Abstract 15095: CSHA Frailty Scale as a Predictor of Hospital Readmission After PCI

Introduction: The Canadian Study on Health and Aging (CSHA) Frailty Scale was included in the National Cardiovascular Data Registry’s (NCDR) CathPCI registry beginning April 2018. The value of this frailty assessment as an independent predictor of hospital readmission is unknown. Methods: A retrospective analysis was performed of patients who underwent PCI within the University of North Carolina Medical System between 04/2018 and 12/2018. Outcome data was obtained from our electronic medical record data repository and procedural data from the institutional CathPCI registry. The primary outcome was repeat hospital admission within 1 year of PCI. Significant covariates (p&lt;0.05) in the univariate analyses were considered for inclusion in the multivariate model. Multivariate logistic regression was then performed to determine if CSHA Frailty Scale was an independent predictor of hospital readmission. Results: 1,592 subjects were identified with 367 readmission events. Patients in the readmission cohort were older, had a higher frailty score, and had more comorbidities. Table 1 summarizes the comorbidities included in the logistic regression. CSHA Frailty Scale did not meet significance requirements (P&lt;.05) to be independently associated with readmission. Covariates that were significant independent predictors of readmission included age (OR 1.024, 95% CI 1.012-1.036); cerebrovascular disease (OR 1.688, 95% CI 1.234-2.308); dialysis (OR 2.983, 95% CI, 1.583-5.622); and CHF (OR 2.465, 95% CI, 1.851-3.282). Conclusions: The CSHA Frailty Scale was not independently associated with readmission in the setting of PCI in our health system. This particular assessment of frailty may not provide added value over traditional comorbidities in this patient population. </jats:p

Preoperative Assessment for Children Requiring Dental Treatment Under General Anesthesia

Objective. This study aimed to describe children &lt;6 years requiring general anesthesia for dental treatment and factors associated with a change in medical management prior to surgery. Study design. This case series reviewed the past medical history and preoperative assessment of patients referred for dental preoperative evaluations at a single institution (2005-2008). A “deflection” was defined as a recommendation to change preoperative or operative care based on the preoperative assessment. The sample was analyzed using descriptive, bivariate, and multivariate analyses. Results. Of 648 subjects (aged 9 months to 6 years, mean 3.9 years), 63% had a past medical history abnormality and 38% had previous surgery. In total, 14% were deflected, most commonly because of the addition of infective endocarditis prophylaxis (29%). A history of coagulation disorder had the strongest association with deflection ( P &lt; .0001, odds ratio = 10.0, 95% confidence interval = 4.6-22.1), followed by cardiac anomalies. Conclusion. Preoperative assessments for pediatric dental treatment frequently identify medical problems resulting in treatment plan alterations. </jats:p

Timing and Duration of Sleep in Hospitalized Children: An Observational Study

BACKGROUND AND OBJECTIVES: Sleep during hospitalization is important, but data on children’s sleep quality during hospitalization are lacking. We sought to document sleep duration and awakenings in hospitalized children and explore associations between sleep and chronic care complexity, home sleep quality, and late-night food consumption. METHODS: Children aged 2 to 17 years admitted to a hospitalist service for at least 24 hours were approached for participation. Children were video recorded from 20:00 to 08:00. Paired investigators reviewed recordings and extracted data. Investigators blinded to sleep data separately extracted clinical and demographic information. Analyses included Spearman correlations and linear and generalized linear regression models with t and Wald χ2 tests. RESULTS: The mean time subjects (n = 57) initiated sleep was 22:35 (range: 20:00–02:47), with a mean sleep duration of 475 minutes (89–719 minutes). Subjects awakened 2.2 times (0–7 times, SD: 1.9) per night, on average, with the average total time awake during those awakenings of 55.7 minutes (2–352 minutes, SD: 75 minutes). In multivariate analysis, children with private insurance had longer sleep duration. Additionally, subjects who ate a snack after 21:00 went to sleep much later (odds ratio: 9.5; confidence interval: 2.6 to 34.9) and had 64 minutes less total sleep time and spent less time in bed than patients who did not eat late (P = .007). CONCLUSIONS: Hospitalized children sleep less than recommended and experience frequent awakenings. Some demographic variables are related to sleep. Many hospitalized children also consume food at night, which is associated with later bedtime and less sleep. Future efforts to improve sleep in hospitalized children are needed. </jats:sec