Predictors of a Prolonged Length of Stay in Children with Perforated Appendicitis.

OBJECTIVES: Little is known about the factors that affect the length of stay (LOS) of children hospitalized for perforated appendicitis. The objective of this study was to identify clinical and demographic factors associated with a prolonged LOS (PLOS) in children with perforated appendicitis. METHODS: A retrospective cohort study was conducted using the records of 197 children 0 to 17 years old with perforated appendicitis. The children were hospitalized at one of two teaching hospitals located in El Paso, Texas, and were discharged between January 2008 and January 2014. PLOS was defined as an LOS greater than the 75th percentile value in our patient cohort, which was 7 days. An initial log-binomial regression model failed to converge, and hence logistic regression was used to calculate adjusted incidence odds ratios (OR) for PLOS, 95% confidence intervals, P values, and a receiver operating characteristic curve. The best subset method was used to identify predictors for inclusion in the final model. RESULTS: The overall risk of PLOS was 23.4% (46/197). Approximately 76% of the children who experienced PLOS and 94% of those who did not have PLOS were Hispanic. After adjusting for insurance status, presence of an abscess, asthma, consulting interventional radiology, and various antibiotics, Hispanics were less likely than non-Hispanics to experience PLOS (adjusted OR 0.20; P = 0.003). Children whose providers consulted the interventional radiologist had an increased odds of PLOS (adjusted OR 3.64; P = 0.01). CONCLUSIONS: Hispanic ethnicity was associated with a lower odds of PLOS, whereas children who required the services of an interventional radiologist were more likely to experience PLOS.

Acute myocardial infarction in pregnancy: a statewide analysis.

OBJECTIVE: Acute myocardial infarction (AMI) during pregnancy and the puerperium is a rare but devastating event. The objective of this study was to describe the clinical and epidemiological features of pregnancy-related AMI. METHODS: A retrospective study was conducted using Texas hospital inpatient data (years 2004-2007). Diagnoses and procedures had been coded using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Adjusted odds ratios (OR) for hospital mortality and length of stay >4 days (prolonged length of stay [PLOS]) were calculated using logistic regression with Firth's bias correction and multiple imputation. RESULTS: 103 women with pregnancy-related AMI were identified in the statewide hospital database (6.5 cases per 100,000 births). The prevalence of cardiomyopathy was 16.5%. Approximately 14% of the pregnancies were complicated by preeclampsia/eclampsia. A history of cocaine use was noted in 3 patients. Congestive heart failure was present in 18 patients (17.5%). Two patients had attempted suicide and 1 died in the hospital. The overall hospital mortality rate was 9.7%. Placement of coronary artery stents was the most common coronary revascularization procedure (11 patients or 10.7%). The adjusted hospital mortality OR for women 35-39 years old (versus 30-34 years old) was 6.29 (P = .07). Patients with preeclampsia were more likely to have PLOS than patients whose deliveries were not complicated by preeclampsia (OR, 3.84; P = .06). CONCLUSIONS: While AMI in pregnancy remains a rare occurrence, it is associated with significant morbidity and a high case-fatality rate.

Is maternal colonization with group B streptococci a risk factor for preeclampsia?

OBJECTIVE: To explore the association between maternal rectovaginal colonization with group B Streptococcus (GBS) and the outcome of preeclampsia, and to identify other factors such as maternal chocolate consumption that may be associated with preeclampsia on the Texas-Mexico border. STUDY DESIGN: A case-control study was conducted among 330 women who delivered at a teaching hospital in El Paso, Texas, during the time period April 2010 to April 2012. Preeclamptic cases (n = 165) and controls free of preeclampsia (n = 165) were matched by gestational age and date of delivery. Conditional logistic regression (with multiple imputation for missing data) was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) that were adjusted for maternal age and other factors. RESULTS: Cases (94.6%) and controls (97.0%) were predominantly Hispanic. GBS colonization was not associated with preeclampsia: adjusted OR = 1.73 (95% CI 0.63-4.74, p = 0.29). Maternal consumption of chocolate desserts once daily or more frequently as compared to < 7 times weekly was associated with a 76% reduction in the odds of preeclampsia: adjusted OR = 0.24 (95% CI 0.09-0.63, p = 0.004). CONCLUSION: Our study did not confirm the protective association between GBS and preeclampsia that was found in 2 existing state hospital datasets. Chocolate consumption during pregnancy was inversely associated with preeclampsia.