Comparison of Statistical Models of Predict the Factors Affecting the Length of Stay (LOS) in the Intensive Care Unit (ICU) of a Teaching Hospital.

INTRODUCTION: Modeling can be a useful tool to find out how the distributions of hospital length of stay (LOS) and the factors affecting the length of stay. The present study aims to determine factors affecting the length of stay and selecting suitable statistical models. MATERIAL AND METHOD: this is a cross - sectional study of 565 patients who were treated in the intensive care unit of Imam Khomeini hospital in Ahwaz. Preliminary data were collected retrospectively through the medical records of all patients admitted on intensive care units of Ahwaz Imam Khomeini Hospital in 2015. Statistical analysis and multivariate regression models were done using of SPSS 21 and STATA 7 software. RESULTS: Average length of stay in ICU was 8.16±0.75 days. The Mean and Median age of patients were 58.61±20 and 61 respectively, The Mean LOS for females (16.44±9.37 days) was more than the men (11.5±5.35 days) (p<0.01). The maximum and minimum lengths of stay belonged to patients with endocrine disorders (14.7±3.1 days) and patients with gastrointestinal disorders (5.53±1.1 days) respectively (p<0.01). The goodness of fit for Gamma model showed that this model was more suitable and powerful than Log-normal model to predict the factors affecting the patient's length of stay in intensive care units of hospital. CONCLUSION: Gamma regression model was more robust to predict factors regarding the hospital length of stay. According to Gamma model the key factor in predicting the length of stay in ICU was the type of disease diagnosis. The result of statistical modeling can help managers and policy makers to estimate hospital resources and allocate them for different hospital services.

A 14-year-old girl with thoracolumbar pain.

We report the second case of Mycobacterium kansasii spondylitis in a 14-year-old Caucasian girl who presented with pain in the thoracolumbar region. There was collapsed T8 and discitis, and a cavitary lesion in new chest CT. Biopsy taken from thoracic lesion T8 with CT guidance which had evidence of osteomyelitis and its smear were negative for acid fast bacilli. Bronchoalveolar lavage (BAL) was performed - PCR was negative for acid fast bacilli. Empirical treatment of tuberculosis started and her symptoms resolved. PCR of thoracic sampling revealed M. kansasii after one month. Two months after treatment of M. kansasii, her thoracolumbar pain resolved and the cavitary lesion of the lung disappeared. In patients who are immunocompromised in the association of cavitary pulmonary lesion and infectious spondylitis, atypical mycobacteria may be on the list of common clinical diagnoses but not in immunocompetent patients such as our patient.