Are vital sign abnormalities associated with poor outcomes after emergency department discharge?

2019 ◽  
Vol 18 (2) ◽  
pp. 88-95
Author(s):  
Cindy Y Chang ◽  
◽  
Samer Abujaber ◽  
Maximilian J Pany ◽  
Ziad Obermeyer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vital Sign ◽  
Conditional Logistic Regression ◽  
Early Death ◽  
Fold Increase ◽  
Additional Risk ◽  
Increased Risk ◽  
Matched Case ◽  
Poor Outcomes ◽  
Emergency Department Discharge

To examine association between vital sign abnormalities in the emergency department (ED) and early death after ED discharge, we performed a matched case-control study. Conditional logistic regression showed that presence of any vital sign abnormality at ED discharge was significantly associated with over three-fold increase in likelihood of death within 15 days of ED discharge (OR: 3.06, 95%CI: 2.81-4.48). Even small changes were associated with increased risk: every additional beat increase in heart rate conferred additional risk (OR: 1.04, 95%CI: 1.02-1.06), while every additional oxygen saturation percentage point was protective (0.89, 0.80-0.98). However, none of these vital sign abnormalities was a good predictor of early death; there was poor discrimination and substantial overlap in values between cases and controls.

Fractures and the increased risk of suicide

2018 ◽  
Vol 100-B (6) ◽  
pp. 780-786 ◽  
Author(s):  
C-F. Chang ◽  
E. C-C. Lai ◽  
M-K. Yeh
Keyword(s):  
Mental Health Problems ◽  
Conditional Logistic Regression ◽  
Spinal Fractures ◽  
High Rate ◽  
Physical And Mental Health ◽  
Additional Risk ◽  
Never Married ◽  
Increased Risk ◽  
Contextual Setting ◽  
Control Study

Aims A high rate of suicide has been reported in patients who sustain fractures, but the association remains uncertain in the context of other factors. The aim of this study was to examine the association between fractures and the risk of suicide in this contextual setting. Patients and Methods We performed a case-control study of patients aged 40 years or older who died by suicide between 2000 and 2011. We included patients’ demographics, physical and mental health problems, and socioeconomic factors. We performed conditional logistic regression to evaluate the associations between fractures and the risk of suicide. Results We included a total of 34 794 patients who died by suicide and 139 176 control patients. We found that fractures as a homogenous group (adjusted odds ratios (aOR), 1.48; 95% confidence interval (CI) 1.43 to 1.53), and specifically pelvic (aOR 2.04; 95% CI 1.68 to 2.47) and spinal fractures (aOR 1.53; 95% CI 1.43 to 1.64), were associated with a higher risk of suicide. In addition, we found that patients who had a lower income, had never married, had lower levels of educational attainment, or had coexistent physical and mental conditions such as anxiety, mood disorders, and psychosis-related disorders had a higher risk of suicide. Conclusion Fractures, specifically those of the hip and spine, were associated with an increased risk of suicide. The findings suggest that greater clinical attention should be given to this risk in patients with fractures, especially for those with additional risk factors. Cite this article: Bone Joint J 2018;100-B:780–6.

scholarly journals 1383. Everolimus is Associated with an Increased Risk of Tuberculosis in Solid-Organ Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S502-S502
Author(s):  
Hsin-Yun Sun ◽  
Aristine Cheng ◽  
So-Meng Wang ◽  
Meng-Kun Tsai ◽  
Yih-Sharng Chen ◽  
...  
Keyword(s):  
Conditional Logistic Regression ◽  
Multivariable Analysis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
University Hospital ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Matched Case ◽  
Control Study

