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2.
J Burn Care Res ; 42(2): 135-140, 2021 03 04.
Article in English | MEDLINE | ID: covidwho-2152044

ABSTRACT

Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.


Subject(s)
Burns/epidemiology , COVID-19/epidemiology , Intensive Care Units/organization & administration , Length of Stay/statistics & numerical data , Adolescent , Adult , Burn Units/organization & administration , Burns/therapy , Child , Child, Preschool , Emergency Service, Hospital/organization & administration , Female , Forecasting , Humans , Infant , Israel , Male , Retrospective Studies , Treatment Outcome
3.
Pediatr Neonatol ; 63(6): 565-566, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2150407
4.
West J Emerg Med ; 23(6): 811-816, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2144842

ABSTRACT

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic caused significant disruptions in daily life. Given the role that social determinants of health play in the overall well-being of individuals and populations, we wanted to determine the effects of the COVID-19 pandemic on our patient population in the emergency department (ED). METHODS: We adapted the Centers for Medicare and Medicaid Services social risk assessment to assess changes to participants' social situations throughout the COVID-19 pandemic from January 2020-February 2021. The survey was administered within the ED to individuals selected by a convenience sample of patients who were stable enough to complete the form. RESULTS: We received 200 (66%) responses from the 305 patients approached. Worsened food access was reported by 8.5% (17) of respondents, while 13.6% (27) reported worsened food concern since the onset of the COVID-19 pandemic. The odds of worsened food access were higher among non-Whites (adjusted odds ratio [aOR] 19.17, 95% confidence interval [CI] 3.33-110.53) and females (aOR 9.77, CI 1.51-63.44). Non-Whites had greater odds of worsened food concern (aOR 15.31, CI 3.94-59.54). Worsened financial difficulty was reported by 24% (48) of respondents. The odds of worsened financial difficulty were higher among females (aOR 2.87, 95% CI 1.08-7.65) and non-Whites (aOR 10.53, CI 2.75-40.35). CONCLUSION: The COVID-19 pandemic has worsened many of the social determinants of health found within communities. Moreover, vulnerable communities were found to be disproportionately affected as compared to their counterparts. Understanding the challenges faced by our patient populations can serve as a guide on how to assist them more comprehensively.


Subject(s)
COVID-19 , Pandemics , Aged , United States/epidemiology , Female , Humans , Social Determinants of Health , COVID-19/epidemiology , Medicare , Emergency Service, Hospital
5.
West J Emerg Med ; 23(6): 794-801, 2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2144841

ABSTRACT

INTRODUCTION: The decision to discharge a patient from the hospital with confirmed or suspected coronavirus 2019 (COVID-19) is fraught with challenges. Patients who are discharged home must be both medically stable and able to safely isolate to prevent disease spread. Socioeconomically disadvantaged patient populations in particular may lack resources to safely quarantine and are at high risk for COVID-19 morbidity. METHODS: We developed a telehealth follow-up program for emergency department (ED) patients who received testing for COVID-19 from April 24-June 29, 2020 and were discharged home. Patients who were discharged with a pending COVID-19 test received follow-up calls on Days 1, 4, and 8. The objective of our program was to screen and provide referrals for health-related social needs (HRSN), conduct clinical screening for worsening symptoms, and deliver risk-reduction strategies for vulnerable individuals. We conducted retrospective chart reviews on all patients in this cohort to collect demographic information, testing results, and outcomes of clinical symptom and HRSN screening. Our primary outcome measurement was the need for clinical reassessment and referral for an unmet HRSN. RESULTS: From April 24-June 29, 2020, we made calls to 1,468 patients tested for COVID-19 and discharged home. On Day 4, we reached 67.0% of the 1,468 patients called. Of these, 15.9% were referred to a physician's assistant (PA) out of concern for clinical worsening and 12.4% were referred to an emergency department (ED) patient navigator for HRSNs. On Day 8, we reached 81.8% of the 122 patients called. Of these, 19.7% were referred to a PA for clinical reassessment and 14.0% were referred to an ED patient navigator for HRSNs. Our intervention reached 1,069 patients, of whom 12.6% required referral for HRSNs and 1.3% (n = 14) were referred to the ED or Respiratory Illness Clinic due to concern for worsening clinical symptoms. CONCLUSION: In this patient population, the demand for interventions to address social needs was as high as the need for clinical reassessment. Similar ED-based programs should be considered to help support patients' interdependent social and health needs beyond those related to COVID-19.


