Agreement between self-reported and objectively assessed physical activity among out-of-hospital cardiac arrest survivors.

BACKGROUND: Low level of physical activity is a risk factor for new cardiac events in out-of-hospital cardiac arrest (OHCA) survivors. Physical activity can be assessed by self-reporting or objectively by accelerometery. AIM: To investigate the agreement between self-reported and objectively assessed physical activity among OHCA survivors HYPOTHESIS: Self-reported levels of physical activity will show moderate agreement with objectively assessed levels of physical activity. METHOD: Cross-sectional study including OHCA survivors in Sweden, Denmark, and the United Kingdom. Two questions about moderate and vigorous intensity physical activity during the last week were used as self-reports. Moderate and vigorous intensity physical activity were objectively assessed with accelerometers (ActiGraph GT3X-BT) worn upon the right hip for 7 consecutive days. RESULTS: Forty-nine of 106 OHCA survivors answered the two questions for self-reporting and had 7 valid days of accelerometer assessment. More physically active days were registered by self-report compared with accelerometery for both moderate intensity (median 5 [3:7] vs. 3 [0:5] days; p < 0.001) and vigorous intensity (1 [0:3] vs. 0 [0:0] days; p < 0.001). Correlations between self-reported and accelerometer assessed physical activity were sufficient (moderate intensity: rs = 0.336, p = 0.018; vigorous intensity: rs = 0.375, p = 0.008), and agreements were fair and none to slight (moderate intensity: k = 0.269, p = 0.001; vigorous intensity: k = 0.148, p = 0.015). The categorization of self-reported versus objectively assessed physical activity showed that 26% versus 65% had a low level of physical activity. CONCLUSION: OHCA survivors reported more physically active days compared with the results of the accelerometer assessment and correlated sufficiently and agreed fairly and none to slightly.

Change in diagnosis from the emergency department to hospital discharge in dyspnoeic patients.

INTRODUCTION: To improve the outcomes of dyspnoeic patients, it is potentially important to determine the influence of uncertain diagnostic aetiology and to characterise this patient group. A change in diagnosis from emergency department (ED) contact to hospital discharge (i.e., a discordant diagnosis) served as a surrogate measure for an uncertain diagnostic aetiology. This study investigated the association between a change in diagnosis from ED contact to hospital discharge and length of stay (LOS), readmission and mortality in patients whose chief complaint was dyspnoea. The study also characterises the group of patients found to have a discordant diagnosis. METHODS: This cohort study was based on data from all ED contacts at Aarhus University Hospital from 1 July 2016 to 30 June 2017. Patients triaged with dyspnoea and subsequently admitted to an inpatient unit were included. RESULTS: Concordant contacts had an average LOS of 3.63 days, whereas discordant contacts had an average LOS of 4.65 days; the adjusted relative difference was 1.28 (95% CI: 1.10-1.48). Readmission, whether at seven or 30 days, was not significantly different between the groups. The 30-day mortality was 5% in the concordant and 10% in the discordant group, with an adjusted OR of 2.32 (95% CI: 1.08-4.96). CONCLUSIONS: We found an association between a change in diagnosis and longer LOS, and between a change in diagnosis and 30-day mortality. The effort made to achieve diagnostic certainty in the ED may have an impact lasting throughout the entire hospital stay. FUNDING: none. TRIAL REGISTRATION: not relevant.

Predicting mortality and readmission based on chief complaint in emergency department patients: a cohort study.

BACKGROUND: Emergency department (ED) patients present with complaints and not diagnoses. Characterization and risk stratification based on chief complaint can therefore help clinicians improve ED workflow and clinical outcome. In this study we investigated the 30-day mortality and readmission among ED patients based on chief complaint. METHODS: In this cohort study we retrieved routinely collected data from electronic medical records and the Danish Civil Registration System of all ED contacts from July 1, 2016 through June 30, 2017. All patients triaged with one chief complaint using the Danish Emergency Process Triage system were included. Patients with minor injuries were excluded. The chief complaint assigned by the triaging nurse was used as exposure, and 30-day mortality and 30-day readmission were the primary outcomes. Logistic regression was used to determine crude and adjusted ORs with reference to the remaining study population. RESULTS: A total of 41 470 patients were eligible. After exclusion of minor injuries and patients not triaged, 19 325 patients were included. The 30-day mortality and 30-day readmission differed significantly among the chief complaints. The highest 30-day mortality was observed among patients presenting with altered level of conscousness (ALOC) (8.4%, OR=2.0, 95% CI 1.3 to 3.1) and dyspnea (8.0%, OR=2.1, 95% CI 1.6 to 2.6). 30-day readmission was highest among patients presenting with fever/infection (11.7%, OR=1.9, 95% CI 1.4 to 2.4) and dyspnea (11.2%, OR=1.7, 95% CI 1.4 to 2.0). DISCUSSION: Chief complaint is associated with 30-day mortality and readmission in a mixed ED population. ALOC and dyspnea had the highest mortality; fever/infection and dyspnea had the highest readmission rate. This knowledge may assist in improving and optimizing symptom-based initial diagnostic workup and treatment, and ultimately improve workflow and clinical outcome. LEVEL OF EVIDENCE: Level III.