Cancer patients’ use of primary care out-of-hours services: a cross-sectional study in Norway

Objective: To investigate how cancer patients in Norway use primary care out-of-hours (OOH) services and describe different contact types and procedures.

Design: A retrospective cross-sectional registry study using a billing registry data source.

Setting: Norwegian primary care OOH services in 2014.

Subjects: All patients’ contacts in OOH services in 2014. Cancer patients were identified by ICPC-2 diagnosis.

Main outcome measures: Frequency of cancer patients’ contacts with OOH services, contact types, diagnoses, procedures, and socio-demographic characteristics.

Results: In total, 5752 cancer patients had 20,220 contacts (1% of all) in OOH services. Half of the contacts were cancer related. Cancer in the digestive (22.9%) and respiratory (18.0%) systems were most frequent; and infection/fever (21.8%) and pain (13.6%) most frequent additional diagnoses. A total of 4170 patients had at least one cancer-related direct contact; of these, 64.5% had only one contact during the year. Cancer patients had more home visits and more physicians’ contact with municipal nursing services than other patients, but fewer consultations (p?p?Conclusion: There was no indication of overuse of OOH services by cancer patients in Norway, which could indicate good quality of cancer care in general.

• KEY POINTS

• Many are concerned about unnecessary use of emergency medical services for non-urgent conditions.

• ??There was no indication of overuse of out-of-hours services by cancer patients in Norway.

• ??Cancer patients had relatively more home visits, physician’s contact with the municipal nursing service, and weekend contacts than other patients.

• ??Cancer patients in the least central municipalities had relatively more contacts with out-of-hours services than those in more central municipalities.

     

Consumption in out-of-hours health care: Danes double Dutch?

Objective. To study the quantitative consumption in out-of-hours (OOH) primary care in Denmark and the Netherlands, in the context of OOH care services. Design. A retrospective observational study describing contacts with OOH care services, using registration data. Setting. OOH care services (i.e. OOH primary care, emergency department, and ambulance care) in one Danish and one Dutch region. Subjects. All patients contacting the OOH care services in September and October 2011. Main outcome measures. Consumption as number of contacts per 1000 inhabitants in total and per age group per contact type. Results. For the two-month period the Danes had 80/1000 contacts with OOH primary care compared with 50/1000 for the Dutch. The number of contacts per 1000 inhabitants per age group varied between the regions, with the largest difference in the 0–5 years age group and a considerable difference in the young-adult groups (20–35 years). The difference was largest for telephone consultations (47/1000 vs. 20/1000), particularly in the youngest age group (154/1000 vs. 39/1000). The Danes also had more home visits than the Dutch (10/1000 vs. 5/1000), while the Dutch had slightly more clinic consultations per 1000 inhabitants than the Danes (25/1000 vs. 23/1000). Conclusion. The Danish population has more contacts with OOH primary care, particularly telephone consultations, especially concerning young patients. Future research should focus on the relevance of contacts and identification of factors related to consumption in OOH primary care.Key Words: After-hours care, Denmark, health services research, primary care, the Netherlands, utilization

• Danish and Dutch health care systems are quite comparable, having strong primary care and large-scale out-of-hours (OOH) primary care settings.
• National figures suggested that the Danish population has twice as many contacts with OOH primary care as the Dutch.
• A regional exploration confirmed this: the Danes generally had more OOH primary care contacts than the Dutch, particularly telephone consultations.
• The difference is most evident for the youngest patients, which may be explained by differences in organizational and patient-related factors.

     

Violence towards personnel in out-of-hours primary care: a cross-sectional study

Objective

To investigate (1) the prevalence of occupational violence in out-of-hours (OOH) primary care, (2) the perceived cause of violence, and (3) the associations between occupation, gender, age, years of work, and occupational violence.

Design

A cross-sectional study using a self-administered postal questionnaire.

Setting

Twenty Norwegian OOH primary care centres.

Subjects

Physicians, nurses, and others with patient contact at OOH primary care centres, 536 responders (75% response rate).

Main outcome measures

Verbal abuse, threats, physical abuse, sexual harassment.

