BACKGROUND:Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking.The aim of this study was to examine the effect of hospital teaching status on mortality i...BACKGROUND:Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking.The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States.METHODS:This was a retrospective observational study,using the Nationwide Emergency Department Sample Database(released in 2018).All patients with septic shock were included.Complex sample logistic regression was performed to assess the impact of hospital teaching status on patient mortality.RESULTS:A total of 388,552 septic shock patients were included in the study.The average age was 66.93 years and 51.7%were males.Most of the patients presented to metropolitan teaching hospitals(68.2%)and 31.8%presented to metropolitan non-teaching hospitals.Septic shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities,were more likely to be intubated and placed on mechanical ventilation(50.5%vs.46.9%)and had a longer average length of hospital stay(12.47 d vs.10.20 d).Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals(adjusted odd ratio[OR]=1.295,95%confidence interval[CI]:1.256-1.335).CONCLUSION:Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching hospitals.They also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals.展开更多
BACKGROUND In-hospital cardiac arrest(IHCA)constitutes a significant cause of morbidity and mortality.As data is scarce in the Middle East and Lebanon,we devised this study to shed some light on it to better inform bo...BACKGROUND In-hospital cardiac arrest(IHCA)constitutes a significant cause of morbidity and mortality.As data is scarce in the Middle East and Lebanon,we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1,2016 and May 2,2019.Sociodemographic variables included age and sex,in addition to the comorbidities listed in the Charlson comorbidity index.IHCA event variables were day,event location,time from activation to arrival,initial cardiac rhythm,and the total number of IHCA events.We also looked at the months and years.We considered the return of spontaneous circulation(ROSC)and survival to discharge(StD)to be our outcomes of interest.RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions(95%CI:6.09−7.08).Non-shockable rhythms were 90.7%of IHCAs.Most IHCA cases occurred in the closed units(87.9%)(intensive care unit,respiratory care unit,neurology care unit,and cardiology care unit)and on weekdays(76.5%).ROSC followed more than half the IHCA events(56%).However,only 5.4%of IHCA events achieved StD.Both ROSC and StD were higher in cases with a shockable rhythm.Survival outcomes were not significantly different between day,evening,and nightshifts.ROSC was not significantly different between weekdays and weekends;however,StD was higher in events that happened during weekdays than weekends(6.7%vs.1.9%,P=0.002).CONCLUSIONS The incidence of IHCA was high,and its outcomes were lower compared to other developed countries.Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week.These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.展开更多
文摘BACKGROUND:Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking.The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States.METHODS:This was a retrospective observational study,using the Nationwide Emergency Department Sample Database(released in 2018).All patients with septic shock were included.Complex sample logistic regression was performed to assess the impact of hospital teaching status on patient mortality.RESULTS:A total of 388,552 septic shock patients were included in the study.The average age was 66.93 years and 51.7%were males.Most of the patients presented to metropolitan teaching hospitals(68.2%)and 31.8%presented to metropolitan non-teaching hospitals.Septic shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities,were more likely to be intubated and placed on mechanical ventilation(50.5%vs.46.9%)and had a longer average length of hospital stay(12.47 d vs.10.20 d).Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals(adjusted odd ratio[OR]=1.295,95%confidence interval[CI]:1.256-1.335).CONCLUSION:Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching hospitals.They also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals.
文摘BACKGROUND In-hospital cardiac arrest(IHCA)constitutes a significant cause of morbidity and mortality.As data is scarce in the Middle East and Lebanon,we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1,2016 and May 2,2019.Sociodemographic variables included age and sex,in addition to the comorbidities listed in the Charlson comorbidity index.IHCA event variables were day,event location,time from activation to arrival,initial cardiac rhythm,and the total number of IHCA events.We also looked at the months and years.We considered the return of spontaneous circulation(ROSC)and survival to discharge(StD)to be our outcomes of interest.RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions(95%CI:6.09−7.08).Non-shockable rhythms were 90.7%of IHCAs.Most IHCA cases occurred in the closed units(87.9%)(intensive care unit,respiratory care unit,neurology care unit,and cardiology care unit)and on weekdays(76.5%).ROSC followed more than half the IHCA events(56%).However,only 5.4%of IHCA events achieved StD.Both ROSC and StD were higher in cases with a shockable rhythm.Survival outcomes were not significantly different between day,evening,and nightshifts.ROSC was not significantly different between weekdays and weekends;however,StD was higher in events that happened during weekdays than weekends(6.7%vs.1.9%,P=0.002).CONCLUSIONS The incidence of IHCA was high,and its outcomes were lower compared to other developed countries.Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week.These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.
