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Article ; Online: Estimating severe and critical illness in children with COVID-19.

Salemi, Jason L / Menard, Janelle / Pathak, Elizabeth Barnett

2020 Volume 144, Page(s) 105052

MeSH term(s)	Betacoronavirus ; COVID-19 ; Child ; Coronavirus Infections ; Critical Illness ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-24
Publishing country	Ireland
Document type	Letter ; Comment
ZDB-ID	752532-1
ISSN	1872-6232 ; 0378-3782
ISSN (online)	1872-6232
ISSN	0378-3782
DOI	10.1016/j.earlhumdev.2020.105052
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Article: Estimating severe and critical illness in children with COVID-19

Salemi, Jason L / Menard, Janelle / Pathak, Elizabeth Barnett

Early Hum Dev

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #116392
Database	COVID19

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Article ; Online: Estimating severe and critical illness in children with COVID-19

Salemi, Jason L. / Menard, Janelle / Pathak, Elizabeth Barnett

Early Human Development

2020 Volume 144, Page(s) 105052

Keywords	Obstetrics and Gynaecology ; Pediatrics, Perinatology, and Child Health ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	752532-1
ISSN	1872-6232 ; 0378-3782
ISSN (online)	1872-6232
ISSN	0378-3782
DOI	10.1016/j.earlhumdev.2020.105052
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: COVID-19 in Children in the United States: Intensive Care Admissions, Estimated Total Infected, and Projected Numbers of Severe Pediatric Cases in 2020.

Pathak, Elizabeth Barnett / Salemi, Jason L / Sobers, Natasha / Menard, Janelle / Hambleton, Ian R

Journal of public health management and practice : JPHMP

2020 Volume 26, Issue 4, Page(s) 325–333

Abstract: Importance: A surge in severe cases of COVID-19 (coronavirus disease 2019) in children would present unique challenges for hospitals and public health preparedness efforts in the United States.: Objective: To provide evidence-based estimates of ... ...

Abstract	Importance: A surge in severe cases of COVID-19 (coronavirus disease 2019) in children would present unique challenges for hospitals and public health preparedness efforts in the United States. Objective: To provide evidence-based estimates of children infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and projected cumulative numbers of severely ill pediatric COVID-19 cases requiring hospitalization during the US 2020 pandemic. Design: Empirical case projection study. Main outcomes and measures: Adjusted pediatric severity proportions and adjusted pediatric criticality proportions were derived from clinical and spatiotemporal modeling studies of the COVID-19 epidemic in China for the period January-February 2020. Estimates of total children infected with SARS-CoV-2 in the United States through April 6, 2020, were calculated using US pediatric intensive care unit (PICU) cases and the adjusted pediatric criticality proportion. Projected numbers of severely and critically ill children with COVID-19 were derived by applying the adjusted severity and criticality proportions to US population data, under several scenarios of cumulative pediatric infection proportion (CPIP). Results: By April 6, 2020, there were 74 children who had been reported admitted to PICUs in 19 states, reflecting an estimated 176 190 children nationwide infected with SARS-CoV-2 (52 381 infants and toddlers younger than 2 years, 42 857 children aged 2-11 years, and 80 952 children aged 12-17 years). Under a CPIP scenario of 5%, there would be 3.7 million children infected with SARS-CoV-2, 9907 severely ill children requiring hospitalization, and 1086 critically ill children requiring PICU admission. Under a CPIP scenario of 50%, 10 865 children would require PICU admission, 99 073 would require hospitalization for severe pneumonia, and 37.0 million would be infected with SARS-CoV-2. Conclusions and relevance: Because there are 74.0 million children 0 to 17 years old in the United States, the projected numbers of severe cases could overextend available pediatric hospital care resources under several moderate CPIP scenarios for 2020 despite lower severity of COVID-19 in children than in adults.
MeSH term(s)	Adolescent ; Betacoronavirus ; COVID-19 ; Child ; Child, Preschool ; Coronavirus Infections/epidemiology ; Critical Care ; Humans ; Infant ; Infant, Newborn ; Pandemics ; Patient Admission ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Severity of Illness Index ; United States/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-06-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2027860-3
ISSN	1550-5022 ; 1078-4659
ISSN (online)	1550-5022
ISSN	1078-4659
DOI	10.1097/PHH.0000000000001190
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Article ; Online: COVID-19 in Children in the United States

Pathak, Elizabeth Barnett / Salemi, Jason L. / Sobers, Natasha / Menard, Janelle / Hambleton, Ian R.