Results

In total, 78% had been verbally abused, 44% had been exposed to threats, 13% physically abused, and 9% sexually harassed during the last 12 months. Significantly more nurses were associated with verbal abuse (OR 3.85, 95% confidence interval 2.17–6.67) after adjusting for gender, age, and years in OOH primary care. Males had a higher risk for physical abuse (OR 2.36, CI 1.11–5.05) and higher age was associated with lower risk for sexual harassment (OR 0.28, CI 0.14–0.59), when adjusted for background variables. Drug influence and mental illness were the most frequently perceived causes for the last occurring episode of physical abuse, threats, and verbal abuse.

Conclusion

This first study on occupational violence in Norwegian OOH primary care found that a substantial number of health care workers experience occupational violence from patients or visitors. The employer should take action to prevent occupational violence in OOH primary care.Key Words: Cross-sectional studies, general practice, nurses, out-of-hours, physicians, prevalence, violenceThis study describes the prevalence of occupational violence among health workers in Norwegian out-of-hours primary care.

• One in three has been exposed to physical abuse during their working career in out-of-hours primary care.
• Nurses experience more verbal abuse than the other occupational groups.
• The perceived main causes of occupational violence are drug influence and mental illness.

     

Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices

Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression and independent samples t-tests. Setting. Seven OOH casualty clinics and 17 GP practices in Norway. Subjects. In October and November 2012, 510 primary health care providers working in OOH casualty clinics and GP practices (316 doctors and 194 nurses) were invited to participate anonymously. Main outcome measures. To study whether patterns in patient safety attitudes were related to professional background, gender, age, and clinical setting. Results. The overall response rate was 52%; 72% of the nurses and 39% of the doctors answered the questionnaire. In the OOH clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. Older health care providers scored significantly higher than younger on Safety climate and Working conditions. In GP practices, male health professionals scored significantly higher than female on Teamwork climate, Safety climate, Perceptions of management and Working conditions. Health care providers in GP practices had significant higher mean scores on the factors Safety climate and Working conditions, compared with those working in the OOH clinics. Conclusion. Our study showed that nurses scored higher than doctors, older health professionals scored higher than younger, male GPs scored higher than female GPs, and health professionals in GP practices scored higher than those in OOH clinics – on several patient safety factors.Key Words: Adverse events, general practice, medical errors, Norway, out-of-hours, patient safety culture, primary care, Safety Attitudes QuestionnairePatient safety culture is how leader and staff interaction, attitudes, routines, and practices in a group setting may protect patients from adverse events.

• In out-of-hours clinics, nurses scored higher than doctors, and older health professionals scored higher than younger on patient safety factors.
• Male professionals in GP practices scored significantly higher than female on four of the patient safety factors.
• Health care providers in GP practices had higher patient safety factor scores than those working in out-of-hours clinics.

     

Contact to the out-of-hours service among Danish parents of small children – a qualitative interview study

Objective: In Denmark, parents with small children have the highest contact frequency to out-of-hours (OOH) service, but reasons for OOH care use are sparsely investigated. The aim was to explore parental contact pattern to OOH services and to explore parents’ experiences with managing their children’s acute health problems.

Design: A qualitative study was undertaken drawing on a phenomenological approach. We used semi-structured interviews, followed by an inductive content analysis. Nine parents with children below four years of age were recruited from a child day care centre in Aarhus, Denmark for interviews.

Results: Navigation, information, parental worry and parental development appeared to have an impact on OOH services use. The parents found it easy to navigate in the health care system, but they often used the OOH service instead of their own general practitioner (GP) due to more compatible opening hours and insecurity about the urgency of symptoms. When worried about the severity, the parents sought information from e.g. the internet or the health care professionals. The first child caused more worries and insecurity due to less experience with childhood diseases and the contact frequency seemed to decrease with parental development.

Conclusion: Parents’ use of the OOH service is affected by their health literacy levels, e.g. level of information, how easy they find access to their GP, how trustworthy and authorized health information is, as well as how much they worry and their parental experience. These findings must be considered when planning effective health services for young families.

