Development of stratification criteria of green codes in a pediatric emergency department: a pilot study.

BACKGROUND: The aim of this study was to find stratification criteria in a group of children assigned to the green triage category at an emergency department (ED). METHODS: We analyzed a sample of patients admitted to the ED of Gaslini Children's Hospital in Genoa between February 2014 and January 2015 who had been given a green code on triage. We analyzed the following parameters: age, sex, nationality, reason for admission, number and type of the procedures performed, length of stay in the ED, destination on discharge, color code and diagnosis on discharge. RESULTS: Of the 2875 patients enrolled, 258 (8.97%) were hospitalized, 135 (4.70%) were placed in short intensive observation, 1609 (55.97%) were discharged from the ED without any intervention, 829 (28.83%) were discharged after undergoing procedures (blood tests, microbiology investigation, imaging, specialist evaluation) and 44 (1.5%) spontaneously left the ED. Among the patients who were hospitalized and those kept under short intensive observation, the most frequent discharge diagnosis was gastrointestinal disease; among those patients discharged with and without undergoing procedures, the most frequent diagnosis was respiratory disease. The mean age of patients admitted to hospital and of those discharged without undergoing procedures was 46 months, while the mean ages of patients kept under short intensive observation and of those discharged after undergoing procedures were 54 and 61 months, respectively. CONCLUSIONS: These preliminary results suggest that one of the main criteria of stratification of green codes on triage is the association between 2 variables: age and pathology.

Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area.

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p<0.001), adequate post-susceptibility test therapies (86% vs. 52%, p<0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p<0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p<0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p=0.002). Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp.