Volume 22, Issue 1, Pages 1 – 56 (2023)

The COVID-19 pandemic has not affected the mortality for patients admitted with pneumonia in Denmark

Correspondence, Volume 22, Issue 1, Pages 1 – 56 (2023)

During the COVID-19 pandemic, several hospital systems observed a reduction in patients with respiratory complaints. Using the Danish national registers, we conducted an observational study on disease severity and 30-day all-cause mortality for acutely admitted pneumonia patients before (3/19-3/20) and during (3/20-2/21) the pandemic. We calculated mortality rate ratios and Cox regression analyses. We identified 54,405 patients and during the pandemic, patients were older, more likely to be male, had more co-morbidity and a lower albumin on admission. Crude mortality was higher during the pandemic (8.4 vs. 6.9%). Adjusted hazard ratio for 30-day all-cause mortality was 1.07 (95%CI 1.01-1.14). We showed a small but significant, increase in mortality risk for patients admitted to hospital during the COVID-19 pandemic in Denmark.

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Acute coronary syndrome after initiation of amoxicillin/clavulanate

Case Reports, Volume 22, Issue 1, Pages 1 – 56 (2023)

We report the case of a 54 year old man referred to the Emergency Department for rapid onset of an itchy rash and oppressive epigastric pain after assumption of amoxicillin/clavulanate. Electrocardiogram aand laboratory findings were consistent with acute coronaty syndrome. After coronary angiography, diagnosis of type II Kounis syndrome was made.

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A whole healthcare system mortality review of the second wave COVID-19 pandemic response, were lessons learned?

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

We previously reported a study of features of emergency healthcare response to COVID-19 that could be modified to mitigate against future excess deaths. Here we determined what themes persisted in later waves.
This was an expert panel review of all components of care delivered to COVID-19 patients who died (primary and secondary care, community services, NHS 111 and 999, COVID oximetry at home, virtual wards).
174 deaths were included. 5% were deemed >50% avoidable, 75% included avoidability themes.
Contact with primary care remains mostly via telephone, creating diagnostic risk. Patient decision to avoid healthcare contact was common.
Recommendations include: better utilisation of home monitoring in future pandemics; improved avoidance of nosocomial spread; patients be encouraged to seek medical advice earlier.

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Use of procedural ultrasound for the insertion of peripheral intravenous catheters: A nationwide survey in acute care departments in Belgium

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

Purpose: Assessment of ultrasound use for peripheral intravenous cannulation among acute care nurses and physicians.
Methods: Over a population of 17,437, the calculated sample size of respondents required was 376.
Results: A total of 388 health professionals; 249 (64.2%) physicians and 139 (35.8%) nurses completed the entire questionnaire. 166 (45.2%) used ultrasound for intravenous cannulation. A statistically significant difference favored physicians’ ultrasound use (p<0.001). Respondents with less than 10 years of clinical practice used ultrasound significantly more (p<0.001). The main reported obstacle among users was the lack of time. Conclusion: This survey revealed the gap between the current recommendations for ultrasound use for peripheral intravenous cannulation and the actual practices. Efforts should be made to develop specific training using ultrasound.

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Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

Background: The incidence of hospital admissions for pulmonary embolism (PE) and associated pleural effusion, and the impact of these effusions on outcomes on a national level is unknown.
Methods: Data from the National Inpatient Sample between 2016 to 2019 was used to conduct a retrospective nationwide cohort study of hospital admissions for PE with and without pleural effusion. Multiple logistic regressions and linear regression analyses were used to determine the independent impact of effusions on in-hospital mortality, length of stay, and cost.
Results: There were 937,744 hospital admissions with PE included in our analysis (median age 64 [interquartile range 50-76] years; 52.5% females). The in-hospital mortality rate overall was 3.7% which was 5.5% for patients with pleural effusion and 3.6% for patients without pleural effusion (p<0.001). The median length of stay was longer in the group with pleural effusion (6 [3-12] days vs 4 [2-6] days, p<0.001) and the median healthcare cost was higher among patients with pleural effusion (13,689 [7,279-30,915] vs 8,855 [5,472-16,531], p<0.001). The factors most associated with pleural effusion were atrial fibrillation (OR 1.89 95%CI 1.78-2.00, p<0.001) and arterial thrombosis (OR 1.48 95%CI 1.19-1.84, p<0.001). Pleural effusion was associated with increased odds of mortality in patients with PE (OR 1.30 95%CI 1.18-1.45, p<0.001). Pleural effusion was associated with increased length of stay (Coefficient 4.15 95%CI 3.99 to 4.32, p<0.001), and healthcare costs (Coefficient 12,164; 95%CI:11,639 to 12,688, p<0.001)). Conclusion: Concomitant pleural effusion is not uncommon among PE patients which is more common in patients with atrial fibrillation and previous arterial thrombosis. Pleural effusions in patients with PE are associated with higher in-hospital mortality, length of stay and cost.

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Enhanced Care Units: Guidance on development and implementation within Acute Medicine

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

The Society for Acute Medicine (SAM) and Intensive Care Society (ICS) have produced joint guidance on the standards of care and infrastructure required to deliver enhanced care within Acute Medicine. The cohort of patients this relates to are in the most part already being looked after on the AMU, but co-location and providing enhanced monitoring and nursing input will ensure safe, high-quality care can be delivered to them. We strongly support the development of enhanced care units, whilst clearly acknowledging that they are not a replacement for critical care where that is indicated. Enhanced care and critical care complement each other and will help foster the close working between the two specialties that modern acute care requires.
This guidance draws on expertise and existing relevant guidance from the two societies, alongside that from the Faculty of Intensive Care Medicine (FICM), British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and NHS England / Improvement (NHSE/I). We recognise this is an area with limited evidence and so will aim to review it regularly as the knowledge and experience in this area increases.

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Centralization of emergency hospital care is not associated with increased in-hospital mortality; a population-based cohort study

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

Background: We describe changes in the distance travelled, the utilization of emergency services, and the in-hospital mortality before and after the centralization of hospital emergency services in Denmark.
Methods: All unplanned non-psychiatric hospital contacts from adults (aged ≥18 years) in 2008 and 2016 are included. Analyses are age-standardized and conducted at a municipality level. The municipalities are divided into groups according to the presence of emergency hospital services.
Results: Municipalities where hospitals with emergency services have been closed differed by having the most significant increase in distance travelled from 2008 to 2016. All groups experienced a reduction in overall in-hospital mortality. The reduction in mortality was not present for acute myocardial infarct contacts from municipalities where hospitals with emergency services have been closed.
Conclusion: Our data do not suggest that hospital closures, and thereby increased travel distance, have contributed significantly as a barrier to emergency-care access and changes to in-hospital mortality.

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Guest Editorial – Enhanced Care: Developing the resource within Acute Medicine

Guest Editorial, Volume 22, Issue 1, Pages 1 – 56 (2023)

Critical Care Units provide care to those patients who traditionally need “organ support”. There is variation in provision and “admission criteria” across the UK, and although Level 2 admissions have been increasing this often reflects increasing perioperative demand and largely ignores the unmet and often unmeasured medical need.

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