This study aimed to determine whether a geriatrics-focused hospitalist trauma comanagement program improves quality of care. A pre-/post-implementation study compared older adult trauma patients who ...were comanaged by a hospitalist with those prior to comanagement at a level 1 trauma center. One-to-one propensity score matching was performed based on age, gender, Injury Severity Score, comorbidity index, and critical illness on admission. Outcomes included orders for geriatrics-focused quality indicators, as well as hospital mortality and length of stay. Wilcoxon rank-sum test (continuous variables) and chi-square or Fisher exact test (categorical variables) were used to assess differences. Propensity score matching resulted in 290 matched pairs. The intervention group had decreased use of restraints (P = 0.04) and acetaminophen (P = 0.01), and earlier physical therapy (P = 0.01). Three patients died in the intervention group compared with 14 in the control (P = 0.0068). This study highlights that a geriatrics-focused hospitalist trauma comanagement program improves quality of care.
Abstract
Background
Diagnosis of COVID-19 relies upon RT-PCR assays for SARS-CoV-2 from a nasopharyngeal swab (NPS). However, results depend upon duration of illness at the time of testing and ...operator performance. False negatives occur 10–30% of the time. In our center we formulated & applied a clinical prediction tool for diagnosis of COVID-19 infection. Patients who satisfied criteria were designated as having COVID-19 regardless of NPS results. Herein, we describe the set of patients who fulfilled full and strict clinical criteria (VHCL) (Table 1) and had at least 2 negative NPSs on hospital admission.
Table 1: Clinical criteria for Very High Clinical Likelihood of COVID-19 Infection (VHCL COVID-19)
Methods
A retrospective descriptive study was conducted from March 4th to April 11th, 2020. We evaluated patients with ≥ 2 consecutive negative NPS COVID-19 results admitted to our hospital. Of these, we identified patients fitting all 5 criteria for Very High Clinical Likelihood (VHCL) of COVID-19 infection (Table 1). We analyzed symptoms & lab data (including results of repeat NPS testing if performed) in those patients.
Results
1855 patients were diagnosed with COVID-19 in the study period. Of these, 23 had ≥ 2 negative COVID-19 NPS results but met criteria for VHCL (Table 2). Of these 23, 7 had a subsequent 3rd NPS that was positive-proving infection. Similar to other reports, patients had low lymphocytes and elevated procalcitonin, ferritin, C-reactive protein levels. And consistent with proven cases, our cohort presented after a median of 5 days of symptoms (Table 3).
Table 2: Clinical and laboratory characteristics of VHCL COVID-19 patients Rows Bolded include those patients who had a 3rd NPS swab that was positive.
Table 3: Demographic and Median Lab Data of VHCL COVID-19 patients
Conclusion
It is critical to be mindful of the imperfection of laboratory testing & to integrate clinical criteria to diagnostic algorithms. This is especially true in the COVID-19 pandemic, which is marked by high morbidity & mortality. In our study, we demonstrated how a set of clinical parameters (which we termed VHCL) can aid in widening the net of patients diagnosed with COVID-19 despite negative laboratory tests. While 16 patients in our cohort did not have a confirmatory result, the strict criteria for VHCL & the close match of other study variables with those of proven cases supports the value of VHCL designation. Applying VHCL can optimize infection control, identify patients for emerging therapeutics & aid in contact tracing to reduce nosocomial & community transmission of COVID-19.
Disclosures
All Authors: No reported disclosures
La thèse, intitulée « Essai sur la Théorie de l’Actualisation : Utilité Escomptée Subjective et Sensibilité à la Variation », s’inscrit dans le périmètre de recherche associé à la théorie de la ...décision intertemporelle et s’engage précisément dans deux sentiers qui ont été, jusqu’à présent, relativement peu exploités. D’une part, elle s’interroge sur la diversité observée – et modélisée – des mécanismes d’actualisation en cherchant à expliquer une telle diversité sur la base d’une structure comportementale unique (Partie I. Une investigation de l’actualisation). D’autre part, face à cette diversité croissante des mécanismes d’actualisation recensés, la thèse s’interroge sur la condition de cohérence temporelle en cherchant à caractériser des préférences temporelles cohérentes sur la base de la même structure comportementale définie dans la première partie (Partie II. Une investigation de la cohérence temporelle).
The thesis, entitled “Essay on the Discounting Theory: Subjective Discounted Utility and Variation Sensibility”, gathers a set of theoretical works related to Intertemporal Decision Theory. In particular, two unexploited fields are investigated. On one hand, the thesis explains the great heterogeneity in discounting by a single behavioral pattern called time perception. A general axiomatic model, the Subjective Discounted Utility, generalizes any Discounted Utility model by associating each discount mechanism to a unique time perception (Part I. An Investigation of Discounting). Many applications are dedicated to extreme time horizons. On the other hand, the Subjective Discounted Utility model is applied to a general study of time consistent preferences. Axiomatic conditions are defined on time preferences to characterize time consistent and time inconsistent preferences (Part II. An Investigation of Time Consistency).
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