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Erik H. Hoyer Dale M. Needham Jason Miller Amy Deutschendorf Michael Friedman Daniel J. Brotman 《Archives of physical medicine and rehabilitation》2013
Objective
To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care.Design
Retrospective cohort study.Setting
Academic hospital-based CIIRP.Participants
Consecutive patients (N=1515) admitted to a CIIRP between January 2009 and June 2012.Interventions
Patients' functional status, the primary exposure variable, was assessed using tertiles of the total FIM score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domains. A propensity score, consisting of 25 relevant clinical and demographic variables, was used to adjust for confounding in the analysis.Main Outcome Measures
Readmission to acute care was categorized as (1) readmission before planned discharge from the CIIRP, (2) readmission within 30 days of discharge from the CIIRP, and (3) total readmissions from both groups, with total readmissions being the a priori primary outcome.Results
Among the 1515 patients, there were 347 total readmissions. Total readmissions were significantly associated with FIM scores, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the highest tertile (AOR=2.6; 95% CI, 1.9–3.7; P<.001 and AOR=1.7; 95% CI, 1.2–2.4; P=.002, respectively). There were similar findings for secondary analyses of readmission before planned discharge from the CIIRP (AOR=3.5; 95% CI, 2.2–5.8; P<.001 and AOR=2.1; 95% CI, 1.3–3.5l P=.002, respectively), and a weaker association for readmissions after discharge from the CIIRP (AOR=1.6; 95% CI, 1.0–2.4; P=.047 and AOR=1.3; 95% CI, 0.8–1.9; P=.28, respectively). The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score.Conclusions
Functional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor. 相似文献3.
Jibby E. Kurichi Dawei Xie Barbara E. Bates Diane Cowper Ripley W. Bruce Vogel Pui Kwong Margaret G. Stineman 《Archives of physical medicine and rehabilitation》2014
Objective
To determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs.Design
Retrospective observational study.Setting
Veterans Affairs facilities nationwide.Participants
Veterans hospitalized for stroke during fiscal year 2007 to fiscal year 2008 (N=12,565).Intervention
Not applicable.Main Outcome Measure
Discharge location after hospitalization.Results
There were 10,130 (80.6%) veterans discharged home after hospitalization for acute stroke. Married veterans were more likely than nonmarried veterans to be discharged home (odds ratio [OR]=1.23; 95% confidence interval [CI]=1.11–1.35). Compared with veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR=.04; 95% CI=.03–.07). Compared with those with occlusion of cerebral arteries, patients with intracerebral hemorrhage (OR=.61; 95% CI=.50–.74) or other central nervous system hemorrhage (OR=.78; 95% CI=.63–.96) were less likely to be discharged home, whereas patients with occlusion of precerebral arteries (OR=1.36; 95% CI=1.07–1.73) were more likely to return home. Evidence of congestive heart failure (OR=.85; 95% CI=.76–.95), fluid and electrolyte disorders (OR=.86; 95% CI=.77–.96), internal organ procedures and diagnostics (OR=.87; 95% CI=.78–.97), and serious nutritional compromise (OR=.49; 95% CI=.40–.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated, whereas treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge.Conclusions
We found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning. 相似文献4.
Rita Andersen Leth Bodil Elisabeth FormanBrian Kristensen MD PhD 《The Journal of emergency medicine》2013
Background
The yield of blood cultures is approximately 10%. This could be caused by inaccurate prediction of patients with bloodstream infection (BSI).Objectives
To evaluate the usability of systemic inflammatory response syndrome (SIRS) or biochemical analyses as predictors for positive blood culture.Methods
We conducted a prospective cohort study at a Danish regional hospital from February 1 to April 30, 2010. All adult patients were included on the first time blood cultures were sampled during admission. Data were obtained from medical records, databases on microbiology, biochemistry, and antibiotic treatment. Data included time of admission, date and result of blood culture, results of biochemical analyses, and clinical measurements on the day of blood culture. Prediction of BSI was analyzed according to both individual parameters and parameters combined in different sepsis score groups. Associations were calculated using multiple logistic regression.Results
Patients with BSI (68 patients) were compared to patients without BSI (828 patients). Respiratory rate, body temperature, and C-reactive protein were strongest associated with BSI, with adjusted odds ratio (OR) 5.42, 95% confidence interval (CI) 1.13–25.9; OR 2.55, 95% CI 1.34–4.87; and OR 6.06, 95% CI 0.82–44.6, respectively. SIRS was associated with BSI, with crude OR 7.25, 95% CI 1.75–30.1. Neutrophil count and p-carbamide were not associated with BSI: adjusted OR 0.88, 95% CI 0.36–2.13 and OR 1.44, 95% CI 0.82–2.52, respectively. Only one of the sepsis score groups was associated with BSI: crude OR 2.13, 95% CI 1.08–4.19.Conclusions
SIRS is an adequate predictor of BSI. By contrast, biochemical parameters were not useful as predictors of BSI. 相似文献5.