• Key points

• The main findings are that the parents in our study found it easy to navigate in the healthcare system, but they used the OOH service instead of their own general practitioner, when this suited their needs. The parents sought information from e.g. the internet or the health care professionals when they were worried about the severity of their children’s diseases. They sometimes navigated strategically in the healthcare system by e.g. using the OOH service for reassurance and when it was most convenient according to opening hours. The first child seemed to cause more worries and insecurity due to limited experience with childhood diseases, and parental development seems to decrease contact frequency.

• Overall, this study contributes with valuable insights into the understanding of parents’ help seeking behaviour. There seems to be a potential for supporting especially first-time parents in their use of the out of hours services.

     

Contacts related to mental illness and substance abuse in primary health care: A cross-sectional study comparing patients' use of daytime versus out-of-hours primary care in Norway

Objective

To investigate prevalence, diagnostic patterns, and parallel use of daytime versus out-of-hours primary health care in a defined population (n = 23,607) in relation to mental illness including substance misuse.

Design

Cross-sectional observational study.

Setting

A Norwegian rural general practice cooperative providing out-of-hours care (i.e. casualty clinic) and regular general practitioners’ daytime practices (i.e. rGP surgeries) in the same catchment area.

Subjects

Patients seeking medical care during daytime and out-of-hours in 2006.

Main outcome measures

Patients’ diagnoses, age, gender, time of contact, and parallel use of the two services.

Results

Diagnoses related to mental illness were given in 2.2% (n = 265) of encounters at the casualty clinic and in 8.9% (n = 5799) of encounters at rGP surgeries. Proportions of diagnoses related to suicidal behaviour, substance misuse, or psychosis were twice as large at the casualty clinic than at rGP surgeries. More visits to the casualty clinic occurred in months with fewer visits to rGP surgeries. Most patients with a diagnosis related to mental illness at the casualty clinic had been in contact with their rGP during the study period.

Conclusion

Psychiatric illness and substance misuse have lower presentation rates at casualty clinics than at rGP surgeries. The distribution of psychiatric diagnoses differs between the services, and more serious mental illness is presented out-of-hours. The casualty clinic seems to be an important complement to other medical services for some patients with recognized mental problems.Key Words: After-hours care, emergency medical services, family practice, physician''s practice patterns, primary health care, psychiatryMost mentally ill patients in Norway are dealt with by the primary health care system, and out-of-hours GP services are the main source of acute referrals to psychiatric wards. Differences between daytime and out-of-hours services regarding relative prevalence, diagnostic challenges, and parallel use have previously been unknown.

• Prevalence of diagnoses related to mental illness is lower at out-of-hours services compared with daytime services. However, suicidal behaviour, substance misuse, and psychosis are more prevalent out-of-hours than during the daytime.
• Use of out-of-hours services increases in periods with low use of daytime services.
• Most patients with diagnoses related to mental illness out-of-hours had also seen their regular general practitioner during the study period.

Norway has a two-tier public health care system where regular general practitioners (rGPs) serve as gatekeepers for all specialized health services including psychiatric health care [1,2]. Most patients with mental illness are therefore dealt with by the primary health care system, with relatively few patients referred to psychiatrists [3,4].Local municipalities (Norwegian kommuner) are responsible for providing all primary health care, including access to an rGP and 24-hour access to emergency health care [5,6]. Although optional, almost all Norwegians are listed with an rGP in their residing municipality. The rGPs provide emergency care to their listed patients during office hours. Out-of-hours, most municipalities organize the emergency care with one or more GPs on call, usually based in a casualty clinic. Depending on the size of the municipality and the population served, the casualty clinic might be cooperatively shared between several municipalities [1]. Henceforth casualty clinic is used as a general term for out-of-hours services, and rGP surgeries refer to rGPs’ work during normal office hours. At a national level, approximately 66% of inhabitants annually have at least one appointment with their rGP and 16% contact the casualty clinics [7].International studies indicate that psychiatric patients are frequent users of emergency medical health services [12–14]. In Norway, however, diagnoses related to mental illness are given in only 2–5% of patient contacts with casualty clinics [7,9,10,15], while mental illness accounts for 5–12% of consultations at rGP surgeries [7–11]. Nevertheless, casualty clinics are the major source of acute referrals to psychiatric wards [16]. This raises the possibility that patients’ use of the two primary health care services may differ, and that casualty clinics mainly deal with more severe mental illness.In this study we compared a defined population''s use of daytime rGP appointments versus their use of the out-of-hours casualty clinic in relation to mental illness. Main measures were relative prevalence and diagnostic differences. We also studied patients’ parallel use of these two services.     

