This study aimed to identify and explore the hospital admission risk factors associated with the length of stay (LoS) by applying a relatively novel statistical method for count data using predictors among COVID-19 patients in Bologna, Italy. The second goal of this study was to model the LoS of COVID patients to understand which covariates significantly influenced it and identify the potential risk factors associated with LoS in Bolognese hospitals from 1 February 2020 to 10 May 2021. The clinical settings we focused on were the Intensive Care Unit (ICU) and ordinary hospitalization, including low-intensity stays. We used Poisson, negative binomial (NB), Hurdle–Poisson, and Hurdle–NB regression models to model the LoS. The fitted models were compared using the Akaike information criterion (AIC), Vuong’s test criteria, and Rootograms. We also used quantile regression to model the effects of covariates on the quantile values of the response variable (LoS) using a Poisson distribution, and to explore a range of conditional quantile functions, thereby exposing various forms of conditional heterogeneity and controlling for unobserved individual characteristics. Based on the chosen performance criteria, Hurdle–NB provided the best fit. As an output from the model, we found significant changes in average LoS for each predictor. Compared with ordinary hospitalization and low-intensity stays, the ICU setting increased the average LoS by 1.84-fold. Being hospitalized in long-term hospitals was another contributing factor for LoS, increasing the average LoS by 1.58 compared with regular hospitals. When compared with the age group [50, 60) chosen as the reference, the average LoS decreased in the age groups [0, 10), [30, 40), and [40, 50), and increased in the oldest age group [80, 102). Compared with the second wave, which was chosen as the reference, the third wave did not significantly affect the average LoS, whereas it increased by 1.11-fold during the first wave and decreased by 0.77-fold during out-wave periods. The results of the quantile regression showed that covariates related to the ICU setting, hospitals with longer hospitalization, the first wave, and the out-waves were statistically significant for all the modeled quantiles. The results obtained from our study can help us to focus on the risk factors that lead to an increased LoS among COVID-19 patients and benchmark different models that can be adopted for these analyses.
Background Acute diarrhea management is solely aimed at fluid replacement and nutritional support while antibiotics have a very limited role. Antibiotic treatment is recommended only for bloody diarrhea (dysentery), cholera and invasive bacterial diarrhea. This study is launched to assess the appropriateness of antibiotic use for the management of acute diarrhea among under-five children in Gondar town primary care centers.Methods Institutional based cross-sectional study was conducted in three primary care centers located in Gondar town, Northwest Ethiopia. Children aged from 2–59 months who visited the three primary care centers from September 12, 2015 to September 10, 2016 and received treatment for acute diarrhea were included in the study. We selected 176 cases from Azezo Health Center, 166 from Poly Health Center and 80 from Woleka Health Center. Cases were drawn using systematic random sampling technique. The findings of the study were summarized using tables and figures; binary logistic analysis was used to identify association between the independent and outcome variables at 95% confidence level where p < 0.05 was considered as statistically significant.Results The mean age of the study participants was 19.1 ± 12.8 months. The majority (60.8%) were males. Appropriate antibiotic use was recorded in less than half (47.2%) of the study subjects. Almost all (98.1%) of children subjected to inappropriate antibiotic use were those with watery diarrhea treated with antibiotics. Out of 253 children who received antidiarrheal antibiotics 202 (79.8%) had acute watery diarrhea which should not be treated with antibiotics. Children diagnosed with acute watery diarrhea were less likely to receive treatment qualified as appropriate antibiotic use [AOR: 0.003 (0.001,0.017)]. Conversely, receiving no antibiotic [AOR: 391.00 (92.46, 1653.37)] and prescriber’s profession of Clinical Nurse [AOR: 3.57 (1.02, 12.51)] were positive predictors for appropriate antibiotic use.Conclusion The findings of the study confirm the prevalence of widespread inappropriate antibiotic use on under-five children presenting with acute diarrhea. The findings can be used by stakeholders as input for promoting appropriate antibiotic use in the healthcare system as well as to deter antimicrobial resistance.
ObjectiveThis study aims to develop and compare different models to predict the Length of Stay (LoS) and the Prolonged Length of Stay (PLoS) of inpatients admitted through the emergency department (ED) in general patient settings. This aim is not only to promote any specific model but rather to suggest a decision-supporting tool (i.e., a prediction framework).MethodsWe analyzed a dataset of patients admitted through the ED to the “Sant”Orsola Malpighi University Hospital of Bologna, Italy, between January 1 and October 26, 2022. PLoS was defined as any hospitalization with LoS longer than 6 days. We deployed six classification algorithms for predicting PLoS: Random Forest (RF), Support Vector Machines (SVM), Gradient Boosting (GB), AdaBoost, K-Nearest Neighbors (KNN), and logistic regression (LoR). We evaluated the performance of these models with the Brier score, the area under the ROC curve (AUC), accuracy, sensitivity (recall), specificity, precision, and F1-score. We further developed eight regression models for LoS prediction: Linear Regression (LR), including the penalized linear models Least Absolute Shrinkage and Selection Operator (LASSO), Ridge and Elastic-net regression, Support vector regression, RF regression, KNN, and eXtreme Gradient Boosting (XGBoost) regression. The model performances were measured by their mean square error, mean absolute error, and mean relative error. The dataset was randomly split into a training set (70%) and a validation set (30%).ResultsA total of 12,858 eligible patients were included in our study, of whom 60.88% had a PloS. The GB classifier best predicted PloS (accuracy 75%, AUC 75.4%, Brier score 0.181), followed by LoR classifier (accuracy 75%, AUC 75.2%, Brier score 0.182). These models also showed to be adequately calibrated. Ridge and XGBoost regressions best predicted LoS, with the smallest total prediction error. The overall prediction error is between 6 and 7 days, meaning there is a 6–7 day mean difference between actual and predicted LoS.ConclusionOur results demonstrate the potential of machine learning-based methods to predict LoS and provide valuable insights into the risks behind prolonged hospitalizations. In addition to physicians' clinical expertise, the results of these models can be utilized as input to make informed decisions, such as predicting hospitalizations and enhancing the overall performance of a public healthcare system.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.