Laurence Seematter-Bagnoud Estelle Lécureux Stéphane Rochat Stéfanie Monod Constanze Lenoble-Hoskovec Christophe J. Büla 《Archives of physical medicine and rehabilitation》2013
Objective
To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation.Design
Observational study.Setting
Postacute rehabilitation facility.Participants
Patients (N=2754) aged ≥65 years admitted over a 4-year period.Interventions
Not applicable.Main Outcome Measure
Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement.Results
Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16–1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01–1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31–1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15–1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19–23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13–2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67–2.93; P<.001, respectively).Conclusions
Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome. 相似文献6.
Barnet Eskin Richard D. Shih Frederick W. Fiesseler Brian W. Walsh John R. Allegra Michael E. Silverman Dennis G. Cochrane David F.E. Stuhlmiller Oliver L. Hung Alex Troncoso Diane P. Calello 《The Journal of emergency medicine》2014
Background
Although oral corticosteroids are commonly given to emergency department (ED) patients with musculoskeletal low back pain (LBP), there is little evidence of benefit.Objective
To determine if a short course of oral corticosteroids benefits LBP ED patients.Methods
Design: Randomized, double-blind, placebo-controlled trial. Setting: Suburban New Jersey ED with 80,000 annual visits. Participants: 18–55-year-olds with moderately severe musculoskeletal LBP from a bending or twisting injury ≤ 2 days prior to presentation. Exclusion criteria were suspected nonmusculoskeletal etiology, direct trauma, motor deficits, and local occupational medicine program visits. Protocol: At ED discharge, patients were randomized to either 50 mg prednisone daily for 5 days or identical-appearing placebo. Patients were contacted after 5 days to assess pain on a 0–3 scale (none, mild, moderate, severe) as well as functional status.Results
The prednisone and placebo groups had similar demographics and initial and discharge ED pain scales. Of the 79 patients enrolled, 12 (15%) were lost to follow-up, leaving 32 and 35 patients in the prednisone and placebo arms, respectively. At follow-up, the two arms had similar pain on the 0–3 scale (absolute difference 0.2, 95% confidence interval [CI] −0.2, 0.6) and no statistically significant differences in resuming normal activities, returning to work, or days lost from work. More patients in the prednisone than in the placebo group sought additional medical treatment (40% vs. 18%, respectively, difference 22%, 95% CI 0, 43%).Conclusion
We detected no benefit from oral corticosteroids in our ED patients with musculoskeletal LBP. 相似文献7.
Sion Jo Young Ho Jin Jae Baek Lee Taeoh Jeong Jaechol Yoon Boyoung Park 《The Journal of emergency medicine》2014
Background
To measure emergency department (ED) crowding, the emergency department occupancy ratio (EDOR) was introduced.Objective
Our aim was to determine whether the EDOR is associated with mortality in adult patients who visited the study hospital ED.Methods
We reviewed data on all patients who visited the ED of an urban tertiary academic hospital in Korea for 2 consecutive years. The EDOR is defined by the total number of patients in the ED divided by the number of licensed ED beds. We tested the association between the EDOR (quartile) and each outcome using a multivariable logistic regression analysis adjusted for potential confounders: age, sex, emergency medical services transport, transferred case, weekend visit, shift, triage acuity, visit cause of injury, operation, vital signs, intensive care unit or ward admission, and ED length of stay (quartile). The main outcome measures were survival status at discharge and at 1–7 days.Results
A total of 54,410 adult patients were enrolled. The EDOR ranged from 0.41 to 2.31 and the median was 1.24. On multivariable analyses, in comparison with the lowest (first) quartile, the highest (fourth) quartile of the EDOR was associated with 1-day mortality (adjusted odds ratio [OR] = 1.42; 95% confidence interval [CI] 1.08–1.88), 2-day mortality (adjusted OR = 1.31; 95% CI 1.04–1.67), and 3-day mortality (adjusted OR = 1.27; 95% CI 1.02–1.58). The EDOR was not significantly associated with 4- to 7-day mortalities and overall mortality at discharge.Conclusions
The EDOR is associated with increased 1- to 3-day mortality even after controlling for potential confounders. 相似文献8.
