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Continuous Data (continuous + data)
Selected AbstractsROC Curves for Continuous Data by KRZANOWSKI, W. J. and HAND, D. J.BIOMETRICS, Issue 2 2010Lori E. Dodd No abstract is available for this article. [source] Independent Evaluation of an Out-of-hospital Termination of Resuscitation (TOR) Clinical Decision RuleACADEMIC EMERGENCY MEDICINE, Issue 6 2008Peter B. Richman MD Abstract Objectives:, Recently, investigators described a clinical decision rule for termination of resuscitation (TOR) designed to help determine whether to terminate emergency medical services (EMS) resuscitative efforts for out-of-hospital cardiac arrests (OOHCA). The authors sought to evaluate the hypothesis that TOR would predict no survival for patients in an independent cohort of patients with OOHCA. Methods:, This was a retrospective cohort analysis conducted in the state of Arizona. Consecutive, adult, OOHCA were prospectively evaluated from October 2004 through October 2006. A statewide OOHCA database utilizing Utstein-style reporting from 30 different EMS systems was used. Data were abstracted from EMS first care reports and hospital discharge records. The TOR guidelines predict that no survival to hospital discharge will occur if 1) an OOHCA victim does not have return of spontaneous circulation (ROSC), 2) no shocks are administered, and 3) the arrest is not witnessed by EMS personnel. Data were entered into a structured database. Continuous data are presented as means (±standard deviations [SD]) and categorical data as frequency of occurrence, and 95% confidence intervals (CIs) were calculated as appropriate. The primary outcome measure was to determine if any cohort member who met TOR criteria survived to hospital discharge. Results:, There were 2,239 eligible patients; the study group included 2,180 (97.4%) patients for whom the data were complete; mean age was 64 (±11) years, and 35% were female. The majority of patients in the study group met at least one or more of the TOR criteria. A total of 2,047 (93.8%) patients suffered from cardiac arrest that was unwitnessed by EMS; 1,653 (75.8%) had an unwitnessed arrest and no ROSC. With respect to TOR, 1,160 of 2,180 (53.2%) patients met all three criteria; only one (0.09%; 95% CI = 0% to 0.5%) survived to hospital discharge. Conclusions:, The authors evaluated TOR guidelines in an independent, statewide OOHCA database. The results are consistent with the findings of the TOR investigation and suggest that this algorithm is a promising tool for TOR decision-making in the field. [source] Diagnosis of melanoma aspirates on ThinPrep®: The University of Michigan experienceDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2002Güliz Akdas Barkan M.D. Abstract The purpose of this study was to compare the cytologic features of melanoma fine-needle aspirates (FNAs) prepared by ThinPrep® (TP) with those in conventional smears (CS) and to identify any diagnostic pitfalls. Fifty-one aspirates diagnosed as melanoma were obtained, 36 of which were prepared by both TP and CS. The preparations were evaluated for cellularity, cell aggregates, cellular appearance, melanin pigment, cytoplasmic, and nuclear features. Categorical data were analyzed by the chi-square test and continuous data by the Wilcoxin-signed rank test. Correlation was determined by Spearman's test for bivariate correlations (rho). Good correlation between the two methods was identified for the following features: cellularity, cell type, bi/multinucleated cells, cytoplasmic features, NC ratio, and presence of macronucleoli. TP exhibits coarser chromatin compared to CS (P = 0.005). Six of 36 CS contained large cellular groups; none of the TP contained them (P = 0.018). Twenty-five of 36 CS contained intranuclear inclusions as opposed to 12/36 TP (P < 0.001). The number of inclusions was significantly reduced on TP. The amount of intracellular melanin was the same with both techniques. Background melanin was markedly reduced on TP except when either trapped by fibrin or attached to cellular clusters (P = 0.006). Background blood was also markedly reduced on TP (P < 0.005). In summary, the cytological features of TP and CS for FNA evaluation of melanoma correlate well; however, one needs to be aware of the cytologic alterations introduced by TP. TP is a sufficient preparation method in the diagnosis of melanoma FNA aspirates when performed by clinicians. It is also a useful adjunct in bloody or low-cellular aspirates, where it tends to reduce the background blood and concentrate the cells. Diagn. Cytopathol. 