Burden of community-acquired pneumonia in North American adults.
Adult; Humans; Incidence; Risk Factors; Cost of Illness; Length of Stay/statistics & numerical data; North America/epidemiology; Health Care Costs; Health Status Indicators; North America; Human; Community-Acquired Infections/economics/epidemiology/microbiology/prevention & control; Hospitalization/economics/statistics & numerical data; Pneumococcal Vaccines; Streptococcus pneumoniae; Pneumonia; Bacterial/economics/*epidemiology/microbiology/prevention & control; Pneumococcal/economics/epidemiology/mortality/prevention & control; Economic Aspects of Illness; Streptococcus; Pneumococcal Vaccine; Length of Stay – Statistics and Numerical Data; Bacterial – Epidemiology; Community-Acquired Infections – Epidemiology; Community-Acquired Infections – Microbiology; Bacterial – Economics; Bacterial – Microbiology; Bacterial – Mortality; Bacterial – Prevention and Control; Community-Acquired Infections – Economics; Community-Acquired Infections – Prevention and Control; Hospitalization – Economics; Hospitalization – Statistics and Numerical Data
To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). In 2005, there were \textgreater60,000 deaths due to pneumonia in persons aged\textgreateror=15 years in the United States alone. The hospitalization rate for all infectious diseases increased from 1525 hospitalizations per 100 000 persons in 1998 to 1667 per 100 000 persons in 2005. Admission to an intensive care unit was required in 10% to 20% of patients hospitalized with pneumonia. The mean length of stay for pneumonia was \textgreateror=5 days and the 30-day rehospitalization rate was as high as 20%. Mortality was highest for CAP patients who were hospitalized; the 30-day mortality rate was as high as 23%. All-cause mortality for CAP patients was as high as 28% within 1 year. Streptococcus pneumoniae continues to be the most frequently identified pathogen associated with CAP, and pneumococcal resistance to antimicrobials may make treatment more difficult. The economic burden associated with CAP remains substantial at \textgreater$17 billion annually in the United States. Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.
File Thomas M Jr; Marrie Thomas J
Postgraduate medicine
2010
2010-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.2010.03.2130" target="_blank" rel="noreferrer noopener">10.3810/pgm.2010.03.2130</a>
Comparison of short-acting intramuscular antipsychotic medication: impact on length of stay and cost.
Adult; Female; Male; Prospective Studies; Health Care Costs; Injections; Middle Age; Retrospective Design; Intramuscular; Antiinfective Agents; Length of Stay – Statistics and Numerical Data; Schizophrenia – Drug Therapy; Heterocyclic Compounds – Therapeutic Use; Antianxiety Agents; Antipsychotic Agents – Administration and Dosage; Antipsychotic Agents – Economics; Antipsychotic Agents – Therapeutic Use; Benzodiazepine – Economics; Benzodiazepine – Therapeutic Use; Haloperidol – Economics; Haloperidol – Therapeutic Use; Heterocyclic Compounds – Economics; Length of Stay – Economics; Psychomotor Agitation – Drug Therapy; Quinolone – Economics; Quinolone – Therapeutic Use; Thiazoles – Economics; Thiazoles – Therapeutic Use
A retrospective cohort study was conducted to determine if there is an association between short-acting intramuscular (SAIM) antipsychotics used for acute agitation and length of stay (LOS). Patients with a diagnosis of schizophrenia or schizoaffective disorder who were dispensed at least one dose of a SAIM antipsychotic were divided into groups based on the initial SAIM antipsychotic received once admitted to a psychiatric unit. Electronic records were used to gather demographic information, LOS, and number of injections received during an admission. Cost was calculated from the number of injections received. One-hundred and thirty-six patients were enrolled. When comparing the haloperidol group to the second generation antipsychotic group, there was no statistically significant difference, in LOS 16.98 ± 9.56 days versus 17.59 ± 11.52 days (P = 0.75), respectively. There was a statistically significant difference in both cost and number of injections between groups, favoring the haloperidol group. Ziprasidone was associated with a shorter LOS compared with olanzapine, 13.57 and 19.10 days, respectively (P = 0.026). Patient characteristics should be evaluated when determining an agent for acute agitation. However, because literature indicates second generation SAIM antipsychotics are only noninferior to haloperidol; other factors should also be evaluated; including impact on LOS and impact on hospital resources. This study indicates use of a second generation SAIM antipsychotic for acute agitation is more costly, requires more injections, and was not associated with a shorter length of stay when compared with SAIM haloperidol.