Background
Some Emergency Medical Services currently use just one component of the Universal Termination of Resuscitation (TOR) Guideline, the absence of prehospital return of spontaneous circulation (ROSC), as the single criteria to terminate resuscitation, which may deny transport to potential survivors.Objective
This study aimed to report the survival to hospital discharge rate in non-traumatic, adult out-of-hospital cardiac arrest (OHCA) patients transported to hospital without a prehospital ROSC.Methods
An observational study of OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport to hospital with ongoing resuscitation. Multivariable logistic regression was used to determine the association of each variable with survival to hospital discharge.Results
Of 20,207 OHCA treated by EMS, 3374 (16.4%) did not have a prehospital ROSC but met the Universal TOR guideline for transport to hospital with ongoing resuscitation. Of these patients, 122 (3.6%) survived to hospital discharge. Survival to discharge was associated with initial shockable VF/VT rhythms (OR 5.07; 95% CI 2.77–9.30), EMS-witnessed arrests (OR 3.51; 95% CI 1.73–7.15), bystander-witnessed arrests (OR 2.11; 95% CI 1.18–3.77), and public locations (OR 1.57; 95% CI 1.02–2.40).Conclusion
In OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport with ongoing resuscitation survival rates were above the 1% futility rate. Employing only the lack of ROSC as criteria for termination of resuscitation may miss survivors after OHCA. 相似文献9.
Background
Most out-of-hospital cardiac arrest (OHCA) studies have been conducted in developed countries or metropolitan areas, and few in developing countries or rural areas.Objectives
The aims of this study were to determine the weak links in the chain of survival and to estimate the outcomes of OHCA patients in Taoyuan, a nonmetropolitan area in Taiwan.Methods
A retrospective review and analysis of OHCA data was conducted. The three outcomes were whether a return of spontaneous circulation (ROSC) was achieved, whether the patient survived to admission, or whether the patient survived to hospital discharge.Results
From April to December 2008, 1048 OHCA patients were resuscitated, and 712 (67.9%) adult cardiac patients were used in this study. Among these 712 patients, 17.8% achieved ROSC (95% confidence interval [CI] 15.2–20.8%), 16.3% survived to admission (95% CI 13.6–19.0%), and 1.4% survived to discharge (95% CI 0.5–2.3%). Factors significantly associated with the three outcomes were witness status, response time to emergency medical services, and whether the patient had a shockable rhythm. Bystander cardiopulmonary resuscitation (CPR) did not add a notable benefit to the outcomes of OHCA.Conclusions
The survival rate of OHCA patients in nonmetropolitan Taiwan was very low (1.4%). Lower witnessed rate, lower bystander CPR rate, and longer response interval in remote areas are the main causes of inferior survival rate. 相似文献10.
