Systemic infection drives urgent care needs and outcome in adults with long-term neurological conditions
Systemic infection drives urgent care needs and outcome in adults with long-term neurological conditions
It is estimated that 1 in 6 people are living with a long-term neurological condition (LTNC). Although it is likely that systemic infections are a common trigger for urgent tertiary care needs in LTNCs, there is a lack of data. Yet this is important since systemic infections are a modifiable risk factor, and hence the motivation for a formal evaluation. We undertook case note review of 155 consecutive unselected adult patients with LTNC receiving urgent care at a tertiary hospital between November and December 2019. Data were collected on presenting symptoms, diagnosis, length of stay, complications, and change in social needs. The most common LTNCs were neurocognitive disorders (n = 68, 44%), cerebrovascular disorders (n = 65, 42%), and epilepsy (n = 19, 12%). Respiratory infections were most common (n = 40, 62.5%), followed by urinary (n = 16, 25%), skin (n = 4, 6%), gastrointestinal (n = 3, 5%) and bone (n = 1, 1.5%). Systemic infection was the trigger for urgent care in 41.3% of patients and in multivariable regression was associated with an increased likelihood of admission (p < 10 -5, OR = 7.8, Nagelkerke R 2 = 0.37), longer length of stay (p = 0.03, β = 5.91, R 2 = 0.06), and death (p = 0.045, OR = 4.3, Nagelkerke R 2 = 0.22). Altered mental status was the presenting symptom most frequently associated with infection (p < 10 -8, χ 2 test). In conclusion, systemic infections are a major trigger of acute tertiary care needs in adults with LTNCs, and play a role in determining clinical outcome. Since systemic infections are preventable or can be treated if identified early, they may represent a modifiable target to improve quality of life, clinical outcomes and health service efficiency.
Long-term neurological conditions, Systemic infections, Urgent care
Saldanha Ramos, Ana
654c6108-660f-4470-8a81-159e66f5b37a
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Varatharaj, Aravinthan
33d833af-9459-4b21-8489-ce9c0b6a09e0
27 October 2022
Saldanha Ramos, Ana
654c6108-660f-4470-8a81-159e66f5b37a
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Varatharaj, Aravinthan
33d833af-9459-4b21-8489-ce9c0b6a09e0
Saldanha Ramos, Ana, Galea, Ian and Varatharaj, Aravinthan
(2022)
Systemic infection drives urgent care needs and outcome in adults with long-term neurological conditions.
Brain, Behavior, & Immunity - Health, 26, [100538].
(doi:10.1016/j.bbih.2022.100538).
Abstract
It is estimated that 1 in 6 people are living with a long-term neurological condition (LTNC). Although it is likely that systemic infections are a common trigger for urgent tertiary care needs in LTNCs, there is a lack of data. Yet this is important since systemic infections are a modifiable risk factor, and hence the motivation for a formal evaluation. We undertook case note review of 155 consecutive unselected adult patients with LTNC receiving urgent care at a tertiary hospital between November and December 2019. Data were collected on presenting symptoms, diagnosis, length of stay, complications, and change in social needs. The most common LTNCs were neurocognitive disorders (n = 68, 44%), cerebrovascular disorders (n = 65, 42%), and epilepsy (n = 19, 12%). Respiratory infections were most common (n = 40, 62.5%), followed by urinary (n = 16, 25%), skin (n = 4, 6%), gastrointestinal (n = 3, 5%) and bone (n = 1, 1.5%). Systemic infection was the trigger for urgent care in 41.3% of patients and in multivariable regression was associated with an increased likelihood of admission (p < 10 -5, OR = 7.8, Nagelkerke R 2 = 0.37), longer length of stay (p = 0.03, β = 5.91, R 2 = 0.06), and death (p = 0.045, OR = 4.3, Nagelkerke R 2 = 0.22). Altered mental status was the presenting symptom most frequently associated with infection (p < 10 -8, χ 2 test). In conclusion, systemic infections are a major trigger of acute tertiary care needs in adults with LTNCs, and play a role in determining clinical outcome. Since systemic infections are preventable or can be treated if identified early, they may represent a modifiable target to improve quality of life, clinical outcomes and health service efficiency.
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Saldanha Ramos et al 2022
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Accepted/In Press date: 15 October 2022
e-pub ahead of print date: 21 October 2022
Published date: 27 October 2022
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Funding Information:
AV is funded by a MRC fellowship ( MR/R017352/1 )
Keywords:
Long-term neurological conditions, Systemic infections, Urgent care
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Local EPrints ID: 472897
URI: http://eprints.soton.ac.uk/id/eprint/472897
PURE UUID: e27719c6-97b6-4afa-ac66-e7c8ac98548b
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Date deposited: 05 Jan 2023 18:01
Last modified: 17 Mar 2024 03:53
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Author:
Ana Saldanha Ramos
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