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2.
BMJ Open ; 11(3): e044853, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789854

RESUMEN

OBJECTIVES: One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. SETTING: Tertiary emergency medicine. PARTICIPANTS: All patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. RESULTS: The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33-66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30-60 years) (p=0.096). 43.6% were directly admitted to hospital care.CART analysis identified the variables oxygen saturation (<95%), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O2 satuaration below 95%. CONCLUSIONS: Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge. TRIAL REGISTRATION NUMBER: DRKS00023117.


Asunto(s)
/epidemiología , Toma de Decisiones , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adulto , Anciano , /terapia , /estadística & datos numéricos , Estudios de Cohortes , Tos/etiología , Disnea/etiología , Servicio de Urgencia en Hospital/organización & administración , Femenino , Fiebre/etiología , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Respiración Artificial/estadística & datos numéricos
4.
Am J Med Qual ; 36(2): 84-89, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33830095

RESUMEN

The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.


Asunto(s)
/epidemiología , Alta del Paciente/normas , Seguridad del Paciente/normas , Centros Médicos Académicos , Factores de Edad , Protocolos Clínicos , Comorbilidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Medición de Riesgo
5.
Ned Tijdschr Geneeskd ; 1652021 03 26.
Artículo en Holandés | MEDLINE | ID: mdl-33793135

RESUMEN

GOAL: To study the effect of the first COVID-19 wave in combination with the lockdown on acute care in the Netherlands. DESIGN: Retrospective cohort study METHOD: For this study, data was collected from patients who visited the emergency department (ED) and Cardiac Care Unit of Noordwest Ziekenhuisgroep in Alkmaar and Den Helder. This data collection took place from 1 February to 28 June in 2019 and during the same period in 2020. The number of visits per day was investigated. The outcome measures for hospital occupation were the number of admissions per day and the average length of stay. Outcome measures for health damage were length of stay and mortality. RESULTS: The number of ED visits fell by 27% during the lockdown. For the specialties of internal medicine and pulmonary medicine, the number of admissions from the ED was the same during the lockdown, but the length of stay was longer. For all other specialties, the number of admissions from the ED was lower during the lockdown, but the admission duration was the same. Mortality was higher and hospital stay longer for patients admitted to the specialties of internal medicine and pulmonary medicine. In all other specialisms studied, there was no higher mortality or longer hospital stay. CONCLUSION: From the start of the lockdown, there was a sharp drop in the number of ED visits. The number of ED visits recovered slowly after this drop. For specialties that did not treat COVID-19 patients, hospital occupation was lower than usual. The number of admissions from the ED had decreased for these specialties. Based on the outcome measures length of stay and mortality, we were unable to find any indications of health damage as a result of the drop in admissions.


Asunto(s)
Ocupación de Camas/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , /prevención & control , Control de Enfermedades Transmisibles , Mortalidad Hospitalaria , Humanos , Países Bajos , Neumología/estadística & datos numéricos , Estudios Retrospectivos
6.
MMWR Morb Mortal Wkly Rep ; 70(15): 566-569, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33857062

RESUMEN

Hispanic or Latino (Hispanic), non-Hispanic Black or African American (Black), and non-Hispanic American Indian or Alaska Native (AI/AN) persons have experienced disproportionately higher rates of hospitalization and death attributable to COVID-19 than have non-Hispanic White (White) persons (1-4). Emergency care data offer insight into COVID-19 incidence; however, differences in use of emergency department (ED) services for COVID-19 by racial and ethnic groups are not well understood. These data, most of which are recorded within 24 hours of the visit, might be an early indicator of changing patterns in disparities. Using ED visit data from 13 states obtained from the National Syndromic Surveillance Program (NSSP), CDC assessed the number of ED visits with a COVID-19 discharge diagnosis code per 100,000 population during October-December 2020 by age and race/ethnicity. Among 5,794,050 total ED visits during this period, 282,220 (4.9%) were for COVID-19. Racial/ethnic disparities in COVID-19 ED visit rates were observed across age groups. Compared with White persons, Hispanic, AI/AN, and Black persons had significantly more COVID-19-related ED visits overall (rate ratio [RR] range = 1.39-1.77) and in all age groups through age 74 years; compared with White persons aged ≥75 years, Hispanic and AI/AN persons also had more COVID-19-related ED visits (RR = 1.91 and 1.22, respectively). These differences in ED visit rates suggest ongoing racial/ethnic disparities in COVID-19 incidence and can be used to prioritize prevention resources, including COVID-19 vaccination, to reach disproportionately affected communities and reduce the need for emergency care for COVID-19.