Yaniv Kerem Joshua S. Eastvold DeAnn Faragoi Diana Strasburger Sean E. Motzny Erik B. Kulstad 《The Journal of emergency medicine》2014
Background
Clinical outcomes in ST-segment elevation myocardial infarction (STEMI) are related to reperfusion times. Given the benefit of early recognition of STEMI and resulting ability to decrease reperfusion times and improve mortality, current prehospital recommendations are to obtain electrocardiograms (ECGs) in patients with concern for acute coronary syndrome.Objectives
We sought to determine the effect of wireless transmission of prehospital ECGs on STEMI recognition and reperfusion times. We hypothesized decreased reperfusion times in patients in whom prehospital ECGs were obtained.Methods
We conducted a retrospective, observational study of patients who presented to our suburban, tertiary care, teaching hospital emergency department with STEMI on a prehospital ECG.Results
Ninety-nine patients underwent reperfusion therapy. Patients with prehospital ECGs had a mean time to angioplasty suite of 43 min (95% confidence interval [CI] 31–54). Compared to patients with no prehospital ECG, mean time to angioplasty suite was 49 min (95% CI 41–57), p = 0.035. Patients with prehospital STEMI identification and catheterization laboratory activation had a mean time to angioplasty suite of 33 min (95% CI 25–41), p = 0.007. Patients with prehospital ECGs had a mean door-to-balloon time of 66 min (95% CI 53–79), whereas the control group had a mean door-to-balloon time of 79 min (95% CI 67–90), p = 0.024. Patients with prehospital STEMI identification and catheterization laboratory activation had a mean door-to-balloon time of 58 min (95% CI 48–68), p = 0.018.Conclusions
Prehospital STEMI identification allows for prompt catheterization laboratory activation, leading to decreased reperfusion times. 相似文献11.
Bart Brown Srikar Adhikari Jared Marx Lina Lander Gordon L. Todd 《The Journal of emergency medicine》2012
Background
The exposure to ultrasound technology during medical school education is highly variable across institutions.Objectives
The objectives of this study were to assess medical students’ perceptions of ultrasound use to teach Gross Anatomy along with traditional teaching methods, and determine their ability to identify sonographic anatomy after focused didactic sessions.Methods
Prospective observational study. Phase I of the study included three focused ultrasound didactic sessions integrated into Gross Anatomy curriculum. During Phase II, first-year medical students completed a questionnaire.Results
One hundred nine subjects participated in this study; 96% (95% confidence interval [CI] 92–99%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods. Ninety-two percent (95% CI 87–97%) indicated that ultrasound-based teaching increases confidence to perform invasive procedures in the future. Ninety-one percent (95% CI 85–96%) believed that it is feasible to integrate ultrasound into the current Anatomy curriculum. Ninety-eight percent (95% CI 95–100%) of medical students accurately identified vascular structures on ultrasound images of normal anatomy of the neck. On a scale of 1 to 10, the average confidence level reported in interpreting the images was 7.4 (95% CI 7.1–7.7). Overall, 94% (95% CI 91–99%) accurately answered questions about ultrasound fundamentals and sonographic anatomy.Conclusions
The majority of medical students believed that it is feasible and beneficial to use ultrasound in conjunction with traditional teaching methods to teach Gross Anatomy. Medical students were very accurate in identifying sonographic vascular anatomy of the neck after brief didactic sessions. 相似文献12.
Emilie S. Powell Rahul K. Khare D. Mark Courtney Joe Feinglass 《The Journal of emergency medicine》2013
Background
Mortality differences in weekend and weekday admissions have been observed for a variety of conditions that require aggressive early intervention. It is unknown if there is a mortality difference that exists for patients presenting to the Emergency Department (ED) with sepsis on the weekend.Study Objectives
We hypothesized that there is an increase in early inpatient mortality (death on day 1 or day 2 of hospitalization) among patients with sepsis who present to the ED on the weekend vs. weekdays.Methods
We performed a cross-sectional analysis of 114,611 ED admissions with a principal diagnosis consistent with sepsis from 576 hospitals in the 2008 Nationwide Inpatient Sample. Adjusted analyses controlled for patient and hospital characteristics, and examined the likelihood of either early (day 1 or day 2 of hospitalization) or overall inpatient mortality.Results
A greater proportion of patients admitted on the weekend died on day 1 and day 2 of hospitalization (5.4% vs. 4.0%, p < 0.001; and 7.5% vs. 6.9%, p = 0.001), the difference for overall inpatient mortality was not significant (17.9% vs. 17.5%, p = 0.08). The risk-adjusted odds ratio (OR) of day 1 and day 2 early inpatient mortality of weekend vs. weekday admissions was 1.10 (95% confidence interval [CI] 1.04–1.17) and 1.08 (95% CI 1.03–1.14), respectively; the association with overall inpatient mortality was not significant (OR 1.03, 95% CI 1.00–1.07).Conclusions
Patients admitted through the ED with sepsis on the weekend had a greater likelihood of early mortality, but not overall mortality, when compared to patients admitted on weekdays. 相似文献13.