Contact with primary health care physicians before an acute hospitalisation

Abstract

Objectives: To assess contacts with general practitioners (GPs), both regular GPs and out-of-hours GP services (OOH) during the year before an emergency hospital admission.

Design: Longitudinal design with register-based information on somatic health care contacts and use of municipality health care services.

Setting: Four municipalities in central Norway, 2012–2013.

Subjects: Inhabitants aged 50 and older admitted to hospital for acute myocardial infarction, hip fracture, stroke, heart failure, or pneumonia.

Main outcome measures: GP contact during the year and month before an emergency hospital admission.

Results: Among 66,952 identified participants, 720 were admitted to hospital for acute myocardial infarction, 645 for hip fracture, 740 for stroke, 399 for heart failure, and 853 for pneumonia in the two-year study period. The majority of these acutely admitted patients had contact with general practitioners each month before the emergency hospital admission, especially contacts with a regular GP. A general increase in GP contact was observed towards the time of hospital admission, but development differed between the patient groups. Patients admitted with heart failure had the steepest increase of monthly GP contact. A sizable percentage did not contact the regular GP or OOH services the last month before admission, in particular men aged 50–64 admitted with myocardial infarction or stroke.

Conclusion: The majority of patients acutely admitted to hospital for different common severe emergency diagnoses have been in contact with GPs during the month and year before the admission. This points towards general practitioners having an important role in these patients’ health care.

• KEY MESSAGES

• There is scarce knowledge about primary health care contact before an emergency hospital admission.

• The percentage of patients with contacts differed between patient groups, and increased towards hospital admission for most diagnoses, particularly heart failure.

• More than 50% having monthly general practitioner contact before admission underscores the general practitioners’ role in these patients’ health care.

• Our results underscore the need to consider medical diagnosis when talking about the role of general practitioners in preventing emergency hospital admissions.

     

Use of laboratory tests in out-of-hours services in Norway

Objective

To investigate the use of laboratory tests and which factors influence the use in Norwegian out-of-hours (OOH) services.

Design

Cross-sectional observational study.

Setting

Out-of-hours services in Norway.

Subjects

All electronic reimbursement claims from doctors at OOH services in Norway in 2007.

Main outcome measures

Number of contacts and laboratory tests in relation to patients’ and doctors’ characteristics.

Results

1 323 281 consultations and home visits were reported. Laboratory tests were used in 31% of the contacts. C-reactive protein (CRP) was the most common test (27% of all contacts), especially in respiratory illness (55%) and infants (44%). Electrocardiogram and rapid strep A test were used in 4% of the contacts. Young doctors, female doctors, and doctors in central areas used laboratory tests more often.

Conclusion

CRP is extensively used in OOH services, especially by young and inexperienced doctors, and in central areas. Further investigations are required to see if this extensive use of CRP is of importance for correct diagnosis and treatment.Key Words: Clinical chemistry tests, CRP, diagnostic tests, emergency medical services, primary health careA few point-of-care laboratory tests are available for diagnostic use in out-of-hours services in Norway.

• A laboratory test was taken in 31% of all consultations/home calls.
• C-reactive protein (CRP) was the dominating test (27% of all contacts), and the rate was especially high in small children.
• Test use was most frequent in out-of-hours services in central areas and by younger doctors.

     

Giving callers the option to bypass the telephone waiting line in out-of-hours services: a comparative intervention study

Objective: Acute out-of-hours (OOH) healthcare is challenged by potentially long waiting time for callers in acute need of medical aid. OOH callers must usually wait in line, even when contacting for highly urgent or life-threatening conditions. We tested an emergency access button (EAB), which allowed OOH callers to bypass the waiting line if they perceived their health problem as severe. We aimed to investigate EAB use and patient characteristics associated with this use.

Design: Comparative intervention study.

Setting: OOH services in two major Danish healthcare regions.

Intervention: Giving callers the option to bypass the telephone waiting line by introducing an EAB.

Participants: OOH service callers contacting during end of October to mid-December 2017.

Main outcome measures: Proportions of EAB use, waiting time and background information on participants in two settings differing on organisation structure, waiting time and triage personnel.

Results: In total, 97,791 out of 158,784 callers (61.6%) chose to participate. The EAB was used 2905 times out of 97,791 (2.97%, 95%CI 2.86; 3.08). Patient characteristics associated with increased EAB use were male gender, higher age, low education, being retired, and increasing announced estimated waiting time. In one region, immigrants used the EAB more often than native Danish callers.

Conclusion: Only about 3% of all callers chose to bypass the waiting line in the OOH service when given the option. This study suggests that the EAB could serve as a new and simple tool to reduce the waiting time for severely ill patients in an OOH service telephone triage setting.

• Key Points

• Acute out-of-hours healthcare is challenged by overcrowding and increasing demand for services.

• This study shows that only approximately 3% of callers chose to bypass the telephone waiting queue when given the opportunity through an emergency access button.

• An emergency access button may serve as a new tool to help reduce the triage waiting time for severely ill patients in out-of-hours medical facilities.

     

One-on-one comparison between qCSI and NEWS scores for mortality risk assessment in patients with COVID-19

ObjectiveTo compare the predictive value of the quick COVID-19 Severity Index (qCSI) and the National Early Warning Score (NEWS) for 90-day mortality amongst COVID-19 patients.MethodsMulticenter retrospective cohort study conducted in adult patients transferred by ambulance to an emergency department (ED) with suspected COVID-19 infection subsequently confirmed by a SARS-CoV-2 test (polymerase chain reaction). We collected epidemiological data, clinical covariates (respiratory rate, oxygen saturation, systolic blood pressure, heart rate, temperature, level of consciousness and use of supplemental oxygen) and hospital variables. The primary outcome was cumulative all-cause mortality during a 90-day follow-up, with mortality assessment monitoring time points at 1, 2, 7, 14, 30 and 90 days from ED attendance. Comparison of performances for 90-day mortality between both scores was carried out by univariate analysis.ResultsFrom March to November 2020, we included 2,961 SARS-CoV-2 positive patients (median age 79 years, IQR 66–88), with 49.2% females. The qCSI score provided an AUC ranging from 0.769 (1-day mortality) to 0.749 (90-day mortality), whereas AUCs for NEWS ranging from 0.825 for 1-day mortality to 0.777 for 90-day mortality. At all-time points studied, differences between both scores were statistically significant (p < .001).ConclusionPatients with SARS-CoV-2 can rapidly develop bilateral pneumonias with multiorgan disease; in these cases, in which an evacuation by the EMS is required, reliable scores for an early identification of patients with risk of clinical deterioration are critical. The NEWS score provides not only better prognostic results than those offered by qCSI at all the analyzed time points, but it is also better suited for COVID-19 patients.

KEY MESSAGES

• This work aims to determine whether NEWS is the best score for mortality risk assessment in patients with COVID-19.
• AUCs for NEWS ranged from 0.825 for 1-day mortality to 0.777 for 90-day mortality and were significantly higher than those for qCSI in these same outcomes.
• NEWS provides a better prognostic capacity than the qCSI score and allows for long-term (90 days) mortality risk assessment of COVID-19 patients.

     

Clinical features,therapy and outcome of patients hospitalized or not for nursing-home acquired pneumonia

Backgroundnursing home-acquired pneumonia (NHAP), is among the main causes of hospitalization and mortality of frail elderly patients. Aim of this study was analysis of patients residing in long-term care facilities (LTCF) and developing pneumonia to reach a better knowledge of criteria for hospitalization and outcomes.Materials/methodsthis is a prospective, observational study in which patients residing in 3 LTCFs (metropolitan area of Rome, Italy) and developing pneumonia, hospitalized or treated in LTCF, were recruited and followed up from January 2017 to June 2019. Primary endpoint was 30-day mortality, secondary endpoint was analysis of risk factors associated with hospitalization.ResultsOverall, 146 episodes of NHAP were enrolled in the study: 57 patients were treated in LTCF, while 89 patients were hospitalized. Overall incidence rates of NHAP varied from 2.6 to 7.5 per 1000 residents. Methicillin-resistant Staphylococcus aureus was the most frequently isolated pathogen (25%), and in 28 (55%) patients was documented a MDR pathogen. For hospitalized patients was reported a higher 30-day mortality (43.8% Vs 7%, p < 0.001). Multivariate analysis showed that severe pneumonia, neoplasm, chronic hepatitis, antibiotic monotherapy, and malnutrition were independent risk factors for hospitalization from LTCF. MDR pathogen, severe pneumonia, COPD, and moderate to severe renal disease were independently associated with death at 30 days.Conclusionfrail elderly patients in LTCF have a high risk of MDR etiology with a higher risk to receive an inadequate antibiotic therapy and a fatal outcome. These results point to the need for increased provision of acute care and strategies in LTCF.     

