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length of hospital stay and mortality associated with burns from assault:a retrospective study with inverse probability weighting analysis

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Burns & Trauma 2020年第1期8卷 351-358页

作者： Ryo Yamamoto Mitsunobu Toyosaki Tomohiro Kurihara Junichi Sasaki Department of Emergency and Critical Care Medicine Keio University School of Medicine35 ShinanomachiShinjukuTokyo160-8582Japan

Background:Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world.However,it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries.To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays,we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes,regardless of the severity of burn injuries.Methods:We conducted a retrospective cohort study,using a city-wide burn registry(1996–2017)accounting for 14 burn centers in Tokyo,Japan.Patients who arrived within 24 hours after injury were included,and those with self-inflicted burn injuries were excluded.Patients were divided into two groups according to mechanism of burns(assault vs.accident),and the number of hospitalfree days until day 30 after injury(a composite of in-hospital death and hospital length of stay)was compared between the groups.To estimate the probability that an injury would be classified as an assault,we calculated propensity scores,using multivariate logistic regression analyses adjusted for known outcome predictors.We also performed an inverse probability weighting(IPW)analysis to compare adjusted numbers of hospital-free days.Results:Of 7419 patients in the registry with burn injuries during the study period,5119 patients were included in this study.Of these,113(2.2%)were injured as a result of assault;they had significantly fewer hospital-free days than did those with burns caused by accident(18[27]vs.24[20]days;coefficient=−3.4[−5.5 to−1.3]days;p=0.001).IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days(adjusted coefficient=−0.6[−1.0 to−0.1]days;p=0.009).Conclusions:Burn from assault was independently associated with fewer hospital-free days,regardless of the severity of burn injuri

关键词： Assault Burn Mortality length of hospital stay Inverse probability weighting

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Malnutrition as a predictor of prolonged length of hospital stay in patients with gynecologic malignancy: A comparative analysis

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Oncology and Translational Medicine 2021年第6期7卷 279-285页

作者： Yongning Chen Runrong Li Li Zheng Wenlian Liu Yadi Zhang Shipeng Gong Department of Gynecology The First Affiliated Hospital of Jinan UniversityGuangzhou 510630China Department of Obstetrics and Gynecology Nanfang HospitalSouthern Medical UniversityGuangzhou 510515China

Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay(LOS).Methods We recruited 147 hospitalized patients with gynecologic malignancy from Nanfang hospital in 2017.Their nutritional status was assessed using the PG-SGA and NRS-2002.The consistency between the two assessments was compared via the Kappa test.The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman’s correlation.Results The PG-SGA demonstrated that 66.7%and 54.4%of patients scoring≥2 and≥4 were malnourished,respectively.Furthermore,the NRS-2002 indicated that 55.8%of patients were at nutritional risk.Patients with ovarian cancer had a relatively high incidence of malnutrition.However,this was only significant for patients who scored≥4 in the PG-SGA(P=0.001 and P=0.019 for endometrial carcinoma and cervical cancer,respectively).The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy(0.689,0.643 for PG-SGA score≥2,score≥4 and NRS-2002,respectively).Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS.Furthermore,prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.Conclusion The PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy.Both assessments could be used as predictors of LOS.

关键词： malnutrition patient-generated subjective global assessment nutritional risk screening-2002 length of hospital stay gynecologic malignancy

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Did the Revision of the Japanese Medical Payment System Work Properly?—An Analysis of Averages and Variances of length of hospital stay for Type 2 Diabetes Patients by Individual hospital

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Health 2016年第6期8卷 505-517页

作者： Kazumitsu Nawata Koichi Kawabuchi Graduate School of Engineering University of Tokyo Tokyo Japan Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan

We evaluated the effects of the 2010 revision of the medical payment system on the length of stay (LOS). In this analysis, we assessed not only the average length of stay (ALOS), but also variance of LOS at individual hospitals. We used a dataset of 18,641 type 2 diabetes patients collected from 51 general hospitals. The variables found to affect LOS were age, comorbidities, complications, acute hospitalization, introduced by other hospitals, winter, one-week hospitalization, specific hospitalization period, and principal diseases coded E11.5, E11.6 and E11.7. Although the effect was marginal, the 2010 revision did reduce ALOS, and the reduction was larger as ALOS became longer. On the other hand, we did not find that the variance of LOS within hospitals became smaller. The results of the study suggest that new incentives and assistance to hospitals to help them make efficient use of medical information are needed.