Alfredo E. Urdaneta Geoff Stroh James Teng Brandy Snowden Tyler W. Barrett Gregory W. Hendey 《The Journal of emergency medicine》2013
Background
Cervical spine injury (CSI) studies have identified different factors contributing to CSI, but none compares the incidence and pattern of injury of patients arriving at the Emergency Department (ED) by private vehicle (PV).Objective
We compared the characteristics and injury patterns in CSI patients who were transported to the ED via Emergency Medical Services (EMS) versus PV.Methods
We conducted a three-hospital retrospective review of patients with CSI from January 1, 2000 to December 31, 2007. We excluded transfers and follow-up visits. Using a standardized data collection form, we reviewed demographics, mode of transport, mechanism of injury, imaging results, injury type and level, and neurologic deficits. Means and proportions were compared using t-tests and chi-squared as appropriate.Results
Of 1174 charts identified, 718 met all study criteria; 671 arrived by EMS and 47 by PV. There was no difference between groups in age or gender. Ground-level fall was more likely in PV patients (32%, 95% confidence interval [CI] 20–46% vs. 6%, 95% CI 4–9%), whereas motor vehicle collision was less likely (32%, 95% CI 20–46% vs. 67%, 95% CI 63–70%). PV patients more often sustained a stable injury (66%, 95% CI 52–78% vs. 40%, 95% CI 36–44%), and were more often triaged to a lower-acuity area (25%, 95% CI 15–40% vs. 4%, 95% CI 3–6%). The incidence of neurologic deficit was similar (32%, 95% CI 20–46% vs. 24%, 95% CI 21–28%), though more PV patients had spinal cord injury without radiographic abnormality (21%, 95% CI 12–35% vs. 5%, 95% CI 4–7%).Conclusion
A small proportion of patients with CSI present to the ED by PV. Although most had stable injuries, a surprising number had unstable injuries with neurologic deficits, and were triaged to lower-acuity areas in the ED. 相似文献14.
Introduction
Spontaneous changes in body temperature after return of circulation (ROSC) from cardiac arrest are common, but the association of these changes with outcomes in hospitalized patients who survive to 24 h post-ROSC is not known. We tested the hypothesis that adults who experience temperature lability in the first 24 h have worse outcomes compared with those who maintain normothermia.Materials and methods
A prospective observational study from a multicenter registry of cardiac arrests (National Registry of Cardiopulmonary Resuscitation) from 355 US and Canadian hospitals. 14,729 adults with return of circulation from a pulseless cardiac arrest. We excluded those who died or were discharged before 24 h post-event, those made Do-Not-Resuscitate (DNR) within 24 h of event, those that had a preceding trauma, and those with multiple cardiac arrests. Finally, we included only subjects that had both a lowest (Tmin) and highest (Tmax) body temperature value recorded during the first 24-h after ROSC, resulting in a study sample of 3426 patients.Results
After adjustment for potential covariates, there was a lower odds of survival in those having an episode of hypothermia (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48–0.80), those having an episode of hyperthermia (OR, 0.67; 95% CI, 0.48–0.80), and those having an episode of both (OR, 0.59; 95% CI, 0.39–0.91). Among those who survived to discharge, there was also a lower odds of favorable neurologic performance in those who had an episode of hyperthermia (OR, 0.71; 95% CI, 0.51–0.98).Conclusions
Episodes of temperature lability following in-hospital resuscitation from cardiac arrest are associated with lower odds of surviving to discharge. Hyperthermia is also associated with fewer patients leaving the hospital with favorable neurologic performance. Further studies should identify whether therapeutic control over changes in body temperature after in-hospital cardiac arrest improves outcomes. 相似文献15.