The impact of previous hospitalization in the preceding 90 days on the outcome in critically ill patients with gram-negative bloodstream infection

We conducted a retrospective cohort study to evaluate the impact of previous hospitalization in the preceding 90 days on mortality in critically ill patients with gram-negative bloodstream infection (BSI) and to identify the risk factors for 30-day mortality in these patients. Of 89 critically ill patients with gram-negative BSI, 42 patients had previous hospitalization in the preceding 90 days. Multivariate Cox regression analysis revealed previous hospitalization in the preceding 90 days as a significant predictor for 30-day mortality (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.11–3.94; P = 0.022), along with Acute Physiology and Chronic Health Evaluation II score at BSI onset (HR, 1.08; 95% CI, 1.04–1.12; P < 0.001), liver cirrhosis (HR, 3.61; 95% CI, 1.46–8.94; P = 0.006), and inappropriate definitive antimicrobial therapy (HR, 4.28; 95% CI, 2.17–8.45; P < 0.001). The effect of previous hospitalization in the preceding 90 days should be considered in evaluating the risk for 30-day mortality when treating such patients, and further study is required.     

Rate and predictors of 30-day readmission for clostridiodes difficile: a United States analysis

BackgroundClostridiodes difficile is a leading cause of healthcare-associated diarrhea. In this study, we aimed to identify the rates and predictors for 30-day readmissions of Clostridiodes difficile Enterocolitis (CDE) in the United States.MethodsWe conducted a retrospective study of the Nationwide Readmissions Database to identify adult hospitalizations with a principal diagnosis of CDE for 2018. Individuals <18 years old and elective hospitalizations were excluded. Primary outcomes included readmission rate and the top ten principal diagnosis on readmission, while the secondary outcomes were inpatient mortality, hospital costs and independent predictors of 30-day all-cause readmissions. Furthermore, we devised a scoring system to estimate the risk of CDE readmissions. Stata® Version 16 was used for statistical analysis and p-values ≤0.05 were statistically significant.ResultsWe identified 94,668 index hospitalizations and 18,296 readmissions at 30-days for CDE in 2018. The 30-day all-cause readmission rate was 25.7%. On readmission, CDE was the most common principal diagnosis (25.7%), followed by unspecified sepsis, and acute renal failure. A female predominance was also noted for index and 30-day readmissions of CDE. Compared to index admissions, we noted higher odds of inpatient mortality [4.4 vs 1.4%, Odds Ratio (OR):3.32, 95% Confidence Interval (CI):2.87–3.84, p < 0.001], longer mean length of stay (LOS) [6.4 vs 5.6 days, Mean Difference (MD):0.9, 95% CI:0.7–1.0, p < 0.001), and higher mean total hospital charge (THC) [$56,015 vs $40,871, MD:15,144, 95% CI:13,260–17,027, p < 0.001] for 30-day readmissions of CDE. Independent predictors for 30-day all-cause readmissions of CDE included discharged against medical advice (AMA) [Adjusd Hazard Ratio (aHR):2.01, 95% CI:1.73–2.53, p < 0.001], diabetes mellitus (DM) [aHR:1.22, 95% CI:1.16–1.29, p < 0.001], and chronic kidney disease (CKD) [aHR:1.29, 95% CI:1.21–1.37, p < 0.001].ConclusionThe all-cause 30-day readmission rate and inpatient mortality for CDE was 25.7% and 4.4%, respectively. Discharge AMA, DM and CKD were independent predictors for 30-day all-cause readmissions of CDE.

