Rhabdomyolysis: review of cases over a decade at a regional teaching hospital

Abstract

Methods:We planned to complete an audit cycle. Review of guidelines and legislations relevant to medical documentation was conducted to establish a gold standard, which resulted in creation of a questionnaire as audit tool. The answers to the questions were among Yes/No/Not applicable. Ninety case notes were audited against the questionnaire by an auditor and areas of deficiencies were identified. To address those deficiencies using the above-mentioned standards, a Medical Assessment Proforma was constructed and implemented for a prospective trial of 3 months. As a secondary measure and to facilitate clinical handover among all disciplines, a section for ISBAR handover was added to the front page of the proforma. The staff got educated regarding the new proforma. At the end of the trial period, using the original audit tool, another audit was conducted on 90 patients to assess thoroughness of documentation on the new proforma. The results were analysed using a Chi-squared test; the significant level was taken as P < 0.05.OutcomesThe implementation of the admission proforma led to statistically significant improvement in details of the clerking in the following areas: None of the items were more accurately documented prior to implementation of the proforma. There was a 100% compliance with documenting ISBAR handover section on the front cover of the proforma which is expected to improve structured clinical handover. Conclusion:Utilizing a standard medical admission proforma significantly improved overall documentation on admission to the acute medical unit. This is expected to enhance the quality of patient care, decrease medico-legal risks to medical patients, generate more accurate funding for medical units and decrease the risk arising from coding errors. Methods:Centre-based haemodialysis patients from three geographically different kidney units in Queensland, Australia, underwent a single, crosssectional assessment of total daily pill burden from phosphate binders between May 2015 and August 2015. The total number of phosphate binder pills per week comprised of calcium carbonate, aluminium hydroxide, sevelamer hydrochloride, lanthanum and cinacalcet. The urea reduction ratio, serum albumin, serum calcium, serum phosphate and serum parathyroid hormone (PTH) were averaged across this period. Results:Of the 138 patients in this study, 62 (44.9%) patients were from the Royal Brisbane and Women's Hospital (RBWH), 40 (29.0%) patients were from Redcliffe Satellite Unit and 36 (26.1%) patients were from the Northlakes Satellite Unit. Eighty-two (59.4%) were male and the mean age was 66 (standard deviation 15) years. Between hospital comparisons of baseline co-morbidities revealed significant difference in hypertension (P = 0.014) only. Sevelamer hydrochloride was most commonly used at RBWH at 41%, followed by calcium carbonate (32%) and aluminium hydroxide (22%). In contrast, both Northlakes and Redcliffe had similar phosphate binder use with calcium carbonate being most popular (36% and 58% respectively), followed...

Aetiologies and factors associated with poor clinical outcomes in rhabdomyolysis: a retrospective cohort study in an Australian trauma centre

“…In terms of severe clinical consequences from rhabdomyolysis, we identified a substantial in‐hospital mortality of 7.2%, consistent with another retrospective Australian study involving 383 patients with rhabdomyolysis 11 . In contrast, a much higher mortality rate of 14% was reported in a larger US study, 10 which included patients post‐cardiac arrest and post‐surgery (vascular and cardiac).…”

“…In contrast, a much higher mortality rate of 14% was reported in a larger US study, 10 which included patients post‐cardiac arrest and post‐surgery (vascular and cardiac). Also, the rate of AKI in our cohort (up to 25%) was found to be lower compared to previous studies that cited up to 60% 7,10,11 . The frequency of AKI varies according to its definition, which evolves with time.…”

“…We employed the AKIN criteria, which have been shown to correlate with clinical outcomes 12 . Despite lower rates of AKI, up to 10% patients required short‐term dialysis, which is consistent with previous studies 10,11 . Only a few needed long‐term dialysis.…”