Journal of Public Health Management and Practice

Intensive Care Admissions, Estimated Total Infected, and Projected Numbers of Severe Pediatric Cases in 2020

2020 Volume 26, Issue 4, Page(s) 325–333

Keywords	Public Health, Environmental and Occupational Health ; Health Policy ; covid19
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publishing country	us
Document type	Article ; Online
ZDB-ID	2027860-3
ISSN	1078-4659
ISSN	1078-4659
DOI	10.1097/phh.0000000000001190
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: COVID-19 in Children in the United States: Intensive Care Admissions, Estimated Total Infected, and Projected Numbers of Severe Pediatric Cases in 2020

Pathak, Elizabeth Barnett / Salemi, Jason L / Sobers, Natasha / Menard, Janelle / Hambleton, Ian R

J Public Health Manag Pract

Abstract: IMPORTANCE: A surge in severe cases of COVID-19 (coronavirus disease 2019) in children would present unique challenges for hospitals and public health preparedness efforts in the United States. OBJECTIVE: To provide evidence-based estimates of children ... ...

Abstract	IMPORTANCE: A surge in severe cases of COVID-19 (coronavirus disease 2019) in children would present unique challenges for hospitals and public health preparedness efforts in the United States. OBJECTIVE: To provide evidence-based estimates of children infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and projected cumulative numbers of severely ill pediatric COVID-19 cases requiring hospitalization during the US 2020 pandemic. DESIGN: Empirical case projection study. MAIN OUTCOMES AND MEASURES: Adjusted pediatric severity proportions and adjusted pediatric criticality proportions were derived from clinical and spatiotemporal modeling studies of the COVID-19 epidemic in China for the period January-February 2020. Estimates of total children infected with SARS-CoV-2 in the United States through April 6, 2020, were calculated using US pediatric intensive care unit (PICU) cases and the adjusted pediatric criticality proportion. Projected numbers of severely and critically ill children with COVID-19 were derived by applying the adjusted severity and criticality proportions to US population data, under several scenarios of cumulative pediatric infection proportion (CPIP). RESULTS: By April 6, 2020, there were 74 children who had been reported admitted to PICUs in 19 states, reflecting an estimated 176 190 children nationwide infected with SARS-CoV-2 (52 381 infants and toddlers younger than 2 years, 42 857 children aged 2-11 years, and 80 952 children aged 12-17 years). Under a CPIP scenario of 5%, there would be 3.7 million children infected with SARS-CoV-2, 9907 severely ill children requiring hospitalization, and 1086 critically ill children requiring PICU admission. Under a CPIP scenario of 50%, 10 865 children would require PICU admission, 99 073 would require hospitalization for severe pneumonia, and 37.0 million would be infected with SARS-CoV-2. CONCLUSIONS AND RELEVANCE: Because there are 74.0 million children 0 to 17 years old in the United States, the projected numbers of severe cases could overextend available pediatric hospital care resources under several moderate CPIP scenarios for 2020 despite lower severity of COVID-19 in children than in adults.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32282440
Database	COVID19

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Article: From hospice to hospital: short-term follow-up study of hospice patient outcomes in a US acute care hospital surveillance system.

Pathak, Elizabeth Barnett / Wieten, Sarah / Djulbegovic, Benjamin

BMJ open

2014 Volume 4, Issue 7, Page(s) e005196

Abstract: Objectives: In the USA, there is little systematic evidence about the real-world trajectories of patient medical care after hospice enrolment. The objective of this study was to analyse predictors of the length of stay for hospice patients who were ... ...

