Prolonged ICU stays are associated with high costs and increased mortality. Thus, early prediction of such stays would help clinicians to plan initial interventions, which could lead to efficient utilization of ICU resources. The aim of this study was to develop models for predicting prolonged stays in Japanese ICUs using APACHE II, APACHE III and SAPS II scores. In this multicenter retrospective cohort study, we analyzed the cases of 85,558 patients registered in the Japanese Intensive care Patient Database between 2015 and 2019. Prolonged ICU stay was defined as an ICU stay of >14 days. Multivariable logistic regression analyses were performed to develop three predictive models for prolonged ICU stay using APACHE II, APACHE III and SAPS II scores, respectively. After exclusions, 79,620 patients were analyzed, 2,364 of whom (2.97%) experienced prolonged ICU stays. Multivariable logistic regression analyses showed that severity scores, BMI, MET/RRT, postresuscitation, readmission, length of stay before ICU admission, and diagnosis at ICU admission were significantly associated with higher risk of prolonged ICU stay in all models. The present study developed predictive models for prolonged ICU stay using severity scores. These models may be helpful for efficient utilization of ICU resources.
Abstract Since the start of the coronavirus disease 2019 (COVID-19) pandemic, it has remained unknown whether conventional risk prediction tools used in intensive care units are applicable to patients with COVID-19. Therefore, we assessed the performance of established risk prediction models using the Japanese Intensive Care database. Discrimination and calibration of the models were poor. Revised risk prediction models are needed to assess the clinical severity of COVID-19 patients and monitor healthcare quality in ICUs overwhelmed by patients with COVID-19.
The significance of forelimb morphology has been discussed with a focus on specific morphological aspects; nonetheless, the correlation of overall morphology, including various linear measurements, with respect to ecological preference and adaptation has not been extensively explored, particularly using multiple taxa. We investigated the morphological characteristics of the long bones in the forelimbs of mammalian species and their relationship with specific functional adaptations using 20 linear measurements and 22 terrestrial species from 7 orders. Principal component analysis and canonical discriminant analysis showed that the lengths of the humerus, radius, and ulna as well as the distance from the smallest width to the proximal and distal ends, and the deltoid tuberosity length distinguished four adaptations: arboreal, terrestrial, fossorial, and semi-aquatic. Moreover, our findings indicate that the distance from the smallest width to the proximal and distal ends, the deltoid tuberosity length, and the breadth of the distal end of the humerus are crucial in differentiating semi-arboreal, aquatic, and fossorial species.
Perforation of colon into the pleural space without diaphragmatic hernia is extremely rare. This report illustrates a case of pneumo-pyothorax caused by perforation of metastatic tumor of the transverse colon of a 67-year-old woman with a history of total gastrectomy and splenectomy for advanced gastric carcinoma 4 years before. The patient was admitted to our hospital presenting with fever and dyspnea, which subsided after a thoracic drainage. Cultures of drained effusion revealed Escherichia coli, Klebsiella and Bacteroides. An emergent laparotomy for treatment of mechanical ileus 2 weeks after her admission disclosed a tumor obstructing the splenic flexure of the transverse colon, and a double-barreled colostomy was made. Pathologic examination of the tumors obtained from colon, mesocolon and the parietal peritoneum revealed poorly differentiated adenocarcinoma that was the same as her primary gastric cancer.
Aims & Objectives: As database construction is the cornerstone of quality improvement and research promotion in critical care, we have implemented a new multicenter Japanese Intensive Care Patient Database (JIPAD), which attempts to cover both children and adults. This is an initiative of the Japanese Society of Intensive Care Medicine and was started in 2015. We report the process by which we have integrated pediatric and adult databases and the trajectory of the pediatric data. Methods: JIPAD initially provided the same format for adults and children, including baseline profiles, background comorbidities and admission diagnoses associated with APACHE scoring, treatment modalities, and outcomes. In 2018, we introduced the top 100 pediatric-specific diagnostic codes from the pediatric intensive care registry courteously provided by the Australia & New Zealand Intensive Care Society. Results: The number of annual registered cases increased from 5,908 in 2015 to 37,268 in 2018 as participating centers increased from 9 to 46. Overall, 5% were children, and 70% of them were admitted for post-operative care. Cardiovascular diagnoses were most common, followed by respiratory and then neurological. In 2018, crude ICU and hospital mortality rates were 2.3% and 4.3%, respectively, which were half of those in adults. The median ICU and hospital lengths of stay were equivalent to those in adults at 1.9 days [IQR 0.8–4.9]) and 19 days [IQR 11–46], respectively. Conclusions: Most of the database format can be shared for critically ill children, adolescents, and adults. It efficiently captures all relevant data, enabling comprehensive evaluation of critical care in Japan.
