 2014–December 31, 2017. Data were obtained from electronic health records (EHR). The primary outcome was in-hospital mortality. Secondary outcomes were ICU admission and hospital LOS. We categorized patients into three risk groups (low, medium or high risk of clinical deterioration) based on EWS. Descriptive analyses were used. Results: After applying inclusion and exclusion criteria, we included 53,180 patients for analysis. We found that the initial (low- vs high-risk) EWS was associated with an increased in-hospital mortality (1.5% vs 25.3%, P <0.001), an increased ICU admission rate (3.1% vs 17.6%, P <0.001), and an extended hospital LOS (4.0 days vs 8.0 days, P <0.001). Conclusion: Our findings suggest that an initial high-risk EWS in patients admitted to a general hospital ward was associated with an increased risk of in-hospital mortality, ICU admission, and prolonged hospital LOS. Close monitoring and precise documentation of the EWS in the EHR may facilitate predicting poor outcomes in individual hospitalized patients and help to identify patients for whom timely and adequate management may improve outcomes.
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de Carvalho, João José Freitas, Monique Bueno Alves, Georgiana Álvares Andrade Viana, Cícera Borges Machado, Bento Fortunato Cardoso dos Santos, Alberto Hideki Kanamura, Claudio Luiz Lottenberg, Miguel Cendoroglo Neto, and Gisele Sampaio Silva. "Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil." Stroke 42, no. 12 (December 2011): 3341–46. http://dx.doi.org/10.1161/strokeaha.111.626523.
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Background and Purpose— Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil. Methods— Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010. Results— We evaluated 2407 consecutive patients (mean age, 67.7±14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8–32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2–26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score ≤2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome. Conclusions— The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series. Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality.
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Zewudie, Ameha Zeleke, Tolcha Regasa, Solomon Hambisa, Dejen Nureye, Yitagesu Mamo, Temesgen Aferu, Desalegn Feyissa, and Tewodros Yosef. "Treatment Outcome and Its Determinants among Patients Admitted to Stroke Unit of Jimma University Medical Center, Southwest Ethiopia." Stroke Research and Treatment 2020 (December 30, 2020): 1–8. http://dx.doi.org/10.1155/2020/8817948.
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Background. Stroke is a public health problem in Ethiopia. Despite the high prevalence of stroke in Ethiopia, there is a paucity of data with regard to drug treatment, treatment outcome, and risk factors of poor treatment outcome of stroke. Hence, this study is aimed at assessing treatment outcome and its determinants among patients admitted to stroke unit of Jimma University Medical Center (JUMC). Methods. A two-year hospital-based retrospective cross-sectional study was employed to analyze the medical records of patients admitted with stroke to stroke unit of Jimma University Medical Centre from February 1st, 2016 to March 30th, 2018. Data was entered by Epidata manager version 4.0.2 and analyzed by SPSS version 24. Multivariable logistic regression analysis with the backward stepwise approach was done to identify independent predictors of poor treatment outcome of stroke. Variables with P value less than 0.05 were considered as statically significant determinants of poor treatment outcome. Results. Of 220 patients with stroke admitted to the Jimma University, 67.30% were male. Nearly two thirds (63.18%) of them had poor treatment outcomes. Dyslipidimics were administered to 60% of the patients, and the most popular antiplatelet used was aspirin, which was prescribed to 67.3% the patients. Age ≥ 65 adjusted odd ratio ((AOR): 2.56; 95% CI: 1.95-9.86, P = 0.001 ), presence of comorbidity (AOR: 5.25; 95% CI: 1.08-17.69, P < 0.001 ), admission with hemorrhagic stroke (AOR: 18.99; 95% CI: 7.05-42.07, P < 0.001 ), and admission to the hospital after 24 hour of stroke onset (AOR: 4.98; 95% CI: 1.09-21.91, P = 0.03 ) were independent predictors of poor treatment outcomes. Conclusion. Substantial numbers of stroke patients had poor treatment outcomes. Elderly patients, patients diagnosed with hemorrhagic stroke, patients with comorbidity, and those with delayed hospital admission were more likely to have poor treatment outcome. Hence, frequent monitoring and care should be given for the aforementioned patients. Awareness creation on the importance of early admission should be delivered particularly for patients who have risk factors of stroke (cardiovascular diseases).
