Factors associated with reattendance to emergency services following COVID-19 hospitalization.
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ABSTRACT:
SUBMITTER: Daunt A
PROVIDER: S-EPMC7675686 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
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Factors associated with reattendance to emergency services following COVID-19 hospitalization.
Daunt Anna A Perez-Guzman Pablo N PN Cafferkey John J Manalan Kavina K Cooke Graham G White Peter J PJ Hauck Katharina K Mallia Patrick P Nayagam Shevanthi S
Journal of medical virology 20201030 3
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Project description:BackgroundMisdiagnosis of cerebrovascular disease among Emergency Department (ED) patients with headache has been reported. We hypothesized that markers of substandard diagnostic processes would be associated with subsequent ischemic cerebrovascular events among patients discharged from the ED with a headache diagnosis even after adjusting for demographic variables and medical history.MethodsWe conducted a case-control study of adult ED patients diagnosed with a primary headache disorder at Montefiore Medical Center from 9/1/2013-9/1/2018. Cases were defined as patients hospitalized for an ischemic stroke or TIA within 365 days of their index ED visit. Control patients were defined as those who lacked a subsequent hospitalization for cerebrovascular disease. Pre-specified demographic, clinical, and diagnostic process factors were compared between groups; conditional logistic regression was used to assess the separate and joint influence of baseline features on risk of cerebral ischemia.ResultsA total of 93 consecutive headache patients with a subsequent ischemic stroke/TIA hospitalization were matched to 93 controls (n = 186). Cases were older than controls and more likely to have traditional cerebrovascular risk factors. Neurological consultation was obtained more often for cases (13% vs. 4%; P = 0.03), cases were in the ED for longer (6 vs. 5 h, P = 0.03), and more frequently received neuroimaging (80% vs. 48%; P < 0.0001). Rates of neurological examination, documented differential diagnoses, and clear discharge follow up plans were similar between cases and controls. In our conditional logistic regression model, only history of prior stroke/TIA was associated with increased odds of subsequent cerebral ischemia.ConclusionFactors associated with diagnostic process failures did not increase the odds of subsequent ischemic stroke/TIA hospitalization following ED headache visit in our study.
| S-EPMC8102647 | biostudies-literature
Project description:BackgroundCharacterizations of coronavirus disease 2019 (COVID-19) vaccine breakthrough infections are limited. We aim to characterize breakthrough infections and identify risk factors associated with outcomes.MethodsThis was a retrospective case series of consecutive fully vaccinated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a multicenter academic center in Southeast Michigan, between December 30, 2020, and September 15, 2021.ResultsA total of 982 patients were identified; the mean age was 57.9 years, 565 (59%) were female, 774 (79%) were White, and 255 (26%) were health care workers (HCWs). The median number of comorbidities was 2; 225 (23%) were immunocompromised. BNT162b2 was administered to 737 (75%) individuals. The mean time to SARS-CoV-2 detection was 135 days. The majority were asymptomatic or exhibited mild to moderate disease, 154 (16%) required hospitalization, 127 (13%) had severe-critical illness, and 19 (2%) died. Age (odds ratio [OR], 1.14; 95% CI, 1.04-1.07; P < .001), cardiovascular disease (OR, 3.02; 95% CI, 1.55-5.89; P = .001), and immunocompromised status (OR, 2.57; 95% CI, 1.70-3.90; P < .001) were independent risk factors for hospitalization. Additionally, age (OR, 1.06; 95% CI, 1.02-1.11; P = .006) was significantly associated with mortality. HCWs (OR, 0.15; 95% CI, 0.05-0.50; P = .002) were less likely to be hospitalized, and prior receipt of BNT162b2 was associated with lower odds of hospitalization (OR, 0.436; 95% CI, 0.303-0.626; P < .001) and/or death (OR, 0.360; 95% CI, 0.145-0.898; P = .029).ConclusionsCOVID-19 vaccines remain effective at attenuating disease severity. However, patients with breakthrough infections necessitating hospitalization may benefit from early treatment modalities and COVID-19-mitigating strategies, especially in areas with substantial or high transmission rates.
| S-EPMC8903475 | biostudies-literature
Project description:ObjectiveTo identify factors, present at 3 months after COVID-19 that are associated with the level of functioning 1 year after hospitalization.DesignMulticenter prospective observational study.SettingRegion Västra Götaland Sweden.ParticipantsPatients ≥ 18 years of age who were followed regarding body functions and activities 3 months and 1 year after discharge from a hospitalization for COVID-19.Main measuresPatient-reported outcome measures at 3 months and 1 year, a clinical follow-up at 1 year, and clinical information retrieved from medical charts.ResultsIn total 169 participants were included in the analysis, including 113 males (67%). The mean patient age was 66 (standard deviation (SD) 13, range 21-95). One year after hospitalization, 50 (34%) participants were under the normative value for forced vital capacity and 57 (39%) were under normative value for forced expiratory volume in 1 second. The mean walking distance was 441 m (SD 118 m) in the 6-minute walking test, and 62 (40%) patients reported mobility problems. Older age, female sex, and more self-reported symptoms of physical fatigue were significantly associated with lower levels of functioning 1 year after COVID-19. The initial severity of COVID-19 did not significantly influence functioning at 1 year.ConclusionPreviously hospitalized individuals with respiratory difficulties 1 year after COVID-19 may present acceptable lung function on spirometry but be close to their maximal functional performance. The findings highlight the need for in-depth assessments to identify rehabilitation needs.