Subject(s)
COVID-19 , Clinical Deterioration , Humans , Patient Discharge , Retrospective Studies , Health Inequities , COVID-19 Testing , Emergency Service, Hospital
6.
West J Emerg Med ; 23(6): 893-896, 2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2144840

ABSTRACT

INTRODUCTION: The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PED) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models. METHODS: We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based questionnaire. The survey was sent via three national pediatric emergency medicine distribution lists, with several follow-up reminders. RESULTS: There were 46 questionnaires included, completed by PED directors from 25 states. Forty-two sites provided PED volume and admission data for the early pandemic (March-July 2020) and a pre-pandemic comparison period (March-July 2019). Mean PED volume decreased >32% for each studied month, with a maximum mean reduction of 63.6% (April 2020). Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020. During the study period, 33 (71.1%) sites had decreased clinician staffing at some point. Only three sites (6.7%) reported decreased faculty protected time. All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between the PED and other units, and added tele-visit shifts. Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (interquartile ratio 25-28). Of 44 sites hosting medical trainees, 37 (84.1%) reported a decrease in number of trainees or elimination altogether. Thirty (68.2%) sites had restrictions on patient care provision by trainees: 28 (63.6%) affected medical students, 12 (27.3%) affected residents, and two (4.5%) impacted fellows. Fifteen sites (34.1%) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%). CONCLUSION: This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models. During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellows' experience largely preserved. Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.


Subject(s)
COVID-19 , Students, Medical , United States/epidemiology , Humans , Child , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Emergency Service, Hospital
7.
West J Emerg Med ; 23(6): 897-906, 2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2144839

ABSTRACT

INTRODUCTION: Few studies have investigated the management of COVID-19 cases from the operational perspective of the emergency department (ED), We sought to compare the management and outcome of COVID-19 positive and negative patients who presented to French EDs. METHODS: We conducted a prospective, multicenter, observational study in four EDs. Included in the study were adult patients (≥18 years) between March 6-May 10, 2020, were hospitalized, and whose presenting symptoms were evocative of COVID-19. We compared the clinical features, management, and prognosis of patients according to their confirmed COVID-19 status. RESULTS: Of the 2,686 patients included in this study, 760 (28.3%) were COVID-19 positive. Among them, 364 (48.0%) had hypertension, 228 (30.0%) had chronic cardiac disease, 186 (24.5%) had diabetes, 126 (16.6%) were obese, and 114 (15.0%) had chronic respiratory disease. The proportion of patients admitted to intensive care units (ICU) was higher among COVID-19 positive patients (185/760, 24.3%) compared to COVID-19 negative patients (206/1,926, 10.7%; P <0.001), and they required mechanical ventilation (89, 11.9% vs 37, 1.9%; P <0.001) and high-flow nasal cannula oxygen therapy (135, 18.1% vs 41, 2.2%; P < 0.001) more frequently. The in-hospital mortality was significantly higher among COVID-19 positive patients (139, 18.3% vs 149, 7.7%; P <0.001). CONCLUSION: Emergency departments were on the frontline during the COVID-19 pandemic and had to manage potential COVID-19 patients. Understanding what happened in the ED during this first outbreak is crucial to underline the importance of flexible organizations that can quickly adapt the bed capacities to the incoming flow of COVID-19 positive patients.


