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  1. Tweel LE, Compher C, Bear DE, Gutierrez-Castrellon P, Leaver SK, MacEachern K, et al.
    Crit Care Med, 2024 Apr 01;52(4):586-595.
    PMID: 37930244 DOI: 10.1097/CCM.0000000000006117
    OBJECTIVES: Across guidelines, protein dosing for critically ill patients with obesity varies considerably. The objective of this analysis was to evaluate whether this population would benefit from higher doses of protein.

    DESIGN: A post hoc subgroup analysis of the effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicenter, pragmatic, registry-based randomized trial.

    SETTING: Eighty-five adult ICUs across 16 countries.

    PATIENTS: Patients with obesity defined as a body mass index (BMI) greater than or equal to 30 kg/m 2 ( n = 425).

    INTERVENTIONS: In the primary study, patients were randomized into a high-dose (≥ 2.2 g/kg/d) or usual-dose protein group (≤ 1.2 g/kg/d).

    MEASUREMENTS AND MAIN RESULTS: Protein intake was monitored for up to 28 days, and outcomes (time to discharge alive [TTDA], 60-d mortality, days of mechanical ventilation [MV], hospital, and ICU length of stay [LOS]) were recorded until 60 days post-randomization. Of the 1301 patients in the primary study, 425 had a BMI greater than or equal to 30 kg/m 2 . After adjusting for sites and covariates, we observed a nonsignificant slower rate of TTDA with higher protein that ruled out a clinically important benefit (hazard ratio, 0.78; 95% CI, 0.58-1.05; p = 0.10). We found no evidence of difference in TTDA between protein groups when subgroups with different classes of obesity or patients with and without various nutritional and frailty risk variables were examined, even after the removal of patients with baseline acute kidney injury. Overall, 60-day mortality rates were 31.5% and 28.2% in the high protein and usual protein groups, respectively (risk difference, 3.3%; 95% CI, -5.4 to 12.1; p = 0.46). Duration of MV and LOS in hospital and ICU were not significantly different between groups.

    CONCLUSIONS: In critically ill patients with obesity, higher protein doses did not improve clinical outcomes, including those with higher nutritional and frailty risk.

    Matched MeSH terms: Length of Stay
  2. Yeoh C, Teo A, Azhar AMN, Suann ST, Thum Y, Wong KD, et al.
    J Acute Med, 2019 Sep 01;9(3):128-144.
    PMID: 32995241 DOI: 10.6705/j.jacme.201909_9(3).0005
    Background: Balanced fluids are preferred in initial resuscitation of septic patients based on several recent studies. The Stewart's concept on acid-base balance predicts that high strong ion difference (SID) fluid thus will increase the pH level. To date, the impact of high SID fluid in septic patient with metabolic acidosis remains uncertain. We conducted single center, randomized, double-blind trial to compare the effect of high SID fluid vs. Hartmann's solution on acid-base status in selected sepsis patients in the Emergency Department.

    Methods: Septic patient with hyperlactatemia and metabolic acidosis were randomized to receive either high SID fl uid or Hartmann's solution during initial fl uid resuscitation. The primary outcome measures the pH and bicarbonate levels difference pre- and post- resuscitation.

    Results: One hundred and sixty-two patients underwent randomization, 81 were assigned each to receive high SID fluid or Hartmann's solution. Both groups had similar baseline characteristics. High SID group received 23.5 mL/kg and the Hartmann's group received 22.7 mL/kg (p = 0.360). High SID fluid increased the mean (± SD) pH by 0.107 (± 0.09) vs. Hartmann's solution by 0.014 (± 0.12), p ≤ 0.001. Mean bicarbonate level increased signifi cantly in high SID group compared to Hartmann's (4.30 ± 3.76 vs. 1.25 ± 3.33, p ≤ 0.001). High SID group had higher post resuscitation lactate clearance than Hartmann's group (25.4 ± 28.3% vs. 12.0 ± 34.1%, p = 0.009). Shorter hospital stay was observed in highSID group 8.04 ± 5.96 days vs. Hartmann's group 12.18 ± 12.41 days (p = 0.048). Both groups showed no difference in incidence of pulmonary oedema, acute kidney injury and mortality.

