Comparison of 4F-PCC and aPCC time to administration and outcomes for oral anticoagulant-related ICH.

INTRODUCTION: Intracranial hemorrhages (ICHs) are associated with increased morbidity and mortality. Use of oral anticoagulants are a potential risk factor for ICH, and reversal of the anticoagulant with agents such as Four-Factor Prothrombin Complex Concentrate (4F-PCC) or Activated Prothrombin Complex Concentrate (aPCC) is vital to prevent hematoma expansion. The objective of the study was to the compare the time to administration and outcomes of 4F-PCC or aPCC in patients with ICH taking an oral anticoagulant. METHODS: This was a multicenter, retrospective cohort chart review of patients with ICH taking an oral anticoagulants who received 4F-PCC or aPCC over a two year period. The primary outcome of the study was to the compare the time to administration of 4F-PCC or aPCC in patients with ICH on an oral anticoagulant. Secondary outcomes included evaluating mortality rate, modified Rankin scale (mRs) score, presence of worsening bleed volume on first computed tomography (CT) six hours after the initial reading, and hospital and intensive care unit (ICU) length of stay. The tertiary outcome was to evaluate the effect of risk factors for delay on time to administration, with delay being greater than 60 min. RESULTS: A total of 350 patient charts were reviewed and 193 patients (4F-PCC [n = 99] and aPCC [n = 94]) were included in the study. There was no significant difference in the primary outcome of median time to administration for the 4F-PCC group (141 min, IQR [93-185]) compared to aPCC (121 min, IQR [107-194]; p = 0.08). No difference was identified between the two groups for all secondary outcomes. Only time to CT results was found to be a risk factor for administration delay (OR, 1.160; 95% CI, 1.073-1.255; p < 0.001). DISCUSSION: In patients with ICH taking oral anticoagulants, there was no significant difference in the time to administration between 4F-PCC and aPCC. More prospective randomized controlled trials are warranted to determine an ideal reversal time to improve patient outcomes.

Pharmacy-facilitated medication history program at a community teaching hospital: A pre-post study in an emergency department.

PURPOSE: A study was conducted to compare the accuracy of medication histories compiled by pharmacy technicians with histories obtained through the usual multidisciplinary process. METHODS: A retrospective cohort study was conducted at a community teaching hospital from January 2017 through February 2018. Inclusion criteria included patient age of at least 18 years, use of 1 or more medications at the time of admission, and hospital admission through the emergency department. Each electronically documented medication history was assessed for accuracy. The objective was to compare the accuracy of pharmacy technician-collected medication histories to those obtained through the usual multidisciplinary process. RESULTS: Of 215 patients screened, 183 were included in the study: 91 patients whose medication histories were obtained through the usual multidisciplinary process and 92 whose medication histories were collected by pharmacy technicians. Overall, documentation for 1,773 medications listed in medication histories was reviewed. The primary outcome of medication history accuracy occurred 38% of the time with the usual multidisciplinary process and 70% of the time with pharmacy technician collection of medication histories (P < 0.001). CONCLUSION: The study showed that the accuracy of medication histories was improved when histories were obtained by pharmacy technicians instead of via the usual multidisciplinary process.

Suspected gonorrhea and chlamydia: Incidence and utilization of empiric antibiotics in a health system emergency department.

BACKGROUND: In the ED, patients are treated empirically for suspected gonorrhea and/or chlamydia (GC). Limited studies have evaluated the treatment of sexually transmitted diseases (STDs) in conjunction with predictor variables. This study will allow providers to better identify patients with potential GC to streamline antibiotic treatment. OBJECTIVES: The primary objective was to determine the incidence of positive assay in patients that underwent GC screening. The secondary objectives included the proportion of patients assayed that received empiric therapy and the predictive value of risk factors to identify positive assays. METHODS: This retrospective cohort study included adult patients who presented to the health-system EDs and underwent GC screening. Subjects were excluded if they were victims of sexual assault, left AMA or eloped. RESULTS: A total of 490 assayed patients were included, of which 84 (17%) were found to be positive for GC assay. Of the 278 patients treated empirically, 74% had a negative assay. Of the entire sample (n = 490), risk factors found to predict a positive assay (p < 0.05) included male, women <25 years of age, concomitant bacterial vaginosis, pelvic inflammatory disease or trichomonas, penile discharge, inconsistent condom use, previous/coexisting STDs, and uninsured. CONCLUSIONS: Compared to previous reports, this study found a higher incidence of positive GC assays for patients with suspected infection. This is the first study to evaluate GC testing in both men and women in the ED, and risk factors not previously reported by the CDC were identified.