Subject(s)
COVID-19 , Adult , Humans , COVID-19/epidemiology , COVID-19/therapy , Prospective Studies , Cohort Studies , Pandemics , Emergency Service, Hospital , Disease Outbreaks
8.
BMC Emerg Med ; 22(1): 181, 2022 11 18.
Article in English | MEDLINE | ID: covidwho-2139147

ABSTRACT

INTRODUCTION: Overcrowding in the Emergency Department (ED) is one of the major issues that must be addressed in order to improve the services provided in emergency circumstances and to optimize their quality. As a result, in order to help the patients and professionals engaged, hospital organizations must implement remedial and preventative measures. Overcrowding has a number of consequences, including inadequate treatment and longer hospital stays; as a result, mortality and the average duration of stay in critical care units both rise. In the literature, a number of indicators have been used to measure ED congestion. EDWIN, NEDOCS and READI scales are considered the most efficient ones, each of which is based on different parameters regarding the patient management in the ED. METHODS: In this work, EDWIN Index and NEDOCS Index have been calculated every hour for a month period from February 9th to March 9th, 2020 and for a month period from March 10th to April 9th, 2020. The choice of the period is related to the date of the establishment of the lockdown in Italy due to the spread of Coronavirus; in fact on 9 March 2020 the Italian government issued the first decree regarding the urgent provisions in relation to the COVID-19 emergency. Besides, the Pearson correlation coefficient has been used to evaluate how much the EDWIN and NEDOCS indexes are linearly dependent. RESULTS: EDWIN index follows a trend consistent with the situation of the first lockdown period in Italy, defined by extreme limitations imposed by Covid-19 pandemic. The 8:00-20:00 time frame was the most congested, with peak values between 8:00 and 12:00. on the contrary, in NEDOCS index doesn't show a trend similar to the EDWIN one, resulting less reliable. The Pearson correlation coefficient between the two scales is 0,317. CONCLUSION: In this study, the EDWIN Index and the NEDOCS Index were compared and correlated in order to assess their efficacy, applying them to the case study of the Emergency Department of "San Giovanni di Dio e Ruggi d'Aragona" University Hospital during the Covid-19 pandemic. The EDWIN scale turned out to be the most realistic model in relation to the actual crowding of the ED subject of our study. Besides, the two scales didn't show a significant correlation value.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Emergency Service, Hospital , Prospective Studies , Communicable Disease Control
9.
BMJ Open Qual ; 11(4)2022 11.
Article in English | MEDLINE | ID: covidwho-2137805

ABSTRACT

BACKGROUND: In response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system. METHODS: All patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention. RESULTS: During the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA's use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time. CONCLUSIONS: EMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.


Subject(s)
COVID-19 , Hepatitis A , Influenza Vaccines , Humans , Electronic Health Records , Hepatitis A/epidemiology , Hepatitis A/prevention & control , SARS-CoV-2 , Vaccination , Disease Outbreaks/prevention & control , Emergency Service, Hospital
10.
Pediatr Neonatol ; 63(6): 633-641, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2132061

