Natalia Martinez-Schlurmann

Predictors of Complications of Tonsillectomy With or Without Adenoidectomy in Hospitalized Children and Adolescents in the United States, 2001-2010: A Population-Based Study

Outcomes of tonsillectomy (with or without adenoidectomy [w/woA]) in hospitalized children are unclear. We sought, to describe the characteristics of hospitalized children who underwent tonsillectomy (w/woA), to estimate the prevalence of complications and to evaluate the relative impact of different comorbid conditions (CMC) on the risk of occurrence of common complications following these procedures. All patients aged ≤21years who underwent a tonsillectomy (w/woA) were selected from the Nationwide Inpatient Sample (NIS 2001-2010). The associations between several patient/hospital-level factors and occurrence of complications were generated using multivariable logistic regression models. Over a decade, a total of 141 599 hospitalized patients underwent tonsillectomy (w116 319; woA 25 280). A total of 58.1% were males. Majority of the procedures were performed in teaching hospitals (TH, 73.7%), in large (bed-size) hospitals (LH, 57.8%), and in those who were electively admitted (EA, 67.3%). Frequently present CMC in patients included obstructive sleep apnea (OSA, 26.4%), chronic pulmonary disease (CPD, 14.6%), neurological disorders (ND, 6.7%), and obesity (4.8%). Majority of patients were discharged routinely (98%). Overall complication rate was 6.4% with common complications being postoperative pneumonia (2.3%), bacterial infections (1.4%), respiratory complications (1.3%), and hemorrhage (1.2%). All-cause mortality included a total of 60 patients. Patients in TH (odds ratio [OR] = 0.72, 95%CI = 0.62-0.85), LH (OR = 0.80, 95% CI = 0.69-0.93), and those who had the procedures during EA (OR = 0.64, 95% CI = 0.56-0.74) had significantly lower odds of complications compared with their counterparts. CMC such as anemia, CPD, coagulopathy, HT, ND, and fluid/electrolyte disorders were independent predictors of significantly higher complication risk (P < .05). In conclusion, hospitalized children who underwent tonsillectomy (w/woA) in large or teaching hospitals, or during elective admissions had lower risk of complications. Comorbidity is an important independent predictor of complications in this cohort.

Prevalence, predictors and outcomes of cardiopulmonary resuscitation in hospitalized adult stem cell transplant recipients in the United States: not just opening the black box but exploring an opportunity to optimize!

Prevalence, predictors and outcomes of cardiopulmonary resuscitation in hospitalized adult stem cell transplant recipients in the United States: not just opening the black box but exploring an opportunity to optimize!

Immediate effects of use of recombinant bone morphogenetic protein in children having spinal fusion and refusion procedures in United States

Study Design. Retrospective study of Nationwide Inpatient Sample (NIS). Objective. The objective of this study is to estimate the prevalence of complications in children who had insertion of recombinant human bone morphogenetic protein (rhBMP) at the time of spinal fusion procedures (SFP) and to examine if the use of rhBMP is associated with an increased risk of complications. Summary of Background Data. Use of rhBMP for SFP has been associated with conflicting safety profile reports in adults. Methods. NIS (years 2004–2010) was used. All patients with age  < 18 years who had a SFP during hospitalization with or without insertion of rhBMP were selected. Complications were selected based on a literature review of studies examining outcomes of SFP. Association between insertion of rhBMP and occurrence of complications was examined by multivariable logistic regression models. Results. Of the 72,898 children who underwent SFP, 7.1% children had insertion of rhBMP. Overall complication rate was 14.34% (15.2% in rhBMP group and 14.3% in no-rhBMP group). There was no statistically significant difference in the overall complication rate [odds ratio (OR) = 1.08, 95% confidence intervals (CI) = 0.89–1.30] or among 14 different complications between rhBMP and no-rhBMP groups. Children who had rhBMP were associated with higher odds for “other infections” (OR = 2.09, 95% CI = 1.26–3.48, P = 0.004) when compared with their counterparts. Conclusion. Despite the lack of Food and Drug Administration approval, rhBMP was not infrequently used in pediatric SFP. In this large retrospective study using administrative data, the use of rhBMP in children during SFP was not associated with higher risks for majority of assessed complications with the exception of “other infections”. Future studies must examine the long-term impact of use of rhBMP in children with SFP. Level of Evidence: 3

Prevalence and predictors of gastrostomy tube and tracheostomy placement in anoxic/hypoxic ischemic encephalopathic survivors of in-hospital cardiopulmonary resuscitation in the United States

Introduction Current prevalence estimates of gastrostomy tube (GT) /tracheostomy placement in hospitalized patients with anoxic/hypoxic ischemic encephalopathic injury (AHIE) post cardiopulmonary resuscitation (CPR) are unknown. We sought, to estimate the prevalence of AHIE in hospitalized patients who had CPR and to identify patient/hospital level factors that predict the performance of GT/tracheostomy in those with AHIE. Methods We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2004–2010). All patients who developed AHIE following CPR were included. In this cohort the odds of having GT and tracheostomy was computed by multivariable logistic regression analysis. Patient and hospital level factors were the independent variables. Results During the study period, a total of 686,578 CPR events occurred in hospitalized patients. Of these, 94,336 (13.7%) patients developed AHIE. In this AHIE cohort, 6.8% received GT and 8.3% tracheostomy. When compared to the 40–49 yrs age group, those aged >70 yrs were associated with lower odds for GT (OR = 0.65, 95% CI:0.53–0.80, p<0.0001). Those aged <18 years & those >60 years were associated with lower odds for having tracheostomy when compared to the 40–49 years group (p<0.0001). Each one unit increase in co-morbid burden was associated with higher odds for having GT (OR = 1.23,p<0.0001) or tracheostomy (OR = 1.17, p<0.0001). Blacks, Hispanics, Asians/Pacific Islanders, and other races were associated with higher odds for having GT or tracheostomy when compared to whites (p<0.05). Hospitals located in northeastern regions were associated with higher odds for performing GT (OR = 1.48, p<0.0001) or tracheostomy (OR = 1.63, p<0.0001) when compared to those in Western regions. Teaching hospitals (TH) were associated with higher odds for performing tracheostomy when compared to non-TH (OR = 1.36, 1.20–1.54, p<0.0001). Conclusions AHIE injury occurs in a significant number of in-hospital arrests requiring CPR. Certain predictors of GT/ Tracheostomy placement are identified. Patients in teaching hospitals were more likely to receive tracheostomy than their counterparts.