KEY MESSAGE

1. The 30-day all-cause readmission rate for Clostridiodes difficile Enterocolitis was noted to be 21.4% in 2018.
2. Independent predictors of 30-day all-cause readmissions for Clostridiodes difficile Enterocolitis include diabetes mellitus, discharged against medical advice and chronic kidney disease.
3. Readmissions of Clostridiodes difficile Enterocolitis had higher mortality rates, healthcare cost and length of hospital stay compared to index admissions.

     

COVID-19 and non–COVID-19 pneumonia: a comparison

BackgroundThe COVID-19 pandemic has caused the relocation of huge financial resources to departments dedicated to infected patients, at the expense of those suffering from other pathologies.AimTo compare clinical features and outcomes in COVID-19 pneumonia and non-COVID-19 pneumonia patients.Patients and methods53 patients (35 males, mean age 61.5 years) with COVID-19 pneumonia and 50 patients (32 males, mean age 72.7 years) with non-COVID-19 pneumonia, consecutively admitted between March and May 2020 were included. Clinical, laboratory and radiological data at admission were analyzed. Duration of hospitalization and mortality rates were evaluated.ResultsAmong the non-COVID patients, mean age, presence of comorbidities (neurological diseases, chronic kidney disease and chronic obstructive pulmonary disease), Charlson Comorbidity Index and risk factors (tobacco use and protracted length of stay in geriatric healthcare facilities) were higher than in COVID patients. The non-COVID-19 pneumonia group showed a higher (24% vs. 17%), although not statistically significant in-hospital mortality rate; the average duration of hospitalization was longer for COVID patients (30 vs. 9 days, p = .0001).ConclusionsIn the early stages of the COVID pandemic, our centre noted no statistical difference in unadjusted in-hospital mortality between COVID and non-COVID patients. Non-COVID patients had higher Charlson Comorbidity Scores, reflecting a greater disease burden in this population.

Key Messages

• In March 2020, the COVID-19 disease was declared a pandemic, with enormous consequences for the organization of health systems and in terms of human lives; this has caused the relocation of huge financial resources to departments dedicated to infected patients, at the expense of those suffering from other pathologies.
• Few published reports have compared COVID-19 and non-COVID-19 pneumonia. In our study, performed in a geographic area with a low prevalence of SARS-CoV-2 infection, we found few statistically significant differences in terms of clinical characteristics between the two groups analyzed.
• In the early stages of the COVID pandemic, our centre noted no statistical difference in unadjusted in-hospital mortality between COVID and non-COVID patients. Non-COVID patients had higher Charlson Comorbidity Scores, reflecting a greater disease burden in this population

     

Stress testing in young low-risk patients with potential acute coronary syndromes

Objective

Young patients are at low risk for an acute coronary syndrome (ACS); however, many of these patients still enter a “rule-out ACS” pathway and receive stress testing. We hypothesized that stress testing in patients younger than 40 years without known coronary disease will not identify patients at high risk for 30-day adverse cardiovascular events.

Methods

We conducted a cohort study of patients younger than 40 years evaluated in the emergency department for potential ACS. Patients were excluded if they used cocaine, had known cardiac disease, or had an abnormal electrocardiogram. Patients were followed up in-house; follow-up was performed by direct telephone contact and medical record review. The main outcome was a composite of death, acute myocardial infarction (AMI), and revascularization at 30 days. Comparisons between patients with and without stress testing were done using χ² or t test, as appropriate; 95% confidence intervals were reported for the main outcomes.

Results

Of 8816 patient visits, 1144 patients met inclusion criteria. Within 30 days, 82 patients (7.2%) received stress testing, 2 of whom led to cardiac catheterization. Death (n = 2), AMI (n = 3), and revascularization (n = 1) were not different between patients who did and did not receive stress testing (2.4% [0.2%-8.5%] vs 0.4% [0.1%-1.0%]).

Conclusion

The 30-day cardiovascular complication rate is not different between young patients without known heart disease who do and do not receive stress testing when they present with symptoms of a potential ACS. Testing of young patients at low risk for disease should be reconsidered.