    Conclusions: Initial resuscitation using high SID fluid in selected septic patient improves pH and bicarbonate levels. The high SID group had better post resuscitation lactate clearance and shorter hospital stay.

    Matched MeSH terms: Length of Stay
  3. Nasir ZM, Subha ST
    Int Arch Otorhinolaryngol, 2021 Apr;25(2):e193-e199.
    PMID: 33968219 DOI: 10.1055/s-0040-1709739
    Introduction  Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective  To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods  We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results  Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion  Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.
    Matched MeSH terms: Length of Stay
  4. Memon MA, Yunus RM, Memon B, Awaiz A, Khan S
    Surg Laparosc Endosc Percutan Tech, 2018 Dec;28(6):337-348.
    PMID: 30358650 DOI: 10.1097/SLE.0000000000000589
    AIMS AND OBJECTIVES: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.

    MATERIALS AND METHODS: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.

    RESULTS: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.

    CONCLUSIONS: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.

    Matched MeSH terms: Length of Stay/statistics & numerical data
  5. Teerawattanapong N, Panich P, Kulpokin D, Na Ranong S, Kongpakwattana K, Saksinanon A, et al.
    Infect Control Hosp Epidemiol, 2018 05;39(5):525-533.
    PMID: 29580299 DOI: 10.1017/ice.2018.58
    OBJECTIVETo summarize the clinical burden (cumulative incidence, prevalence, case fatality rate and length of stay) and economic burden (healthcare cost) of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDROs) among patients in intensive care units (ICUs) in Southeast Asia.DESIGNSystematic review.METHODSWe conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, EconLit, and the Cochrane Library databases from their inception through September 30, 2016. Clinical and economic burdens and study quality were assessed for each included study.RESULTSIn total, 41 studies met our inclusion criteria; together, 22,876 ICU patients from 7 Southeast Asian countries were included. The cumulative incidence of HAI caused by A. baumannii (AB) in Southeast Asia is substantially higher than has been reported in other regions, especially carbapenem-resistant AB (CRAB; 64.91%) and multidrug-resistant AB (MDR-AB) (58.51%). Evidence of a dose-response relationship between different degrees of drug resistance and excess mortality due to AB infections was observed. Adjusted odds ratios were 1.23 (95% confidence interval [CI], 0.51-3.00) for MDR-AB, 1.72 (95% CI, 0.77-3.80) for extensively drug-resistant AB (XDR-AB), and 1.82 (95% CI, 0.55-6.00) for pandrug-resistant AB (PDR-AB). There is, however, a paucity of published data on additional length of stay and costs attributable to MDROs.CONCLUSIONSThis review highlights the challenges in addressing MDROs in Southeast Asia, where HAIs caused by MDR gram-negative bacteria are abundant and have a strong impact on society. With our findings, we hope to draw the attention of clinicians and policy makers to the problem of antibiotic resistance and to issue a call for action in the management of MDROs.Infect Control Hosp Epidemiol 2018;39:525-533.
    Matched MeSH terms: Length of Stay
  6. Khoo CS, Tee TY, Tan HJ, Ali RA
    J Neurosci Rural Pract, 2019 4 20;10(2):324-326.
    PMID: 31001027 DOI: 10.4103/jnrp.jnrp_315_18
    We report a patient with end-stage renal disease on peritoneal dialysis, who developed encephalopathy after receiving a few doses of cefepime. He recovered clinically and electroencephalographically after having discontinued the culprit agent and undergone hemodialysis. This case highlights the importance of promptly recognizing this reversible encephalopathy, which can lead to the avoidance of unnecessary workup, reduce the length of hospital stay, and thereby improve the patients' outcome.
    Matched MeSH terms: Length of Stay
  7. Boo NY, Ng SF, Lim VK
    J Hosp Infect, 2005 Sep;61(1):68-74.
    PMID: 15953660
    To determine the risk factors for rectal colonization by extended-spectrum beta-lactamase (ESBL) Klebsiella sp. in 368 newborns admitted consecutively to a neonatal intensive care unit over six months, rectal swabs were cultured on admission and weekly until discharge. Eighty infants (21.7%) had ESBL Klebsiella sp. cultured from their rectal swabs. Eighty controls were selected at random from infants with negative cultures admitted within the 14-day period prior to the detection of ESBL Klebsiella sp. in the cases. Cases had significantly lower birth weight, gestational age, earlier age of admission, longer hospital stay, and higher proportions of congenital malformations, early-onset pneumonia and respiratory distress syndrome compared with controls. Significantly more cases received mechanical ventilation, nasal continuous positive airway pressure support, total parenteral nutrition, umbilical vascular catheterization, arterial line insertion, urinary bladder catheterization, and prior treatment with antibiotics. However, stepwise logistic regression analysis showed that only two independent risk factors were significantly associated with ESBL rectal colonization: duration of hospital stay [adjusted odds ratio (OR): 1.3; 95% confidence intervals (CI): 1.2, 1.4; P<0.0001) and early-onset pneumonia (adjusted OR: 8.3; 95% CI: 1.6, 43.4; P=0.01).
    Matched MeSH terms: Length of Stay
  8. Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW
    Hum Psychopharmacol, 2010 Aug;25(6):500-8.
    PMID: 20737523 DOI: 10.1002/hup.1140
    The objectives of this study were to determine the risk factors and life stressors that are prevalent among the acetaminophen deliberate self-poisoning (DSP) cases, to identify gender differences in the associated factors, and to determine the prevalence of psychiatric diagnosis and the patterns and types of psychotherapeutic interventions provided by psychiatrists.
    Matched MeSH terms: Length of Stay/statistics & numerical data
  9. Loh SY, Chin CM
    BJU Int, 2002 Apr;89(6):531-3.
    PMID: 11942958
    OBJECTIVE: To evaluate, in a prospective study, the demographic profile of patients with benign prostate enlargement who presented in acute urinary retention (AUR).