ABSTRACT

BACKGROUND: Singapore was one of the first countries to begin COVID-19 vaccination with the BNT162b2 vaccine for adolescents aged 12-18 years. This study evaluates the incidence of COVID-19 vaccine related attendances to a Pediatric Emergency Department (PED) to understand post-vaccination health behaviors among adolescents. METHODS: This was a retrospective review of electronic medical records over a 4 month period, from the start of the adolescent vaccination drive to when more than 85% of this group had been fully vaccinated. RESULTS: The incidence of COVID-19 vaccination-related presentations to our PED was 3.1% over 4 months (291 of 9387 PED attendances), with a peak daily incidence of 15.4% (14 of 91 attendances). Presentations were characterized by severity into: severe (3.4%), moderate (7.9%) or mild (88.7%) based on predefined criteria. The most common presenting complaints were chest pain (58.8%), dyspnea (28.2%) and palpitations (22.6%). Hospitalization was required in only 6.2% of attendances. Patients with moderate-severe presentations were 0.7 years older (p = 0.030), more likely to have underlying drug allergies (p = 0.048) and had higher rates of hospitalization (p < 0.005) compared to mild presentations. Despite concerns of cardiac inflammation, chest pain related attendances were less likely to be severe (p < 0.005) with reduced hospitalization need (p = 0.043) compared to other presentations. Investigations beyond clinical assessment comprised 91% of attendances, but abnormalities were only found in 6.4% cases. CONCLUSION: Our study supports current evidence that COVID-19 vaccination is safe amongst adolescents. We highlight the health behaviors among adolescents post-vaccination, which is partly driven by media reports on vaccine side effects and an element of anxiety. While most of the presentations were mild, these can have implications on health resource utilization, particularly in an ongoing pandemic. As healthcare workers, we have an ongoing role to ensure accurate information on vaccine safety is communicated effectively to the public.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adolescent , Child , Humans , BNT162 Vaccine , Chest Pain/chemically induced , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Emergency Service, Hospital , Singapore/epidemiology , Vaccination/adverse effects , Retrospective Studies
11.
Enferm Infecc Microbiol Clin (Engl Ed) ; 40(9): 503-506, 2022 11.
Article in English | MEDLINE | ID: covidwho-2130676

ABSTRACT

INTRODUCTION: The objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. METHODS: Retrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. RESULTS: A notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DISCUSSION: The reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.


Subject(s)
COVID-19 , Humans , Child , Pandemics , Tertiary Care Centers , SARS-CoV-2 , Emergencies , Retrospective Studies , Emergency Service, Hospital , Hospitalization
12.
Clin Microbiol Infect ; 28(12): 1651.e1-1651.e8, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2130467

ABSTRACT

OBJECTIVES: Emergency departments (EDs) were on the front line for the diagnostic workup of patients with COVID-19-like symptoms during the first wave. Chest imaging was the key to rapidly identifying COVID-19 before administering RT-PCR, which was time-consuming. The objective of our study was to compare the costs and organizational benefits of triage strategies in ED during the first wave of the COVID-19 pandemic. METHODS: We conducted a retrospective study in five EDs in France, involving 3712 consecutive patients consulting with COVID-like symptoms between 9 March 2020 and 8 April 2020, to assess the cost effectiveness of imaging strategies (chest radiography, chest computed tomography (CT) scan in the presence of respiratory symptoms, systematic ultra-low-dose (ULD) chest CT, and no systematic imaging) on ED length of stay (LOS) in the ED and on hospital costs. The incremental cost-effectiveness ratio was calculated as the difference in costs divided by the difference in LOS. RESULTS: Compared with chest radiography, workup with systematic ULD chest CT was the more cost-effective strategy (average LOS of 6.89 hours; average cost of €3646), allowing for an almost 4-hour decrease in LOS in the ED at a cost increase of €98 per patient. Chest radiography (extendedly dominated) and RT-PCR with no systematic imaging were the least effective strategies, with an average LOS of 10.8 hours. The strategy of chest CT in the presence of respiratory symptoms was more effective than the systematic ULD chest CT strategy, with the former providing a gain of 37 minutes at an extra cost of €718. DISCUSSION: Systematic ULD chest CT for patients with COVID-like symptoms in the ED is a cost-effective strategy and should be considered to improve the management of patients in the ED during the pandemic, given the need to triage patients.