Abstract	Objectives: In the USA, there is little systematic evidence about the real-world trajectories of patient medical care after hospice enrolment. The objective of this study was to analyse predictors of the length of stay for hospice patients who were admitted to hospital in a retrospective analysis of the mandatorily reported hospital discharge data. Setting: All acute-care hospitals in Florida during 1 January 2010 to 30 June 2012. Participants: All patients with source of admission coded as 'hospice' (n=2674). Primary outcome measures: The length of stay and discharge status: (1) died in hospital; (2) discharged back to hospice; (3) discharged to another healthcare facility; and (4) discharged home. Results: Patients were elderly (median age=81) with a high burden of disease. Almost half died (46%), while the majority of survivors were discharged to hospice (80% of survivors, 44% of total). A minority went to a healthcare facility (5.6%) or to home (5.2%). Only 9.2% received any procedure. Respiratory services were received by 29.4% and 16.8% were admitted to the intensive care unit. The median length of stay was 1 day for those who died. In an adjusted survival model, discharge to a healthcare facility resulted in a 74% longer hospital stay compared with discharge to hospice (event time ratio (ETR)=1.74, 95% CI 1.54 to 1.97 p<0.0001), with 61% longer hospital stays among patients discharged home (ETR=1.61, 95% CI 1.39 to 1.86 p<0.0001). Total financial charges for all patients exceeded $25 million; 10% of patients who appeared to exit hospice incurred 32% of the charges. Conclusions: Our results raise significant questions about the ethics and pragmatics of end-of-life medical care, and the intentions and scope of hospices in the USA. Future studies should incorporate prospective linkage of subjective patient-centred data and objective healthcare encounter data.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hospice Care ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Discharge ; Patient Outcome Assessment ; Population Surveillance ; Retrospective Studies ; United States
Language	English
Publishing date	2014-07-22
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2599832-8
ISSN	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2014-005196
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Percutaneous coronary intervention, comorbidities, and mortality among emergency department-admitted ST-elevation myocardial infarction patients in Florida.

Pathak, Elizabeth Barnett / Strom, Joel A

Journal of interventional cardiology

2010 Volume 23, Issue 3, Page(s) 205–215

Abstract: Background: Risk of mortality following an ST-elevation myocardial infarction (STEMI) can be significantly reduced by prompt percutaneous coronary intervention (PCI). National guidelines specify primary PCI as the preferred recommended treatment for ... ...

Abstract	Background: Risk of mortality following an ST-elevation myocardial infarction (STEMI) can be significantly reduced by prompt percutaneous coronary intervention (PCI). National guidelines specify primary PCI as the preferred recommended treatment for STEMI. In this study, we examined same-day PCI as an independent predictor of in-hospital mortality, after adjustment for comorbidities, other patient factors, and hospital PCI-volume using unselected surveillance data from Florida. Methods: We analyzed hospital discharge data for adults, 18+ years old, with a primary diagnosis of STEMI who were admitted to PCI-capable hospitals through the emergency department during 2001-2005 (n = 43,849). Hierarchical (multilevel) logistic regression models were used for analysis. Results: Overall, 4,143 STEMI patients (9.4%) did not survive to hospital discharge. In late 2005, the in-hospital mortality rates were 1.9% for those who received same-day PCI versus 13.0% for those who did not. After adjustment for multiple patient factors, same-day PCI was a significant predictor of in-hospital survival with a strong protective effect (adjusted OR = 0.35, 95% CI 0.31-0.38 P < 0.0001). Restriction of the analysis to those patients who survived the first day of admission did not appreciably change this result (adjust OR = 0.37, 95% CI 0.33-0.42, P < 0.0001). Hospital PCI-volume did not significantly impact mortality risk. Conclusions: Same-day PCI markedly reduced the risk of in-hospital mortality among STEMI patients after multivariate adjustment. Serious comorbidities and complications, older age, and female gender continued to predict elevated risk of mortality after control for treatment status. Our results provide additional evidence in support of national clinical recommendations and aggressive treatment of STEMI.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Comorbidity ; Confidence Intervals ; Emergency Service, Hospital/statistics & numerical data ; Female ; Florida ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy ; Odds Ratio ; Patient Discharge/statistics & numerical data ; Risk Assessment ; Risk Factors ; Survival Analysis
Language	English
Publishing date	2010-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1036325-7
ISSN	1540-8183 ; 0896-4327
ISSN (online)	1540-8183
ISSN	0896-4327
DOI	10.1111/j.1540-8183.2010.00541.x
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Article: Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals.

Pathak, Elizabeth Barnett / Comins, Meg M / Forsyth, Colin J / Strom, Joel A

Open heart

2015 Volume 2, Issue 1, Page(s) e000042

Abstract: Objective: To quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, 'STEMI referral ... ...

