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Quek MS, Oei CW, Ong PL, Chung CLH, Kong PW, Zhang X, Leo KH. Prognosticating Prosthetic Ambulation Ability in People With Lower Limb Amputation in Early Post-operative Phase. Arch Phys Med Rehabil 2024; 105:1346-1354. [PMID: 38570179 DOI: 10.1016/j.apmr.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/27/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To formulate a prognostication model in the early post-operation phase of lower limb amputation to predict patient's ability to ambulate with a prosthesis post rehabilitation. DESIGN Retrospective cohort study, using data collected from electronic medical records. Predictive factors and prosthetic ambulation outcomes post rehabilitation were used to develop prognostic models via machine learning techniques. SETTING Regional hospital's ambulatory rehabilitation clinic. PARTICIPANTS Patients with major lower limb amputation (N=329). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome of prosthetic ambulation ability post rehabilitation collected was categorized in 3 groups: non-ambulant with prosthesis, homebound ambulant with prosthesis (AP), and community AP. RESULTS In a 2-class model of non-ambulant and AP (homebound and community), the model with highest accuracy of prediction included ethnicity, total Functional Comorbidity Index (FCI), level of amputation, being community ambulant prior to amputation, and age. The f1-score and area under receiver operator curve (AUROC) of the model is 0.78 and 0.82. In a 3-class model consisting of all 3 groups of outcomes, the model with highest accuracy of prediction required 10 factors. The additional factors from the 2-class model include presence of caregiver, history of congestive heart failure, diabetes, visual impairment, and stroke. The 3-class model has a moderate accuracy with a f1-score and AUROC of 0.60 and 0.79. CONCLUSION The 2-class prognostication model has a high accuracy which can be used early post-amputation to predict if patient would be ambulant with a prosthesis post rehabilitation. The 3-class prognostication model has moderate accuracy and is able to further differentiate the walking ability to either homebound or community ambulation with a prosthesis, which can assist in prosthetic prescription and setting realistic rehabilitation goals.
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Affiliation(s)
- Mei Sing Quek
- Physiotherapy Department, Tan Tock Seng Hospital, Singapore.
| | - Chien Wei Oei
- Office of Clinical Epidemiology, Analytics & kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Poo Lee Ong
- Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Pui Wah Kong
- National Institute of Education, Nanyang Technological University, Singapore
| | - Xiaojin Zhang
- Office of Clinical Epidemiology, Analytics & kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Kee Hao Leo
- Office of Clinical Epidemiology, Analytics & kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
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Zhang Y, Guo JY, Wang F, Li CW, Yu K. Start with muscle mass or muscle strength in diagnosis and management of sarcopenia? A systematic review of guidance documents. Asia Pac J Clin Nutr 2024; 33:247-271. [PMID: 38794984 PMCID: PMC11170015 DOI: 10.6133/apjcn.202406_33(2).0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/29/2024] [Accepted: 01/18/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Sarcopenia has garnered extensive attention in clinical practice since its high prevalence and significant impact on clinical outcomes. Multiple organizations have published guidance documents on sarcopenia, offering evidence-based recommendations for clinical practice and/or research. We aimed to appraise the methodological quality of the included documents and synthesize available recommendations for the screening, diagnosis, and intervention of sarcopenia. METHODS AND STUDY DESIGN We conducted a search on PubMed, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, guideline database, and guideline organizations and professional societies websites for clinical practices, consensus statements and position papers in terms of sarcopenia, muscle atrophy or muscle loss published before April 17, 2023. The AGREE II instrument was used by three independent reviewers to assess the methodological quality of these documents. RESULTS Thirty-six guidance documents published between 2010 and 2023 were included. Seven documents fulfilled ≥ 50% of all the AGREE II domains. Seven underwent a Delphi process and six graded the strength of the recommendations. The process of screening (n=21), early diagnosis of sarcopenia (n=12), diagnosis of sarcopenia and severe sarcopenia (n=10), and management (n=21) were increasingly recommended. SARC-F (n=14) was the most recommended screening tool, and the assessment of muscle function was considered the first step in diagnosing sarcopenia. The management strategy for both age-related and disease-related sarcopenia mainly focused on exercise and nutrition intervention. CONCLUSIONS The guidance documents have provided referential recommendations that have great guiding significance. But the inconsistency in recommendations and variation in methodological rigour suggests that high-quality evidence is lacking yet.
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Affiliation(s)
- Yu Zhang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Yu Guo
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun-Wei Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Sears JM, Rundell SD, Fulton-Kehoe D, Hogg-Johnson S, Franklin GM. Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats. Am J Ind Med 2024; 67:99-109. [PMID: 37982343 PMCID: PMC10824282 DOI: 10.1002/ajim.23550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. METHODS WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. RESULTS The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change). CONCLUSIONS The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Sean D. Rundell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- The Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders; University of Washington, Seattle, WA, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Sheilah Hogg-Johnson
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Gary M. Franklin
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Washington State Department of Labor and Industries, Tumwater, WA, USA
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Risk Factors for Unplanned ICU Readmission Among Trauma Patients: Age Matters. Crit Care Explor 2022; 4:e0778. [PMID: 36284550 PMCID: PMC9586921 DOI: 10.1097/cce.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
UNLABELLED To determine the frequency of unplanned ICU readmission (UIR) among adult (18-64) and elderly (65+) trauma patients and to compare the risk factors for UIR and its clinical impact between age groups. DESIGN Retrospective cohort study using clinical data from a statewide trauma registry. SETTING All accredited trauma centers in Pennsylvania. PATIENTS Consecutive adult and elderly trauma patients requiring admission from the emergency department to the ICU between 2012 and 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among the 48,340 included in the analysis, 49.5% were elderly and 3.8% experienced UIR. UIR was 1.7 times more likely among elderly patients and was associated with increased hospital length of stay in both age groups. UIR was associated with an absolute increased risk of hospital mortality of 6.1% among adult patients and 16.9% among elderly patients experiencing UIR. In addition to overall injury severity and burden of preexisting medical conditions, specific risk factors for UIR were identified in each age group. In adult but not elderly patients, UIR was significantly associated with history of stroke, peptic ulcer disease, cirrhosis, diabetes, and malignancy. In elderly but not adult patients, UIR was also significantly associated with chronic kidney disease. CONCLUSIONS UIR is associated with worse clinical outcomes in both adult and elderly trauma patients, but risk factors and the magnitude of impact differ between age groups. Interventions to mitigate the risk of UIR that take into account patients' age group and specific risk factors may improve outcomes.
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Welford P, Östh J, Hoy S, Diwan V, Hallgren M. Effects of yoga and aerobic exercise on wellbeing in physically inactive older adults: randomized controlled trial (FitForAge). Complement Ther Med 2022; 66:102815. [PMID: 35143970 DOI: 10.1016/j.ctim.2022.102815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the effects of yoga and aerobic exercise (AE) on wellbeing in physically inactive, but otherwise healthy older adults. A secondary objective was to assess and compare the frequency of adverse events associated with yoga and AE. DESIGN Twelve-week, three-group, parallel randomized controlled trial with blinded follow-up assessment. INTERVENTIONS Participants were supported to complete ≥3 Hatha yoga classes/week or ≥3 AE sessions/week. A wait-list control (WLC) group continued usual daily activities. MAIN OUTCOME MEASURE Change in wellbeing, assessed using the Satisfaction with Life Scale (SWLS) and Life Satisfaction Index-Z (LSI),at baseline and at 12-week follow up. RESULTS In total, 82 adults (mean age 72.5 years, range 65-85, 77% female) were recruited. Of these, 27 were randomized to yoga, 29 to aerobic exercise and 26 to wait-list control. Medium-magnitude treatment effects (Hedges' g) were seen for yoga versus WLC and AE versus WLC(SWLS, g = 0.65 and 0.56; LSI, g = 0.54 and 0.54, respectively). In per-protocol analyses, larger effect sizes were found (SWLS, g = 0.72 and 0.66; LSI, g = 0.76 and 0.76, respectively). Adverse events were less frequent in the yoga group (6/27; 22%) compared to AE (10/27; 37%). CONCLUSIONS Among physically inactive older adults, participation in yoga or AE was associated with beneficial effects on subjective wellbeing when compared to a non-active control group. Yoga was associated with fewer injuries and may be especially suitable for older adults (DRKS 00015093).