关键词： Type 2 Diabetes length of hospital stay Analysis of Variances

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Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity

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World Journal of Gastroenterology 2022年第38期28卷 5602-5613页

作者： Yao-Chi Huang Chi-Huan Wu Mu Hsien Lee Sheng Fu Wang Yung-Kuan Tsou Cheng-Hui Lin Kai-Feng Sung Nai-Jen Liu Department of Medicine College of MedicineChang Gung UniversityTaoyuan 333Taiwan Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333Taiwan

BACKGROUND The optimal timing of endoscopic retrograde cholangiopancreatography(ERCP)in acute cholangitis(AC) is uncertain,especially in patients with AC of varying severity.AIM To report whether the timing of ERCP is associated with outcomes in AC patients with different severities.METHODS According to the 2018 Tokyo guidelines,683 patients who met the definite diagnostic criteria for AC were retrospectively identified.The results were first compared between patients receiving ERCP ≤ 24 h and>24 h and then between patients receiving ERCP ≤ 48 h and>48 h.Subgroup analyses were performed in patients with grade Ⅰ,Ⅱ or Ⅲ AC.The primary outcome was 30-d mortality.Secondary outcomes were intensive care unit(ICU) admission rate,length of hospital stay(LOHS) and 30-d readmission rate.RESULTS Taking 24 h as the critical value,compared with ERCP>24 h,malignant biliary obstruction as a cause of AC was significantly less common in the ERCP ≤ 24 h group(5.2% vs 11.5%).The proportion of cardiovascular dysfunction(11.2% vs 2.6%),respiratory dysfunction(14.2% vs 5.3%),and ICU admission(11.2% vs 4%)in the ERCP ≤ 24 h group was significantly higher,while the LOHS was significantly shorter(median,6 d vs 7 d).Stratified by the severity of AC,higher ICU admission was only observed in grade Ⅲ AC and shorter LOHS was only observed in grade Ⅰ and Ⅱ AC.There were no significant differences in 30-d mortality between groups,either in the overall population or in patients with grade Ⅰ,Ⅱ or Ⅲ AC.With 48 h as the critical value,compared with ERCP>48 h,the proportion of choledocholithiasis as the cause of AC was significantly higher in the ERCP ≤ 48 h group(81.5% vs 68.3%).The ERCP ≤ 48 h group had significantly lower 30-d mortality(0 vs 1.9%) and shorter LOHS(6 d vs 8 d).Stratified by AC severity,lower 30-d mortality(0 vs 6.1%) and higher ICU admission rates(22.2% vs 10.2%) were only observed in grade Ⅲ AC,and shorter LOHS was only observed in grade I and Ⅱ AC.In the multivariate analysis,cardiovascular dysfunction and time to ERCP were two

关键词： Acute cholangitis Endoscopic retrograde cholangiopancreatography severity Timing Thirtyday mortality length of hospital stay

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Nasogastric or nasojejunal feeding in pediatric acute pancreatitis: a randomized controlled trial

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World Journal of Pediatrics 2021年第5期17卷 536-543页

作者： Hong Zhao Yan Han Ke-Rong Peng You-You Luo Jin-Dan Yu You-Hong Fang Jie Chen Jin-Gan Lou Department of Gastroenterology The Children's HospitalZhejiang University School of MedicineHangzhou 310052China National Clinical Research Center for Child Health The Children's HospitalZhejiang University School of MedicineHangzhou 310052China

Background The aim of this study was to compare nasogastric(NG)feeding with nasojejunal(NJ)feeding when treating pediatric patients with acute pancreatitis(AP)..Methods We performed a single-center,prospective,randomized,active-controlled trial involving 77 pediatric patients with AP from April 2014 to December 2017.The patients were randomized into two groups:the NG tube feeding group(34 patients)and the NJ tube feeding group(33 patients).The primary outcome measures included the enteral nutrition intoler-ance,the length of tube feeding time,the recurrent pain of pancreatitis and complications.Results A total of 62 patients with AP(31 patients for each group)came into the final analysis.No differences were found in baseline characteristics,pediatric AP score and computed tomography severity score between the lwo groups.Three(9.7%)patients in the NG group and one(3.2%)patient in the NJ group developed intolerance(relative risk=3.00,95%confidence interval 0.33-27.29,P=0.612).The tube feeding time and length of hospital stay of the NG group were significantly shorter than those of the NJ group(P=0.016 and 0.027,respectively).No patient died in the trial.No significant differences were found in recurrent pain,complications,nutrition delivery efficacy,and side effects between the two groups.Conclusions NG tube feeding appears to be effective and safe for acute pediatric pancreatitis compared with NJ tube feeding.In addition,high qualifed,large sample sized,randomized controlled trials in pediatric population are needed.