Leung JG; Benedetti AM; Frazee L A; Myers N; Leung Jonathan G; Benedetti Amanda M; Frazee Lawrence A; Myers Nancy
American Journal of Therapeutics
2011
2011-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e3181d48320" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3181d48320</a>
Epidemiology and clinical outcomes of patients with Fusobacterium bacteraemia.
*Hospital Mortality; 80 and over; 80 and Over; Adult; Aged; Bacteremia – Mortality; Bacteremia – Physiopathology; Bacteremia/*mortality/physiopathology; Creatinine – Blood; Creatinine/blood; Female; Fusobacterium Infections – Mortality; Fusobacterium Infections – Physiopathology; Fusobacterium Infections/*mortality/physiopathology; Hospital Mortality; Hospitals; Human; Humans; Intensive Care Units – Statistics and Numerical Data; Intensive Care Units/statistics & numerical data; Length of Stay – Statistics and Numerical Data; Length of Stay/statistics & numerical data; Male; Middle Age; Middle Aged; Retrospective Design; Retrospective Studies; Risk Factors; Special – Statistics and Numerical Data; Tertiary Care Centers/*statistics & numerical data; Treatment Outcome; Treatment Outcomes; United States; United States/epidemiology
This 10-year retrospective study assessed the epidemiology and outcomes of patients with Fusobacterium bacteraemia (FB) at a tertiary-care hospital in the
Goldberg E A; Venkat-Ramani T; Hewit M; Bonilla H F
Epidemiology and infection
2013
2013-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1017/S0950268812000660" target="_blank" rel="noreferrer noopener">10.1017/S0950268812000660</a>
Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.
Adult; Female; Male; Ohio; Incidence; Intubation; Human; Chi Square Test; Case Control Studies; Retrospective Design; Violence; Physical; Restraint; Intratracheal; Treatment Outcomes; Nonparametric Statistics; Trauma Severity Indices; Length of Stay – Statistics and Numerical Data; Wounds and Injuries – Complications; Hypnotics and Sedatives – Therapeutic Use; Lorazepam – Therapeutic Use; Patient Discharge – Statistics and Numerical Data; Pneumonia – Epidemiology
BACKGROUND:: The purpose of this study was to determine whether trauma patients who are intubated because of combativeness, and not because of medical necessity, have more complications resulting in longer lengths of stay. METHODS:: Data were retrospectively collected from 2001 through 2004 on trauma patients who were intubated because of combative behavior before hospital admission (group 1, N = 34). Cases were matched 1:2 by age, sex, injury severity score (ISS), and injury to controls each who were not intubated (group 2, N = 68). Additionally, there were 187 patients identified who were intubated because of medical necessity before hospital admission; these represented unmatched intubated controls and were divided based on ISS \textless15 (group 3, N = 58) and ISS \textgreater15 (group 4, N = 129). RESULTS:: There were no significant differences between groups 1, 2, and 3 with regard to age, sex, or ISS. There was no significant difference between the groups 1 and 2 in frequency of head injuries as demonstrated by positive computed tomography (50 vs. 37%, p = 0.28); however, there was a significant difference in frequency of neurologic deficit at discharge (33 vs. 6%, p = 0.006). There was a significant difference in the frequency of head injuries between groups 1 and 3 (50 vs. 22%, p = 0.006); however, there was no significant difference in neurologic deficit at discharge (33 vs. 22%, p = 0.24). There was a significant difference in hospital length of stay between groups 1 and 2 (7.4 +/- 5.9 vs. 4.3 +/- 4.5 days, p = 0.0009). The incidence of pneumonia was significantly greater in group 1 than in group 2 (29 vs. 0%, p \textless 0.0001). The amount of lorazepam in average mg per day was also significantly greater in group 1 versus group 2 (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p \textless 0.0001). There was also a difference in the discharge status, with significantly fewer group 1 cases being discharged home compared with group 2 (56 vs. 91%, p \textless 0.0001). There was no significant difference between groups 1 and 3 with regard to length of stay, ventilator days, pneumonia, or discharge status. There was a significant difference between groups 1 and 3 in the amount of lorazepam per day (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p = 0.002). CONCLUSION:: The results from this study indicate that trauma patients who are intubated because of combativeness, and not because of medical necessity, have longer lengths of stay, increased incidence of pneumonia, and poorer discharge status when compared with matched controls. The outcomes of this group are similar to that of patients who are intubated because of medical necessity.