Wayne F. GuerraThomas R. Mayfield MS NREMT-P Mary S. MeyersAnne E. Clouatre MHS EMT-P John C. Riccio MD 《The Journal of emergency medicine》2013
Background
Severe sepsis is a condition with a high mortality rate, and the majority of patients are first seen by Emergency Medical Services (EMS) personnel.Objective
This research sought to determine the feasibility of EMS providers recognizing a severe sepsis patient, thereby resulting in better patient outcomes if standard EMS treatments for medical shock were initiated.Methods
We developed the Sepsis Alert Protocol that incorporates a screening tool using point-of-care venous lactate meters. If severe sepsis was identified by EMS personnel, standard medical shock therapy was initiated. A prospective cohort study was conducted for 1 year to determine if those trained EMS providers were able to identify 112 severe sepsis patients before arrival at the Emergency Department. Outcomes of the sample of severe sepsis patients were examined with a retrospective case control study.Results
Trained EMS providers transported 67 severe sepsis patients. They identified 32 of the 67 severe sepsis patients correctly (47.8%). Overall mortality for the sample of 112 severe sepsis patients transported by EMS was 26.7%. Mortality for the sample of severe sepsis patients for whom the Sepsis Alert Protocol was initiated was 13.6% (5 of 37), crude odds ratio for survival until discharge was 3.19 (95% CI 1.14–8.88; p = 0.040).Conclusions
This pilot study is the first to utilize EMS providers and venous lactate meters to identify patients in severe sepsis. Further research is needed to validate the Sepsis Alert Protocol and the potential associated decrease in mortality. 相似文献16.
Joonghee Kim Kyuseok KimJae Hyuk Lee You Hwan JoTaeyun Kim Joong Eui RheeKyeong Won Kang 《Resuscitation》2013
Objective
We sought to investigate the prognostic implication of early coagulopathy represented by initial DIC score in out-of-hospital cardiac arrest (OHCA).Methods
OHCA registry was analyzed to identify patients with ROSC without recent use of anticoagulant between 2008 and 2011. Patients were assessed for prehosptial factors, initial laboratory results and therapeutic hypothermia. Outcome variables were survival discharge, 6-month CPC and survival duration within the first week after ROSC. Logistic regression and Cox proportional hazards models were used for both univariable and multivariable analysis.Results
Among 273 eligible patients, initial DIC score was available in 252 (92.3%). Higher DIC score was associated with increased inhospital death (odds ratio [OR], 1.89 per unit; 95% confidence interval [CI], 1.48–2.41) and unfavorable long-term outcome (6-month CPC 3–5; OR, 2.21 per unit; 95% CI, 1.60–3.05). The adjusted ORs for both outcomes were 1.61 (95% CI, 1.17–2.22) and 1.84 (95% CI, 1.26–2.67), respectively. We categorized DIC score in five groups as <3, 3, 4, 5 and >5 and analyzed differential mortality risk using Cox proportional hazards model. Compared with reference group (DIC score < 3), the adjusted HR for early mortality in each remaining group was 1.96 (95% CI, 1.13–3.40), 2.26 (95% CI, 1.27–4.02), 2.77 (95% CI, 1.58–4.85) and 4.29 (95% CI, 2.22–8.30), respectively (p-trend < 0.001). The area under the receiver operating characteristic of DIC score for prediction of unfavorable long-term outcome was 0.79 (95% CI, 0.69–0.88).Conclusion
Increased initial DIC score in OHCA was an independent predictor for poor outcomes and early mortality risk. 相似文献17.
Matthias Bethge Christoph Gutenbrunner Silke Neuderth 《Archives of physical medicine and rehabilitation》2013
Objective
To determine whether the Work Ability Index (WAI), a short 7-item self-report questionnaire addressing issues of perceived disability, impairment, and expectations for resuming work, predicts application for disability pension, recommendations for further treatment, and other adverse work-related criteria in patients with chronic back pain after rehabilitation.Design
Cohort study with 3-month follow-up.Setting
Seven inpatient rehabilitation centers.Participants
Patients (N=294; 168 women; mean age, 49.9y) with chronic back pain.Intervention
The WAI was completed at the beginning of rehabilitation. All patients were treated according to the German rehabilitation guidelines for chronic back pain and work-related medical rehabilitation.Main Outcome Measure
Application for disability pension, as assessed by a postal questionnaire 3 months after discharge.Results
Receiver operating characteristic curve analysis of the association between the WAI at baseline and subsequent application for disability pension revealed an area under the curve of .80 (95% confidence interval [CI], .62–.97). Youden index was highest when the WAI cutoff value was ≤20 points (sensitivity, 72.7%; specificity, 82.2%; total correct classification, 81.7%). After adjusting for age and sex, persons with a baseline WAI score of ≤20 points had 15.6 times (95% CI, 3.6–68.2) higher odds of subsequent application for disability pension, 4.9 times (95% CI, 1.5–16.8) higher odds of unemployment, and 6 times (95% CI, 2.4–15.2) higher odds of long-term sick leave at follow-up.Conclusions
The WAI could help rehabilitation professionals identify patients with back pain with a high risk of a subsequent application for disability pension. 相似文献18.