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Affiliation(s)
- Paul Welford
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Josefine Östh
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Sara Hoy
- Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Vinod Diwan
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Mats Hallgren
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
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6
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Daly SL, Gabbe BJ, Climie RE, Ekegren CL. Association between type 2 diabetes and long-term outcomes in middle-aged and older trauma patients. J Trauma Acute Care Surg 2022; 92:185-192. [PMID: 34137744 DOI: 10.1097/ta.0000000000003317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetes is associated with increased hospital complications and mortality following trauma. However, there is limited research on the longer-term recovery of trauma patients with diabetes. The aim of this study was to explore the association between type 2 diabetes (T2D) and in-hospital and 24-month outcomes in major trauma patients. METHODS In this cohort study using the Victorian State Trauma Registry, middle-aged and older adults (≥45 years) with major trauma were followed up at 24 months postinjury. Logistic regression (univariable and multivariable) analyses were used to determine the association between diabetes status and 24-month patient-reported outcomes. In-hospital outcomes were compared between groups using χ2 tests. RESULTS Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24 months postinjury and were followed up at that time point: 953 people (11%) with and 7540 (89%) without T2D. People with T2D had a higher in-hospital death rate (19%) compared with people without T2D (16%; p < 0.001). After adjusting for confounders, people with T2D had poorer outcomes 24 months postinjury than people without T2D, with respect to functional recovery (Glasgow Outcome Scale Extended) (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.48-0.69) and return to work/study (AOR, 0.51; 95% CI, 0.37-0.71]). People with T2D experienced higher odds of problems with mobility (AOR, 1.92; 95% CI, 1.60-2.30), self-care (AOR, 1.94; 95% CI, 1.64, 2.29), usual activities (AOR, 1.50; 95% CI, 1.26-1.79), pain and discomfort (AOR, 1.75; 95% CI, 1.49-2.07), anxiety and depression (AOR, 1.45; 95% CI, 1.24, 1.70), and self-reported disability (AOR, 1.51; 95% CI, 1.28-1.79) than people without T2D. CONCLUSION Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24 months postinjury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential. LEVEL OF EVIDENCE Prognostic, level III.
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Affiliation(s)
- Stuart L Daly
- From the School of Public Health and Preventive Medicine (S.L.D., B.J.G., C.L.E.), Monash University; Emergency Medicine (S.L.D., C.L.E.), Alfred Health, Melbourne, VIC, Australia; Health Data Research UK (B.J.G.), Swansea University, Swansea, UK; Farr Institute (B.J.G.), Swansea University Medical School, Swansea University, Swansea, UK; Baker Heart and Diabetes Institute (R.E.C., C.L.E.), Melbourne; Menzies Institute for Medical Research (R.E.C.), University of Tasmania, Hobart, Tasmania, Australia; and Rehabilitation, Ageing and Independent Living (RAIL) Research Centre (C.L.E.), Monash University, Melbourne, VIC, Australia
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7
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Charlson ME, Wells MT. Comorbidity: From a Confounder in Longitudinal Clinical Research to the Main Issue in Population Management. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:145-151. [PMID: 35196663 PMCID: PMC9064932 DOI: 10.1159/000521952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Mary E. Charlson
- Department of Medicine, Weill Cornell Medicine, New York, New York
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Dipnall JF, Rivara FP, Lyons RA, Ameratunga S, Brussoni M, Lecky FE, Bradley C, Beck B, Lyons J, Schneeberg A, Harrison JE, Gabbe BJ. Predictors of health-related quality of life following injury in childhood and adolescence: a pooled analysis. Inj Prev 2021; 28:301-310. [PMID: 34937765 DOI: 10.1136/injuryprev-2021-044309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Injury is a leading contributor to the global disease burden in children and places children at risk for adverse and lasting impacts on their health-related quality of life (HRQoL) and development. This study aimed to identify key predictors of HRQoL following injury in childhood and adolescence. METHODS Data from 2259 injury survivors (<18 years when injured) were pooled from four longitudinal cohort studies (Australia, Canada, UK, USA) from the paediatric Validating Injury Burden Estimates Study (VIBES-Junior). Outcomes were the Paediatric Quality of Life Inventory (PedsQL) total, physical, psychosocial functioning scores at 1, 3-4, 6, 12, 24 months postinjury. RESULTS Mean PedsQL total score increased with higher socioeconomic status and decreased with increasing age. It was lower for transport-related incidents, ≥1 comorbidities, intentional injuries, spinal cord injury, vertebral column fracture, moderate/severe traumatic brain injury and fracture of patella/tibia/fibula/ankle. Mean PedsQL physical score was lower for females, fracture of femur, fracture of pelvis and burns. Mean PedsQL psychosocial score was lower for asphyxiation/non-fatal submersion and muscle/tendon/dislocation injuries. CONCLUSIONS Postinjury HRQoL was associated with survivors' socioeconomic status, intent, mechanism of injury and comorbidity status. Patterns of physical and psychosocial functioning postinjury differed according to sex and nature of injury sustained. The findings improve understanding of the long-term individual and societal impacts of injury in the early part of life and guide the prioritisation of prevention efforts, inform health and social service planning to help reduce injury burden, and help guide future Global Burden of Disease estimates.
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Affiliation(s)
- Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Frederick P Rivara
- Departments of Pediatrics and Epidemiology, and the Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Ronan A Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK.,National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Shanthi Ameratunga
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Population Health, University of Auckland, Auckland, New Zealand.,Kidz First Hospital and Population Health Directorate, Counties Manukau District Health Board, Auckland, New Zealand
| | - Mariana Brussoni
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Fiona E Lecky
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.,Emergency Department, Salford Royal Hospital, Salford, UK
| | - Clare Bradley
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Amy Schneeberg
- British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - James E Harrison
- Flinders Institute for Health and Medical Research, Flinders University, Adelaide, South Australia, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK
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Toppi J, Hughes J, Phillips D. Bacterial infections of the oropharynx and deep neck spaces: an investigation of changes in presentation patterns during the COVID-19 pandemic. ANZ J Surg 2021; 91:2726-2730. [PMID: 34427384 PMCID: PMC8646372 DOI: 10.1111/ans.17178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether changes in practice during the COVID-19 pandemic altered clinical presentation characteristics among adults with bacterial throat infections. METHODS A retrospective cohort study was conducted that included adult patients presenting with bacterial oropharyngeal infections to a tertiary level hospital in Melbourne, Australia. All patients presenting during the first phase of COVID-19 lockdown in Melbourne (1st April- 1st July in 2020), and those from the same period 12-months prior, were included. RESULTS There were fewer presentations of bacterial throat infections during the pandemic period compared to the same time 1 year prior. There was a significantly reduced proportion of patients on oral antibiotics prior to their presentation in 2020, as compared to the same period 12-months earlier (30% vs. 50%, respectively; P < 0.01), as well as a significant increase in the length of time patients were symptomatic before presenting to hospital (5 days vs. 4 days, respectively; P < 0.01). Despite this, there was no significant increase in the number of representations post discharge from hospital, or the length of hospital admission. CONCLUSION The overall number of patients presenting with tonsillitis, pharyngitis, peritonsillar abscess and deep neck space infection were reduced during the pandemic period. Patients experienced symptoms for a longer period of time and fewer were on antimicrobial therapy prior to presentation. This study highlights a shift towards delayed patient presentation and reduced oral antibiotic commencement in cases of oropharyngeal infections as a result of the COVID-19 pandemic.
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Affiliation(s)
- Jason Toppi
- Otolaryngology and Head and Neck UnitAustin HospitalHeidelbergVictoriaAustralia
- Otolaryngology and Head and Neck UnitRoyal Children's HospitalParkvilleVictoriaAustralia
| | - Jed Hughes
- Otolaryngology and Head and Neck UnitAustin HospitalHeidelbergVictoriaAustralia
| | - Damien Phillips
- Otolaryngology and Head and Neck UnitAustin HospitalHeidelbergVictoriaAustralia
- Otolaryngology and Head and Neck UnitRoyal Children's HospitalParkvilleVictoriaAustralia
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Giummarra MJ, Beck B, Gabbe BJ. Classification of road traffic injury collision characteristics using text mining analysis: Implications for road injury prevention. PLoS One 2021; 16:e0245636. [PMID: 33503030 PMCID: PMC7840051 DOI: 10.1371/journal.pone.0245636] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 01/30/2023] Open
Abstract
Road traffic injuries are a leading cause of morbidity and mortality globally. Understanding circumstances leading to road traffic injury is crucial to improve road safety, and implement countermeasures to reduce the incidence and severity of road trauma. We aimed to characterise crash characteristics of road traffic collisions in Victoria, Australia, and to examine the relationship between crash characteristics and fault attribution. Data were extracted from the Victorian State Trauma Registry for motor vehicle drivers, motorcyclists, pedal cyclists and pedestrians with a no-fault compensation claim, aged > = 16 years and injured 2010-2016. People with intentional injury, serious head injury, no compensation claim/missing injury event description or who died < = 12-months post-injury were excluded, resulting in a sample of 2,486. Text mining of the injury event using QDA Miner and Wordstat was used to classify crash circumstances for each road user group. Crashes in which no other was at fault included circumstances involving lost control or avoiding a hazard, mechanical failure or medical conditions. Collisions in which another was predominantly at fault occurred at intersections with another vehicle entering from an adjacent direction, and head-on collisions. Crashes with higher prevalence of unknown fault included multi-vehicle collisions, pedal cyclists injured in rear-end collisions, and pedestrians hit while crossing the road or navigating slow traffic areas. We discuss several methods to promote road safety and to reduce the incidence and severity of road traffic injuries. Our recommendations take into consideration the incidence and impact of road trauma for different types of road users, and include engineering and infrastructure controls through to interventions targeting or accommodating human behaviour.