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Bacha, Lensa Tamiru, Wase Benti Hailu, and Edosa Tesfaye Geta. "Clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College." SAGE Open Medicine 10 (January 2022): 205031212211460. http://dx.doi.org/10.1177/20503121221146068.
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Objective: Aim of the study was to assess the clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College. Methods: Hospital-based cross-sectional study was conducted using 242 randomly selected medical records of preterm neonates admitted to Adama comprehensive specialized hospital. Clinical outcome was categorized as poor if the neonate died or left against advice and good if discharged after improvement. Data were coded, entered into Epidata v.7.4.2 and exported to SPSS v.27 for analysis. After initial bi-variable logistic regression analysis, predictor variables with p-value of <0.2 were included in multivariable analysis. Significant association of factors with clinical outcome was claimed at p-value <0.05 and calculated 95% adjusted odds ratio. Results: Majority of admissions were male (63.2%), mean birth weight of 1440.3 g (+321.2 SD) and sepsis (82%), hypothermia (73%), and apnea (21.5%) were leading comorbidities. One hundred fifty-two (62.8%) of preterm neonates had poor outcomes. Neonates born singleton were 47% less likely to develop poor clinical outcomes (adjusted odds ratio 0.53 (0.48–0.94). The odds of poor clinical outcomes were higher during the first 3 days of admission (adjusted odds ratio 3.83 (3.28–14.77). Extremely preterm neonates (adjusted odds ratio 4.16 (4.01–12.97), extremely low birth weight preterm neonates had higher odds of poor clinical outcome. Conclusion: The study found higher poor clinical outcome among preterm neonates admitted with respiratory distress syndrome. Poor outcome was higher in lower gestational age, lower birth weight, twins and majority of it happened during 3 days of their life. Effective preventive care and initiation of low-cost, life-saving interventions including heated humidified high-flow nasal cannula and surfactant administration could significantly improve the clinical outcome of the neonates.
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Singh, Bhagteshwar, Suzannah Lant, Sofia Cividini, Jonathan W. S. Cattrall, Lynsey C. Goodwin, Laura Benjamin, Benedict D. Michael, et al. "Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis." PLOS ONE 17, no. 6 (June 2, 2022): e0263595. http://dx.doi.org/10.1371/journal.pone.0263595.
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Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Akram, Muhammad Junaid, Xinni Lv, Lan Deng, Zuoqiao Li, Tiannan Yang, Hao Yin, Xiaofang Wu, et al. "Off-Hour Admission Is Associated with Poor Outcome in Patients with Intracerebral Hemorrhage." Journal of Clinical Medicine 12, no. 1 (December 21, 2022): 66. http://dx.doi.org/10.3390/jcm12010066.
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The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at the First Affiliated Hospital of Chongqing Medical University. Acute ICH within 72 h after onset with a baseline computed tomography and 3-month follow-up were included in our study. Multivariable logistic regression analysis was performed for calculating the odds ratios (OR) and 95% confidence interval (CI) for the outcome measurements. Of the 656 participants, 318 (48.5%) were admitted during on-hours, whereas 338 (51.5%) were admitted during off-hours. Patients with a poor outcome had a larger median baseline hematoma volume, of 27 mL (interquartile range 11.1–53.2 mL), and a lower median time from onset to imaging, of 2.8 h (interquartile range 1.4–9.6 h). Off-hour admission was significantly associated with a poor functional outcome at 3 months, after adjusting for cofounders (adjusted OR 2.17, 95% CI 1.35–3.47; p = 0.001). We found that patients admitted during off-hours had a higher risk of poor functional outcomes at 3 months than those admitted during working hours.
Dissertations / Theses on the topic "Poor outcomes after hospital admission"
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King, Rosie. "'What is going to happen to me now?’: systemic uncertainty and complexity between hospital and home for older people, people with disability, carers and service providers." Thesis, 2010. http://hdl.handle.net/2440/64112.
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The focus of this thesis is on the impact that a hospital admission can have on the continuing ability of Home and Community Care¹ (HACC) clients (older people and people with disability) to remain living in their home. Of concern to HACC service providers were their clients' readmissions to hospital and/or unnecessary institutionalisation after hospitalisation. Both events were considered poor outcomes by HACC service providers. The desire to improve these poor outcomes and to alleviate discontinuous care led the HACC program to fund a project in Adelaide, which I undertook as action research.