Asunto(s)
/etnología , Grupos de Población Continentales/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Disparidades en el Estado de Salud , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
7.
MMWR Morb Mortal Wkly Rep ; 70(15): 552-556, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33857069

RESUMEN

During March 29-April 25, 2020, emergency department (ED) visits in the United States declined by 42% after the declaration of a national emergency for COVID-19 on March 13, 2020. Among children aged ≤10 years, ED visits declined by 72% compared with prepandemic levels (1). To assess the continued impact of the COVID-19 pandemic on EDs, CDC examined trends in visits since December 30, 2018, and compared the numbers and types of ED visits by patient demographic and geographic factors during a COVID-19 pandemic period (December 20, 2020-January 16, 2021) with a prepandemic period 1 year earlier (December 15, 2019-January 11, 2020). After an initial decline during March-April 2020 (1), ED visits increased through July 2020, but at levels below those during the previous year, until December 2020-January 2021 when visits again fell to 25% of prepandemic levels. During this time, among patients aged 0-4, 5-11, 12-17, and ≥18 years, ED visits were lower by 66%, 63%, 38%, and 17%, respectively, compared with ED visits for each age group during the same period before the pandemic. Differences were also observed by region and reasons for ED visits during December 2020-January 2021; more visits during this period were for infectious diseases or mental and behavioral health-related concerns and fewer visits were for gastrointestinal and upper-respiratory-related illnesses compared with ED visits during December 2019-January 2020. Although the numbers of ED visits associated with socioeconomic factors and mental or behavioral health conditions are low, the increased visits by both adults and children for these concerns suggest that health care providers should maintain heightened vigilance in screening for factors that might warrant further treatment, guidance, or intervention during the COVID-19 pandemic.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Estados Unidos/epidemiología
8.
Cir Pediatr ; 34(2): 85-89, 2021 Apr 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33826261

RESUMEN

INTRODUCTION: As a result of the emergence of the SARS-CoV-2 respiratory virus in Wuhan in December 2019, the Spanish Government declared the state of emergency with restrictions such as stay-at-home lockdown. The objective of this study was to analyze emergency activity at a referral pediatric surgery unit in its territory and determine whether surgical pathologies had decreased or not. METHODS: A retrospective study of pediatric patients presenting at the emergency department and referred to the pediatric surgery unit from March 14, 2020 to April 20, 2020 was carried out. The results were compared with those from the same dates of the previous year. Demographic variables, pathologies, and management strategies were studied for each case. The number of patients with abdominal pain requiring surgical assessment was also analyzed. RESULTS: 161 patients were included - 91 from 2019 and 70 from 2020. Of the 2020 patients, 62 (88.6%) underwent surgery and 8 (11.4%) were admitted, whereas in 2019, patient distribution was 67 (73.6%) and 24 (26.4%), which means there were fewer admissions in 2020 (p= 0.018). There were no differences in terms of hours to emergency department consultation - just an increase in the case of appendicular pathologies in the 2020 period, with 24 [23-48] hours vs. 24 [12-30] hours (p =  0.045). CONCLUSION: The current pandemic has not caused emergency surgeries to decrease. It has only increased time to consultation in patients with appendicular pathologies.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Pediatría/estadística & datos numéricos , Servicio de Cirugía en Hospital/estadística & datos numéricos , Dolor Abdominal/epidemiología , Apendicitis/epidemiología , Apendicitis/cirugía , Niño , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Estudios Retrospectivos , Centros de Atención Terciaria , Tiempo de Tratamiento
9.
CJEM ; 23(2): 232-236, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33709356

