Analysis and prediction of long-term survival using a clinically applicable risk score based on the Electronic Health Record.

BACKGROUND: The long-term survival of a population assigned to a hospital can be essential to anticipate, manage, and provide appropriate hospital healthcare resources or lead preventive actions for high-risk mortality individuals. In this study, we discriminate which electronic health record variables are most relevant to predict the long-term survival of a population, and apply the results to identify high-risk mortality groups. MATERIALS AND METHODS: A prospective cohort study was conducted on a population of 113,403 individuals alive on July 1st, 2018 from the General Hospital of Castellón (Spain). Considering electronic health record patients' variables and survival days from the start date of the study, a Kaplan-Meier analysis and a multivariate Cox regression model were performed, and a risk score based on Cox coefficients was applied to predict survival over 3 years. RESULTS: All significant covariates from the Cox model (91.5% c-index) were associated with increased mortality risk. Using the proposed risk score, Kaplan-Meier curves show that survival probability in the 3rd year is 99.23% (95% confidence interval (CI) 99.18-99.29) for the low-risk, 91.21% (95% CI 90.67-91.76) for medium-risk, 76.52% (95% CI 75.59-77.46) for the high-risk, and 48.61 % (95% CI 46.85-50.36) for the very high-risk groups. DISCUSSION: The Cox model obtained is highly predictive, and it has been found that some electronic health record variables little studied to date, such as Clinical Risk Groups, have a strong impact on survival. Regarding clinical application, the proposed risk score is particularly useful for identifying high-risk subpopulations within a large population.

Risk Measurement of Perinatal and Neonatal Morbidity Characteristics and Applicability of GAIA Case Definitions: Results and Lessons Learnt of a Hospital-Based Prospective Cohort Study in the Valencia Region (2019-2020).

Post-marketing safety surveillance of new vaccines aimed to be administered during pregnancy is crucial to orchestrate efficient adverse events evaluation. This is of special relevance in the current landscape of new vaccines being introduced in the pregnant women population, and particularly due to the recent administration of COVID-19 vaccines in pregnant women. This multi-center prospective cohort study, nested within the WHO-Global Vaccine Safety-MCC study, involved two hospitals in the Valencia region. Hereby, the incidence rates of seven perinatal and neonatal outcomes in the Valencia region are presented. The pooled data analysis of the two Valencian hospitals allowed the estimation of incidence rates in the Valencia Region (per 1000 live births): 86.7 for low birth weight, 78.2 for preterm birth, 58.8 for small for gestational age, 13 for congenital microcephaly, 0.4 for stillbirth, 1.2 for neonatal death and 6.5 for neonatal infection. These figures are in line with what is expected from a high-income country and the previously reported rates for Spain and Europe, except for the significantly increased rate for congenital microcephaly. Regarding the data for maternal immunization, the vaccination status was collected for 94.4% of the screened pregnant women, highlighting the high quality of the Valencian Vaccine Registry. The study also assessed the Valencian hospitals' capacity for identifying and collecting data on maternal immunization status, as well as the applicability of the GAIA definitions to the identified outcomes.

Tratamiento hospitalario de la bronquiolitis moderada-grave: ¿suero salino hipertónico o fisiológico? Análisis de factores de riesgo asociados al reingreso / Hospital treatment of moderate-severe bronchiolitis, hypertonic or physiological saline? Analysis of risk factors associated with readmission

Introducción: a pesar de los numerosos estudios publicados hasta la fecha sobre el tratamiento hospitalario de la bronquiolitis y de la prometedora eficacia del suero salino hipertónico, lo cierto es que existe controversia al respecto. Material y métodos: estudio observacional prospectivo que evalúa la eficacia del suero salino hipertónico al 3% frente al suero fisiológico en el tratamiento hospitalario de la bronquiolitis, en términos de reducción de estancia y de puntuación de escala clínica de gravedad; en una segunda fase se analizan factores de riesgo asociados al reingreso por broncoespasmo de los mismos pacientes. Resultados: se analizan 67 de los 73 pacientes ingresados por bronquiolitis, de los cuales 9 recibieron fisiológico y 58 hipertónico, con o sin broncodilatador asociado. La estancia hospitalaria fue de 6,07 ± 3,12 días para el grupo fisiológico, y de 6,67 ± 4,36 días para el grupo con hipertónico. La media de la puntuación (Wood-Downes modificado por Ferrés) para el grupo con fisiológico fue de 3,67 ± 1,1 y de 3,16 ± 1,1 para los que recibieron hipertónico. Para la segunda fase se obtiene una tasa de reingresos del 8,2%. Conclusiones: no encontramos diferencias significativas entre ambos grupos en tiempo de hospitalización ni en mejoría de escala clínica y días de oxigenoterapia. Pese al reducido tamaño muestral no observamos ninguna tendencia a favor de diferencias significativas en nuestra muestra. Los factores más relacionados con el reingreso han sido la edad menor a 6 meses, el sexo masculino, el tener hermanos mayores y el tabaquismo familiar

Introduction: although numerous studies have been published to date on the subject of inpatient management of bronchiolitis and the promising outcomes obtained with hypertonic saline, this subject remains controversial. Materials and methods: we conducted a prospective observational study to assess the effectiveness of 3% hypertonic saline compared to physiological saline in the inpatient management of bronchiolitis, understood as the achieved reductions in length of stay and clinical severity scores. In a second phase, we analysed the risk factors associated with readmission due to bronchospasm in the same sample of patients. Results: we included 67 out of the 73 patients admitted with bronchiolitis in the analysis, of who 9 received physiological saline and 58 hypertonic saline, with or without an added bronchodilator. The mean length of stay was 6.07 ± 3.12 days in the physiological saline group and 6.67 ± 4.36 days in the hypertonic saline group. The mean severity score (Wood-Downes scale modified by Ferrés) was 3.67 ± 1.1 in the physiological saline group versus 3.16 ± 1.1 in the hypertonic saline group. In the second phase of the study, we found a readmission rate of 8.2%. Conclusion: we did not find statistically significant differences between the two groups in the length of stay or in the improvement in the clinical severity score or duration of oxygen therapy. Although the sample size was small, we did not find any trends in our sample suggesting the actual presence of significant differences. The factors associated most strongly with readmission were age of less than 6 months, male sex, having older siblings and exposure to smoke in the household