OBJECTIVES: To evaluate the impact of ICU surge on mortality and to explore clinical and sociodemographic predictors of mortality. DESIGN: Retrospective cohort analysis. SETTING: NYC Health + Hospitals ICUs. PATIENTS: Adult ICU patients with coronavirus disease 2019 admitted between March 24, and May 12, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Hospitals reported surge levels daily. Uni- and multivariable analyses were conducted to assess factors impacting in-hospital mortality. Mortality in Hispanic patients was higher for high/very high surge compared with low/medium surge (69.6% vs 56.4%; p = 0.0011). Patients 65 years old and older had similar mortality across surge levels. Mortality decreased from high/very high surge to low/medium surge in, patients 18–44 years old and 45–64 (18–44 yr: 46.4% vs 27.3%; p = 0.0017 and 45–64 yr: 64.9% vs 53.2%; p = 0.002), and for medium, high, and very high poverty neighborhoods (medium: 69.5% vs 60.7%; p = 0.019 and high: 71.2% vs 59.7%; p = 0.0078 and very high: 66.6% vs 50.7%; p = 0.0003). In the multivariable model high surge (high/very high vs low/medium odds ratio, 1.4; 95% CI, 1.2–1.8), race/ethnicity (Black vs White odds ratio, 1.5; 95% CI, 1.1–2.0 and Asian vs White odds ratio 1.5; 95% CI, 1.0–2.3; other vs White odds ratio 1.5, 95% CI, 1.0–2.3), age (45–64 vs 18–44 odds ratio, 2.0; 95% CI, 1.6–2.5 and 65–74 vs 18–44 odds ratio, 5.1; 95% CI, 3.3–8.0 and 75+ vs 18–44 odds ratio, 6.8; 95% CI, 4.7–10.1), payer type (uninsured vs commercial/other odds ratio, 1.7; 95% CI, 1.2–2.3; medicaid vs commercial/other odds ratio, 1.3; 95% CI, 1.1–1.5), neighborhood poverty (medium vs low odds ratio 1.6, 95% CI, 1.0–2.4 and high vs low odds ratio, 1.8; 95% CI, 1.3–2.5), comorbidities (diabetes odds ratio, 1.6; 95% CI, 1.2–2.0 and asthma odds ratio, 1.4; 95% CI, 1.1–1.8 and heart disease odds ratio, 2.5; 95% CI, 2.0–3.3), and interventions (mechanical ventilation odds ratio, 8.8; 95% CI, 6.1–12.9 and dialysis odds ratio, 3.0; 95% CI, 1.9–4.7) were significant predictors for mortality. CONCLUSIONS: Patients admitted to ICUs with higher surge scores were at greater risk of death. Impact of surge levels on mortality varied across sociodemographic groups.
ObjectiveTo utilize an established syndromic reporting system for surveillance of potentially preventable emergency department (ED) oral health visits (OHV) in New York City (NYC). IntroductionNYC Department of Health and Mental Hygiene recently reoriented its oral health care strategy to focus on health promotion and expanded surveillance. One surveillance challenge is the lack of timely OHV data; few dental providers are in our electronic health record project, and statewide utilization data are subject to delays. Prior research has examined OHV using ICD-9-CM from ED records, and has suggested that diagnostic specificity may be limited by ED providers' lack of training in dental diagnoses (1-3). We considered our existing ED syndromic system as a complement to periodic population-based surveys. This system captures approximately 95% of all ED visits citywide; 98% of records have a completed chief complaint text field whereas only 52% contain an ICD-9-CM diagnosis.
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