Regionalization of stem cell transplant procedures into teaching hospitals in United States: are we ready?

Regionalization of stem cell transplant procedures into teaching hospitals in United States: are we ready?

Firearm injuries by legal personnel in the USA: a new public health burden

Objective and background: Violence necessitating legal intervention is a common occurrence in the USA. Such legal intervention may include the use of firearms by law enforcement personnel. However, very little is known about such firearm related injuries necessitating medical care. The objective of the present study is to characterize the burden in terms of mortality and emergency department charges of firearm related interventions requiring ED care in USA. Further we sought to identify high-risk cohorts for such injuries. Methods: A nationwide (USA) emergency department sample for the year 2008 through 2010 was used for the present study. All patients treated in an emergency department (ED) due to firearm injuries by law enforcement personnel were selected for analysis. Outcomes examined including mortality in the ED and ED charges. Findings: There were 6144 ED visits due to firearm injuries caused by law enforcement. The mean age was 33 years. Most patients (69.1%) resided in geographic regions designated as low income areas, and the vast majority were males (91.8%). Many patients (39%) were uninsured. For those with insurance, payers included Medicare (5%), Medicaid (13.5%), private (26.5%), and other insurance (15.6%). Following an ED visit 56.9% were discharged as routine, 25.5% were admitted as inpatients, 3.5% were transferred to another short-term hospital, and 2.8% were transferred to a long-term facility. 338 patients died in the ED and 102 patients died following admission as an inpatient. The mean ED charge was US

774: INCIDENCE, PREDICTORS, AND IMPACT OF C. DIFFICILE AND MRSA INFECTIONS IN PATIENTS UNDERGOING ECAOHS

3631 and total ED charges across the USA was US

782: HYPONATREMIA AND IVF TONICITY ARE ASSOCIATED WITH UNFAVORABLE OUTCOMES IN CRITICAL BRONCHIOLITIS

12.8 million. Hospitalization and rehabilitation charges were not assessed in this study. Young adults, males, uninsured, and those residing in low-income areas were identified as the high-risk groups involved in firearm related injuries delivered by legal personnel. Nearly 390 children were involved in such injuries. Discussion: Our study offers initial insights into a complex, important, and not an uncommon problem facing the public. Preventive measures and alternative protective strategies should be considered in the high risk cohorts, especially for children. Language: en

962: IMPACT OF HEMODIALYSIS FOLLOWING ARF ON MORTALITY IN ADULT STEM CELL TRANSPLANT RECIPIENTS

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) visible identification placards, dedicated education for the respiratory therapist and bedside nurse, 1:1 nurse to patient ratio, and an electronic order set to delineate the process of alerting physicians. The rate of UPE with subsequent re-intubation per 100 ventilator days, and the total number of UPE in DA patients were tracked for 1.5 yr pre-implementation and 2 yr post-implementation. Results: Following application of UPE team measures, the total UPE rate per 100 ventilator days decreased from 0.6 prior to implementation to 0.46 following interventions (p = 0.04). UPE in DA patients were decreased from 14 in 2012 to 3 in 2014, and none to date in 2015. Conclusions: Implementation of specific multidisciplinary team quality improvement measures was associated with a significant reduction in UPE rates. A DA early identification and management approach also led to reduced UPEs in DA patients.

481: SEIZURES IN HOSPITALIZED ADULTS WITH ICH ARE ASSOCIATED WITH INCREASED HOSPITAL RESOURCE UTILIZATION

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) time was defined as PCU Index = first contiguous PCU census encounter > 24 hr (time thresholds derived from greater than median LOS). Intervention group inclusion defined as > 24 hr Tele-intervention during PCU Index time. Results: The two groups were fairly balanced. Comparing outcomes in PCU Tele-intervention vs. PCU standard of care, respectfully, the intervention group is older (70+/-16 vs. 65+/-18, p<0.001); of the patients who had MSDRG expected mortalities (6359, 7018), expected mortality (6.39% vs. 5.62%, p=0.0025); however, actual mortality direction was reversed and lower (4.65% vs. 5.10%, p=0.2444). PCU Index LOS was shorter (67 hr vs. 93 hr, p<0.001); and as expected hospital LOS (9.7 vs. 9.1, p<0.008). Of the patients who had an APACHE IV prediction (5852; 1319), predicted mortality (10.43% vs.17.36%, p<0.000); however, actual mortality is lower (4.41% vs.10.42% vs. p<0.000). Conclusions: In our population, Tele-ICU approach resulted in significantly decreased mortality and much shorter PCU Index LOS. These findings provide evidence of the effectiveness of Tele-innovation and validate the impact on quality and cost in the progressive care setting, providing a rationale for extension of access to Tele-PCU care services across broader hospital populations. Further investigation is needed to examine influence of Tele-PCU care service on severity adjusted predictions across varying practice settings.