RESUMEN

BACKGROUND: The impact of the COVID-19 pandemic on public health, specifically on patients presenting to the emergency department (ED) with non-COVID-related diseases, remains largely undocumented. OBJECTIVE: This study explored how overall rates of presentations to the emergency department were impacted immediately after the declaration of the COVID-19 pandemic, and specifically how key presenting symptoms representing emergency, standard and low-acuity conditions were impacted. METHODS: A sequential modified Delphi survey and cross-sectional analysis of administrative census data from a tertiary care center in New Brunswick, Canada, were performed. Details of ED presentations for emergency, standard and low-acuity conditions from February 1 to April 30, 2020, were compared to data from previous years. RESULTS: There was a significant decrease in the number of patients visiting the ED with emergency, standard and low-acuity complaints immediately after March 13, 2020, compared to 2019. The proportion of females and males remained similar, with a median age of 48 years in 2020 and 44 years in 2019. Total presentation patterns to the ED (registrations, admissions to hospital and left without being seen numbers) decreased, compared to previous years. CONCLUSIONS: We report a predictable decrease in patient visits to the ED with minor, non-life-threatening conditions during a pandemic. However, we also report a decrease in presentations for emergency and standard conditions. Improved messaging highlighting the need to seek help for "true" emergencies, while providing non-ED options for minor, non-life-threatening conditions, may be helpful under normal circumstances and during future pandemics.


Asunto(s)
/epidemiología , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Pandemias , /terapia , Estudios Transversales , Estudios de Seguimiento , Humanos , Incidencia , Nuevo Brunswick/epidemiología , Estudios Retrospectivos
10.
PLoS One ; 16(3): e0248995, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33750990

RESUMEN

The COVID-19 pandemic forced healthcare services organization to adjust to mutating healthcare needs. Not exhaustive data are available on the consequences of this on non-COVID-19 patients. The aim of this study was to assess the impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants' area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality. We conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year. Non-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases. The pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. As recurrencies of the COVID-19 pandemic are underway, the scenario described in this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.


Asunto(s)
Causas de Muerte , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , /epidemiología , /virología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/patología , Humanos , Italia/epidemiología , Enfermedades Metabólicas/mortalidad , Enfermedades Metabólicas/patología , Neoplasias/mortalidad , Neoplasias/patología , Pandemias , Cuarentena , Estudios Retrospectivos , /aislamiento & purificación
11.
PLoS One ; 16(3): e0248438, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33690722

RESUMEN

OBJECTIVES: Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care. METHODS: Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables. RESULTS: Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation<95%, Black race, Hispanic or Latino ethnicity, household contact with known or suspected COVID-19, patient reported history of dry cough, anosmia/dysgeusia, myalgias or fever; and -1 point each for White race, no direct contact with infected person, or smoking. In the validation sample (n = 9,975), the probability from logistic regression score produced an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.79-0.81), and this level of accuracy was retained across patients enrolled from the early spring to summer of 2020. In the simplified score, a score of zero produced a sensitivity of 95.6% (94.8-96.3%), specificity of 20.0% (19.0-21.0%), negative likelihood ratio of 0.22 (0.19-0.26). Increasing points on the simplified score predicted higher probability of infection (e.g., >75% probability with +5 or more points). CONCLUSION: Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints.


Asunto(s)
/diagnóstico , Servicio de Urgencia en Hospital/tendencias , Adulto , Anciano , Reglas de Decisión Clínica , Infecciones por Coronavirus/diagnóstico , Tos , Bases de Datos Factuales , Árboles de Decisión , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Fiebre , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Sistema de Registros , Estados Unidos/epidemiología
13.
CJEM ; 23(1): 80-84, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33683615

RESUMEN

OBJECTIVES: To understand the feasibility, utilization rate, and satisfaction of the first Virtual Pediatric ED (V-PED) in Canada. METHODS: We conducted a prospective cohort study examining the feasibility and impact of virtual care as an adjunct to in-person emergency care at a tertiary pediatric hospital from May to July 2020. Children (< 18 years) from Ontario and Quebec seeking V-PED care were included. A secure, encrypted, video platform within the hospital's electronic medical record was used. Caregivers self-determined appropriateness of V-PED using a standardized online triage questionnaire to request their appointment. The V-PED is directly launched from the patient's chart and the family joins the portal via hyperlink. Outcome measures included the number of V-PED visits, hospital admission rates, and caregiver satisfaction using a 10-item voluntary post-visit online survey. RESULTS: A total of 1036 V-PED visits were seen of which 176 (17.0%) were referred for further in-person ED assessment, and 8 (0.8%) required hospital admission. Of the 107 completing patient experience surveys (10% response), most respondents (69%) endorsed they "very likely" or "definitely" would have presented in-person to the ED if V-PED were unavailable. Overall satisfaction was rated as excellent (9 or 10 out of 10) in 87% of respondents. CONCLUSION: Our novel V-PED is feasible, has high caregiver satisfaction, and can reduce the burden of in-person ED visits. Future work must ensure the safety of emergency virtual care and examine how to increase capacity and integrate V-PED within traditional emergency medicine.