In this thesis I investigated how poor outcomes could be avoided and continuity of care improved in the South Australian hospital and HACC systems. A literature review revealed that population ageing, the demand and resource pressures on acute hospitals and community services and the paucity of discharge planning were factors leading to discontinuity of care of older people and people with disability, as well as impacting on their carers. Theoretical perspectives first look at the divisions between the biomedical and social models of health, as well as the critiques of medical care and the role of bureaucracy put forward by iatrogenesis and medicalisation. Next, the theoretical lens turns to the lives of people, where the centrality of 'care' and interdependence are considered, along with the need to improve our understanding of the nature of vulnerability and the importance of resilience to moving beyond the dominant 'problem-based' discourse of ageing and disability.
Processes in the action research included two cyclical phases of making plans, embarking on actions and observing the results of the actions. Methods for collecting data included surveys (n=16 older patients and 10 carers), an evaluation (n=28), face-to-face interviews (n=52), one focus group (n=8), three Reference Groups (n=46), a workshop (n=14) and a nominal group (n=14). The interviews and surveys provided the opportunity to analyse the admission, hospitalisation and discharge issues for HACC clients and their carers from the perspectives of hospital nurses (n=19) and 33 community care providers. The latter participants were clinicians and case managers from domiciliary care² (n=23) and community nurses³ (n=10). These interviews were analysed thematically.
Results from the action research project yielded valuable research insights and successful actions which were reflexively planned, implemented and evaluated. The actions increased local linkages between the hospital and community service providers, collaboration, communication and access to information about the HACC program. Despite this, the action research project appeared to have little or no direct effect on avoiding poor outcomes or improving discontinuity of care. Such effects were more complex and beyond the scope of a project of this size. Achieving the necessary systems and structural changes to address these problems would have required more time, resources, capacity and leadership to be committed by government departments and the agencies.
The descriptive statistics of surveys with patients and carers and the key issues identified by the Reference Group supported triangulation of the interviews with domiciliary, community nursing and hospital participants. Findings from the interviews with domiciliary, community nursing and hospital participants point to uncertainty and complexity before, during and after hospitalisation of older people, people with disability, their carer/family, and also for service providers. Before admission to hospital there are four 'dimensions of uncertainty', and during hospitalisation, there were four categories which contributed to 'complexity in discharge planning'. When leaving hospital, 'adjustment and adaptation' highlights individual patients' and carer/families' adjustments. In addition, it points to the need/potential for service adaptation to support people's ability to return home. Putting these dimensions together, the main themes to emerge in this context are ‘systemic uncertainty and complexity'. In building upon these themes, I have developed a model of systemic uncertainty and complexity before, during and after hospital. Given this new knowledge about the context of uncertainty and complexity on the one hand, and adjustment and adaptation on the other, I conclude by considering the implications of these understandings for theory, policy and practice.
¹ The HACC program, funded jointly by the Australian, State and Territory governments, targets community-dwelling frail aged people, people with disability, and their carers, who in the absence of basic maintenance and support services are at risk of premature or inappropriate long-term residential care.
² Domiciliary care services are provided to older people (aged 65 years and over) and younger people with disability whose ability to care for themselves is reduced. Domiciliary care assists them to stay living in their own homes, by providing physical assistance, rehabilitation and personal care, as well as respite and support for carers. By promoting independence and improving quality of life for clients, domiciliary care services aim to prevent unnecessary admission into hospital or residential care.
³ Community nursing services provide community based health and care services, including rehabilitation, therapy and nursing care.Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2010
Book chapters on the topic "Poor outcomes after hospital admission"
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Fenner, Peter J. "Drowning." In Oxford Textbook of Medicine, edited by Jon G. Ayres, 1691–96. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0207.
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Drowning is a major preventable cause of death, most frequently in children and in developing countries. Aspiration (whether of salt or fresh water) is usual in drowning and near-drowning (known as non-fatal, or submersion injury) and leads to cardiac arrest within a few minutes. Death or severe neurological impairment occurs after submersion for more than 5–10 min, but much longer durations may be tolerated in hypothermic conditions. Prognosis cannot reliably be predicted, but cardiovascular status is a better prognostic indicator than neurological presentation. Patients who are neurologically responsive at the scene of immersion, in sinus rhythm and with reactive pupils, have good outcomes. Those who are asystolic on arrival at hospital and remain comatose for more than 3 h have a poor prognosis unless they are hypothermic. Patients with a normal chest radiograph on admission usually survive.