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Affiliation(s)
- Melita J. Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom
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11
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Sears JM, Rundell SD. Development and Testing of Compatible Diagnosis Code Lists for the Functional Comorbidity Index: International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, 10th Revision, Clinical Modification. Med Care 2020; 58:1044-1050. [PMID: 33003052 PMCID: PMC7717170 DOI: 10.1097/mlr.0000000000001420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Functional Comorbidity Index (FCI) was developed for community-based adult populations, with function as the outcome. The original FCI was a survey tool, but several International Classification of Diseases (ICD) code lists-for calculating the FCI using administrative data-have been published. However, compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM versions have not been available. OBJECTIVE We developed ICD-9-CM and ICD-10-CM diagnosis code lists to optimize FCI concordance across ICD lexicons. RESEARCH DESIGN We assessed concordance and frequency distributions across ICD lexicons for the FCI and individual comorbidities. We used length of stay and discharge disposition to assess continuity of FCI criterion validity across lexicons. SUBJECTS State Inpatient Databases from Arizona, Colorado, Michigan, New Jersey, New York, Utah, and Washington State (calendar year 2015) were obtained from the Healthcare Cost and Utilization Project. State Inpatient Databases contained ICD-9-CM diagnoses for the first 3 calendar quarters of 2015 and ICD-10-CM diagnoses for the fourth quarter of 2015. Inpatients under 18 years old were excluded. MEASURES Length of stay and discharge disposition outcomes were assessed in separate regression models. Covariates included age, sex, state, ICD lexicon, and FCI/lexicon interaction. RESULTS The FCI demonstrated stability across lexicons, despite small discrepancies in prevalence for individual comorbidities. Under ICD-9-CM, each additional comorbidity was associated with an 8.9% increase in mean length of stay and an 18.5% decrease in the odds of a routine discharge, compared with an 8.4% increase and 17.4% decrease, respectively, under ICD-10-CM. CONCLUSION This study provides compatible ICD-9-CM and ICD-10-CM diagnosis code lists for the FCI.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Services, University of Washington,
Seattle, WA
- Department of Environmental and Occupational Health
Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, Seattle,
WA
- Institute for Work and Health, Toronto, Ontario,
Canada
| | - Sean D. Rundell
- Department of Health Services, University of Washington,
Seattle, WA
- Department of Rehabilitation Medicine, University of
Washington, Seattle, WA
- Comparative Effectiveness, Cost, and Outcomes Research
Center; University of Washington, Seattle, WA
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Factors Associated With Long-term Outcomes After Injury: Results of the Functional Outcomes and Recovery After Trauma Emergencies (FORTE) Multicenter Cohort Study. Ann Surg 2020; 271:1165-1173. [PMID: 30550382 DOI: 10.1097/sla.0000000000003101] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury. SUMMARY OF BACKGROUND DATA Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma. METHODS Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes. RESULTS We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were. CONCLUSION The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.
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Lau G, Gabbe BJ, Collie A, Ponsford J, Ameratunga S, Cameron PA, Harrison JE, Giummarra MJ. The Association Between Fault Attribution and Work Participation After Road Traffic Injury: A Registry-Based Observational Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:235-254. [PMID: 31820220 DOI: 10.1007/s10926-019-09867-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose To characterise associations between fault attribution and work participation and capacity after road traffic injury. Methods People aged 15-65 years, working pre-injury, without serious brain injury, who survived to 12 months after road traffic injury were included from two Victorian trauma registries (n = 2942). Fault profiles from linked compensation claims were defined as no other at fault, another at fault, denied another at fault, claimed another at fault, and unknown. Claimant reports in the denied and claimed another at fault groups contradicted police reports. Patients reported work capacity (Glasgow outcome scale-extended) and return to work (RTW) at 6, 12 and 24 months post-injury (early and sustained RTW, delayed RTW (≥ 12 months), failed RTW attempts, no RTW attempts). Analyses adjusted for demographic, clinical and injury covariates. Results The risk of not returning to work was higher if another was at fault [adjusted relative risk ratio (aRRR) = 1.67, 95% confidence interval (CI) 1.29, 2.17] or was claimed to be at fault (aRRR = 1.58, 95% CI 1.04, 2.41), and lower for those who denied that another was at fault (aRRR = 0.51, 95% CI 0.29, 0.91), compared to cases with no other at fault. Similarly, people had higher odds of work capacity limitations if another was at fault (12m: AOR = 1.49, 95% CI 1.24, 1.80; 24m: 1.63, 95% CI 1.35, 1.97) or was claimed to be at fault (12m: AOR = 1.54, 95% CI 1.16, 2.05; 24m: AOR = 1.80, 95% CI 1.34, 2.41), and lower odds if they denied another was at fault (6m: AOR = 0.67, 95% CI 0.48, 0.95), compared to cases with no other at fault. Conclusion Targeted interventions are needed to support work participation in people at risk of poor RTW post-injury. While interventions targeting fault and justice-related attributions are currently lacking, these may be beneficial for people who believe that another caused their injury.
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Affiliation(s)
- Georgina Lau
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, SA2 8PP, UK
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, SA, Australia
| | - Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. The Australian Injury Comorbidity Index to Predict Mortality. Ann Emerg Med 2020; 75:339-353. [PMID: 31955941 DOI: 10.1016/j.annemergmed.2019.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/20/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Existing comorbidity indices such as the Charlson comorbidity index are dated yet still widely used. This study derives and validates up-to-date comorbidity indices for hospital-admitted injury patients, specific to mortality outcomes. METHODS Injury-related hospital admissions data for 2 cohorts of patients in the Australian state of Victoria were linked to mortality data: July 2012 to June 2014 (161,334 patients) and July 2006 to June 2015 (614,762 patients). Logistic regression models were fitted, and results were used to derive binary and weighted comorbidity indices to predict mortality outcomes. The indices were validated with data from New South Wales (Australia). RESULTS There were 11 comorbidity groups identified as associated with inhospital death (cohort 1), 13 with 30-day mortality, and 19 with 1-year mortality (cohort 2). The newly derived weights for comorbidities were very different from the Charlson comorbidity index weights for some conditions. The area under the curve statistics for inhospital death, 30-day mortality, and 1-year mortality were similar for the newly derived binary comorbidity indices (0.920, 0.923, and 0.910, respectively), the Charlson comorbidity index (0.915, 0.919, and 0.906, respectively), and the Elixhauser comorbidity measure (0.924, 0.923, and 0.908, respectively). The false-negative rates for the new binary indices (15.8%, 15.8%, and 16.3%, respectively) were statistically equal to those of the Charlson comorbidity index (17.4%, 16.3%, and 16.5%, respectively) and the Elixhauser comorbidity measure (15.2%, 14.8%, and 16.3%, respectively). CONCLUSION The newly derived Australian Injury Comorbidity Indices, which are a binary representation of individual conditions associated with the outcome of interest, are useful in quantifying the effect of comorbidity among injury patients. They include a shorter list of conditions than existing indices such as the Charlson comorbidity index and Elixhauser comorbidity measure, are up to date, and consider the individual association of each condition over a summed score such as the Charlson comorbidity index. Indices that quantify the effect of comorbidities should consider the population, disease prevalence, and outcome of interest and require periodic updating.