关键词： Acute pancreatitis Enteral nutrition Enteral nutrition intolerance length of hospital stay Tube feeding time

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Role of peripheral eosinophilia in acute exacerbation of chronic obstructive pulmonary disease

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World Journal of Clinical Cases 2020年第13期8卷 2727-2737页

作者： Chih-Wei Wu Chou-Chin Lan Po-Chun Hsieh I-Shiang Tzeng Yao-Kuang Wu Division of Pulmonary Medicine Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationNew Taipei City 23142Taiwan Department of Chinese Medicine Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationNew Taipei City 23142Taiwan Department of Research Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationNew Taipei City 23142Taiwan

BACKGROUND Eosinophil counts are a promising guide to systemic steroid administration for chronic obstructive pulmonary disease(COPD).AIM To study the role of peripheral eosinophilia in hospitalized patients with acute exacerbation of COPD(AECOPD).METHODS From January 2014 to May 2017,patients with AECOPD hospitalized in Taipei Tzu Chi hospital were retrospectively stratified into two groups according to their peripheral eosinophil count:The EOS group(eosinophil count≥2%)and the non-EOS group(eosinophil countlength of hospital stay,and COPD-related readmissions were compared between the groups.RESULTS A total of 625 patients were recruited,with 176 patients(28.2%)in the EOS group.The EOS group showed a lower prevalence of infection,lower cumulative doses of prednisolone equivalents,shorter length of hospital stay,and higher number of COPD-related readmissions than the non-EOS group.There were significantly linear correlations between eosinophil percentage and number of readmissions and between eosinophil percentage and length of hospital stay Plength of hospital stay,and lower doses of systemic steroids,but more frequent readmissions.The EOS group and lower percent-predicted FEV1 values were risk factors for shorter time to first COPD-related readmission.

关键词： Chronic obstructive pulmonary disease Exacerbation Eosinophil Readmission Systemic steroid length of hospital stay Forced expiratory volume in one second

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Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care

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Chinese Journal of Traumatology 2020年第3期23卷 163-167页

作者： Peng-Fei Li Yao-Li Wang Yu-Li Fang Ling Nan Jian Zhou Dan Zhang Department of Emergency and Critical Care First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China Critical Care Unit Doping HospitalArmy Medical UniversityChongqing 400042China

Purpose: To investigate the effect of early enteral nutrition on outcomes of trauma patients in the intensive care unit (ICU).Methods: Clinical data of trauma patients in the ICU of Daping hospital, China from January 2012 to December 2017 was retrospectively analyzed, including patient age, gender, injury mechanism, injury severity score (ISS), nutritional treatment, postoperative complications (wound infection, abdominal abscess, anastomotic rupture, pneumonia), mortality, and adverse events (nausea, vomiting, abdominal distention). Only adult trauma patients who developed bloodstream infection after surgery for damage control were included. Patients were divided into early enteral nutrition group (48 h). Data of all trauma patients were collected by the same investigator. Data were expressed as frequency (percentage), mean ± standard deviation (normal distribution), or median (Q1, Q3) (non-normal distribution) and analyzed by Chi-square test, Student’st-test, or rank-sum test accordingly. Multiple logistic regression analysis was further adopted to investigate the significant variables with enteral nutrition.Results: Altogether 876 patients were assessed and 110 were eligible for this study, including 93 males and 17 females, with the mean age of (50.0 ± 15.4) years. Traffic accidents (46 cases, 41.8%) and fall from height (31 cases, 28.2%) were the dominant injury mechanism. There were 68 cases in the early enteral nutrition group and 42 cases in the control group. Comparison of general variables between early enteral nutrition group and control group revealed significant difference regarding surgeries of enterectomy (1.5% vs. 19.0%,p = 0.01), ileum/transverse colon/sigmoid colostomy (4.4% vs. 16.3%,p = 0.01) and operation time (h) (3.2 (1.9, 6.1) vs. 4.2 (1.8, 8.8),p = 0.02). Other variables like ISS (p = 0.31), acute physiology and chronic health evaluation≥20 (p = 0.79), etc. had no obvious difference. Chi-square test showed a much better result i

关键词： Trauma intensive care Enteral nutrition Wound infection Mortality length of hospital stay