| S-EPMC11927034 | biostudies-literature
Project description:Background: A key to an effective Coronavirus 2019 (COVID-19) Community Intervention is to understand populations who are most vulnerable to it. We aimed at evaluating characteristics of New York City communities where rates of confirmed COVID-19 cases were particularly high. Methods: The study outcomes - neighborhood-specific confirmed COVID-19 cases, positive tests, and COVID-19 attributable deaths were calculated using data extracted from the New York City government health website, which were linked to results from Community Health Survey. Distributions of study outcomes across New York City community districts and their associations with neighborhood characteristics were examined using Jonckheere-Terpstra tests. Results: As of May 21, 2010, rates of confirmed cases ranged from 0.8% (Greenwich Village and Soho) to 3.9% (Jackson Heights), and the rates of attributable death from to 0.6‰ (Greenwich Village and Soho) to 4.2‰ (Coney Island). Higher percentages of black, Hispanic and foreign-born populations, lower educational attainment, poverty, lack of health insurance, and suboptimal quality of health care were all factors found to be correlated with increased rates of confirmed COVID-19 cases. Conclusions: The epidemiology of COVID-19 exhibited great variations among neighborhoods in New York City. Community interventions aimed at COVID-19 prevention and mitigation should place high priorities in areas with large populations of blacks and Hispanics and economically disadvantages areas.
| S-EPMC9120001 | biostudies-literature
Project description:ObjectiveEmergency department (ED) use has increased disproportionately for pediatric psychiatric care. This study aimed to identify predictors of ED use within 30 days of discharge from a pediatric psychiatric hospitalization.MethodsED use was assessed in the 30 days after discharge. Univariate logistic regression modeling identified predictors of ED use, which were used in subsequent multivariate modeling.ResultsGreater number of trauma types (odds ratio [OR]=1.92, 95% confidence interval [CI]=1.50-2.45, z=2.67, p=0.008), generalized anxiety disorder (OR=3.20, 95% CI=1.78-5.76, z=1.98, p=.048), and longer length of stay (OR=1.05, 95% CI=1.03-1.07, z=2.74, p=0.006) were associated with increased ED use within 30 days of discharge.ConclusionsED use may be an important marker of negative outcomes within 30 days of discharge from pediatric psychiatric hospitalization. Patients with high trauma exposure, anxiety, and acuity marked by increased length of stay may require additional services to prevent unplanned ED use for psychiatric crises.
| S-EPMC6602797 | biostudies-literature
Project description: Not available
| S-EPMC7834109 | biostudies-literature
Project description:PurposeThe aim of this study was to describe the incidence and risk factors for hospital readmission and infection during the months after COVID-19 hospital admission.MethodsThis prospective study included adult patients who were hospitalized due to COVID-19 and had been discharged from April 2020 to August 2020. All patients had a medical evaluation with a structured questionnaire 6 to 11 months after hospital admission. The authors included only patients with confirmed COVID-19 by RT-PCR. Patients with pregnant/postpartum women, with a proven COVID-19 reinfection or incapable of answering the questionnaire were excluded.ResultsA total of 822 patients completed the follow-up assessment, and 68% reported at least one recurrent symptom related to COVID-19. The most frequent symptom was myalgia (42%). Thirty-two percent of patients visited an emergency room after COVID-19 hospitalization, and 80 (10%) patients required re-hospitalization. Risk factors for hospital readmission were orotracheal intubation during COVID-19 hospitalization (p = 0.003, OR = 2.14), Charlson score (p = 0.002, OR = 1.21), congestive heart failure (p = 0.005, OR = 2.34), peripheral artery disease (p = 0.06, OR = 2.06) and persistent diarrhea after COVID-19 hospitalization discharge (p = 0.02, OR = 1.91). The main cause of hospital readmission was an infection, 43 (54%). Pneumonia was the most frequent infection (29%).ConclusionsThe presence of symptoms after six months of COVID-19 diagnosis was frequent, and hospital readmission was relatively high.
| S-EPMC9189119 | biostudies-literature
Project description:Background Data on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across racial/ethnic groups and assessed their associations with COVID-19 outcomes. Methods This retrospective cohort study examined 629,953 patients tested for SARS-CoV-2 in a large health system spanning California, Oregon, and Washington between March 1 and December 31, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression. Results 570,298 patients with known race/ethnicity were tested for SARS-CoV-2, of whom 27.8% were non-White minorities. 54,645 individuals tested positive, with minorities representing 50.1%. Hispanics represented 34.3% of infections but only 13.4% of tests. While generally younger than White patients, Hispanics had higher rates of diabetes but fewer other comorbidities. 8,536 patients were hospitalized and 1,246 died, of whom 56.1% and 54.4% were non-White, respectively. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increased odds of testing positive and hospitalization were associated with all minority races/ethnicities. Hispanic patients also exhibited increased morbidity, and Hispanic race/ethnicity was associated with in-hospital mortality (OR: 1.39 [95% CI: 1.14-1.70]). Conclusion Major healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, required excess hospitalization and mechanical ventilation, and had higher odds of in-hospital mortality despite younger age. Targeted, culturally-responsive interventions and equitable vaccine development and distribution are needed to address the increased risk of poorer COVID-19 outcomes among minority populations. .
| S-EPMC7885938 | biostudies-literature
Project description: Not available
| S-EPMC10129907 | biostudies-literature
Project description:Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk-factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data, and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific autoantibodies. In patients with gastrointestinal PASC, SARS-CoV-2-specific and CMV-specific CD8+ T cells exhibited unique dynamics during recovery from COVID-19. Analysis of symptom-associated immunological signatures revealed coordinated immunity polarization into four endotypes exhibiting divergent acute severity and PASC. We find that immunological associations between PASC factors diminish over time leading to distinct convalescent immune states. Detectability of most PASC factors at COVID-19 diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests PASC treatment strategies.
2022-02-01 | E-MTAB-10129 | biostudies-arrayexpress