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Affiliation(s)
- D Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia. https://twitter.com/tharanga361
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia; Victorian Injury Surveillance Unit, Monash University, Clayton, Victoria, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
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Patterns and Predictors of Return to Work After Major Trauma: A Prospective, Population-based Registry Study. Ann Surg 2020; 269:972-978. [PMID: 29342014 DOI: 10.1097/sla.0000000000002666] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize patterns of engagement in work during the 4-year period after major traumatic injury, and to identify factors associated with those patterns. BACKGROUND Employment is an important marker of functional recovery from injury. There are few population-based studies of long-term employment outcomes, and limited data on the patterns of return to work (RTW) after injury. METHODS A population-based, prospective cohort study using the Victorian State Trauma Registry. A total of 1086 working age individuals, in paid employment or full-time education before injury, were followed-up through telephone interview at 6, 12, 24, 36, and 48 months post-injury. Responses to RTW questions were used to define 4 discrete patterns: early and sustained; delayed; failed; no RTW. Predictors of RTW patterns were assessed using multivariate multinomial logistic regression. RESULTS Slightly more than half of respondents (51.6%) recorded early sustained RTW. A further 15.5% had delayed and 13.3% failed RTW. One in 5 (19.7%) did not RTW. Compared with early sustained RTW, predictors of delayed and no RTW included being in a manual occupation and injury in a motor vehicle accident. Older age and receiving compensation predicted both failed and no RTW patterns. Preinjury disability was an additional predictor of failed RTW. Presence of comorbidity was an additional predictor of no RTW. CONCLUSIONS A range of personal, occupational, injury, health, and compensation system factors influence RTW patterns after serious injury. Early identification of people at risk for delayed, failed, or no RTW is needed so that targeted interventions can be delivered.
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Rundell SD, Resnik L, Heagerty PJ, Kumar A, Jarvik JG. Performance of the Functional Comorbidity Index (FCI) in Prognostic Models for Risk Adjustment in Patients With Back Pain. PM R 2020; 12:891-898. [PMID: 31901004 DOI: 10.1002/pmrj.12315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/16/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Functional Comorbidity Index (FCI) is a comorbidity measure associated with physical function and may contribute to risk adjustment models in rehabilitation settings, but an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) of the FCI has not been tested in outpatient settings. OBJECTIVE This study examines the ability of an ICD-9-CM- based FCI to predict function, health-related quality of life, and overall health care use. DESIGN Cohort study. SETTING AND PARTICIPANTS This was a secondary analysis of 5155 adults ≥65 years of age with a new back pain visit from the Back pain Outcomes using Longitudinal Data cohort study. INDEPENDENT VARIABLES We measured 18 comorbidities with an ICD-9-CM version of the FCI using diagnosis codes 12 months prior to an index visit. MAIN OUTCOME MEASUREMENTS Outcomes included the Roland Morris Disability Questionnaire (RMDQ, 0-24), health-related-quality-of-life (EQ5D, 0-1), and total health care use (sum of all relative value units [RVUs]) measured at baseline and 12 months after the index visit. Linear regression and generalized linear models estimated the association between the FCI and each outcome and to examine goodness of fit. We used a 10-fold cross-validation to develop and compare predictive models with and without the FCI. RESULTS There were 1398 participants (27%) with two or more comorbidities. Adjusted estimates show that for every one unit increase in FCI, RMDQ increased by 1.0 (95% confidence interval [CI] 0.8 to 1.1) and R2 = 0.093; EQ5D decreased by 0.023 (95% CI -0.028 to -0.019) and R2 = 0.076; and mean total RVUs increased by 13% (95% CI 1.09 to 1.17). Cross-validation showed that FCI contributed to small improvements in the performance of predictive models. CONCLUSION An ICD-9-CM version of the FCI is associated with long-term function, health-related quality of life, and total health care use among older adults with back pain; however, it explains only a small proportion of the variance.
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Affiliation(s)
- Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, WA
| | - Linda Resnik
- Department of Health Services, Policy and Practice; Brown University, Providence, RI.,Providence VA Medical Center, Providence, RI
| | - Patrick J Heagerty
- Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, WA.,Department of Biostatistics, University of Washington, Seattle, WA
| | - Amit Kumar
- Doctor of Physical Therapy Program, Northern Arizona University, Phoenix, AZ
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, WA.,Department of Radiology, Health Services, and Neurological Surgery, University of Washington, Seattle, WA
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Considine J, Fox K, Plunkett D, Mecner M, O Reilly M, Darzins P. Factors associated with unplanned readmissions in a major Australian health service. AUST HEALTH REV 2019; 43:1-9. [PMID: 29092726 DOI: 10.1071/ah16287] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to gain an understanding of the factors associated with unplanned hospital readmission within 28 days of acute care discharge from a major Australian health service. Methods A retrospective study of 20575 acute care discharges from 1 August to 31 December 2015 was conducted using administrative databases. Patient, index admission and readmission characteristics were evaluated for their association with unplanned readmission in ≤28 days. Results The unplanned readmission rate was 7.4% (n=1528) and 11.1% of readmitted patients were returned within 1 day. The factors associated with increased risk of unplanned readmission in ≤28 days for all patients were age ≥65 years (odds ratio (OR) 1.3), emergency index admission (OR 1.6), Charlson comorbidity index >1 (OR 1.1-1.9), the presence of chronic disease (OR 1.4) or complications (OR 1.8) during the index admission, index admission length of stay (LOS) >2 days (OR 1.4-1.8), hospital admission(s) (OR 1.7-10.86) or emergency department (ED) attendance(s) (OR 1.8-5.2) in the 6 months preceding the index admission and health service site (OR 1.2-1.6). However, the factors associated with increased risk of unplanned readmission ≤28 days changed with each patient group (adult medical, adult surgical, obstetric and paediatric). Conclusions There were specific patient and index admission characteristics associated with increased risk of unplanned readmission in ≤28 days; however, these characteristics varied between patient groups, highlighting the need for tailored interventions. What is known about the topic? Unplanned hospital readmissions within 28 days of hospital discharge are considered an indicator of quality and safety of health care. What does this paper add? The factors associated with increased risk of unplanned readmission in ≤28 days varied between patient groups, so a 'one size fits all approach' to reducing unplanned readmissions may not be effective. Older adult medical patients had the highest rate of unplanned readmissions and those with Charlson comorbidity index ≥4, an index admission LOS >2 days, left against advice and hospital admission(s) or ED attendance(s) in the 6 months preceding index admission and discharge from larger sites within the health service were at highest risk of unplanned readmission. What are the implications for practitioners? One in seven discharges resulted in an unplanned readmission in ≤28 days and one in 10 unplanned readmissions occurred within 1 day of discharge. Although some patient and hospital characteristics were associated with increased risk of unplanned readmission in ≤28 days, statistical modelling shows there are other factors affecting the risk of readmission that remain unknown and need further investigation. Future work related to preventing unplanned readmissions in ≤28 days should consider inclusion of health professional, system and social factors in risk assessments.
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Affiliation(s)
- Julie Considine
- Deakin University, Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety, 1 Gheringhap St, Geelong, Vic. 3220, Australia
| | - Karen Fox
- Eastern Health, Box Hill, Vic. 3128, Australia. ;
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18
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Toppi J, Cleland H, Gabbe B. Severe burns in Australian and New Zealand adults: Epidemiology and burn centre care. Burns 2019; 45:1456-1461. [DOI: 10.1016/j.burns.2019.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/04/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022]
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Cook MJ, Bellou E, Bowes J, Sergeant JC, O'Neill TW, Barton A, Verstappen SMM. The prevalence of co-morbidities and their impact on physical activity in people with inflammatory rheumatic diseases compared with the general population: results from the UK Biobank. Rheumatology (Oxford) 2019; 57:2172-2182. [PMID: 30107595 PMCID: PMC6256331 DOI: 10.1093/rheumatology/key224] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare the prevalence and incidence of chronic co-morbidities in people with inflammatory rheumatic and musculoskeletal diseases (iRMDs), and to determine whether the prevalent co-morbidities are associated with physical activity levels in people with iRMDs and in those without iRMDs. Methods Participants were recruited to the UK Biobank; a population-based cohort. Data were collected about demographics, physical activity, iRMDs (RA, PsA, AS, SLE) and other chronic conditions, including angina, myocardial infarction, stroke, hypertension, pulmonary disease, diabetes and depression. The standardized prevalence of co-morbidities in people with iRMDs was calculated. Cox regression was used to determine the relationship between the presence of an iRMD and an incident co-morbidity. The relationship between the presence (versus absence) of a (co-)morbidity and physical activity level (low, moderate, high) in people with iRMDs and in those without was assessed using multinomial logistic regression. Results A total of 488 991 participants were included. The estimated prevalence of each co-morbidity was increased in participants with an iRMD, compared with in those without, particularly for stroke in participants with SLE (standardized morbidity ratio (95% CI), 4.9 (3.6, 6.6). Compared with people with no iRMD and no morbidity, the odds ratios (95% CI) for moderate physical activity were decreased for: no iRMD and morbidity, 0.87 (0.85, 0.89); iRMD and no co-morbidity, 0.71 (0.64, 0.80); and iRMD and co-morbidity, 0.58 (0.54, 0.63). Conclusion Having a (co-)morbidity is associated with reduced physical activity in the general population, and to a greater extent in participants with an iRMD. Optimal management of both iRMDs and co-morbidities may help to reduce their impact on physical activity.