Abstract Background Tuberculosis (TB) is an important post-transplant infection. Everolimus has been documented to reduce the risk of cytomegalovirus infection in transplant recipients, but its impact on other infections is less known. The present study aimed to assess immunosuppressive regimens on TB risk in solid-organ transplant (SOT) recipients via a matched case–control study. Methods From May 2005 to December 2018, SOT recipients with TB were retrospectively identified, and those without TB undergoing transplantation at the same university hospital were selected as controls. Controls and cases were matched by age (±5 years), transplant type and year (±5 years) at a ratio of 4:1. Conditional logistic regression was used to analyze the risk factors of TB. Results TB developed in 30 SOT recipients (13 kidney, 7 heart, 6 liver, and 4 lung) after a mean duration of 1,601 days after transplantation, with predominant lung involvement (87%). The diagnosis was made by culture in 70% and pathology in 17%. Rifamycins-based regimens were used in 27 cases, and 4 developed rejection without graft failure. A total of 106 controls were selected. At the time of TB diagnosis, cases were more likely to use everolimus than controls (27% vs. 11%, P < 0.05), but no significant differences were observed in the use of tacrolimus, cyclosporin, sirolimus, prednisolone, or mycophenolate mofetil. The median duration of everolimus use was 585 and 698 days in 8 cases and 12 controls, respectively. Multivariable analysis showed that everolimus use (adjust odds ratio [aOR] 22.3, 95% conference interval [CI] 2.5–203.0) and hemodialysis (aOR 19.6, 95% CI 1.3–287.1) were independently associated with TB. Conclusion TB is more likely to develop in SOT recipients on everolimus and hemodialysis. Further studies to confirm our findings are warranted, and TB risk assessment should be performed for those receiving everolimus and hemodialysis. Disclosures All authors: No reported disclosures.

scholarly journals The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sarah M. Perman ◽  
Mark E. Mikkelsen ◽  
Munish Goyal ◽  
Adit Ginde ◽  
Abhishek Bhardwaj ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Serum Lactate ◽  
Risk Category ◽  
Suspected Infection ◽  
Increased Risk ◽  
Screening And Identification ◽  
Lactate Levels ◽  
Poor Outcomes ◽  
Sirs Criteria

AbstractThe quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of “poor outcomes:” a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective observational study, we explored the performance of triage qSOFA (tqSOFA), maximum qSOFA, and first initial serum lactate (> 3 mmol/L) at predicting in-hospital mortality and compared these results to those for the initial SIRS criteria obtained in triage. A total of 2859 sepsis cases were included and the in-hospital mortality rate was 14.4%. The sensitivity of tqSOFA ≥ 2 and maximum qSOFA ≥ 2 to predict in-hospital mortality were 33% and 69%, respectively. For comparison, the triage SIRS criteria and the initial lactate > 3 mmol/L had sensitivities of 82% and 65%, respectively. These results demonstrate that in a large ED sepsis database the earliest measurement of end organ impairment, tqSOFA, performed poorly at identifying patients at increased risk of mortality and maximum qSOFA did not significantly outperform initial serum lactate levels.

scholarly journals Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243303
Author(s):  
John Rek ◽  
Alex Musiime ◽  
Maato Zedi ◽  
Geoffrey Otto ◽  
Patrick Kyagamba ◽  
...  
Keyword(s):  
Malaria Transmission ◽  
Perceived Risk ◽  
Universal Access ◽  
Indoor Residual Spraying ◽  
Fold Increase ◽  
School Aged Children ◽  
Increased Risk ◽  
Llin Use ◽  
Matched Case ◽  
Barriers To Use

Indoor residual spraying (IRS) and long-lasting insecticide-treated bednets (LLINs) are common tools for reducing malaria transmission. We studied a cohort in Uganda with universal access to LLINs after 5 years of sustained IRS to explore LLIN adherence when malaria transmission has been greatly reduced. Eighty households and 526 individuals in Nagongera, Uganda were followed from October 2017 –October 2019. Every two weeks, mosquitoes were collected from sleeping rooms and LLIN adherence the prior night assessed. Episodes of malaria were diagnosed using passive surveillance. Risk factors for LLIN non-adherence were evaluated using multi-level mixed logistic regression. An age-matched case-control design was used to measure the association between LLIN non-adherence and malaria. Across all time periods, and particularly in the last 6 months, non-adherence was higher among both children <5 years (OR 3.31, 95% CI: 2.30–4.75; p<0.001) and school-aged children 5–17 years (OR 6.88, 95% CI: 5.01–9.45; p<0.001) compared to adults. In the first 18 months, collection of fewer mosquitoes was associated with non-adherence (OR 3.25, 95% CI: 2.92–3.63; p<0.001), and, in the last 6 months, residents of poorer households were less adherent (OR 5.1, 95% CI: 1.17–22.2; p = 0.03). Any reported non-adherence over the prior two months was associated with a 15-fold increase in the odds of having malaria (OR 15.0, 95% CI: 1.95 to 114.9; p = 0.009). Knowledge about LLIN use was high, and the most frequently reported barriers to use included heat and low perceived risk of malaria. Children, particularly school-aged, participants exposed to fewer mosquitoes, and those from poorer households, were less likely to use LLINs. Non-adherence to LLINs was associated with an increased risk of malaria. Strategies, such as behavior change communications, should be prioritized to ensure consistent LLIN use even when malaria transmission has been greatly reduced.