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Abcejo, Arnoley S., and Jeffrey J. Pasternak. "Cerebral Circulation and Cerebral Blood Flow." In Mayo Clinic Critical and Neurocritical Care Board Review, edited by Eelco F. M. Wijdicks, James Y. Findlay, William D. Freeman, and Ayan Sen, 79–85. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190862923.003.0010.
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Cardiac arrest occurs suddenly, often without premonitory symptoms. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow in the midst of complete hemodynamic collapse. Anoxic-ischemic brain injury is most commonly caused by cardiac arrest, which is frequently lethal; of the US patients with out-of-hospital cardiac arrest treated by emergency medical services, almost 90% die. Among the patients who survive to hospital admission, inpatient mortality may be decreasing, but a substantial number of those survivors have poor neurologic outcomes from anoxic-ischemic brain injury.
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van de Glind, Esther M. M., Barbara C. van Munster, and Marije E. Hamaker. "Cardiopulmonary resuscitation: outcomes and decision-making processes for older adults." In Oxford Textbook of Geriatric Medicine, 857–62. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198701590.003.0110.
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Cardiopulmonary resuscitation (CPR) was developed in the 1950s as a treatment for cardiopulmonary arrest. Outcome of CPR remains poor, particularly in older people, as demonstrated by two recent meta-analyses. The first addressed out-of-hospital resuscitation in patients aged 70 years and over, and found pooled overall rates of survival to discharge of 4.1%. For in-hospital resuscitation, the overall pooled rate of survival to discharge was 18.7% for patients aged 70–79 years, 15.4% for patients aged 80–89 years and 11.6% for those aged 90 or over. It is not clear if age alone is a limiting factor, or rather a marker of comorbidity. Overall, information about the quality of life after surviving CPR is lacking. Older patients should be adequately informed about their chances of survival in good condition in order to make a decision about the desirability of CPR.
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Bil, Cees, Silke Walter, Jonas Sauer, and Sebastian Feldmann. "Towards an Air Mobile Stroke Unit for Rapid Medical Response in Rural Australia." In Advances in Transdisciplinary Engineering. IOS Press, 2019. http://dx.doi.org/10.3233/atde190153.
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Stroke is highly treatable but time critical. The greatest opportunity to improve outcomes is in the first ‘Golden Hour’ after onset. Pre-hospital care for stroke in Australia is patchy and poorly coordinated, resulting in gross disparities in clinical outcomes between rural and urban Australians. Clinical outcomes are at least twice as poor for rural Australians compared to their urban counterparts. This paper discusses a transformative research program that investigates the technical feasibility of transporting a CT-scan device to the patient to determine the cause of stroke and initiate treatment immediately. This concept follows in the tradition of the Royal Flying Doctors Service who have been providing medical service to rural Australians since 1928.
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Chipperfield, David, Michael Cheesman, Cees Bil, and Greg Hanlon. "Transdisciplinary Design Aspects of an Air Mobile Stroke Unit." In Advances in Transdisciplinary Engineering. IOS Press, 2020. http://dx.doi.org/10.3233/atde200083.
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Stroke is highly treatable but time critical. The greatest opportunity to improve outcomes is in the first ‘Golden Hour’ after onset. Pre-hospital care for stroke in Australia is patchy and poorly coordinated, resulting in gross disparities in clinical outcomes between rural and urban Australians. Clinical outcomes are at least twice as poor for rural Australians compared to their urban counterparts. A proposed solution is an Air MSU, an aircraft configured for rapid response to stroke victims so that diagnosis and treatment can commence onsite. This concept follows the tradition of the Royal Flying Doctors Service who have been providing medical services to rural Australians since 1928. This paper discusses the conflicting medical and aerospace requirements for an aircraft equipped with a CT-scanner including supporting equipment and personnel.
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Lehoux, Juan M., and Giles J. Peek. "Extracorporeal Cardiopulmonary Resuscitation in Children." In Extracorporeal Membrane Oxygenation, edited by Marc O. Maybauer, 309–16. Oxford University Press, 2022. http://dx.doi.org/10.1093/med/9780197521304.003.0030.