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Affiliation(s)
- Michael J Cook
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Manchester, UK
| | - Eftychia Bellou
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jamie C Sergeant
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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20
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. Effect of comorbidity on injury outcomes: a review of existing indices. Ann Epidemiol 2019; 36:5-14. [DOI: 10.1016/j.annepidem.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/08/2019] [Accepted: 06/16/2019] [Indexed: 01/13/2023]
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21
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Baker W, Samaranayaka A, Wyeth E, Ameratunga S, Derrett S. Migrants and disability following injury: findings from a prospective study in New Zealand. Aust N Z J Public Health 2019; 43:470-476. [PMID: 31287940 DOI: 10.1111/1753-6405.12927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/01/2018] [Accepted: 06/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To compare the prevalence of disability between migrants and non-migrants at three and 24 months post-injury, and to identify key predictors of post-injury disability among migrants. METHODS Disability among 2,850 injured participants, including 677 migrants to New Zealand, was measured prospectively using the World Health Organization Disability Assessment Schedule. RESULTS Migrants experienced higher risk of disability than non-migrants at three months post-injury (aRR=1.14, 95%CI 1.03-1.26). Both groups had similar disability prevalence, but higher than pre-injury, at 24 months. For migrants, strong predictors of disability at three months post-injury were: higher injury severity, pre-injury obesity, and perceiving the injury as a threat of disability. Having multiple chronic conditions was a predictor of disability at both time points. CONCLUSIONS Disability was persistent for migrants and non-migrants to 24 months post-injury. The disability risk at three months was higher for migrants. Certain predictors associated with disability were identified. Implications for public health: Despite having accessed healthcare services for their injury, migrants (compared with non-migrants) had higher risks of disability at least in the first three months post-injury. Interventions should be focused during this critical period on identified key predictors to promote faster recovery and reduce disability.
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Affiliation(s)
- Warinthon Baker
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | | | - Emma Wyeth
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
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22
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. Complications, burden and in-hospital death among hospital treated injury patients in Victoria, Australia: a data linkage study. BMC Public Health 2019; 19:798. [PMID: 31226975 PMCID: PMC6588941 DOI: 10.1186/s12889-019-7080-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background A wide range of outcome measures can be calculated for hospital-treated injury patients. These include mortality, use of critical care services, complications, length of stay, treatment costs, readmission and nursing care after discharge. Each address different aspects and phases of injury recovery and can yield vastly different results. This study aims to: (1) measure and report this range of outcomes in hospital-treated injury patients in a defined population; and (2) describe the associations between injury characteristics, socio-demographics and comorbidities and the various outcomes. Methods A retrospective analysis was conducted of injury-related hospital admissions from July 2012 to June 2014 (152,835 patients) in Victoria, Australia. The admission records were linked within the dataset, enabling follow-up, to assess the outcomes of in-hospital death, burden, complications and 30-day readmissions. Associations between factors and outcomes were determined using univariate regression analysis. Results The proportion of patients who died in hospital was 0.9%, while 26.8% needed post-discharge care. On average patients had 2.4 complications (confidence interval (CI) 2.4–2.5) related to their initial injury, the mean cost of treating a patient was Australian dollars 7013 (CI 6929–7096) and the median length of stay was one day (inter quartile range 1–3). Intensive-care-unit-stay was recorded in 3% of the patients. All-cause 30-day readmissions occurred in 12.3%, non-planned 30-day readmissions in 7.9%, while potentially avoidable 30-day readmissions were observed in 3.2% of the patients. Increasing age was associated with all outcomes. The need for care post-discharge from hospital was highest among children and the oldest age group (85 years and over). Injury severity was associated with all adverse outcomes. Increasing number of comorbidities increased the likelihood of all outcomes. Overall, outcomes are shown to differ by age, gender, comorbidities, body region injured, injury type and injury severity, and to a lesser extent by socio-economic areas. Conclusions Outcomes and risk factors differ depending on the outcome measured, and the method used for measuring the outcome. Similar outcomes measured in different ways produces varying results. Data linkage has provided a valuable platform for a comprehensive overview of outcomes, which can help design and target secondary and tertiary preventive measures. Electronic supplementary material The online version of this article (10.1186/s12889-019-7080-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia.
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, 50 Lonsdale Street, Melbourne, Victoria, 3000, Australia
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23
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Lin SK, Lo PC, Chen WC, Lai JN. Integrating traditional Chinese medicine healthcare into dementia care plan by reducing the need for special nursing care and medical expenses. Medicine (Baltimore) 2019; 98:e14468. [PMID: 30762764 PMCID: PMC6407982 DOI: 10.1097/md.0000000000014468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56-0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.
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Affiliation(s)
- Shun-Ku Lin
- Department of Chinese Medicine, Taipei City Hospital, Renai Branch
- Institute of Public Health, National Yang-Ming University
| | - Pei-Chia Lo
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Wang-Chuan Chen
- The School of Chinese Medicine for Post Baccalaureate, I-Shou University
- Department of Chinese Medicine, E-Da hospital, Kaohsiung
| | - Jung-Nien Lai
- School of Chinese Medicine, China Medical University
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
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Tan AL, Chiong Y, Nadkarni N, Cheng JYX, Chiu MT, Wong TH. Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study. World J Emerg Surg 2018; 13:57. [PMID: 30524498 PMCID: PMC6276158 DOI: 10.1186/s13017-018-0217-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/14/2018] [Indexed: 02/03/2023] Open
Abstract
Background There is increasing focus on long-term survival, function and quality-of-life for trauma patients. There are few studies tracking longitudinal changes in functional outcome over time. The goal of our study was to compare the Glasgow Outcome Scale-Extended (GOSE) at 6 months and 12 months in blunt trauma survivors with an Injury Severity Score (ISS) of more than 15. Methods Using the Singapore National Trauma Registry 2011–2013, patients with 6-month GOSE and 12-month GOSE scores were analysed. Patients were grouped into three categories—those with the same score at 6 months and 12 months, an improvement in score, and a worse score at 12 months. Ordinal regression was used to identify risk factors for improved score. Patients with missing scores at either 6 months or 12 months were excluded. Results We identified 478 patients: 174 had an improvement in score, 233 stayed the same, and 71 had worse scores at 12 months compared to 6 months. On univariate ordinal regression, the following variables were associated with same or better function at 12-months compared to 6-months: male gender, being employed pre-injury, thoracic Abbreviated Injury Scale (AIS) of 3 or more, anatomical polytrauma (AIS of 3 or more in 2 or more body regions), and road traffic injury mechanism. Older age, low fall, increasing Charlson comorbidity scores, new injury severity score, and head and neck AIS of 3 or more were associated with worse function at 12 months compared to 6 months. ISS and revised trauma score were not significant predictors on univariate or multivariable analysis. On multivariable ordinal regression, motor vehicle mechanism (OR 2.78, 1.51–5.12, p = 0.001) was associated with improved function, while male gender (OR 1.36, 95% CI 1.02–1.82, p = 0.039) predicted improved function at 12 months. Conclusions Females experience worse functional outcomes at 12 months, potentially due to majority of female injuries being low falls in the elderly. In contrast, motor vehicle injury patients had better functional outcomes at 12 months. Additional interventional strategies for high-risk groups should be explored.
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Affiliation(s)
- Aidan Lyanzhiang Tan
- 1Preventive Medicine, National University Hospital, Singapore, Singapore.,2Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Yi Chiong
- 3Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nivedita Nadkarni
- 4Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | | | - Ming Terk Chiu
- 5National Trauma Unit, Tan Tock Seng Hospital, Singapore, Singapore.,6Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ting Hway Wong
- 7General and Trauma Surgery, Singapore General Hospital, Singapore, Singapore.,8Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
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Rhon DI, Greenlee TA, Marchant BG, Sissel CD, Cook CE. Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. Br J Sports Med 2018; 53:547-553. [DOI: 10.1136/bjsports-2018-099294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Abstract
ObjectivesWe aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy.MethodsData from individuals (ages 18–50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery.Results1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%.ConclusionsMajor (potentially ‘hidden’) clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery.Level of evidencePrognostic, level III.
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Considine J, Berry D, Newnham E, Jiang M, Fox K, Plunkett D, Mecner M, Darzins P, O’Reilly M. Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study. BMC Health Serv Res 2018; 18:713. [PMID: 30217155 PMCID: PMC6137861 DOI: 10.1186/s12913-018-3527-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable. METHODS A retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015. RESULTS In Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1-5 hospital admissions in the 6 months preceding index admission. In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission. CONCLUSIONS Advanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.