    PATIENTS AND METHODS: The study comprised all patients admitted for transurethral resection of the prostate and categorised into two groups, i.e. those presenting in AUR or electively. The factors evaluated included the length of hospitalization, the patients' occupation, their duration of symptoms and reasons for not seeking treatment.

    RESULTS: There was no significant difference in the mean age and occupational status of the two groups but those in AUR had more complications and a longer hospital stay after surgery; 60% of these men had had their urinary symptoms for > 1 year. When asked why they did not seek treatment earlier, 35% reported fear of surgery, while 41% thought that their symptoms were a normal part of ageing.

    CONCLUSION: There is a need to raise the level of public awareness of benign prostatic enlargement because those who present with AUR incur excess morbidity and longer hospitalization that could otherwise be avoided through earlier treatment and elective surgery.

    Matched MeSH terms: Length of Stay
  10. Tan-Loh J, Cheong BMK
    Med J Malaysia, 2021 01;76(1):24-28.
    PMID: 33510104
    INTRODUCTION: COVID-19 is a highly transmissible respiratory virus that has affected millions of people worldwide in the span of months. The burden of disease among healthcare workers (HCW) has not been well studied despite reports of infectivity and transmission around the world. Two HCW in Hospital Teluk Intan (HTI) contracted COVID-19 while attending a social event. They were in close proximity with colleagues upon returning to work, resulting in the spread of infection among other HCW in HTI.

    OBJECTIVE: The objectives of this paper are to gain a better understanding of the key presenting symptoms of COVID-19 in HCWs in a district specialist hospital, to establish the proportion of symptomatic COVID-19 cases among HCWs and its severity and to determine the time taken from onset of symptoms or perceived exposure to diagnostic testing.

    METHODOLOGY: This is a retrospective descriptive analysis of clinical characteristics of subjects infected with COVID-19 among HCW in HTI. Their demography and clinical characteristics were recorded.