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Pediatric veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was first used in the 1970s in patients with postcardiotomy shock. In the subsequent decades, improving outcomes in the postcardiac surgery patient have led to increased V-A ECMO use in ever-widening scenarios and for a variety of indications. Given the very poor outcomes of in-hospital cardiac arrest treated with traditional cardiopulmonary resuscitation (CPR) in children, extracorporeal cardiopulmonary resuscitation (ECPR) has become a viable treatment modality with improved survival to hospital discharge. Children in particular pose a significant therapeutic challenge given their variable size, weight, and wide-ranging etiology of the cardiac arrest. Favorable outcomes after ECPR depend on a wide range of factors, both patient and system dependent. Success depends on the establishment of a sound ECMO program, including established criteria for ECMO team activation, efficient mobilization of resources, standardized cannulation strategies and technique, evidence-based postimplant management protocol, including anticoagulation management, prompt complication management, and preestablished V-A ECMO weaning criteria. In conclusion, ECPR provides superior outcomes compared to traditional CPR. High morbidity and mortality remain a challenge, providing ample opportunity for continued improvement.
Conference papers on the topic "Poor outcomes after hospital admission"
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Garcia-Rivero, Juan Luis, Cristina Esquinas, Miriam Barrecheguren, Patricia Garcia-Sidro, Elsa Naval, Carlos Martinez, Rosa Malo de Molina, et al. "Risk factors of poor outcomes after admission for a COPD exacerbations. Multivariate logistic predictive models." In Annual Congress 2015. European Respiratory Society, 2015. http://dx.doi.org/10.1183/13993003.congress-2015.pa403.
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Nuñez, M. J., M. Mamchur, C. Chao, C. Rodriguez Flores, E. Pacheco, A. Tempone, K. Rabuñal, et al. "Respiratory Outcomes in COVID-19 patients 3-6 months after admission to Public Health Hospital Maciel. Montevideo, Uruguay. A Follow up Cohort Study." In ERS International Congress 2022 abstracts. European Respiratory Society, 2022. http://dx.doi.org/10.1183/13993003.congress-2022.2765.
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Akpa, B., S. Baveja, J. Ferris, J. Hecht, E. Heidel, and R. Dhand. "Relation of Subjective Assessment of Perceived Activity and Weakness Score (PAWS) to Health Outcomes Up to 90 Days After Hospital Admission for a Medical Illness." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a2068.
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Freire, Gabriel Praxedes, Juliana de Alencar Fontes, Gabriel Nascimento Silva, and Pedro Antonio Pereira de Jesus. "Association of pre-stroke hyperglycemia with hemorrhagic transformation in patients undergoing thrombolysis." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.628.
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Background: Hyperglycemia is a frequent finding in patients suffering from ischemic stroke. Hemorrhagic transformation is a complication associated with thrombolytic treatment, with poor prognosis. In addition, hyperglycemia and diabetes are related to worse outcomes in vascular events. Objective: This study aims to analyze the association between hyperglycemia at admission and hemorrhagic transformation in patients undergoing thrombolysis after ischemic stroke. Methods: A cross-sectional study was carried out with patients from the DISPASS cohort (DOI: 10.1161 / STROKEAHA.120.026425), admitted in a reference stroke unit in Salvador-BA. Those over 18 years of age who underwent thrombolysis with alteplase were included and patients without data on glycemic control or who did not meet the admission criteria in the cohort were excluded. Results: Of the 173 patients within the therapeutic window for thrombolysis, 14 underwent hemorrhagic transformation evidenced in computed tomography of the skull and, among these, only 04 presented with hyperglycemia at admission and beginning of thrombolytic treatment, which represented a non-important association (p <0.485) between hyperglycemia and hemorrhagic transformation after thrombolysis. Discussion and Conclusion: The findings are in line with what was reported by Olsen in 2009 and with what was expected, due to the known relationship between hyperglycemia and diabetes with hemorrhagic complications in patients who suffered a stroke. The present study found no association between the incidence of hemorrhagic transformations in patients with pre- thrombolysis hyperglycemia in a stroke context.
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Fontes, Juliana de Alencar, Gabriel Praxedes Freire, Gabriel Nascimento, and Pedro Antônio Pereira de Jesus. "Relationship between sodium disturbances on admission, stroke severity (NIHSS) and functional outcome (mRs)." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.648.