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Affiliation(s)
- Julie Considine
- Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety – Eastern Health Partnership, Deakin University, Geelong, Australia
| | - Debra Berry
- Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety – Eastern Health Partnership, Deakin University, Geelong, Australia
| | | | | | | | | | | | - Peteris Darzins
- Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mary O’Reilly
- Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Comparison of the performance of mental health, drug and alcohol comorbidities based on ICD-10-AM and medical records for predicting 12-month outcomes in trauma patients. BMC Health Serv Res 2018; 18:408. [PMID: 29871639 PMCID: PMC5989374 DOI: 10.1186/s12913-018-3248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/29/2018] [Indexed: 02/08/2023] Open
Abstract
Background Many outcome studies capture the presence of mental health, drug and alcohol comorbidities from administrative datasets and medical records. How these sources compare as predictors of patient outcomes has not been determined. The purpose of the present study was to compare mental health, drug and alcohol comorbidities based on ICD-10-AM coding and medical record documentation for predicting longer-term outcomes in injured patients. Methods A random sample of patients (n = 500) captured by the Victorian State Trauma Registry was selected for the study. Retrospective medical record reviews were conducted to collect data about documented mental health, drug and alcohol comorbidities while ICD-10-AM codes were obtained from routinely collected hospital data. Outcomes at 12-months post-injury were the Glasgow Outcome Scale – Extended (GOS-E), European Quality of Life Five Dimensions (EQ-5D-3L), and return to work. Linear and logistic regression models, adjusted for age and gender, using medical record derived comorbidity and ICD-10-AM were compared using measures of calibration (Hosmer-Lemeshow statistic) and discrimination (C-statistic and R2). Results There was no demonstrable difference in predictive performance between the medical record and ICD-10-AM models for predicting the GOS-E, EQ-5D-3L utility sore and EQ-5D-3L mobility, self-care, usual activities and pain/discomfort items. The area under the receiver operating characteristic (AUC) for models using medical record derived comorbidity (AUC 0.68, 95% CI: 0.63, 0.73) was higher than the model using ICD-10-AM data (AUC 0.62, 95% CI: 0.57, 0.67) for predicting the EQ-5D-3L anxiety/depression item. The discrimination of the model for predicting return to work was higher with inclusion of the medical record data (AUC 0.69, 95% CI: 0.63, 0.76) than the ICD-10-AM data (AUC 0.59, 95% CL: 0.52, 0.65). Conclusions Mental health, drug and alcohol comorbidity information derived from medical record review was not clearly superior for predicting the majority of the outcomes assessed when compared to ICD-10-AM. While information available in medical records may be more comprehensive than in the ICD-10-AM, there appears to be little difference in the discriminative capacity of comorbidities coded in the two sources. Electronic supplementary material The online version of this article (10.1186/s12913-018-3248-x) contains supplementary material, which is available to authorized users.
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Wada T, Yasunaga H, Yamana H, Matsui H, Fushimi K, Morimura N. Development and validation of an ICD-10-based disability predictive index for patients admitted to hospitals with trauma. Injury 2018; 49:556-563. [PMID: 29352592 DOI: 10.1016/j.injury.2017.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There was no established disability predictive measurement for patients with trauma that could be used in administrative claims databases. The aim of the present study was to develop and validate a diagnosis-based disability predictive index for severe physical disability at discharge using the International Classification of Diseases, 10th revision (ICD-10) coding. METHODS This retrospective observational study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to hospitals with trauma and discharged alive from 01 April 2010 to 31 March 2015 were included. Pediatric patients under 15 years old were excluded. Data for patients admitted to hospitals from 01 April 2010 to 31 March 2013 was used for development of a disability predictive index (derivation cohort), while data for patients admitted to hospitals from 01 April 2013 to 31 March 2015 was used for the internal validation (validation cohort). The outcome of interest was severe physical disability defined as the Barthel Index score of <60 at discharge. Trauma-related ICD-10 codes were categorized into 36 injury groups with reference to the categorization used in the Global Burden of Diseases study 2013. A multivariable logistic regression analysis was performed for the outcome using the injury groups and patient baseline characteristics including patient age, sex, and Charlson Comorbidity Index (CCI) score in the derivation cohort. A score corresponding to a regression coefficient was assigned to each injury group. The disability predictive index for each patient was defined as the sum of the scores. The predictive performance of the index was validated using the receiver operating characteristic curve analysis in the validation cohort. RESULTS The derivation cohort included 1,475,158 patients, while the validation cohort included 939,659 patients. Of the 939,659 patients, 235,382 (25.0%) were discharged with severe physical disability. The c-statistics of the disability predictive index was 0.795 (95% confidence interval [CI] 0.794-0.795), while that of a model using the disability predictive index and patient baseline characteristics was 0.856 (95% CI 0.855-0.857). CONCLUSIONS Severe physical disability at discharge may be well predicted with patient age, sex, CCI score, and the diagnosis-based disability predictive index in patients admitted to hospitals with trauma.
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Affiliation(s)
- Tomoki Wada
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoto Morimura
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Davie G, Samaranayaka A, Derrett S. The role of pre-existing comorbidity on the rate of recovery following injury: A longitudinal cohort study. PLoS One 2018; 13:e0193019. [PMID: 29466432 PMCID: PMC5821361 DOI: 10.1371/journal.pone.0193019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 02/02/2018] [Indexed: 11/17/2022] Open
Abstract
Understanding the role of comorbidity in recovery following injury is an important challenge given the increasing prevalence of multimorbidity (2 or more comorbidities) in many countries. The Prospective Outcomes of Injury Study recruited 2856 injured 18–64 year olds that had registered for entitlements with New Zealand’s universal no-fault injury insurer. Recovery, or lack of, in this longitudinal cohort was measured using the World Health Organization Disability Assessment Schedule at 3, 12 and 24 months post-injury. Twenty-one pre-existing chronic conditions were used to identify comorbidity. To investigate whether rates of recovery differed by pre-injury comorbidity, the interaction between time and comorbidity was modelled using Generalised Estimating Equations. Of 1,862 participants with complete data, the distribution reporting none, one comorbidity, or multimorbidity pre-injury was 51%, 27%, and 21% respectively. Longitudinal analysis estimated no difference (log odds per year 0.05, 95% Confidence Interval -0.17 to 0.27) between the rate of change of disability for those with one pre-injury comorbidity compared to those with none. Those with pre-injury multimorbidity had significantly slower reduction in disability over time than those with no pre-injury comorbidity (log odds per year 0.27, 95% Confidence Interval 0.05 to 0.48). In a working age cohort, the rate of recovery in the 24 months following injury was similar for those with none or one pre-existing comorbidity and significantly slower for those with multimorbidity. It is important that further research explores mechanisms driving this, and that researchers and health providers identify and implement better supports for injured people with multimorbidity.
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Affiliation(s)
- Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Kellezi B, Coupland C, Morriss R, Beckett K, Joseph S, Barnes J, Christie N, Sleney J, Kendrick D. The impact of psychological factors on recovery from injury: a multicentre cohort study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:855-866. [PMID: 27803978 PMCID: PMC5504249 DOI: 10.1007/s00127-016-1299-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/16/2016] [Indexed: 12/03/2022]
Abstract
PURPOSE Unintentional injuries have a significant long-term health impact in working age adults. Depression, anxiety and post-traumatic stress disorder are common post-injury, but their impact on self-reported recovery has not been investigated in general injury populations. This study investigated the role of psychological predictors 1 month post-injury in subsequent self-reported recovery from injury in working-aged adults. METHODS A multicentre cohort study was conducted of 668 unintentionally injured adults admitted to five UK hospitals followed up at 1, 2, 4 and 12 months post-injury. Logistic regression explored relationships between psychological morbidity 1 month post-injury and self-reported recovery 12 months post-injury, adjusting for health, demographic, injury and socio-legal factors. Multiple imputations were used to impute missing values. RESULTS A total of 668 adults participated at baseline, 77% followed up at 1 month and 63% at 12 months, of whom 383 (57%) were included in the main analysis. Multiple imputation analysis included all 668 participants. Increasing levels of depression scores and increasing levels of pain at 1 month and an increasing number of nights in hospital were associated with significantly reduced odds of recovery at 12 months, adjusting for age, sex, centre, employment and deprivation. The findings were similar in the multiple imputation analysis, except that pain had borderline statistical significance. CONCLUSIONS Depression 1 month post-injury is an important predictor of recovery, but other factors, especially pain and nights spent in hospital, also predict recovery. Identifying and managing depression and providing adequate pain control are essential in clinical care post-injury.