Antibiotic exposure and risk of breast cancer: A causal association or a skyfall?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12524-e12524
Author(s):  
Anna Koumarianou ◽  
Efrosyni D Manali ◽  
Archontoula Fragou ◽  
Panagiotis Katsaounis ◽  
Georgia Bouga ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Conditional Logistic Regression ◽  
Control Group ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
History Of ◽  
Single Cancer ◽  
Matched Case ◽  
Sparse Methods ◽  
Age Of Menarche

e12524 Background: Although it has long been hypothesized that the use of antibiotics may increase the risk of breast cancer, through effects on inflammation, immunity and gastrointestinal microflora that alter the metabolism of phytochemicals, clinical data on this association are sparse. Methods: Matched case-control study among 158 women with newly diagnosed primary invasive breast cancer from a single cancer unit and 158 age-matched controls (± 12 months) from healthy individuals accompanying patients to the outpatient clinics between January 1, 2006 and December 30, 2007. Clinical examination and a standard questionnaire for the collection of baseline characteristics and known aggravating factors, such as body mass index, smoking, age of menarche and menopause, parity, breastfeeding, history of respiratory, urinary or other infections and previous estrogen use, were carried out in all individuals. All antibiotic classes, such as β-lactams, amoxyl and clavulanic acid, cephalosporins, macrolides, quinolones, tetracyclines, trimethoprim, clindamycin and imidazoles, were recorded. Type of antibiotic and dose was ascertained from health insurance’s pharmacy records. Data were analyzed using multivariable conditional logistic regression models including adjustments for potential confounding factors. Results: The age matched groups of patients and controls were found to have statistically significant differences in the considered parameters such as delayed age of menopause, less parity and less smoking in the control group and more antibiotic intake in the patient population. The cumulative use for more than 21 days of any antibiotic classes were found to statistically significant correlate with increased risk of breast cancer [odds ratio(OR):3.5, 95%confidence interval(CI):1.7-7.3, p=0.001]. By subanalyses according to antibiotic class this increased risk was mainly associated with β-lactams (OR:11.4, 95%CI:3.8, 34.1, p<0.001) and less with macrolides (OR:2.8, 95%CI:1.1-7.5, p=0.039). Conclusions: Our study links β-lactam and macrolide consumption with increased breast cancer risk but further investigation of this association in large cohorts together with exploration of the underlying cause are needed.

scholarly journals Association between Rheumatoid Arthritis and Respiratory Allergic Diseases in Korean Adults: A Propensity Score Matched Case-Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Han Eol Jeong ◽  
Sung-Mok Jung ◽  
Sung-Il Cho
Keyword(s):  
Rheumatoid Arthritis ◽  
Propensity Score ◽  
Conditional Logistic Regression ◽  
Allergic Diseases ◽  
T Helper ◽  
T Helper 1 ◽  
T Helper 2 ◽  
Korean Adults ◽  
Increased Risk ◽  
Matched Case

Rheumatoid arthritis (RA) and allergic diseases are result of a poor functioning immune system, giving dominance to either T-helper 1 (Th1) or T-helper 2 (Th2) diseases, respectively. Studies have stated that there seems to be a relationship present between the immune response subsets. This study was designed to examine the association between RA and respiratory allergic diseases in Korean adults. The study utilized the KNHANES 2013–2015 data and excluded individuals diagnosed with RA before being diagnosed with allergic diseases, using age at clinical diagnosis. Total of 253 RA patients were matched 1 : 1 with non-RA patients by a propensity score, using sex and age as matched variables. Multivariate conditional logistic regression analyses were used to evaluate for association between RA and respiratory allergic diseases in the matched 506 participants. RA was associated with an increased risk of prevalence of respiratory allergic diseases with an OR of 1.51 (95% CI, 1.31–1.75), adjusted for socioeconomic demographic variables. The adjusted OR for prevalence of RA among participants with prevalence of asthma and allergic rhinitis was as follows: 3.12 (95% CI, 2.77–3.51) and 1.39 (95% CI, 1.16–1.67). Participants with prevalence of asthma in particular had an increased risk of developing prevalence of RA. Based on our findings, Th1 and Th2 diseases may indeed coexist, and one pathway may stimulate or contribute towards the onset of the other.