2002;26:334,339. © 2002 Wiley-Liss, Inc. [source] Statistical issues on the determination of the no-observed-adverse-effect levels in toxicologyENVIRONMETRICS, Issue 4 2001Takashi Yanagawa Abstract The determination of a safe exposure level for toxic agents, often defined as the highest dose level with no toxic effect and termed the no-observed-adverse-effect level (NOAEL) is reviewed. The conventional methods based on statistical tests are criticized, particularly when the sample size is small, and an alternative method, which is based on the Akaike information criterion (AIC), is discussed. The method is extended to the estimation of the NOAEL for continuous data. Computer programs for Windows 95/NT for determining the NOAEL by the AIC approach are developed and its application to practical data is illustrated with examples. Copyright © 2001 John Wiley & Sons, Ltd. [source] Do Diabetic Patients Have Higher In-hospital Complication Rates When Admitted from the Emergency Department for Possible Myocardial Ischemia?ACADEMIC EMERGENCY MEDICINE, Issue 3 2000Peter B. Richman MD Abstract Objective: To compare in-hospital complication rates for diabetic and nondiabetic patients admitted from the emergency department (ED) for possible myocardial ischemia. Methods: This was a prospective, observational study of consecutive consenting patients presenting to a suburban university hospital ED during study hours with typical and atypical symptoms consistent with cardiac ischemia. Demographic, historical, and clinical data were recorded by trained research assistants using a standardized, closed-question, data collection instrument. Inpatient records were reviewed by trained data abstractors to ascertain hospital course and occurrence of complications. Final discharge diagnosis of acute myocardial infarction (AMI) was assigned by World Health Organization criteria. Categorical and continuous data were analyzed by chi-square and t-tests, respectively. All tests were two-tailed with alpha set at 0.05. Results: There were 1,543 patients enrolled who did not have complications at initial presentation; 283 were diabetic. The rule-in rate for AMI was 13.8% for nondiabetic patients and 17.7% for diabetic patients (p = 0.09). Times to presentation were similar for nondiabetic vs diabetic patients [248 minutes (95% CI = 231 to 266) vs 235 minutes (95% CI = 202 to 269); p = 0.32]. Nondiabetic patients tended to be younger [56.6 years (95% CI = 55.8 to 57.4) vs 61.6 years (95% CI = 60.2 to 63.1); p = 0.001] and were less likely to be female (34.3% vs 48.1%; p = 0.001). The two groups had similar prevalences for initial electrocardiograms diagnostic for AMI (5.5% vs 7.4%; p = 0.21). There was no significant difference between nondiabetic and diabetic patients for the occurrence of the following complications after admission to the hospital: congestive heart failure (1.3% vs 1.1%, p = 0.77); nonsustained ventricular tachycardia (VT) (1.3% vs 1.2%, p = 0.93); sustained VT (1.2% vs 1.1%, p = 0.85); supraventricular tachycardia (1.7% vs 3.2%, p = 0.12); bradydysrhythmias (1.9% vs 1.1%, p = 0.33); hypotension necessitating the use of pressors (0.9% vs 1.1%, p = 0.76); cardiopulmonary resuscitation (0.2% vs 0.7%, p = 0.10); and death (0.3% vs 0.7%, p = 0.34). One or more complications occurred with similar frequencies for patients in the two groups (6.3% vs 5.7%; p = 0.70). Conclusions: No statistically significant difference was found in the post-admission complication rates for initially stable diabetic vs nondiabetic patients admitted for possible myocardial ischemia. Based on these results, the presence or absence of diabetes as a comorbid condition does not indicate a need to alter admitting decisions with respect to risk for inpatient complications. [source] The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisationINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2008Sek Ying Chair RN MBA PhD Background, Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications. Objectives, The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest. Search strategy, We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field. Selection criteria, All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review. Data collection and analysis, Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. Main results, Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest. Authors' conclusions, There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3 h of bed rest. There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans-femoral cardiac catheterisation. Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2,2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest. [source] Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2007Ritin Fernandez RN MN (Critical care) PhD Candidate Abstract Background, The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established. Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low. Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors. Objectives, The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease. Search strategy, A literature search was performed using the following databases MEDLINE (1966,2006), CINAHL (1982,2006), EMBASE (1980,current) and up to the Cochrane Controlled Trials Register (Issue 2, 2006 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. Company representatives, experts and investigators were contacted to elicit further information. Selection criteria, All randomised and quasi-randomised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were considered for inclusion in the review. Data collection and analysis, Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, trials were considered separately. Main results, Seventeen trials involving a total of 4725 participants were included in the final review: three trials compared the effects of brief structured interventions on diet modification; seven on smoking cessation; and seven on multiple risk factors. Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification. Although there was a tendency for more participants in the intervention arm to lose weight at the 12-week follow up and achieve target cholesterol levels at the 6-month follow up, these results were not statistically significant. Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention. However, no difference in fish, fruit and vegetable intake between the groups was evident. Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation. There was no difference in the smoking cessation rates at the 3- and 6-week follow up, however, there was evidence of a benefit of brief structured interventions for smoking cessation at the 3-, 6- and 12-month follow up. In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups. In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake, weight loss and consequently on reduction in the body mass index, smoking cessation and physical activity among the participants. The findings concerning the effect on blood pressure, blood glucose levels and the lipid profile, however, remain inconclusive. Conclusions, There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease. This review, however, supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease. Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors. [source] Prognostic Factors for Mortality and Thromboembolism in Canine Immune-Mediated Hemolytic Anemia: A Retrospective Study of 72 DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2002Anthony P. Carr Medical records of 72 dogs diagnosed with immune-mediated hemolytic anemia (IMHA) were reviewed to find risk factors for the disease, for mortality, and for thromboembolism. Coagulation data of 32 patients were evaluated for mortality or thromboembolism risk factors. Cocker Spaniels were at increased risk for IMHA (P= .012). Timing of vaccination was not associated with development of IMHA. PCV ranged from 5 to 33%, with a mean of 16 ± 5%. Autoagglutination was present in 42% of the dogs. Platelet counts (n = 60) varied from 3,000 to 793,000/,L (mean, 160,117 ± 133,571; median, 144,000). Thrombocytopenia (platelet count, <200,000/,L) was present in 70% of the dogs, with severe thrombocytopenia (platelet count, <50,000/,L) being present in 22%. One-step prothrombin time (OSPT) was prolonged in 28% of the dogs tested, and activated partial thromboplastin time (APTT) was prolonged in 47% of the dogs tested. Fibrin(ogen) degradation products (FDPs) were detected in 16 of 28 dogs tested (57%). Disseminated intravascular coagulation (DIC) was diagnosed in 10 of 31 (32%) dogs and was suspected in 8 dogs. Thromboemboli were found in 20 of 25 dogs given postmortem examinations. Mortality rate was 58%. Thrombocytopenia (P= .008) and serum bilirubin concentration of >5 mg/dL (P= .015) were risk factors for mortality, and hypoalbuminemia approached significance (P= .053). Severe thrombocytopenia (P= .046), serum bilirubin concentration of >5 mg/dL (P= .038), and hypoalbuminemia (P= .016) were risk factors for thromboembolism. On evaluation of continuous data, decreased platelet count (P= .057), increased bilirubin (P= .062), and decreased albumin (P= .054) approached significance for decreased survival. A higher risk for thrombosis was found with increased alkaline phosphatase (ALKP) (P= .042), increased bilirubin (P= .047), and decreased albumin (P= .012). [source] Sociodemographic determinants of growth among Malian adolescent femalesAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2010Timothy F. Leslie In Africa, research concerning the social determinants of poor nutritional status has typically focused on children under 5 years of age and has used defined categorical boundaries based on international reference standards. In this article, stunting and wasting of 1,157 Malian adolescent girls is measured through both categorical and continuous data. The focus on adolescent girls is significant because there is relatively little literature examining this group, and because adolescence marks the time when girls gain greater workload responsibilities, autonomy of food choices, and, as a result of the adolescent growth spurt, require the greatest amount of caloric intake respective to their weight since infancy. To differentiate stunting and wasting causes, a number of socioeconomic, geographic, and demographic factors are explored. The findings suggest that continuous data provides a basis for modeling stunting and wasting superior to utilizing international reference categories. Estimations show that decreasing age, the presence of servants, a greater number of wives in a compound, and residence in a large urban area correlate with improved nutritional status while wealthier families appear to correlate with greater stunting and wasting, and no correlation exists with estimated energy expenditure. Future studies should incorporate continuous data, and the need exists for greater analysis of social determinants of growth indicators among adolescent females. Further, these findings have significant implications in the development of nutrition intervention programs aimed at the vulnerable population in Mali, leading us to conclude that factors beyond socioeconomic indicators such as household structure and location should be more fully examined. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Agreement between clinical examination and quantitative tests of neurologic function among 384 subjects,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2001Kyle Steenland Abstract Background Quantitative neurological tests are often cheaper and easier than clinical examinations, and provide continuous data which may discriminate between exposed and nonexposed groups with more sensitivity than dichotomous (normal/abnormal) examination data. Methods We compare clinical examinations and analogous quantitative tests for arm tremor, postural sway, and vibrotactile sensitivity (finger and toe), for 384 subjects. Results The "abnormal" clinical outcomes studied were relatively common (range, 3,36%), and did not result in impairment of daily activity for affected subjects. All the quantitative tests were reasonably good predictors of the corresponding clinical outcome. The most predictive test was for toe vibrotactile sensitivity. The probability of an abnormal clinical result for those in the worst quartile for the toe test was 0.63, compared with 0.36 for all subjects. Conclusions Our results suggest that certain quantitative tests might be used in epidemiologic studies instead of a physical examination. Am. J. Ind. Med. 39:361,368, 2001. Published 2001 Wiley-Liss, Inc. [source] Continuous water-level monitoring in the assessment of groundwater remediation and refinement of a conceptual site modelREMEDIATION, Issue 4 2005John J. Quinn An Erratum has been published for this article in Remediation 16(1) 2005, 155,157. Water-level data collection is a fundamental component of groundwater investigations and remediation. While the locations and depths of monitored wells are important, the frequency of data collection may have a large impact on conclusions made about site hydrogeology. Data-logging water-level probes may be programmed to record water levels at frequent intervals, providing site decision makers with abundant, detailed information on the response of an aquifer to both anticipated and unforeseen stresses. In this study, a network of movable probes has provided several years of hourly water- level data. The understanding of the site's phytoremediation system has been enhanced by the continuous data, but subsequent insights into an unexpected situation regarding the site's infrastructure have been the most valuable result of the monitoring program. © 2005 Wiley Periodicals, Inc. [source] The effect of early removal of indwelling urinary catheter on postoperative urinary complications in anterior colporrhaphy surgeryAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2008Leila SEKHAVAT Objective: To assess whether immediate removal of an indwelling catheter after anterior colporrhaphy influences the rate of re-catheterisation and symptomatic urinary tract infections. Methods: A prospective randomised study conducted on 90 women divided into two groups who underwent anterior repair. The indwelling catheter was removed immediately (early catheter removal), and at least 24 h after the operation in case and control groups, respectively. The association between clinical variables and the duration of catheterisation and continuous data were analysed by ,2 test and two-tailed t -test, respectively. Excel and SPSS 15.0 software were used, and a P -value of 0.05 or less was considered to indicate statistically significant differences. Result: Symptomatic urinary tract infection was significantly lower in early catheter-removal group; also patients in this group reported significantly less pain and voiding disturbances. Only a few of women required re-catheterisation after failing to void and all were able to resume normal voiding, also had shorter ambulation time and hospital stay. Conclusion: Early removal of an indwelling catheter immediately after anterior colporrhaphy was not associated with adverse events and increased rate of re-catheterisation. In this group, symptomatic urinary tract infection was significantly lower. Moreover, early removal of indwelling catheters immediately after operation seemed to decrease the ambulation time and hospital stay. [source] A New Approach for Handling Longitudinal Count Data with Zero-Inflation and Overdispersion: Poisson Geometric Process ModelBIOMETRICAL JOURNAL, Issue 4 2009Wai-Yin Wan Abstract For time series of count data, correlated measurements, clustering as well as excessive zeros occur simultaneously in biomedical applications. Ignoring such effects might contribute to misleading treatment outcomes. A generalized mixture Poisson geometric process (GMPGP) model and a zero-altered mixture Poisson geometric process (ZMPGP) model are developed from the