    RESULTS: There were 47 HCW in HTI who tested positive for COVID-19. The mean age of the patients was 37.5 years old. 7 patients (15.2%) had at least more than one comorbidity. Average duration of time from perceived close contact to onset of symptom was 4.5 days, while the mean duration of time from symptoms to first positive RT-PCR result was 3.4 days. Six patients (13.0%) were asymptomatic throughout, whereas 40 (87.0%) had at least one symptom prior to hospitalization. The most commonly reported symptoms were fever (65.2%), sore throat (39.1%) and cough (37.0%). In terms of severity of symptoms, the majority of patients experienced mild symptoms (Group 2, 52.2%). Two patients (4.3%) with multiple comorbidities had severe disease requiring ICU admission and mechanical ventilation. There were no mortalities, and the longest staying patient was hospitalized for 18 days. The high rates of infectivity among HCW in HTI can be attributed to working in close proximity while in the asymptomatic incubation phase, while no HCW directly involved in the care of COVID-19 positive patients were tested positive.

    CONCLUSION: We report that HCW share similar clinical characteristics of COVID-19 infection as those of non HCW patients in earlier studies. The infection can spread rapidly within healthcare settings via close contacts among infected HCWs. As such, we advocate distancing when working and usage of personal protective equipment when treating patients with respiratory illness to reduce transmission of COVID-19.

    Matched MeSH terms: Length of Stay/statistics & numerical data
  11. Yap PY, Hwang JS, Bong JJ
    Asian J Surg, 2017 Mar 10.
    PMID: 28286020 DOI: 10.1016/j.asjsur.2017.01.003
    BACKGROUND/OBJECTIVE: Postoperative pancreatic fistula (POPF) remains an important cause of morbidity and mortality after pancreaticoduodenectomy. Pancreaticogastrostomy (PG) as a reconstruction method after pancreaticoduodenectomy is a safe and optional surgical technique in decreasing the risk of POPF. In this study, a retrospective analysis was carried out to evaluate a new modification of PG technique that uses a two-layer anastomoses with an internal stent.

    METHODS: Forty-seven patients underwent this newly modified PG technique between February 2012 and August 2016. Demographics, histopathological findings, type of surgery performed, perioperative parameters, postoperative length of stay, postoperative complications and interventional procedures, follow-up, and mortality data were collected and analyzed. Clavien-Dindo classification was used to grade the complications' severity.

    RESULTS: Postoperative mortality was 4.25%, unrelated to POPF, and postoperative morbidity was 44.68%. Thirteen patients had severe (>Grade IIIa) complications, according to Clavien-Dindo classification. As classified in accordance to the International Study Group of Pancreatic Fistula, 24 (51.06%) patients developed Grade A POPF, and no occurrence of Grade B/C POPF was noted. All patients recovered uneventfully with successful treatment interventions.

    CONCLUSION: The reported PG anastomotic technique is a safe and dependable reconstruction procedure with acceptable morbidity and mortality.

    Matched MeSH terms: Length of Stay
  12. Jarmin, R., Othman, H., Zuhdi, Z., Mohamad, I.S., Ahmad, A.W., Ariffin, A.C.
    MyJurnal
    Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
    surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
    time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
    liver resection was initiated.

    Objective: The aim of this study was to achieve discharge by postoperative
    day 3 for minor resection and day 5 for major resection.

    Design and Setting: This is a prospective study
    conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.

    Material
    and Methods: All patients undergoing open liver resection were included in the study. They were then
    managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
    demographics data, intra operative parameters, postoperative complications and adherence to
    postoperative recovery protocol were recorded.

    Results: Seventeen patients (7 major and 10 minor
    resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
    was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
    in the major group were discharged on time. 9 patients had postoperative complications with no mortality
    recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
    15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
    35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14
    patients).

    Conclusion: From these overall achievement, most of our targets have been met and this shows
    that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.