Asunto(s)
Urgencias Médicas/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Derivación y Consulta , Telemedicina/métodos , Triaje/métodos , Realidad Virtual , Adolescente , Niño , Preescolar , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Ontario/epidemiología , Estudios Prospectivos , Quebec/epidemiología
14.
Medicine (Baltimore) ; 100(11): e25133, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725994

RESUMEN

ABSTRACT: The purpose of this research was to identify whether a certain set of drivers of satisfaction/perceived quality of healthcare (PQHC) could indirectly affect patients' confidence/trust in the emergency department (ED).Patients were seen at an ED in the public hospital in Lisbon, Portugal between January and December 2016. Data were collected between May and November 2017, using a questionnaire, by mail or e-mail. The total sample size comprised 382 patients. The data analysis included structural equation modeling to test the conceptual model with specific drivers of satisfaction/PQHC (privacy; accessibility and availability; doctors; meeting expectations; waiting time for triage [perception]; waiting time to be called back by the doctor following examinations and/or tests [perception]; information about possible delays in receiving treatment/waiting times) and with the main outcome (confidence/trust in the ED) using path analysis.The analysis of the coefficients revealed that all the mediated paths are statistically significant (P ≤ .05). Although, altogether, the direct paths did not prove statistically significant (P > .05), the overall satisfaction with doctors (P ≤ .01) and meeting expectations (P = .01) can still directly explain the confidence/trust in the ED without the mediating role of satisfaction and PQHC. Hence, overall satisfaction with doctors and meeting expectations can influence, both directly and indirectly, confidence/trust in the ED. All other variables can only indirectly affect confidence/trust in the ED, either through PQHC or through satisfaction.Even though there are more variables that influence confidence/trust in the ED through PQHC (1)waiting time to be called back by the doctor following examinations and/or tests [perception]; 2) privacy; 3) accessibility and availability; 4) doctors; 5) meeting expectations than through satisfaction (1)waiting time for triage [perception]; 2) information about possible delays in receiving treatment/waiting times; 3) doctors; 4) meeting expectations), we observe the strongest contribution in the mediation model through satisfaction, which reveals its dominant role over PQHC.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Aceptación de la Atención de Salud/psicología , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas de Atención de la Salud , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Percepción , Portugal , Factores de Tiempo , Triaje/normas , Triaje/estadística & datos numéricos , Listas de Espera , Adulto Joven
15.
Pediatr Emerg Care ; 37(4): 232-236, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33780408

RESUMEN

OBJECTIVES: The purposes of this study were to describe the clinical characteristics of febrile infants younger than 90 days with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, to investigate the prevalence of serious bacterial infections (SBIs) in these infants, and to compare the risk of SBI in SARS-CoV-2-positive febrile infants with sex- and age-matched SARS-CoV- 2-negative febrile infants. METHODS: This was a retrospective cohort study conducted from March to November 2020 in a tertiary children's hospital. Patients were identified by International Classification of Diseases, 10th Revision codes and included if age was younger than 90 days, a SARS-CoV-2 test was performed, and at least 1 bacterial culture was collected. Positive cases of SARS-CoV-2 were age- and sex-matched to negative controls for analysis. Serious bacterial infection was defined as a urinary tract infection, bacterial enteritis, bacteremia, and/or bacterial meningitis. RESULTS: Fifty-three SARS-CoV-2-positive infants were identified with a higher rate of respiratory symptoms and lower white blood cell and C-reactive protein values than their SARS-CoV-2 matched controls. The rate of SBI in the SARS-CoV-2-positive infants was 8% compared with 34% in the controls; the most common infections were urinary tract infections (6% vs 23%). There were no cases of bacteremia or bacterial meningitis in the COVID-19 (coronavirus disease 2019) infants and 2 (4%) cases of bacteremia in the controls. The relative risk of any SBI between the 2 groups was 0.22 (95% confidence interval, 0.1-0.6; P ≤ 0.001). CONCLUSIONS: These results suggest that febrile infants younger than 90 days with COVID-19 have lower rates of SBI than their matched SARS-CoV-2-negative controls. These data are consistent with previous studies describing lower risks of SBI in febrile infants with concomitant viral respiratory tract infections.


