Racial disparities in patients hospitalized for COVID-19.

BACKGROUND: The COVID-19 pandemic has demonstrated the significance of health disparities across populations with older adults and minoritized groups being disproportionately affected. Data during the COVID-19 pandemic demonstrated higher infection rates, hospitalization rates, morbidity, and potentially greater mortality in Black, Hispanic, and Native Americans compared to Whites. METHODS: This is a retrospective cohort study of de-identified patient data from 178 hospitals across the United States. Outcome variables were the length of stay, in-hospital mortality, disease severity, and discharge disposition. Outcomes were stratified by sex and racial groups. RESULTS: Of 45,360 patients, 22% were Black, 35% were Hispanic, 37% were White, and 6% were Other. The overall mortality rate was 15% across all groups but was 17% for White patients, 10% for Black patients, 14% for Hispanic patients, and 15% for patients categorized as Other. However, White patients have higher median age on admission (71 years) compared to Blacks (60 years), Hispanics (57 years), and Other (61 years). Race remained statistically significant in a multivariable model that included age, sex, and race. 6484 patients required ICU admission, intubation, and hemodynamic support. This burden was disproportionate across racial groups, with 15.6% of Blacks and 13.9% of non-Blacks having such critical disease (p < 0.0001, z-test for proportions). CONCLUSIONS: In this national study of admitted patients with COVID-19, White patients admitted were older on average compared to other racial/ethnic groups and had a higher mortality rate compared to non-Whites hospitalized for COVID-19. Black patients were significantly more likely to require admission to the ICU, mechanical ventilation, and hemodynamic support. These COVID-19 health disparities highlight the importance of addressing social and structural determinants of health.

Acromioclavicular Osteomyelitis: When Simple Cellulitis Is No Longer Simple.

The objective of this case report is to highlight the importance of continued examination and evaluation to correctly diagnose and treat the rare condition of acromioclavicular osteomyelitis and associated septic arthritis. A 51-year-old diabetic male presented with right shoulder pain and overlying cellulitis without history of trauma, intravenous (IV) drug use, lacerations, prostheses or endocarditis later developed septic arthritis and osteomyelitis of the acromion and distal clavicle requiring operative management. Decision to re-image the joint using magnetic resonance imaging (MRI) with contrast after lack of symptomatic improvement was key to making the diagnosis.

The A to E (ABCDE) Pit Crew Model: A Novel Approach to Team Based Care of Critical Patients in the Prehospital Setting.

Background: This study aimed to evaluate the effectiveness of a Pit Crew intervention to improve team dynamics and time to performance of critical actions in a prehospital critical care scenario. The primary outcome was successful completion of critical actions and time to completion of these critical actions. Secondary outcomes included effectiveness of communication and overall team functioning. Methods: The study was conducted with a fire-based Emergency Medical Services (EMS) system with 233 paramedics and 115 Emergency Medical Technicians (EMT). Eight EMS crews comprised of five members each were randomly selected and assigned to either the intervention or the control group. The intervention group (n=20) watched a thirty-minute video prior to the training describing the "Pit Crew Approach;" the control group (n=20) did not watch the video. Each crew was given the same simulation scenario of a pediatric patient that had overdosed on a beta-blocker. Completion of predetermined critical tasks were noted and timestamped. A survey was administered to the participants following the training to assess team dynamics and level of confidence. Results: Three outcomes were statistically significant between the two arms: The interventional group felt they themselves had a more defined role in the resuscitation in comparison to the non-interventional group (p= 0.021). The interventional group also felt that their team members had a clearer and more defined role than the nonintervention group (p= 0.018). The interventional group also felt more confident managing a beta blocker overdose than the nonintervention group (p.007). The only statistically significant secondary outcome finding was in scene departure decision: the interventional arm spent more time on-scene (p=0.031). Of note, the non-intervention group missed performing tasks more often than the interventional group and team leaders of these groups often performed task(s) while also directing the patient care. Conclusion: The Pit Crew model was developed to optimize communication and team function. Our data identified that a formal instruction of the pit crew approach to a critical care scenario improved comfort in patient care. Future studies are needed evaluate other methods of training and the effects of continued formal pit-crew training over time.

Acromioclavicular Osteomyelitis: When Simple Cellulitis Is No Longer Simple.

The objective of this case report is to highlight the importance of continued examination and evaluation to correctly diagnose and treat the rare condition of acromioclavicular osteomyelitis and associated septic arthritis. A 51-year-old diabetic male presented with right shoulder pain and overlying cellulitis without history of trauma, intravenous (IV) drug use, lacerations, prostheses or endocarditis later developed septic arthritis and osteomyelitis of the acromion and distal clavicle requiring operative management. Decision to re-image the joint using magnetic resonance imaging (MRI) with contrast after lack of symptomatic improvement was key to making the diagnosis.