    Limitations: Some patients
    had achieved their target but not discharged for unknown reason.
    Matched MeSH terms: Length of Stay
  13. Thong MK, Ho JJ, Khatijah NN
    Ann Hum Biol, 2005 Mar-Apr;32(2):180-7.
    PMID: 16096215 DOI: 10.1080/03014460500075332
    Birth defects are one of the leading causes of paediatric disability and mortality in developed and developing countries. Data on birth defects from population-based studies originating from developing countries are lacking. One of the objectives of this study was to determine the epidemiology of major birth defects in births during the perinatal period in Kinta district, Perak, Malaysia over a 14-month period, using a population-based birth defect register. There were 253 babies with major birth defects in 17,720 births, giving an incidence of 14.3/1000 births, a birth prevalence of 1 in 70. There were 80 babies with multiple birth defects and 173 with isolated birth defects. The exact syndromic diagnosis of the babies with multiple birth defects could not be identified in 18 (22.5%) babies. The main organ systems involved in the isolated birth defects were cardiovascular (13.8%), cleft lip and palate (11.9%), clubfeet (9.1%), central nervous system (CNS) (including neural tube defects) (7.9%), musculoskeletal (5.5%) and gastrointestinal systems (4.7%), and hydrops fetalis (4.3%). The babies with major birth defects were associated with lower birth weights, premature deliveries, higher Caesarean section rates, prolonged hospitalization and increased specialist care. Among the cohort of babies with major birth defects, the mortality rate was 25.2% during the perinatal period. Mothers with affected babies were associated with advanced maternal age, birth defects themselves or their relatives but not in their other offspring, and significantly higher rates of previous abortions. The consanguinity rate of 2.4% was twice that of the control population. It is concluded that a birth defects register is needed to monitor these developments and future interventional trials are needed to reduce birth defects in Malaysia.
    Matched MeSH terms: Length of Stay
  14. Kong CH, Ibrahim MF, Zainuddin ZM
    Ann Saudi Med, 2009;29(6):429-32.
    PMID: 19847078 DOI: 10.4103/0256-4947.57163
    BACKGROUND AND OBJECTIVE: For treatment of benign prostatic hyperplasia (BPH), Plasma Kinetic loop Resection of the Prostate (PKRP) is an alternative to conventional monopolar transurethral resection of prostate (TURP). We compared outcomes with the two treatments in a randomized trial.

    PATIENTS AND METHODS: Over a one-year period, we randomly assigned patients with an indication for surgery for BPH and who met inclusion criteria to treatment with either PKRP or TURP. We measured prostate volume by transrectal ultrasound, relief of bladder outlet obstruction, operative time, decline in serum sodium and hemoglobin, weight of resected prostatic chips, duration of catheterization and hospital stay. Patients were evaluated one month after discharge for obstructive symptoms. Complications were also recorded.

    RESULTS: Of 102 patients enrolled, 51 underwent PKRP and 51 underwent TURP. Relief of obstructive symptoms and mean operative time showed no statistically significant difference. The PKRP group had a smaller decline in hemoglobin than the TURP group (0.6 g/dL vs 1.8 g/dL, P=.01), a lower reduction in serum sodium levels (1.03 mmol/L vs 5.01 mmol/L, P=.01), a shorter catheterization time (37.2 hours versus 57.7 hours, P=.03) and a shorter hospital stay (1.5 days versus 2.6 days, P=.02). One patient in the bipolar PKRP group needed recatheterization versus four patients in the TURP group.

    CONCLUSION: PKRP reduces morbidity with an outcome similar to conventional monopolar TURP in the treatment of BPH.

    Matched MeSH terms: Length of Stay
  15. Zangrillo A, Alvaro G, Pisano A, Guarracino F, Lobreglio R, Bradic N, et al.
    Am Heart J, 2016 Jul;177:66-73.
    PMID: 27297851 DOI: 10.1016/j.ahj.2016.03.021
    OBJECTIVE: Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome due to postoperative myocardial dysfunction. Myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and anti-inflammatory), which appears effective in improving clinically relevant outcomes.

    DESIGN: Double-blind, placebo-controlled, multicenter randomized trial.

    SETTING: Tertiary care hospitals.

    INTERVENTIONS: Cardiac surgery patients (n = 1,000) with postoperative myocardial dysfunction (defined as patients with intraaortic balloon pump and/or high-dose standard inotropic support) will be randomized to receive a continuous infusion of either levosimendan (0.05-0.2 μg/[kg min]) or placebo for 24-48 hours.

    MEASUREMENTS AND MAIN RESULTS: The primary end point will be 30-day mortality. Secondary end points will be mortality at 1 year, time on mechanical ventilation, acute kidney injury, decision to stop the study drug due to adverse events or to start open-label levosimendan, and length of intensive care unit and hospital stay. We will test the hypothesis that levosimendan reduces 30-day mortality in cardiac surgery patients with postoperative myocardial dysfunction.