Abstract	Objective: To quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, 'STEMI referral hospitals'). Background: Negative financial impacts on STEMI referral hospitals have been discussed as an important barrier to implementing regional STEMI bypass/transfer protocols. However, there is little empirical data available that directly quantifies this potential financial impact. Methods: Using detailed financial charges from Florida hospital discharge data, we examined the potential negative financial impact on 112 STEMI referral hospitals from losing all inpatient STEMI revenue. The main outcome was projected revenue loss (PRL), defined as total annual patient with STEMI charges as a proportion of total annual charges for all patients. We hypothesised that for most community hospitals (>90%), STEMI revenue represented only a small fraction of total revenue (<1%). We further examined the financial impact of the 'worst case' scenario of loss of all acute coronary syndrome (ACS) (ie, chest pain) patients. Results: PRLs were $0.33 for every $100 of patient revenue statewide for STEMI and $1.73 for ACS. At the individual hospital level, the 90th centile PRL was $0.74 for STEMI and $2.77 for ACS. PRLs for STEMI were not greater in rural areas compared with major metropolitan areas. Hospital revenue centres that would be most impacted by loss of patients with STEMI were cardiology procedures and intensive care units. Conclusions: Loss of patient with STEMI revenues would result in only a small financial impact on STEMI referral hospitals in Florida under proposed STEMI diversion/rapid transfer protocols. However, spillover loss of patients with ACS would increase revenue loss for many hospitals.
Language	English
Publishing date	2015-06-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2053-3624 ; 2044-6055
ISSN	2053-3624 ; 2044-6055
DOI	10.1136/openhrt-2014-000042
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Recent racial/ethnic disparities in stroke hospitalizations and outcomes for young adults in Florida, 2001-2006.

Pathak, Elizabeth Barnett / Sloan, Michael A

Neuroepidemiology

2009 Volume 32, Issue 4, Page(s) 302–311

Abstract: Background: Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001-2006) trends in stroke hospitalizations ... ...

Abstract	Background: Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001-2006) trends in stroke hospitalizations and hospital case-fatality for black, Hispanic, and white adults aged 25-49 years in Florida. Methods: Hospitalization rates were calculated using population estimates from the census, and hospital discharges with a primary diagnosis of stroke (ICD-9-CM 430, 431, 434, 436) (n = 16,317). Multivariate logistic regression modeling was used to examine racial/ethnic disparities in stroke mortality prior to discharge, after adjustment for patient sociodemographics, stroke subtype, risk factors, and comorbidities. Results: Age-adjusted stroke hospitalization rates for blacks were over 3 times higher than rates for whites, while rates for Hispanics were slightly higher than rates for whites. Hemorrhagic strokes were proportionally greater among Hispanics compared with blacks and whites (p < 0.0001). Blacks were most likely to have diagnosed hypertension (62.3%), morbid obesity (10.9%) or drug abuse (13.6%). Whites were most likely to have diagnosed hyperlipidemia (21.0%), alcohol abuse (9.5%), and to be smokers (30.6%). The in-hospital fatality rate for all strokes was highest among blacks (10.0%) compared with whites (9.0%) and Hispanics (8.2%). After adjustment for age, gender, insurance status, and all diagnosed risk factors and comorbidities, the black excess was no longer observed [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.88-1.15, p = 0.93]. However, the Hispanic advantage in case-fatality was strengthened (OR 0.66, 95% CI 0.55-0.79, p < 0.0001). Separate case-fatality analyses for ischemic versus hemorrhagic strokes yielded similar results. Conclusions: Our study found a strong and persistent black-white disparity in stroke hospitalization rates for young adults. In contrast, rates were similar for Hispanics and whites. Multivariate adjustment explained the 15% excess case-fatality for blacks; the short-term mortality advantage among Hispanics was strengthened after adjustment.
MeSH term(s)	Adult ; African Americans/statistics & numerical data ; Age Factors ; Brain Ischemia/epidemiology ; Brain Ischemia/ethnology ; Brain Ischemia/therapy ; Cerebral Hemorrhage/epidemiology ; Cerebral Hemorrhage/ethnology ; Cerebral Hemorrhage/therapy ; Comorbidity ; European Continental Ancestry Group/statistics & numerical data ; Female ; Florida/epidemiology ; Health Status Disparities ; Hispanic Americans/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Male ; Middle Aged ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; Stroke/epidemiology ; Stroke/ethnology ; Stroke/therapy ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2009
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	603189-4
ISSN	1423-0208 ; 0251-5350
ISSN (online)	1423-0208
ISSN	0251-5350
DOI	10.1159/000208795
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