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Affiliation(s)
- Blerina Kellezi
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK.
| | - C Coupland
- Division of Primary Care, University of Nottingham, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health and CLAHRC East Midlands, University of Nottingham, Nottingham, UK
| | - K Beckett
- Education Centre, University of the West of England, Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8AE, UK
| | - S Joseph
- School of Education, University of Nottingham, Nottingham, NG8 1BB, UK
| | - J Barnes
- Design School, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK
| | - N Christie
- Centre for Transport Studies, UCL, Gower Street, London, WC1E 6BT, UK
| | - J Sleney
- Department of Sociology, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - D Kendrick
- Division of Primary Care, University of Nottingham, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK
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Gabbe BJ, Simpson PM, Cameron PA, Ponsford J, Lyons RA, Collie A, Fitzgerald M, Judson R, Teague WJ, Braaf S, Nunn A, Ameratunga S, Harrison JE. Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study. PLoS Med 2017; 14:e1002322. [PMID: 28678814 PMCID: PMC5497942 DOI: 10.1371/journal.pmed.1002322] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improved understanding of the quality of survival of patients is crucial in evaluating trauma care, understanding recovery patterns and timeframes, and informing healthcare, social, and disability service provision. We aimed to describe the longer-term health status of seriously injured patients, identify predictors of outcome, and establish recovery trajectories by population characteristics. METHODS AND FINDINGS A population-based, prospective cohort study using the Victorian State Trauma Registry (VSTR) was undertaken. We followed up 2,757 adult patients, injured between July 2011 and June 2012, through deaths registry linkage and telephone interview at 6-, 12-, 24-, and 36-months postinjury. The 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L) was collected, and mixed-effects regression modelling was used to identify predictors of outcome, and recovery trajectories, for the EQ-5D-3L items and summary score. Mean (SD) age of participants was 50.8 (21.6) years, and 72% were male. Twelve percent (n = 333) died during their hospital stay, 8.1% (n = 222) of patients died postdischarge, and 155 (7.0%) were known to have survived to 36-months postinjury but were lost to follow-up at all time points. The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression. Continued improvement to 36-months postinjury was only present for the usual activities item; the adjusted relative risk (ARR) of reporting problems decreased from 6 to 12 (ARR 0.87, 95% CI: 0.83-0.90), 12 to 24 (ARR 0.94, 95% CI: 0.90-0.98), and 24 to 36 months (ARR 0.95, 95% CI: 0.95-0.99). The risk of reporting problems with pain or discomfort increased from 24- to 36-months postinjury (ARR 1.06, 95% CI: 1.01, 1.12). While loss to follow-up was low, there was responder bias with patients injured in intentional events, younger, and less seriously injured patients less likely to participate; therefore, these patient subgroups were underrepresented in the study findings. CONCLUSIONS The prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder. These findings have implications for trauma system design. Investment in interventions to reduce the longer-term impact of injuries is needed, and greater investment in primary prevention is needed.
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Affiliation(s)
- Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Pam M. Simpson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ronan A. Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Trauma Service, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Rodney Judson
- Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Warwick J. Teague
- Trauma Service, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Surgical Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Sandra Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - James E. Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, South Australia, Australia
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Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm. Injury 2017; 48:184-194. [PMID: 27839797 DOI: 10.1016/j.injury.2016.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Self-harm and intentional injuries represent a significant public health concern. People who survive serious injury from self-harm can experience poor outcomes that negatively impact on their daily life. The aim of this study was to investigate a cohort of major trauma patients hospitalised for self-harm in Victoria, and to identify risk factors for longer term mortality, functional recovery and return to work. METHOD 482 adult major trauma patients who were injured due to self-harm and survived to hospital discharge, and were captured by the population-based Victorian State Trauma Registry (VSTR), were included. For those with a date of injury from January 1, 2007 to December 31, 2013, demographics and injury event data, Glasgow Outcome Scale Extended (GOS-E) and return to work (RTW) outcomes at 6, 12 and 24 months post-injury were extracted from the registry. Post-discharge mortality was identified through the Victorian Registry of Births, Deaths and Marriages (BDM). Multivariable logistic regression was used to determine predictors of the GOS-E and RTW and survival analysis was used to identify predictors of mortality. RESULTS A total of 37 (7.7%) deaths occurred post-discharge. There were no clear predictors of all-cause mortality. Overall, 36% of patients reported making a good recovery at 24 months. Older age (p=0.01), transport-related methods of self-harm (p=0.02), higher Injury Severity Score (p<0.001) and having a Charlson Comorbidity Index weighting of one or more (p=0.02) were predictive of poorer functional recovery. Of patients who were working or studying prior to injury, 54% reported returning to work by 24 months post-injury. Higher Injury Severity Score was an important predictor of not returning to work (p=0.002). CONCLUSION The vast majority of major trauma patients who self-harmed and survived to hospital discharge were alive at two years post-injury, yet only half of this cohort returned to work and just over a third of patients experienced a good recovery.
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Nguyen TQ, Simpson PM, Gabbe BJ. The prevalence of pre-existing mental health, drug and alcohol conditions in major trauma patients. AUST HEALTH REV 2017; 41:283-290. [DOI: 10.1071/ah16050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/23/2016] [Indexed: 11/23/2022]
Abstract
Objective
Capturing information about mental health, drug and alcohol conditions in injury datasets is important for improving understanding of injury risk and outcome. This study describes the prevalence of pre-existing mental health, drug and alcohol conditions in major trauma patients based on routine discharge data coding.
Methods
Data were extracted from the population-based Victorian State Trauma Registry (July 2005 to June 2013, n = 16 096).
Results
Seventeen percent of major trauma patients had at least one mental health condition compared with the Australian population prevalence of 21%. The prevalence of mental health conditions was similar to the Australian population prevalence in men (19% v. 18%), but lower in women (14% v. 25%) and across all age groups. Mental health conditions were more prevalent in intentional self-harm cases (56.3%) compared with unintentional (13.8%) or other intentional (31.2%) cases. Substance use disorders were more prevalent in major trauma patients than the general population (15% v. 5%), higher in men than women (17% v. 10%) and was highest in young people aged 25–34 years (24%).
Conclusions
Under-reporting of mental health conditions in hospital discharge data appears likely, reducing the capacity to characterise the injury population. Further validation is needed.
What is known about the topic?
Medical record review, routine hospital discharge data and self-report have been used by studies previously to characterise mental health, drug and alcohol conditions in injured populations, with medical record review considered the most accurate and reliance on self-report measures being considered at risk of recall bias. The use of routinely collected data sources provides an efficient and standardised method of characterising pre-existing conditions, but may underestimate the true prevalence of conditions.
What does this paper add?
No study to date has explored the prevalence of Abbreviated Injury Scale and International Classification of Diseases and Health Related Problems, Tenth Revision, Australian Modification (ICD-10-a.m)-coded mental health, alcohol and drug conditions in seriously injured populations. The results of this study show the incidence of mental health conditions appeared to be under-reported in major trauma patients, suggesting limitations in the use of ICD-10-a.m. to measure mental health comorbidities.
What are the implications for practitioners?
In order to achieve improvements in measuring mental health, drug and alcohol comorbidities, we suggest the use of a series of different diagnostic systems to be used in conjunction with ICD-10-a.m., such as medical record review and self-reporting as well as linkage to other datasets. When applied simultaneously, diagnosis and outcomes of mental health may be compared and validated across diagnostic systems and deviations in diagnoses could be more readily accounted for.