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Background: Hyponatremia is the most common electrolyte disturbance in hospitalized patients and is associated with several unfavorable outcomes, as it promotes cerebral edema and consequent intracranial hypertension. As isn’t clear if there is a causal relationship or if it is only a marker of severity, we described and analyzed the association between sodium disorders, especially hyponatremia, with the severity level of the stroke and the functional condition of discharge of these patients. Methods: We did a cross-sectional study with patients admitted to a stroke unit of a reference hospital in Salvador-Ba between 11/2017 and 03/2020 included in the DISPASS cohort. We classify hyponatremia as serum sodium 145mEq / L. To analyze the association between the variables, Fisher’s exact test was performed. Results: We analyzed 399 patients whose mean age was 62. The mean sodium on admission was 138.2 mEq / L, with 56 patients (14%) with hyponatremia and 11 (3%) with hypernatremia. Among those who had sodium disorders at admission (67), 32 had moderate NIHSS, 24 severe / very severe NIHSS and 11 had mild NIHSS. X² = 2.48, p = 0.443. In addition, of these 67 patients, 13 were discharged and still needed help in daily activities and to walk (mRs 4), 15 were discharged restricted to bed (mRs 5) and 6 died during hospitalization (mRs 6). Therefore, of the 17% who had sodium disorder at admission, more than half had a poor functional outcome. Among those who had hyponatremia (56), 35.7% (20) had severe / very severe stroke, 46.4% (26) had a moderate degree, while only 10 had a mild degree. X² = 1.91, p = 0.53. Conclusions: Although the Fisher Test did not show a significant association (p> 0.05), the frequencies of patients with sodium disorders at admission and classified as having high stroke severity were presented with relevant values, so it is important to carry out further studies to investigate the relationship of these variables.
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Pachnicki, Jan Pawel Andrade, Alice Soares Paes Giugliano Meschino, Fernanda Cristina Kilian, Gabriela Vanim de Moraes, and Sarah Oliveira de Lima. "PUERPERAL MASTITIS COMPLICATED WITH MYIASIS: A CASE REPORT." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1083.
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Introduction: Puerperal mastitis is an inflammatory process of the mammary gland that affects women during lactation, due to stasis in the mammary ducts. The clinical findings vary from focal inflammation to abscesses when not treated early. Additional complications may arise, such as tissue loss by necrosis, leading to the appearance of opportunistic diseases. Myiasis consists of appearance of fly larvae in these tissues, a rare condition in humans. When in cutaneomucosal area, there are complaints of intense pruritus and local pain. The authors seeked to correlate the clinical aspects of puerperal mastitis with breast involvement by myiasis, aiming at the importance of early management and treatment of these pathologies. Case report: A 23-year-old patient, GIV PIII, was admitted to a maternity hospital in Paraná, Brazil, with mastitis. The day after the admission, under treatment with Oxacillin, she evolved to natural birth. During the immediate puerperium, abscedation was observed, and surgical drainage was indicated. The patient refused to be submitted to the procedure and evaded the hospital. One week later, she returned with an engorged, edematous and hyperemic right breast, with fluctuation point at 2h and spontaneous drainage of purulent secretion, in addition to a subareolar hematoma. The patient was submitted to drainage, surgical debridement, removal of the myiasis larvae noticed in the mammary tissue, and placement of a drain. Material sent for culture demonstrated growth of Staphylococcus epidermidis; deescalating broad-spectrum antibiotic regimen started empirically when she was admitted, associated with Ivermectin and Cabergoline. She presented a satisfactory response of the inflammatory process, though dehiscence of the surgical wound occurred, and she was submitted to reconstruction with breast flap during reoperation. The diagnosis of mastitis is based on breast tenderness, local flogistic signs, decreased lactopoiesis, associated with fever and fatigue, and among its serious complications is the breast abscess. The patient presented a unilateral mastitis complaining of pain, edema, local heat and hyperemia, in addition to periareolar purulent discharge and abscedation, suggesting complicated puerperal mastitis. However, because the case was not immediately resolved, the clinical situation deteriorated, with perimammary necrosis and myiasis. The necrosed tissue facilitated the penetration of larvae, a determining factor for this co-infection. It is prevalent in developing countries with poor sanitary conditions, and open wounds or necrosis are more favorable for the growth of larvae. It is necessary to emphasize the importance of good personal hygiene and adequate clothes’ washing, especially in endemic areas of myiasis, to avoid this complication and its late diagnosis.