Predictor of 30-day mortality in elderly patients with nursing-home acquired pneumonia at the emergency department

Objective@#This study evaluated the usefulness, as a risk factor of 30-day mortality, in patients residing in nursing-homes (NHs) or long-term care facilities with the diagnosis of pneumonia. @*Methods@#We conducted a retrospective study in a public hospital between January 2017 and December 2017. The subjects included elderly patients residing in NHs and diagnosed with pneumonia in the emergency room. Data on age, gender, comorbidities, laboratory findings, pneumonia severity index score (PSI), and CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and Age 65 or older) were entered into an electronic database. @*Results@#A total of 439 patients were enrolled during the study period. The mean age was 82.1±8.0 years; 195 (44.4%) were men, and 30-day mortality was 21.8%. On multivariate Cox proportional hazard analysis, cerebrovascular accidents (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.33-0.87; P=0.012), chronic renal disease (HR, 2.28; 95% CI, 1.11-4.67; P=0.024), malignancy (HR, 1.69; 95% CI, 1.04-2.76; P=0.034), lactate (HR, 1.02; 95% CI, 1.01-1.03; P<0.001), albumin (HR, 0.52; 95% CI, 0.36-0.73; P<0.001), and red cell distribution width (RDW; HR, 1.11; 95% CI, 1.03- 1.19; P=0.007) were independently associated with 30-day mortality. Areas under the curve of PSI, RDW, albumin, lactate, and PSI+RDW+albumin+lactate were 0.690 (95% CI, 0.629-0.751), 0.721 (95% CI, 0.666-0.775), 0.668 (95% CI, 0.607-0.728), 0.661 (95% CI, 0.597-0.726), and 0.801 (95% CI, 0.750-0.852), respectively. @*Conclusion@#RDW, albumin, lactate and especially the combination of PSI and these factors appear to be major determinants of 30-day mortality in NH residents with pneumonia.

Analysis of characteristics of patients who come to ‘emergency medical center via one-stop treat system for heavily drunken people’

Objective@#This study described the effectiveness of the one-stop treat system (OTS) and the improvements characterizing the patients who come to an emergency medical center via the one-stop treat system for heavily drunken people @*Methods@#An observational retrospective study was conducted on patients, aged 19 years or older, who visited the emergency department (ED) from January 2014 to December 2017 with alcohol intoxication (AI). The subjects were divided into two groups, that is, AI patients who come to ED directly or those who came via OTS. We compared and analyzed the characteristics of two groups including gender, age, date, mode of the ED visit, level of consciousness, diagnosis, ED length of stay (LOS), hospital LOS, and final outcomes. @*Results@#A total of 8,144 patients were enrolled in the study. There were 2,221 AI patients who visited ED directly and 5,923 AI patients who visited ED via OTS. Patients arriving via OTS had more medical or surgical problems than the patients who came directly from the ED. Discharged patients via OTS showed a longer ED LOS (312 minutes [range, 169-520 minutes], P<0.001). Compared with patients who came directly from ED, the patients via OTS showed a higher admission rate (10.7% vs. 3.4%, respectively; P<0.001), and a higher death rate in ED (0.6% vs. 0%, respectively; P<0.001). @*Conclusion@#Compared the characteristics of the patients from ED directly in 2014-2017, the patients via OTS had higher severity and admission rate, and a longer ED LOS. Our findings suggest that we should pay attention to patients via OTS because the patients have high severity of illness.

Analysis of Delayed Arrival Time According to the Residences Type of Elderly Acute Ischemic Stroke Patients

PURPOSE: We made a clinical comparison of elderly patients from home and residential aged care facilities (RACFs) who visited the emergency department and were hospitalized with acute ischemic stroke. In addition, we investigated the factors associated with prehospital delay in acute ischemic stroke. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2016. Information regarding the patients was registered including gender, age, comorbidities, symptoms at onset, use of emergency medical services, National Institute of Health Stroke Scale (NIHSS) at the emergency department, symptom-to-door time, etc. Characteristics of the patients were analyzed and logistic regression analysis was conducted to identify factors associated with symptom-to-door time. RESULTS: A total of 402 patients were enrolled during the study period. Overall, 339 elderly patients visited from home and 63 patients from RACFs, and patients from home were divided into two groups, living with family (n=274) and living alone (n=65). Patients from RACFs were older (≤0.001) and had higher NIHSS (p=0.007) than patients from home, but there were no significant relationships between symptom-to-door time and age (p=0.525), NIHSS (p=0.428). There was no difference in symptom-to-door time between patients living with family and patients from RACFs, but patients living alone had delayed symptom-to-door time (p < 0.001). CONCLUSION: Elderly patients living alone were among the three groups that had the most delayed symptom-to-door time. Therefore, it is necessary to expand and supplement support for elderly patients living alone, as well as to improve education regarding acute ischemic stroke.

The Relationship between the Number of Community Acquired Pneumonia Patients and the Weather among the Patients Who Visit ER: A Poisson Regression with Variable Selection Via Elastic net

PURPOSE: This study shows the relationship between meteorological factors and the number of community acquired pneumonia (CAP) patients in the emergency room and lag effect of meteorological factors affecting CAP. METHODS: A retrospective study was conducted. Patients diagnosed with CAP in the emergency room between January 2012 and December 2014 were enrolled. The patients were over 18 years old and lived in Seoul, Korea. Meteorological factors (highest daily temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine, and powdery dust under 10 microg/m3 (PM10)) between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. Multiple Poisson regression (Generalized Linear Model) was used with daily patient's number of CAP as the response variable and meteorological factors as the explanatory variable. Variable selection was performed via Elastic net. RESULTS: A total of 568 CAP patients were checked. Highest temperature (before 6 days), rainfall (before 1 day), relative humidity (before 20, 15, 13, 6, 2, and 1 days), and PM10 (before 27, 24, 17, and 13 days) showed relationship and lag effect with the incidence of CAP. CONCLUSION: This study showed that meteorological factors (highest temperature, rainfall, relative humidity, and PM10) had relationship and lag effect with the incidence of CAP. We can make a prediction model with health weather index for prevention of CAP and redistribution of medical facilities and resources.