Subject(s)
COVID-19 , Pandemics , Humans , COVID-19/diagnosis , Cost-Benefit Analysis , Retrospective Studies , Emergency Service, Hospital
13.
Skeletal Radiol ; 51(12): 2359-2370, 2022 12.
Article in English | MEDLINE | ID: covidwho-2128588
14.
Tijdschr Gerontol Geriatr ; 52(4)2021 Dec 07.
Article in Dutch | MEDLINE | ID: covidwho-2146516

ABSTRACT

The use of telemedicine (telephone and video consultations) has increased over the past decades and has grown substantially during the COVID-19 pandemic. Multimorbidity, visual - and hearing impairment, cognitive impairment and lack of technical skills might complicate the use of telemedicine in frail elderly patients. Limited research on this topic is has been performed. The aim of this article is to investigate which elements of care could be performed by telemedicine and what patient characteristics are useful in selecting patients for telemedicine. To get more information about the use of telemedicine in frail elderly patients, an online survey was conducted amongst caregivers working in geriatric outpatient care departments in the Netherlands. 67 caregivers completed the survey. The results indicate there is limited experience in video consultations in this population. The experience so far is mainly positive. Caregivers indicate the following elements of care could be performed by telemedicine: follow-up consultations, taking an (hetero)anamnesis, medication review, conversations with multiple contacts or caregivers and informing about test results. Our advice is to decide in dialogue with patient and caregiver, which form of consultation is feasible, desirable and appropriate for every individual process and consultation.


Subject(s)
COVID-19 , Telemedicine , Humans , Aged , Caregivers , Outpatients , Frail Elderly , Netherlands , Pandemics , Emergency Service, Hospital , COVID-19/epidemiology , Telemedicine/methods
15.
J Med Life ; 15(10): 1294-1298, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2146201

ABSTRACT

The study aimed to assess the frequency of neurological presentations of pediatric COVID-19 patients and compare the clinical and laboratory characteristics and the outcomes of those who presented with neurological complaints and those without complaints. A cross-sectional study enrolled 84 children diagnosed with COVID-19 at the emergency department over 12 months. All previously healthy children with a laboratory-confirmed diagnosis of COVID-19 were included in the study. The diagnosis of COVID-19 was made by positive PCR of a nasopharyngeal swab. Patients were divided into 2 groups: group 1 included COVID-19 patients with neurological complaints, and group 2 included COVID-19 patients with non-neurological complaints. Demographical, clinical, and laboratory characteristics were compared among groups. During the study period, 84 children aged 2 months-15years were diagnosed with COVID-19. Only 17 patients (20.2%) presented with new-onset neurological complaints. Seizure was the most common neurological complaint (58.8%), and febrile convulsion was the most frequent diagnosis of COVID-19 patients with neurological presentation (47.1%). C-reactive protein (CRP) and duration of hospitalization were higher in patients with neurological presentations, with P values of 0.002 and 0.001, respectively. All patients with neurological complaints survived the acute illness. Neurological symptoms were present in 20% of the COVID-19 pediatric patients, having higher CRP than patients with non-neurological presentations. CRP can be used as a reliable indicator for neurological symptoms in COVID-19 pediatric patients.


Subject(s)
COVID-19 , Child , Humans , COVID-19/complications , COVID-19/diagnosis , Cross-Sectional Studies , Hospitalization , Emergency Service, Hospital , C-Reactive Protein
17.
PLoS One ; 17(11): e0276055, 2022.
Article in English | MEDLINE | ID: covidwho-2119161

ABSTRACT

BACKGROUND: During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. MATERIALS AND METHODS: We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. RESULTS: Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers' journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived "overwhelmed" NHS by speaking to trusted sources, predominantly general practitioners (GPs). CONCLUSION: Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child's health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.