Asunto(s)
Infecciones Bacterianas/etiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Medición de Riesgo/métodos , Infecciones Bacterianas/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Estudios Retrospectivos , Estados Unidos
16.
BMC Emerg Med ; 21(1): 39, 2021 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-33781229

RESUMEN

BACKGROUND: The COVID-19 pandemic is a major public health problem. Subsequently, emergency medical services (EMS) have anecdotally experienced fluctuations in demand, with reports across Canada of both increased and decreased demand. Our primary objective was to assess the effect of the COVID-19 pandemic on call volumes for several determinants in Niagara Region EMS. Our secondary objective was to assess changes in paramedic-assigned patient acuity scores as determined using the Canadian Triage and Acuity Scale (CTAS). METHODS: We analyzed data from a regional EMS database related to call type, volume, and patient acuity for January to May 2016-2020. We used statistical methods to assess differences in EMS calls between 2016 and 2019 and 2020. RESULTS: A total of 114,507 EMS calls were made for the period of January 1 to May 26 between 2016 and 2020, inclusive. Overall, the incidence rate of EMS calls significantly decreased in 2020 compared to the total EMS calls in 2016-2019. Motor vehicle collisions decreased in 2020 relative to 2016-2019 (17%), while overdoses relatively increased (70%) in 2020 compared to 2016-2019. Calls for patients assigned a higher acuity score increased (CTAS 1) (4.1% vs. 2.9%). CONCLUSION: We confirmed that overall, EMS calls have decreased since the emergence of COVID-19. However, this effect on call volume was not consistent across all call determinants, as some call types rose while others decreased. These findings indicate that COVID-19 may have led to actual changes in emergency medical service demand and will be of interest to other services planning for future pandemics or further waves of COVID-19.


Asunto(s)
/epidemiología , Servicios Médicos de Urgencia/estadística & datos numéricos , Socorristas/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Triaje/estadística & datos numéricos , Estudios Transversales , Auxiliares de Urgencia/estadística & datos numéricos , Humanos , Ontario , Gravedad del Paciente , Servicios Urbanos de Salud/estadística & datos numéricos
18.
J Hosp Med ; 16(4): 223-226, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33734985

RESUMEN

Children's hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children's hospitals before and during the COVID-19 pandemic. We performed a retrospective analysis, comparing healthcare encounters and inflation-adjusted charges from 26 tertiary children's hospitals reporting to the PROSPECT database from February 1 to June 30 in 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). All children's hospitals experienced similar trends in healthcare encounters and charges during the study period. Inpatient bed-days, emergency department visits, and surgeries were lower by a median 36%, 65%, and 77%, respectively, per hospital by the week of April 15 (the nadir) in 2020 compared with 2019. Across the study period in 2020, children's hospitals experienced a median decrease of $276 million in charges.


Asunto(s)
/economía , Prestación de Atención de Salud , Costos de la Atención en Salud , Hospitales Pediátricos/economía , Pacientes Internos/estadística & datos numéricos , Niño , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Estudios Retrospectivos
19.
Sao Paulo Med J ; 139(2): 170-177, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33681885

RESUMEN

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.


Asunto(s)
/terapia , Puntuación de Alerta Temprana , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neumonía , Medición de Riesgo/métodos , Triaje/métodos , Anciano , Anciano de 80 o más Años , Presión Sanguínea , /epidemiología , Femenino , Humanos , Masculino , Pandemias , Neumonía/diagnóstico , Neumonía/epidemiología , Frecuencia Respiratoria/fisiología , Estudios Retrospectivos , Turquia , Uremia/epidemiología , Uremia/etiología
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