Journal of Acute Disease

227-232

Authors: Hakan Aydın, Halil Dogan

Objective: To investigate the effect of the use of color codes for patient triage on physicians’ clinical decision. Methods: This prospective study was conducted among female patients aged 18-65 years who visited the emergency department (ED) with complaints of acute abdominal pain. A 3-level of triage system [red (very urgent), yellow (urgent) and green (less urgent)] was used in our ED. All patients were green level. Half of these patients remained at the green level (the green group), and the remaining patients were re-labeled as false yellow (the false yellow group) in the order of ED visits. Ordering tests, consultation requests, intravenous treatment, length of hospital stay, and cost were compared between the two groups of patients. Results: In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group. There was no statistically significant difference between the two groups in age, temperature, systolic blood pressure, diastolic blood pressure, pulse and oxygen saturation (P>0.05). It was observed that more tests (P=0.001), consultations (P<0.001), and intravenous treatment were requested (P<0.001), and the duration of stay in the ED was longer (P<0.001) and cost (P<0.001) was higher in the false yellow group. Conclusions: Triage do affect the deci

242-246

Authors: Parvesh Malik1 , Shalendra Singh2 , Onkar Singh3 , Mannu Tiwari3 , Nipun Gupta2 , Munish Sood4

Objective: To report demographic and injury characteristics of tendo-Achilles (TA) injury, and determine its association with the use of Indian style commode seat (ISCS), the clinical and functional outcomes. Methods: This observational study was conducted between 1 January 2016 and 31 December 2019, and a total of 44 patients with TA injury were included in the study. Their demographic profile, etiology, operative details, and functional outcomes were studied. All patients underwent primary repair followed by standard postoperative management and follow-up for 6 months. Results: Out of 44 patients, 7 (15.9%) sustained closed injuries while 37 (84.1%) sustained open injuries. In open injury cases, 30 (81%) patients suffered an injury due to slipping in ISCS, 4 (11%) from road traffic accidents, and 3 (8%) due to falling of a heavy object. Besides, 20.45% of cases of ISCS injury had associated neurovascular injury. Twenty (45%) patients took more than 90 days to start independent ambulation. At 6 months follow-up, no one could reach pre-injury fitness status. Conclusions: Open TA injury by ISCS is an important, underreported, and preventable cause of loss of physically active manpower in institutional setups.

252-257

Authors: Ajay Kumar Gupta1 , Neena Katoch2 , Rachna Gulati3 , Vikas Kumar4 , Sharmendra Singh5 , Ketan Garg6 ,

Objectives: To determine COVID-19 mortality and its risk factors in hospitalized patients at of a tertiary care center in north India. Methods: A retrospective observational study was conducted of patients who were hospitalized from May 2020 to January 2021. The in-hospital mortality was assessed, and demographic variables and comorbidities between COVID-19 deaths and survivors were compared. Results: A total of 24000 patients were admitted during the study period, among which 17000 had shown positive results of the RTPCR test for COVID-19. The total mortality was 329 patients (1.37%), among which 232 (70.52%) succumbed due to COVID-19, and 97 (29.48%) died due to other illnesses. The mean age of the patients was (64.09依16.99) years. The mean age was significantly higher in COVID-19 related deaths [(67.63±13.78) years] as compared to that of the survivors [(60.52±19.5) years] (P<0.001). Compared to COVID-19 survivors, there were more males (72.41% v.s. 61.5%) and less females (27.59% v.s. 38.5%) in COVID-19 related deaths (P=0.001). Comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease showed a significant correlation with COVID-19 mortality with an adjusted odds ratio of 2.389 (95% CI: 1.465-2.982), 3.891 (95% CI: 2.059-5.392), and 6.358 (95% CI: 5.675-10.564), respectively. Conclusions: Elderly males with comorbidities have higher risk for mortality related to COVID-19. Ongoing vaccination drive is rightfully prioritised to serve the high-risk category first.

261-264

Authors: Jyoti Aggarwal , Amtoj Singh Lamba, Saurabh Gaba, Monica Gupta, Suraj Kumar Arora

Rationale: COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations. Among them, patients with cardiovascular involvement have a high mortality. Patient’s concerns: A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes, myalgia, and mild respiratory symptoms. Diagnosis: Mild COVID-19 infection with complete heart block. Interventions: Temporary pacing followed by permanent pacemaker insertion 10 days after the onset. Outcomes: The patient was managed as per COVID-19 protocol in an isolation ward, and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative, after which he was shifted back to the cardiac care unit for permanent pacemaker insertion. The patient was discharged after inflammatory markers were normal and clinical condition was completely stable. Lessons: COVID-19 has a wide range of clinical presentations, and extrapulmonary manifestations, especially, cardiovascular involvement can not be ignored.