Muakkassa FF; Marley RA; Workman MC; Salvator AE
Journal of Trauma
2010
2010-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/TA.0b013e3181dcd137" target="_blank" rel="noreferrer noopener">10.1097/TA.0b013e3181dcd137</a>
Incidental findings in the cervical spine at CT for trauma evaluation.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Registries; Incidental Findings; Injury Severity Score; Length of Stay/statistics & numerical data; Data Collection; Tomography; Human; Middle Age; Adolescence; Retrospective Design; Diagnosis; Cervical Vertebrae/*diagnostic imaging/*injuries; Spinal Injuries/*diagnostic imaging; 80 and over; X-Ray Computed/*methods; Nonparametric; Statistics; Nonparametric Statistics; Trauma Severity Indices; 80 and Over; Length of Stay – Statistics and Numerical Data; X-Ray Computed – Methods; Cervical Vertebrae – Injuries; Cervical Vertebrae – Radiography; Spinal Injuries – Radiography
OBJECTIVE: CT is the standard of care for assessment of traumatic injuries. Because of the detail depicted with this technique, findings incidental to the injury are easily detected. We sought to determine the frequency and types of incidental findings in the cervical spines of trauma patients undergoing CT. MATERIALS AND METHODS: The trauma registry was accessed to identify the cases of patients evaluated with cervical spine CT at a level 1 trauma center from January to July 2007. Trauma registry data, including age, sex, injury severity score, mechanism of injury, length of stay, and diagnosis were recorded, and all CT scans of the cervical spine were reviewed for incidental findings. Clinically significant incidental findings were classified according to bodily location, and the association between various patient characteristics and the likelihood of an incidental finding was assessed. RESULTS: We identified incidental CT findings in 230 of 1,256 patients (18.3%) who underwent CT of the cervical spine during an initial trauma evaluation. We stratified the incidental findings as trauma-related and not trauma-related. The likelihood of non-trauma-related incidental findings was associated with age (p \textless 0.0001). The likelihood of trauma-related incidental findings was associated with injury severity score (p \textless 0.0001). CONCLUSION: Incidental findings in the cervical spine were associated with age, injury severity score, and mechanism of injury. Awareness of the prevalence of incidental findings is important to assuring that both traumatic and nontraumatic pathologic findings are detected and appropriately managed.
Barboza Richard; Fox Jason H; Shaffer Lynn E T; Opalek Judy M; Farooki Shella
AJR. American journal of roentgenology
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.08.1420" target="_blank" rel="noreferrer noopener">10.2214/AJR.08.1420</a>
Outcomes of non-STEMI patients transported by emergency medical services vs private vehicle.
*Electrocardiography; 80 and over; 80 and Over; Adult; Age Distribution; Aged; Comparative Studies; Demography; Electrocardiography; Emergency Medical Services – Methods; Emergency Medical Services – Statistics and Numerical Data; Emergency Medical Services/methods/*statistics & numerical data; Evaluation Research; Female; Hospital Mortality; Human; Humans; Length of Stay – Statistics and Numerical Data; Length of Stay/statistics & numerical data; Male; Medical Records – Statistics and Numerical Data; Medical Records/statistics & numerical data; Middle Age; Middle Aged; Multicenter Studies; Myocardial Infarction – Diagnosis; Myocardial Infarction – Mortality; Myocardial Infarction – Therapy; Myocardial Infarction/diagnosis/*mortality/therapy; Ohio; Ohio/epidemiology; Outcome Assessment – Statistics and Numerical Data; Outcome Assessment (Health Care)/*statistics & numerical data; Retrospective Design; Retrospective Studies; Severity of Illness Index; Severity of Illness Indices; Time Factors; Transportation of Patients – Methods; Transportation of Patients – Statistics and Numerical Data; Transportation of Patients/*methods/*statistics & numerical data; Trauma Centers – Statistics and Numerical Data; Trauma Centers/statistics & numerical data; Validation Studies
BACKGROUND: Non-ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS). OBJECTIVE: The purpose of this study was to evaluate the differences in baseline characteristics and outcomes of NSTEMI patients when arriving by EMS vs self-transport. METHODS: We performed a retrospective medical record review of 96 EMS patients and 96 self-transport patients with the diagnosis of NSTEMI based on billing code. RESULTS: The mean age of patients arriving by EMS was 75 vs 65 years for self-transport patients (P
Bhalla Mary Colleen; Frey Jennifer; Dials Sarah; Baughman Kristin
The American journal of emergency medicine
2016
2016-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2015.12.070" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2015.12.070</a>