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9 results on '"Sloane, Richard J."'

5. Is use of mechanical ventilation a reasonable proxy indicator for coma among medicare patients hospitalized for acute stroke?

Author

Horner, Ronnie D., Sloane, Richard J., and Kahn, Katherine L.

Subjects
Artificial respiration -- Research, Respirators -- Research, Coma -- Research, Critically ill -- Research, Stroke patients -- Care and treatment
Abstract

Objective. To ascertain whether use of mechanical ventilation on admission to the hospital is a proxy indicator of coma (i.e., very severe stroke) among acute stroke patients. Methods. A secondary analysis of data from a medical record review on a nationally representative sample of 2,824 Medicare patients, ages 65 years or older, who were hospitalized for stroke in 1982-1983 or 1985-1986 in 297 acute care hospitals in 30 areas within five geographically dispersed states. Results. Use of mechanical ventilation on the first day of hospitalization was significantly associated with level of consciousness on admission: [less than] 2 percent of noncomatose patients versus 17.5 percent of comatose (p [less than] .001). With a high specificity and high likelihood ratio for a positive test, use of mechanical ventilation on the first day of hospitalization ruled-in coma. It was also significantly associated with severity of illness, prognostic indicators (i.e., admission through the emergency room, admission to intensive care, and having a "do-not-resuscitate" order written during the hospital stay), and with in-hospital death. Adjusting for patient demographics, stroke type, comorbidity, and process of care, early initiation of mechanical ventilation remained significantly associated with both coma and in-hospital death. Conclusions. A stroke patient's use of mechanical ventilation on the first day of hospitalization is a valid proxy indicator of level of consciousness. Key Words. Cerebrovascular disorders, critical care, patient outcome assessment, prognosis, artificial respiration, In studies of the diagnosis, treatment, and outcomes of cerebrovascular disease, it is essential to adjust for the severity of each patient's stroke in addition to the type of stroke. [...]

Published
1998

9. Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults.

Author

Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Cohen HJ, Gallagher D, Morey MC, McCarty M, Ortel TL, and Hastings SN

Subjects
Aged, Aged, 80 and over, Automation, Female, Humans, Male, Retrospective Studies, Risk Assessment, Data Mining methods, Hospitalization, Venous Thromboembolism
Abstract

Objective: Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algorithm using electronic health record (EHR) data. This study examines the accuracy of APPS and its individual components versus manual data extraction., Methods: This is a retrospective cohort study of hospitalized general internal medicine patients, aged 70 and over. Fourteen clinical variables were collected to determine their PPS; APPS used EHR data exports from health system databases, and a trained abstractor performed manual chart abstractions. We calculated sensitivity and specificity of the APPS, using manual PPS as the gold standard for classifying risk category (low vs. high). We also examined performance characteristics of the APPS for individual variables., Results: PPS was calculated by both methods on 311 individuals. The mean PPS was 3.6 (standard deviation, 1.8) for manual abstraction and 2.8 (1.4) for APPS. In detecting patients at high risk for VTE, the sensitivity and specificity of the APPS algorithm were 46 and 94%, respectively. The sensitivity for APPS was poor (range: 6-34%) for detecting acute conditions (i.e., acute myocardial infarction), moderate (range: 52-74%) for chronic conditions (i.e., heart failure), and excellent (range: 94-98%) for conditions of obesity and restricted mobility. Specificity of the automated extraction method for each PPS variable was > 87%., Conclusion: APPS as a stand-alone tool was suboptimal for classifying risk of VTE occurrence. The APPS accurately identified high risk patients (true positives), but lower scores were considered indeterminate., Competing Interests: None., (Georg Thieme Verlag KG Stuttgart · New York.)

Published
2018
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