geometric process model, which was originally developed for modelling positive continuous data and was extended to handle count data. These models are motivated by evaluating the trend development of new tumour counts for bladder cancer patients as well as by identifying useful covariates which affect the count level. The models are implemented using Bayesian method with Markov chain Monte Carlo (MCMC) algorithms and are assessed using deviance information criterion (DIC). [source] Power and Sample Size Estimation for the Wilcoxon Rank Sum Test with Application to Comparisons of C Statistics from Alternative Prediction ModelsBIOMETRICS, Issue 1 2009B. Rosner Summary The Wilcoxon Mann-Whitney (WMW) U test is commonly used in nonparametric two-group comparisons when the normality of the underlying distribution is questionable. There has been some previous work on estimating power based on this procedure (Lehmann, 1998, Nonparametrics). In this article, we present an approach for estimating type II error, which is applicable to any continuous distribution, and also extend the approach to handle grouped continuous data allowing for ties. We apply these results to obtaining standard errors of the area under the receiver operating characteristic curve (AUROC) for risk-prediction rules under H1 and for comparing AUROC between competing risk prediction rules applied to the same data set. These results are based on SAS -callable functions to evaluate the bivariate normal integral and are thus easily implemented with standard software. [source] Continuous Support for Women During ChildbirthBIRTH, Issue 1 2005E.D. Hodnett ABSTRACT Background:, Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. Objectives:, Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). Selection criteria:, All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. Data collection and analysis:, Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Main results:, Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. Reviewers' conclusions:, All women should have support throughout labour and birth. Citation:, Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. ,,,The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd. [source] Noninvasive Ventilation Outcomes in 2,430 Acute Decompensated Heart Failure Patients: An ADHERE Registry AnalysisACADEMIC EMERGENCY MEDICINE, Issue 4 2008Thomas A. Tallman DO Abstract Objectives:, Continuous or bilevel positive airway pressure ventilation, called noninvasive ventilation (NIV), is a controversial therapy for acute decompensated heart failure (ADHF). While NIV is considered safe and effective in patients with chronic obstructive pulmonary disease (COPD), clinical trial data that have addressed safety in ADHF patients are limited, with some suggestion of increased mortality. The objective of this study was to assess mortality outcomes associated with NIV and to determine if a failed trial of NIV followed by endotracheal intubation (ETI) (NIV failure) is associated with worse outcomes, compared to immediate ETI. Methods:, This was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE), which enrolls patients with treatment for, or with a primary discharge diagnosis of, ADHF. The authors compared characteristics and outcomes in four groups: no ventilation, NIV success, NIV failure, and ETI. One-way analysis of variance or Wilcoxon testing was performed for continuous data, and chi-square tests were used for categorical data. In addition, multivariable logistic regression was used to adjust mortality comparisons for risk factors. Results:, Entry criteria were met by 37,372 patients, of which 2,430 had ventilation assistance. Of the ventilation group, 1,688 (69.5%) were deemed NIV success, 72 (3.0%) were NIV failures, and 670 (27.6%) required ETI. The NIV failure group had the lowest O2 saturation (SaO2) (84 ± 16%), compared to either NIV success (89.6 ± 10%) or ETI (88 ± 13%; p = 0.017). ETI patients were more likely to receive vasoactive medications (p < 0.001) than the NIV success cohort. When comparing NIV failures to ETI, there were no differences in treatment during hospitalization (p > 0.05); other than that the NIV failure group more often received vasodilators (68.1% vs. 54.3%; p = 0.026). In-hospital mortality was 7.9% with NIV, 13.9% with NIV failure, and 15.4% with ETI. After risk adjustment, the mortality odds ratio for NIV failure versus ETI increased to 1.43, although this endpoint was not statistically significant. Conclusions:, In this analysis of ADHF patients receiving NIV to date, patients placed on NIV for ADHF fared better than patients requiring immediate ETI. Patients who failed NIV and required ETI still experienced lower mortality than those initially placed on ETI. Thus, while the ETI group may be more severely ill, starting therapy with NIV instead of immediate ETI will likely not harm the patient. When ETI is required, mortality and length of stay may be adversely affected. Since a successful trial of NIV is associated with improved outcomes in patients with ADHF, application of this therapy may be a reasonable treatment option. [source] | |||||||||||||