Browsing by Subject "hospitals"

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    Association between socioeconomic status and risk of hospitalization due to child maltreatment in the USA.
    (Journal of investigative medicine : the official publication of the American Federation for Clinical Research, 2019-02) Imran, Sehyr; Cross, Chad; Das, Samrat U
    Child maltreatment remains a significant problem in the USA. There is a dearth of literature examining the association of socioeconomic status (SES) and incidence of child maltreatment among hospitalized children across the entire USA. Our aim was to study the association between SES and incidence and mortality from child maltreatment among hospitalized children in the USA. We used 2013-2014 data from the Nationwide Inpatient Sample, a discharge database representative of all hospitals in the USA. International Classification of Diseases-9 codes for general child maltreatment were used to identify patients discharged with a primary diagnosis of child maltreatment. Trends in the incidence and outcomes of child maltreatment were compared with SES based on quartiles (Qx) of median household income. In 2013-2014, there were a total of about 2.3 million pediatric discharges. Out of these, a total of 8985 had a primary diagnosis of child maltreatment. Approximately 40 per cent of the cases were from families with the lowest SES (Q1). In-hospital mortality was 2.4 per cent in Q1 (lowest SES) compared with 0.4 per cent in Q4 (highest SES). We conclude that children from lower SES households have a higher incidence of child maltreatment and have worse outcomes, including significantly higher in-hospital mortality among hospitalized children. This trend was generally consistent across all age groups and ethnicities. To our knowledge, this is the first report studying the association between SES and children with child maltreatment among hospitalized children across the entire USA.
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    More Hospitals are Closing
    (ACEP Now) Severance, Harry
    The wave of increasing hospital closures and service line cutbacks continues to sweep the U.S. Worsening Doctor/Nursing Shortages Playing a Significant Role!
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    Patterns, predictors, variations, and temporal trends in emergency medical service hospital prenotification for acute ischemic stroke.
    (J Am Heart Assoc, 2012-08) Lin, Cheryl B; Peterson, Eric D; Smith, Eric E; Saver, Jeffrey L; Liang, Li; Xian, Ying; Olson, Daiwai M; Shah, Bimal R; Hernandez, Adrian F; Schwamm, Lee H; Fonarow, Gregg C
    BACKGROUND#ENTITYSTARTX02014;: Emergency medical services (EMS) hospital prenotification of an incoming stroke patient is guideline recommended as a means of increasing the timeliness with which stroke patients are evaluated and treated. Still, data are limited with regard to national use of, variations in, and temporal trends in EMS prenotification and associated predictors of its use. METHODS AND RESULTS#ENTITYSTARTX02014;: We examined 371 988 patients with acute ischemic stroke who were transported by EMS and enrolled in 1585 hospitals participating in Get With The Guidelines-Stroke from April 1, 2003, through March 31, 2011. Prenotification occurred in 249 197 EMS-transported patients (67.0%) and varied widely by hospital (range, 0% to 100%). Substantial variations by geographic regions and by state, ranging from 19.7% in Washington, DC, to 93.4% in Montana, also were noted. Patient factors associated with lower use of prenotification included older age, diabetes mellitus, and peripheral vascular disease. Prenotification was less likely for black patients than for white patients (adjusted odds ratio 0.94, 95% confidence interval 0.92-0.97, P<0.0001). Hospital factors associated with greater EMS prenotification use were absence of academic affiliation, higher annual volume of tissue plasminogen activator administration, and geographic location outside the Northeast. Temporal improvements in prenotification rates showed a modest general increase, from 58.0% in 2003 to 67.3% in 2011 (P temporal trend <0.0001). CONCLUSIONS#ENTITYSTARTX02014;: EMS hospital prenotification is guideline recommended, yet among patients transported to Get With The Guidelines-Stroke hospitals it is not provided for 1 in 3 EMS-arriving patients with acute ischemic stroke and varies substantially by hospital, state, and region. These results support the need for enhanced implementation of stroke systems of care. (J Am Heart Assoc. 2012;1:e002345 doi: 10.1161/JAHA.112.002345.).