scholarly journals Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study

2016 ◽  
Vol 68 (1) ◽  
pp. 43-51.e2 ◽  
Author(s):  
Gelareh Z. Gabayan ◽  
Michael K. Gould ◽  
Robert E. Weiss ◽  
Neil Patel ◽  
Kwame A. Donkor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Control Study ◽  
The Elderly ◽  
Case Control ◽  
Poor Outcomes ◽  
Emergency Department Discharge ◽  
Control Study

scholarly journals Relationship of Hydroxychloroquine and Ophthalmic Complications in Patients with Type 2 Diabetes in Taiwan

2021 ◽  
Vol 18 (15) ◽  
pp. 8154
Author(s):  
Hung-Chih Chen ◽  
Hung-Yu Lin ◽  
Michael Chia-Yen Chou ◽  
Yu-Hsun Wang ◽  
Pui-Ying Leong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Conditional Logistic Regression ◽  
Categorical Variables ◽  
Control Group ◽  
Case Group ◽  
Research Database ◽  
Continuous Variables ◽  
Chi Square ◽  
Increased Risk

The purpose of this study is to evaluate the relationship between hydroxychloroquine (HCQ) and diabetic retinopathy (DR) via the national health insurance research database (NHIRD) of Taiwan. All patients with newly diagnosed type 2 diabetes (n = 47,353) in the NHIRD (2000–2012) were enrolled in the study. The case group consists of participants with diabetic ophthalmic complications; 1:1 matching by age (±1 year old), sex, and diagnosis year of diabetes was used to provide an index date for the control group that corresponded to the case group (n = 5550). Chi-square test for categorical variables and Student’s t-test for continuous variables were used. Conditional logistic regression was performed to estimate the adjusted odds ratio (aOR) of DR. The total number of HCQ user was 99 patients (1.8%) in the case group and 93 patients (1.7%) in the control group. Patients with hypertension (aOR = 1.21, 95% CI = 1.11–1.31) and hyperlipidemia (aOR = 1.65, 95% CI = 1.52–1.79) significantly increased the risk of diabetic ophthalmic complications (p < 0.001). Conversely, the use of HCQ and the presence of rheumatoid diseases did not show any significance in increased risk of DR. HCQ prescription can improve systemic glycemic profile, but it does not decrease the risk of diabetic ophthalmic complications.

scholarly journals Association of Infrastructure and Route Environment Factors with Cycling Injury Risk at Intersection and Non-Intersection Locations: A Case-Crossover Study of Britain

2021 ◽  
Vol 18 (6) ◽  
pp. 3060
Author(s):  
Rachel Aldred ◽  
Georgios Kapousizis ◽  
Anna Goodman
Keyword(s):  
Injury Risk ◽  
Conditional Logistic Regression ◽  
Traffic Signals ◽  
Control Groups ◽  
Class A ◽  
Case Crossover ◽  
Main Class ◽  
Road Intersections ◽  
Matched Case ◽  
Safety In Numbers

Objective: This paper examines infrastructural and route environment correlates of cycling injury risk in Britain for commuters riding in the morning peak. Methods: The study uses a case-crossover design which controls for exposure. Control sites from modelled cyclist routes (matched on intersection status) were compared with sites where cyclists were injured. Conditional logistic regression for matched case–control groups was used to compare characteristics of control and injury sites. Results: High streets (defined by clustering of retail premises) raised injury odds by 32%. Main (Class A or primary) roads were riskier than other road types, with injury odds twice that for residential roads. Wider roads, and those with lower gradients increased injury odds. Guard railing raised injury odds by 18%, and petrol stations or car parks by 43%. Bus lanes raised injury odds by 84%. As in other studies, there was a ‘safety in numbers’ effect from more cyclists. Contrary to other analysis, including two recent studies in London, we did not find a protective effect from cycle infrastructure and the presence of painted cycle lanes raised injury odds by 54%. At intersections, both standard and mini roundabouts were associated with injury odds several times higher than other intersections. Presence of traffic signals, with or without an Advanced Stop Line (‘bike box’), had no impact on injury odds. For a cyclist on a main road, intersections with minor roads were riskier than intersections with other main roads. Conclusions: Typical cycling environments in Britain put cyclists at risk, and infrastructure must be improved, particularly on busy main roads, high streets, and bus routes.

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