No abstract

Background: "Failure to thrive" and associated diagnoses are non-specific terms applied to older adults when there is lack of diagnostic clarity and imply an absence of medical acuity. We investigated the effect of such admission diagnoses on delivery of patient care in a cohort of older adults admitted to a tertiary care teaching hospital. Methods: Retrospective matched cohort study conducted at a tertiary care hospital in Vancouver, BC. Cases identified were adults aged ≥65 years admitted to acute medical wards with an admission diagnosis of "failure to thrive", "FTT", "failure to cope", or "FTC", between January 1, 2016 and November 1, 2017 (n = 60, median age 80 years). Age-matched controls met the same inclusion criteria with admission diagnoses other than those of interest (n = 60, median age 79 years). Results: The primary outcome was time to admission, measured from time points in the emergency room that spanned from triage to completion of admission orders. Secondary outcomes were concordance of admission and discharge diagnoses and length of stay in hospital. The total time from triage to admission for older adults admitted with FTT and associated diagnoses was 10 h 40 min, compared to 6 h 58 min for controls (p = .02). Concordance of admission and discharge diagnoses was only 12% for the "failure to thrive" cohort, and 95% for controls. Notably, 88% of the "failure to thrive" cohort had an acute medical diagnosis at the time of discharge. Patients in this cohort stayed 18.3 days in hospital compared to 10.2 days (p = .001). Conclusions: Patients with an admission diagnosis of FTT or other associated diagnoses had significant delays in care when presenting to the emergency room, despite often having acute medical conditions on presentation. The use of this non-specific label can lead to premature diagnostic closure and should be avoided in clinical practice.

Background: Atrial arrhythmias (AA) are common in adults with congenital heart disease (ACHD). Although Intra-atrial Reentrant Tachycardia (IART) is well described in ACHD, Atrial Fibrillation (AF) is uncommon, but increasingly recognized. Patients with Transposition of the Great Arteries (TGA) and congenitally corrected-TGA (CC-TGA) have a high burden of AA at a relatively young age. However, long-term data of AA and associated thromboembolic risk are lacking in these patients. The prevalence, associated clinical factors, and complications of AA in a longitudinal TGA cohort was studied. Methods: A retrospective cohort study of all TGA patients from a single tertiary care centre was conducted. Data regarding documented atrial arrhythmias, thromboembolic events, and factors associated with thromboembolism were extracted and analyzed. Mean values and standard deviations were calculated for normally distributed continuous variables. When frequencies and means were compared, the chi-squared test and student t-test were used, respectively.

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

No abstract