    CONCLUSIONS: This trial is planned to determine whether levosimendan could improve survival in patients with postoperative low cardiac output syndrome. The results of this double-blind, placebo-controlled randomized trial may provide important insights into the management of low cardiac output in cardiac surgery.

    Matched MeSH terms: Length of Stay/statistics & numerical data
  16. Chong SL, Khan UR, Santhanam I, Seo JS, Wang Q, Jamaluddin SF, et al.
    BMJ Open, 2017 Aug 18;7(8):e015759.
    PMID: 28821516 DOI: 10.1136/bmjopen-2016-015759
    OBJECTIVE: We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes.

    DESIGN AND SETTING: We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 - August 2015.

    PARTICIPANTS: We included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients' physical findings on presentation.

    OUTCOMES: Primary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay.

    RESULTS: 1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR 1.0-10.0). Falls predominated especially among children younger than 2 years (82.9%), while road traffic injuries were more likely to occur among children 2 years and above compared with younger children (25.8% vs 11.1%). Centres from upper and lower middle-income countries were more likely to receive head injured children from road traffic collisions compared with those from high-income countries (51.4% and 40.9%, vs 10.9%, p<0.0001) and attended to a greater proportion of children with severe outcomes (58.2% and 28.4%, vs 3.6%, p<0.0001). After adjusting for age, gender, intent of injury and gross national income, traffic injuries (adjusted OR 2.183, 95% CI 1.448 to 3.293) were associated with severe outcomes, as compared with falls.

    CONCLUSIONS: Among children with head injuries, traffic injuries are independently associated with death, endotracheal intubation and neurosurgery. This collaboration among Asian centres holds potential for future prospective childhood injury surveillance.

    Matched MeSH terms: Length of Stay
  17. Koh KH, Chew PH, Kiyu A
    Singapore Med J, 2004 Jan;45(1):28-36.
    PMID: 14976579
    To study the clinical and demographic aspects as well as the outcomes of severe cases of malaria infections managed in the intensive care unit of the Sarawak General Hospital, Kuching from January 1996 to December 2001.
    Matched MeSH terms: Length of Stay/statistics & numerical data
  18. Farouk Musa A, Quan CZ, Xin LZ, Soni T, Dillon J, Hay YK, et al.
    F1000Res, 2018;7:164.
    PMID: 30254739 DOI: 10.12688/f1000research.13244.2
    Background: Atrial fibrillation (AF) is common after cardiac surgery and has been associated with poor outcome and increased resource utilization. The main objective of this study is to determine the incidence of POAF in Malaysia and identify the predictors of developing POAF. The secondary outcome of this study would be to investigate the difference in mortality and morbidity rates and the duration of intensive care unit (ICU), high dependency unit (HDU) and hospital stay between the two. Methods: This is a retrospective single-center, cross sectional study conducted at the National Heart Institute, Malaysia. Medical records of 637 who underwent coronary artery bypass grafting (CABG) surgery in 2015 were accrued. Pre-operative, operative and post-operative information were subsequently collected on a pre-formulated data collection sheet. Data were then analyzed using IBM SPSS v23. Results: The incidence of POAF in our study stands at 28.7% with a mean onset of 45±33 hours post operatively. Variables with independent association with POAF include advancing age, Indian population, history of chronic kidney disease, left ventricular ejection fraction and beta-blocker treatment. The mortality rate is significantly higher statistically ( p < 0.05), and similarly the incidence of stroke. The incidence of other post-operative complications was also significantly higher statistically. The duration of ICU, HDU and hospital stays were statistically longer ( p < 0.001) with higher rates of ICU readmissions and reintubations seen. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and therefore increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.
    Matched MeSH terms: Length of Stay/statistics & numerical data*
  19. McGregor EB
    Med J Malaysia, 1975 Dec;30(2):74-82.
    PMID: 1228385
    Matched MeSH terms: Length of Stay
  20. Lau LG, Kong KO, Chew PH
    Singapore Med J, 2001 Aug;42(8):346-50.
    PMID: 11764050
    To study the demographic and clinical features as well as outcomes of tetanus patients at the Sarawak General Hospital, Kuching from 1990 to 1999.
    Matched MeSH terms: Length of Stay
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