Background
Cardiac arrest physiology has been proposed to occur in three distinct phases: electrical, circulatory and metabolic. There is limited research evaluating the relationship of the 3-phase model of cardiac arrest to functional survival at hospital discharge. Furthermore, the effect of post-cardiac arrest targeted temperature management (TTM) on functional survival during each phase is unknown.Objective
To determine the effect of TTM on the relationship between the time of initial defibrillation during each phase of cardiac arrest and functional survival at hospital discharge.Methods
This was a retrospective observational study of consecutive adult (≥18 years) out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythms. Included patients obtained a return of spontaneous circulation (ROSC) and were eligible for TTM. Multivariable logistic regression was used to determine predictors of functional survival at hospital discharge.Results
There were 20,165 OHCA treated by EMS and 871 patients were eligible for TTM. Of these patients, 622 (71.4%) survived to hospital discharge and 487 (55.9%) had good functional survival. Good functional survival was associated with younger age (OR 0.94; 95% CI 0.93–0.95), shorter times from collapse to initial defibrillation (OR 0.73; 95% CI 0.65–0.82), and use of post-cardiac arrest TTM (OR 1.49; 95% CI 1.07–2.30). Functional survival decreased during each phase of the model (65.3% vs. 61.7% vs. 50.2%, P < 0.001).Conclusion
Functional survival at hospital discharge was associated with shorter times to initial defibrillation and was decreased during each successive phase of the 3-phase model. Post-cardiac arrest TTM was associated with improved functional survival. 相似文献19.
Getaw Worku Hassen Ana Costea Tennyson Smith Claire Carrazco Hafiz Hussein Bahareh Soroori-Rad Sonia Vaidian Justin Seashore Edris Alderwish Wei Sun Alice Chen Bonnie Simmons Shakeel Usmani Hossein Kalantari George Fernaine 《The Journal of emergency medicine》2014
Background
The electrocardiogram (ECG) is the most important diagnostic tool for acute myocardial infarction (AMI). T wave inversion (TWI) in lead aVL has not been emphasized or well recognized.Objective
This study examined the relationship between the presence of TWI before the event and mid-segment left anterior descending (MLAD) artery lesion in patients with AMI.Methods
Retrospective charts of patients with acute coronary syndrome between the months of January 2009 and December 2011 were reviewed. All patients with MLAD lesion were identified and their ECG reviewed for TWI in lead aVL.Results
Coronary angiography was done on 431 patients. Of these, 125 (29%) had an MLAD lesion. One hundred and six patients (84.8%) had a lesion > 50% and 19 patients (15.2%) had a lesion < 50%. Of the 106 patients who had a MLAD lesion > 50%, 90 patients (84.9%) had TWI in lead aVL and one additional lead. Of the 19 patients who had an MLAD lesion < 50%, 8 patients (42.1%) had TWI in lead aVL and one additional lead. Isolated TWI in lead aVL had an overall sensitivity of 76.7% (95% confidence interval [CI] 0.65–0.86), a specificity of 71.4% (95% CI 0.45–0.88), a positive predictive value of 92%, a negative predictive value of 41.7%, a positive likelihood ratio of 2.7 (95% CI 1.16–6.22), and negative likelihood ratio of 0.32 (95% CI 0.19–0.58) for predicting a MLAD lesion of > 50% (p = 0.0011).Conclusions
TWI in lead aVL might signify a mid-segment LAD lesion. Recognition of this finding and early appropriate referral to a cardiologist might be beneficial. Additional studies are needed to validate this finding. 相似文献20.
Marylou Cárdenas-Turanzas Joe Ensor Chris Wakefield Karen Zhang Susannah Kish Wallace Kristen J. Price Joseph L. Nates 《Journal of critical care》2012