Background—The aim of this study was to assess the relationship between the volume of cardiac transplantation procedures performed in a center and the outcome after cardiac transplantation.
Methods and Results—PubMed, Embase, and the Cochrane library were searched for articles on the volume–outcome relationship in cardiac transplantation. Ten studies were identified, and all adopted a different approach to data analysis and varied in adjustment for baseline characteristics. The number of patients in each study ranged from 798 to 14401, and observed 1-year mortality ranged from 12.6% to 34%. There was no association between the continuous variables of center volume and observed mortality. There was a weak association between the continuous variables of center volume and adjusted mortality up to 1 year and a stronger association at 5 years. When centers were grouped in volume categories, low-volume centers had the highest adjusted mortality, intermediate-volume centers had lower adjusted mortality, and high-volume centers had the lowest adjusted mortality but were not significantly better than intermediate-volume centers. Category limits were arbitrary and varied between studies
Conclusions—There is a relationship between center volume and mortality in heart transplantation. The existence of a minimum acceptable center volume or threshold is unproven. However, a level of 10 to 12 heart transplants per year corresponds to the upper limit of low-volume categories that may have relatively higher mortality. It is not known whether outcomes for patients treated in low-volume transplant centers would be improved by reorganizing centers to ensure volumes in excess of 10 to 12 heart transplants per year.
Background Acetaminophen poisoning is a common clinical problem,
and early identification of patients with more severe poisoning is key
to improving outcomes.
Purposes This study intends to document prevalence,
clinical characteristics, and predictors of gastrointestinal (GI)
manifestations and to assess the impact of these manifestations on
outcome in patients with acetaminophen poisoning.
Methods This is a
retrospective cohort study of hospital admissions for acute
acetaminophen poisoning conducted over a period of 5 years from 1
January 2004 to 31 December 2008. Parametric and non-parametric tests
were used to test differences between groups depending on the normality
of the data. Statistical Package for Social Sciences (SPSS) 15 was used
for data analysis.
Results Two hundred and ninety-one patients were
studied; their mean age was 23.01 ± 7.4 years and 76.6% had GI
manifestations. Multiple logistic regression showed that significant
risk factors for GI manifestations were present among patients who
reported acetaminophen dose ingested ≥10 g (p < 0.001), and latency
time more than 8 hours (p = 0.030). GI manifestations at first
admission predicted poorer outcomes in terms of estimated acetaminophen
levels to be a possible toxic (p < 0.001), elevated bilirubin levels
(p = 0.002), prolonged prothrombin time (PT; p = 0.002), elevated
creatinine level (p = 0.028), declination of potassium level
(p < 0.001), and prolonged hospital stay (p < 0.001).
Conclusions GI manifestations were common among patients with acetaminophen poisoning. This study suggests that the presence of GI manifestations at first presentation appears to be an important risk marker of subsequent hepatotoxicity and nephrotoxicity.
Background Acetaminophen poisoning is a common clinical problem, and early identification of patients with more severe poisoning is key to improving outcomes. Purposes This study intends to document prevalence, clinical characteristics, and predictors of gastrointestinal (GI) manifestations and to assess the impact of these manifestations on outcome in patients with acetaminophen poisoning.
Methods This is a retrospective cohort study of hospital admissions for acute acetaminophen poisoning conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. Statistical Package for Social Sciences (SPSS) 15 was used for data analysis.
Results Two hundred and ninety-one patients were studied; their mean age was 23.017.4 years and 76.6% had GI manifestations. Multiple logistic regression showed that significant risk factors for GI manifestations were present among patients who reported acetaminophen dose ingested [1]10 g (p<0.001), and latency time more than 8 hours ( p¼0.030). GI manifestations at first admission predicted poorer outcomes in terms of estimated acetaminophen levels to be a possible toxic ( p<0.001), elevated bilirubin levels (p¼0.002), prolonged prothrombin time (PT; p¼0.002), elevated creatinine level ( p¼0.028), declination of potassium level ( p<0.001), and prolonged hospital stay ( p<0.001).
Conclusions GI manifestations were common among patients with acetaminophen poisoning. This study suggests that the presence of GI manifestations at first presentation appears to be an important risk marker of subsequent hepatotoxicity and nephrotoxicity.