Subject(s)
COVID-19 , Caregivers , Humans , Child , COVID-19/epidemiology , Pandemics , State Medicine , Emergency Service, Hospital
19.
N Engl J Med ; 387(19): 1759-1769, 2022 11 10.
Article in English | MEDLINE | ID: covidwho-2112693

ABSTRACT

BACKGROUND: Invasive mechanical ventilation in critically ill adults involves adjusting the fraction of inspired oxygen to maintain arterial oxygen saturation. The oxygen-saturation target that will optimize clinical outcomes in this patient population remains unknown. METHODS: In a pragmatic, cluster-randomized, cluster-crossover trial conducted in the emergency department and medical intensive care unit at an academic center, we assigned adults who were receiving mechanical ventilation to a lower target for oxygen saturation as measured by pulse oximetry (Spo2) (90%; goal range, 88 to 92%), an intermediate target (94%; goal range, 92 to 96%), or a higher target (98%; goal range, 96 to 100%). The primary outcome was the number of days alive and free of mechanical ventilation (ventilator-free days) through day 28. The secondary outcome was death by day 28, with data censored at hospital discharge. RESULTS: A total of 2541 patients were included in the primary analysis. The median number of ventilator-free days was 20 (interquartile range, 0 to 25) in the lower-target group, 21 (interquartile range, 0 to 25) in the intermediate-target group, and 21 (interquartile range, 0 to 26) in the higher-target group (P = 0.81). In-hospital death by day 28 occurred in 281 of the 808 patients (34.8%) in the lower-target group, 292 of the 859 patients (34.0%) in the intermediate-target group, and 290 of the 874 patients (33.2%) in the higher-target group. The incidences of cardiac arrest, arrhythmia, myocardial infarction, stroke, and pneumothorax were similar in the three groups. CONCLUSIONS: Among critically ill adults receiving invasive mechanical ventilation, the number of ventilator-free days did not differ among groups in which a lower, intermediate, or higher Spo2 target was used. (Supported by the National Heart, Lung, and Blood Institute and others; PILOT ClinicalTrials.gov number, NCT03537937.).


Subject(s)
Critical Illness , Oxygen , Respiration, Artificial , Adult , Humans , Critical Illness/therapy , Hospital Mortality , Intensive Care Units , Oxygen/administration & dosage , Oxygen/blood , Oxygen/therapeutic use , Respiration, Artificial/methods , Critical Care/methods , Cross-Over Studies , Emergency Service, Hospital , Academic Medical Centers , Oximetry
20.
Bratisl Lek Listy ; 123(12): 908-912, 2022.
Article in English | MEDLINE | ID: covidwho-2110498

ABSTRACT

OBJECTIVES: COVID-19 can also cause multi-organ failure or severe pneumonia. Therefore, new biomarkers are being investigated for rapid diagnosis, early treatment and reduced mortality rates. In this study, D-dimer and albumin were looked at from a different perspective. BACKGROUND: We think that D-dimer/Albumin ratio (DAR), D-dimer and albumin may be parameters that can be used to predict in-hospital mortality and intensive care unit admission in COVID-19 patients. METHODS: The patients included in the study were divided into 2 groups according to their hospitalization status in the service and intensive care unit. These two groups were compared in terms of DAR, other laboratory data and in-hospital mortality. RESULTS: The primary findings we obtained are as follows: (1) DAR and D-dimer values are higher in patients who died in-hospital, and albumin values are lower than those who survived; (2) D-dimer and DAR median values are significantly higher in the intensive care group than in the service group. Albumin was significantly lower in the intensive care group; (3) D-dimer, albumin and DAR predicting in-hospital mortality, respectively: D-Dimer's sensitivity 56 % and specificity 57 %, albumin's sensitivity 70 % and specificity 53 %, DAR's sensitivity 56 %, specificity is 58 %; (4) The parameter with the highest predictive power for intensive care admission is albumin. CONCLUSION: Although albumin had the highest sensitivity values in determining mortality or predicting intensive care admission in our study, we think that D-dimer and DAR may be other parameters to be used to predict intensive care admission and in-hospital mortality (Tab. 5, Fig. 2, Ref. 19) Keywords: COVID-19, albumin, D-dimer, mortality, D-dimer/albumin.


Subject(s)
COVID-19 , Humans , COVID-19/diagnosis , Hospital Mortality , Intensive Care Units , Hospitalization , Emergency Service, Hospital , Albumins , Retrospective Studies
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