scholarly journals Failure to Clear Intermediate Lactate Levels in Ward Patients With Admission Blood Cultures Did Not Increase the Risk of Intensive Care Unit Transfer or In-Hospital Mortality: A Retrospective Cohort Study

Cureus ◽  
2021 ◽  
Author(s):  
Roman Dudaryk ◽  
Jose R Navas-Blanco ◽  
Tanira D Ferreira ◽  
Richard H Epstein
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Blood Cultures ◽  
Lactate Levels ◽  
Intensive Care Unit Transfer

Time to positivity of blood cultures among a veteran population: How long to wait before discontinuing antimicrobial therapy when suspicion of infection is low

2020 ◽  
Vol 41 (12) ◽  
pp. 1452-1454
Author(s):  
Brett H. Heintz ◽  
Zach T. DeLanoit ◽  
Leah J. Granroth ◽  
Whitni T. Patterson
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Antimicrobial Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Blood Cultures ◽  
Single Center ◽  
Time To Positivity ◽  
Clinically Significant

AbstractTime to positivity (TTP) of blood cultures can guide antimicrobial therapy. This single-center retrospective cohort study aimed to determine the yield of clinically significant organisms from blood cultures that were initially negative at 24 hours. Clinically significant organisms were uncommon after 24 hours (1.5%) and more common in intensive care unit settings.

scholarly journals Performance in mortality prediction of SAPS 3 And MPM-III scores among adult patients admitted to the ICU of a private tertiary referral hospital in Tanzania: a retrospective cohort study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12332
Author(s):  
Nadeem Kassam ◽  
Eric Aghan ◽  
Samina Somji ◽  
Omar Aziz ◽  
James Orwa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Goodness Of Fit ◽  
Tertiary Referral ◽  
Goodness Of Fit Test ◽  
Saps 3

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar- es- Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model was assessed by discrimination and calibration. Discrimination between survivors and non–survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Results A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n = 208, 62.8%), of African origin (n = 178, 53.8%) and admitted from the emergency department (n = 306, 92.4%). In- hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM0-III was 0.89 (95% CI [0.844–0.935]) and 0.90 (95% CI [0.864–0.944]) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with Chi- square values of 4.61 and 5.08 respectively and P–Value > 0.05. Conclusion Both SAPS 3 and MPM0-III performed well in predicting mortality and outcome in our cohort of patients admitted to the intensive care unit of a private tertiary hospital. The in-hospital mortality of critically ill patients was lower compared to studies done in other intensive care units in tertiary referral hospitals within Tanzania.

Association Between Afterhours Discharge From the Intensive Care Unit and Hospital Mortality: A Multi-Center Retrospective Cohort Study

2021 ◽  
pp. 088506662098190
Author(s):  
Adam Hall ◽  
Xioaming Wang ◽  
Danny J. Zuege ◽  
Dawn Opgenorth ◽  
Damon C. Scales ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mixed Effect ◽  
Icu Discharge

Background: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. Methods: We performed a multi-center retrospective cohort study of 10,463 adults discharged from 9 mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a 2-stage modeling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. Results: Of 10,463 patients, 23.7% (n = 2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. A greater average SOFA score in the 72 hours prior to ICU discharge was not associated with afterhours discharge. However, a greater average SOFA score was associated with hospital mortality (adjusted-odds ratio [OR], 1.23; 95% CI, 1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR, 1.19; 95% CI, 1.01-1.39), increased hospital stay (adjusted-risk ratio [RR], 1.10; 95% CI, 1.09-1.11) and increased post-ICU stay (adjusted-RR, 1.16; 95% CI, 1.14-1.17) when compared with workhours discharge. Conclusions: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.

scholarly journals Association between Afterhours Discharge from the Intensive Care Unit and Hospital Mortality: A Multi-Centre Retrospective Cohort Study

2020 ◽  
Author(s):  
Adam Hall ◽  
Xioaming Wang ◽  
Danny J Zuege ◽  
Dawn Opgenorth ◽  
Damon C Scales ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Potential Effect ◽  
Mixed Effect ◽  
Size Type

Abstract Background: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. Methods: We performed a multi-centre retrospective cohort study of 10,463 adults discharged from nine mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a two-stage modelling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. Results: Of 10,463 patients, 23.7% (n=2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. Greater SOFA score in the 72 hours prior to discharge was not associated with afterhours discharge; however, was associated with hospital mortality (adjusted-OR 1.23; 95%CI,1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR 1.19; 95%CI, 1.01-1.39), increased hospital stay (adjusted-OR 1.10; 95%CI,1.09-1.11) and increased post-ICU stay (adjusted-OR 1.16; 95%CI,1.14-1.17).Conclusions: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.

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