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Hagen J, Castillo R, Dubina A, Gaski G, Manson TT, O’Toole RV. Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients' Pain, Reduce Narcotic Use, and Improve Mobilization? Clin Orthop Relat Res 2016; 474:1422-9. [PMID: 26304045 PMCID: PMC4868153 DOI: 10.1007/s11999-015-4525-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Debate remains over the role of surgical treatment in minimally displaced lateral compression (Young-Burgess, LC, OTA 61-B1/B2) pelvic ring injuries. Lateral compression type 1 (LC1) injuries are defined by an impaction fracture at the sacrum; type 2 (LC2) are defined by a fracture that extends through the posterior iliac wing at the level of the sacroiliac joint. Some believe that operative stabilization of these fractures limits pain and eases mobilization, but to our knowledge there are few controlled studies on the topic. QUESTIONS/PURPOSES (1) Does operative stabilization of LC1 and LC2 pelvic fractures decrease patients' narcotic use and lower their visual analog scale pain scores? (2) Does stabilization allow patients to mobilize earlier with physical therapy? METHODS This retrospective study of LC1 and LC2 fractures evaluated patients treated definitively at one institution from 2007 to 2013. All patients treated surgically, all nonoperative LC2, and all nonoperative LC1 fractures with complete sacral injury were included. In general, LC1 or LC2 fractures with greater than 10 mm of displacement and/or sagittal/axial plane deformity on static radiographs were treated surgically. One hundred fifty-eight patients in the LC1 group (107 [of 697 screened] nonoperative, 51 surgical) and 123 patients in the LC2 group (78 nonoperative, 45 surgical) met inclusion criteria. The surgical and nonoperative groups were matched for fracture type. To account for differences between patients treated surgically and nonoperatively, we used propensity modeling techniques incorporating treatment predictors. Propensity scores demonstrated good overlap and were used as part of multiple variable regression models to account for selection bias between the surgically treated and nonoperative groups. Patient-reported pain scores and narcotic administration were tallied in 24-hour increments during the first 24 hours of hospitalization, at 48 hours after intervention, and in the 24 hours before discharge. Time from intervention to mobilization out of bed was recorded; intervention was defined as the date of definitive surgical intervention or the day the surgeon determined the patient would be treated without surgery. RESULTS There was no difference in the narcotics distributed to any of the groups with the exception that the patients with surgically treated LC2 fractures used, on average (mean [95% confidence interval]) 40.2 (-72.9 to -7.6) mg morphine less at the 48-hour mark (p = 0.016). In general, there were no differences between the groups' pain scores. The surgically treated patients with LC1 fractures mobilized 1.7 (-3.3 to -0.01) days earlier (p = 0.034) than their nonoperative counterparts. There was no difference in the LC2 cohort in terms of time to mobilization between those treated with and without surgery. CONCLUSIONS There were few differences in pain scores and morphine use between the surgical and nonoperative groups, and the differences observed likely were not clinically important. We found no evidence that surgical stabilization of certain LC1 and LC2 pelvic fractures improves patients' pain, decreases their narcotic use, and improves time to mobilization. A randomized trial of patients with similar fractures and similar degrees initial displacement would help remove some of the confounders present in this study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Jennifer Hagen
- University of Florida, 3450 Hull Road, Gainesville, FL 32608 USA
| | - Renan Castillo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Andrew Dubina
- University of Maryland School of Medicine, Baltimore, MD USA
| | - Greg Gaski
- IU Health Methodist, Indianapolis, IN USA
| | - Theodore T. Manson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Robert V. O’Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
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Hassani-Mahmooei B, Berecki-Gisolf J, Hahn Y, McClure RJ. The effect of pre-existing health conditions on the cost of recovery from road traffic injury: insights from data linkage of medicare and compensable injury claims in Victoria, Australia. BMC Health Serv Res 2016; 16:162. [PMID: 27130277 PMCID: PMC4850713 DOI: 10.1186/s12913-016-1386-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/14/2016] [Indexed: 11/16/2022] Open
Abstract
Background Comorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the immediate post-accident care period. The aim of this study was to investigate the role of pre-existing health conditions in the cost of recovery from road traffic injury using health service use records for 1 year before and after the injury. Methods Individuals who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) linkage were included (n = 738) in the analysis. PBS and MBS records dating from 12 months prior to injury were provided by the Department of Human Services (Canberra, Australia). Pre-injury use of health service items and pharmaceuticals were considered to indicate pre-existing health condition. Bayesian Model Averaging techniques were used to identify the items that were most strongly correlated with recovery cost. Multivariate regression models were used to determine the impact of these items on the cost of injury recovery in terms of compensated ambulance, hospital, medical, and overall claim cost. Results Out of the 738 study participants, 688 used at least one medical item (total of 15,625 items) and 427 used at least one pharmaceutical item (total of 9846). The total health service cost of recovery was $10,115,714. The results show that while pre-existing conditions did not have any significant impact on the total cost of recovery, categorical costs were affected: e.g. on average, for every anaesthetic in the year before the accident, hospital cost of recovery increased by 24 % [95 % CI: 13, 36 %] and for each pathological test related to established diabetes, hospital cost increased by $10,407 [5466.78, 15346.28]. For medical costs, each anaesthetic led to $258 higher cost [174.16, 341.16] and every prescription of drugs used in diabetes increased the cost by 8 % [5, 11 %]. Conclusions Services related to pre-existing conditions, mainly chronic and surgery-related, are likely to increase certain components of cost of recovery after road traffic trauma but pre-existing physical health has little impact on the overall recovery costs.
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Affiliation(s)
- Behrooz Hassani-Mahmooei
- Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia.
| | | | - Youjin Hahn
- Department of Economics, Yonsei University, Seoul, South Korea.,Department of Economics, Monash University, Melbourne, Australia
| | - Roderick J McClure
- Harvard Injury Control Research Centre, Harvard School of Population Health, Boston, USA
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Toson B, Harvey LA, Close JC. The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture. J Clin Epidemiol 2015; 68:44-51. [DOI: 10.1016/j.jclinepi.2014.09.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 09/20/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
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Nilssen Y, Strand TE, Wiik R, Bakken IJ, Yu XQ, O'Connell DL, Møller B. Utilizing national patient-register data to control for comorbidity in prognostic studies. Clin Epidemiol 2014; 6:395-404. [PMID: 25368532 PMCID: PMC4216019 DOI: 10.2147/clep.s70742] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective To construct an updated comorbidity index (Patient Register Index [PRI]) using national data collections from Norway and compare its predictive ability of 1-year mortality with the Charlson Comorbidity Index (CCI). Materials and methods Data regarding over 1.11 million patients registered in the Norwegian Patient Register in 2010 and 2011 were used to construct the PRI. The PRI was evaluated by comparing its model fit and discrimination with the CCI. Results Compared with the CCI, the PRI weights decreased for six, increased for four, and were unchanged for seven diseases. When the PRI was added to the model including age and sex, the age effects were reduced by up to 38% for patients older than 50 years. All measures of model fit improved for the PRI model. Conclusion Adjustment for comorbidity is especially important for patients 50 years of age or older, and its effect on 1-year mortality is almost comparable to the age effect. The PRI is based on more recent data than the CCI, and is more representative of the general population due to its construction.
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Affiliation(s)
- Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | | | - Robert Wiik
- Norwegian Patient Register Department, Norwegian Directorate of Health, Trondheim, Norway
| | | | - Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia ; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia ; School of Public Health, University of Sydney, Sydney, NSW, Australia ; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia ; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
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Heckenbach K, Ostermann T, Schad F, Kröz M, Matthes H. Medication and falls in elderly outpatients: an epidemiological study from a German Pharmacovigilance Network. SPRINGERPLUS 2014; 3:483. [PMID: 25207204 PMCID: PMC4158008 DOI: 10.1186/2193-1801-3-483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/12/2014] [Indexed: 01/07/2023]
Abstract
The aim of this study was to investigate the relationship between fall risk increasing drugs (FRIDS) and the risk of falls in regard to fall-related chronic diseases. In total, 39 primary care physicians in Germany participated in the EvaMed Pharmacovigilance Network. Antihypertensives, non-steroidal anti-inflammatory drugs, hypnotics and sedatives, antidepressants and psycholeptics were labelled as FRIDS. A fall was defined according to a diagnosis in the chapter Injury or poisoning (S00-T14 in International Statistical Classification of Diseases 10th Revision (ICD-10)). Patients older than or equal to 65 years with at least two doctor’s visits were included. FRIDS were prescribed for 1768 patients from a total of 5124 patients included in the analysis. FRIDS and seven chronic diseases were statistically significant associated with a higher risk of experiencing a fall. The risk was highest for patients with a diagnosis abnormalities of gait and mobility, vertigo, visual -impairment and weight loss, and increased by 50-90% with arthritis, diseases of arteries, arterioles and capillaries and heart failure. From patients (N = 425) with at least one diagnosis of fall, 219 patients were prescribed FRIDS. In 100 (45.7%) of cases the diagnoses for fall were made before and in 105 (47.9%) of cases at least a month after the prescription of FRIDS. 14 (6.4%) patients had a prescription of FRIDS and a diagnosis of fall within one month. Perceptual disorders, low walking speed and pain are prominent predictors for falls in the elderly. A prescription of FRIDS selects more vulnerable patients having a higher risk of falls. However, experiencing a fall is mainly due to the disease followed by treatment. Thus, not prescribing FRIDS will avoid only a small number of falls.
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Affiliation(s)
| | - Thomas Ostermann
- Institute of Integrated medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, D-58313 Herdecke, Germany
| | - Friedemann Schad
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Matthias Kröz
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Harald Matthes
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
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