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Comparison of Mortality, length of stay, and hospitalization Costs of hospitalized COVID-19 Patients with Cardiac and Non-Cardiac Disease

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Open Journal of Emergency Medicine 2023年第3期11卷 57-67页

作者： Babak Heidari Aghdam Zahra Kamali Seyedbaglou Amin Shams Akhtari Department of Cardiology Jam Hospital Tehran Iran Jam hospital Tehran Iran Department of Emergency Medicine Jam Hospital Tehran Iran Emergency Department of Hervey Bay hospital Queensland Hervey Bay Australia

Background: The COVID-19 pandemic has presented unprecedented challenges to global healthcare systems. As the pandemic unfolded, it became evident that certain groups of individuals were at an elevated risk of experiencing severe disease outcomes. Among these high-risk groups, individuals with pre-existing cardiac conditions emerged as particularly vulnerable. Objective: This study aimed to investigate the relationship between the length of stay, mortality, and costs of COVID-19 patients with and without a history of cardiac disease. Design: This retrospective study was conducted in Jam hospital in Tehran, Iran, from March 21, 2021, to March 21, 2022. All patients with laboratory-confirmed COVID-19 who were hospitalized during this period were included. Results: A total of 500 COVID-19 patients were hospitalized, with 31.6% having a history of cardiac disease and 68.4% without any cardiac disease. Patients with cardiac disease were significantly older (median [range] age, 69.35 [37 - 94] years) compared to non-cardiac patients (54.95 [13 - 97] years) (p Conclusion: Patients with cardiac disease who are hospitalized with COVID-19 have a higher mortality rate, longer hospital stays, greater disease severity, ICU admission, and higher costs. Therefore, improved prevention and management strategies are crucial for these patients.

关键词： COVID-19 Cardiac Disease length of hospital stay Costs Mortality

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Time Course of Postoperative Complications in Low-Risk Women after Planned Cesarean Section

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Open Journal of Obstetrics and Gynecology 2022年第5期12卷 394-407页

作者： Anne Raabjerg Kruse Linn Håkonsen Arendt Christian Erikstrup Ulrik Schiøler Kesmodel Finn Friis Lauszus Niels Uldbjerg Iben Sundtoft Axel Forman Department of Obstetrics and Gynecology Regional Hospital G&oslash dstrup Herning Denmark Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark Department of Clinical Immunology Aarhus University Hospital Aarhus Denmark Department of Obstetrics and Gynecology Aalborg University Hospital Aalborg Denmark

Objectives: length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.

关键词： Cesarean Section Postoperative Complications Postoperative Hemorrhage Early Discharge length of hospital stay

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A combination regimen by lopinave/litonawe (LPV/r), emtricitabine and tenofovir alafenamide fumarate (FTC/TAF) for treatment of novel coronavirus pneumonia (TARCoV)

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中华急诊医学杂志 2020年第3期29卷 E006-E006页

作者： Jiang Hua Wang Yu Wang Kai Yang Xingxiang Zhang Jiancheng Deng Hongfei Wang Lu Zeng Jun Institute for Emergency and Disaster Medicine Sichuan Provincial People’’s hospital School of Medicine University of Electronic Science and Technology of China Chengdu 610072 ChinaInstitute for Emergency and Disaster Medicine ChinaDepartment of Infection

Objective To explore the efficacy of a combination regimen by Lopinave/Litonawe (LPV/r), emtricitabine and tenofovir alafenamide fumarate (FTC/TAF) for the treatment of novel coronavirus pneumonia (NCP).Methods We design the protocol as a real world study, which includes two groups: prospective intervention cohort (T1) and historical control group (T2). For T1 group, ninety patients will be enrolled who are diagnosed as NCP. All patients in T1 group will receive standard therapies following the recommendation in the guidelines of National Commission of Health, and they will be administered an anti-virus regimen includes LPV/r and FTC/TAF. The T2 group will enroll patients who have received single regimen includes LPV/r. The major outcome is the survival rate of patients. Secondary outcomes are the time of seroconversion of RNA, ARDS progression rate and length of hospital stay.Conclusions The results of this real world study might provide clinical practitioners a high efficiency and fast antivirus regimen for NCP. In addition, the conduction of this study will accelerate screening for other new effective therapeutic method.

关键词： Novel coronavirus pneumonia Lopinave/Litonawe Emtricitabine and tenofovir alafenamide fumarate Survival rate length of hospital stay

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