Many patients meeting criteria for severe sepsis are not given a sepsis-related diagnosis by emergency physicians (EP). This study 1) compares emergency department (ED) interventions and in-hospital outcomes among patients with severe sepsis, based on the presence or absence of sepsis-related diagnosis, and 2) assesses how adverse outcomes relate to three-hour sepsis bundle completion among patients fulfilling severe sepsis criteria but not given a sepsis-related diagnosis. We performed a retrospective cohort study using patients meeting criteria for severe sepsis at two urban, academic tertiary care centers from March 2015 through May 2015. We included all ED patients with the following: 1) the 1992 Consensus definition of severe sepsis, including two or more systemic inflammatory response syndrome criteria and evidence of organ dysfunction; or 2) physician diagnosis of severe sepsis or septic shock. We excluded patients transferred to or from another hospital and those <18 years old. Patients with an EP-assigned sepsis diagnosis created the "Physician Diagnosis" group; the remaining patients composed the "Consensus Criteria" group. The primary outcome was in-hospital mortality. Secondary outcomes included completed elements of the current three-hour sepsis bundle; non-elective intubation; vasopressor administration; intensive care unit (ICU) admission from the ED; and transfer to the ICU in < 24 hours. We compared proportions of each outcome between groups using the chi-square test, and we also performed a stratified analysis using chi square to assess the association between failure to complete the three-hour bundle and adverse outcomes in each group. Of 418 patients identified with severe sepsis we excluded 54, leaving 364 patients for analysis: 121 "Physician Diagnosis" and 243 "Consensus Criteria." The "Physician Diagnosis" group had a higher in-hospital mortality (12.4% vs 3.3%, P < 0.01) and compliance with the three-hour sepsis bundle (52.1% vs 20.2%, P < 0.01) compared with the "Consensus Criteria" group. An incomplete three-hour sepsis bundle was not associated with a higher incidence of death, intubation, vasopressor use, ICU admission or transfer to the ICU in <24 hours in patients without a sepsis diagnosis. "Physician Diagnosis" patients more frequently received sepsis-specific interventions and had a higher incidence of mortality. "Consensus Criteria" patients had infrequent adverse outcomes regardless of three-hour bundle compliance. EPs' sepsis diagnoses reflect risk-stratification beyond the severe sepsis criteria.

Background: Haemophilus influenzae type b (HIB) is a gram-negative pathogenic bacterium that mostly impacts the pediatric and geriatric population, sometimes resulting in permanent sequelae or death. Objective: In this study we set out to discover adverse outcomes from the thimerosal-free HibTITER^® vaccine derived from a Florida Medicaid dataset spanning from January 2003 to June 2007 ( n = 277,484). Methods: HIB vaccinated children were isolated from the Florida Medicaid dataset. Using other HIB vaccines as the control, we analyzed diagnoses for statistically significant adverse outcomes related to the HibTITER^® vaccine (only the strictest p-value of <0.0001 was used in analyzing this dataset). We simultaneously and independently examined the statistical significance of symptoms reported to VAERS related to HIB vaccines to corroborate our findings ( p-value significance was reported at <0.05, <0.001, and <0.0001). Results: The study revealed 19 individual ICD-9 codes positively associated ( p-value<0.0001 post Bonferroni correction) with recipients of the HibTITER^® vaccine within 30-days of vaccination. Of these conditions, 14 have VAERS corroborators. The diseases span severity from mild to life-threatening and areas of respiration (e.g., asthma), gastrointestinal, otolaryngologic (e.g., common cold), dermatologic, generalized infections (e.g., tuberculosis), and other conditions. Conclusion: Incidence of 19 different medical conditions was significantly higher compared to the control group who received other HIB vaccine formulations. These results were corroborated using the VAERS database, and have profound medical implications for the estimated 35 million Americans between the ages of 16 and 33 who received the vaccine.

Introduction: Tracking the COVID-19 pandemic using existing metrics such as confirmed cases and deaths are insufficient for understanding the trajectory of the pandemic and identifying the next wave of cases. In this study, we demonstrate the utility of monitoring the daily number of patients with COVID-like illness (CLI) who present to the Emergency Department (ED) as a tool that can guide local response efforts. Methods: Using data from two hospitals in King County, WA, we examined the daily volume of CLI visits, and compare them to confirmed COVID cases and COVID deaths in the County. A linear regression model with varying lags is used to predict the number of daily COVID deaths from the number of CLI visits. Results: CLI visits appear to rise and peak well in advance of both confirmed COVID cases and deaths in King County. Our regression analysis to predict daily deaths with a lagged count of CLI visits in the ED showed that the R ² value was maximized at 14 days. Conclusions: ED CLI visits are a leading indicator of the pandemic. Adopting and scaling up a CLI monitoring approach at the local level will provide needed actionable evidence to policy makers and health officials struggling to confront this health challenge.

A large body of evidence implicates the exposure of susceptible individuals to acetaminophen in the etiology of ASD. We undertook this study to probe the association between ASD and a wide range of childhood diagnoses that would typically warrant acetaminophen use for treatment of pain, fever, or both. The Florida Medicaid database was utilized as the source of medical records. Associations between “acetaminophen exposure surrogates” and ASD were unexpectedly large, with odds ratios of 2.629 (2.343 to 2.949), p-value < 0.0001, for children with at least four diagnoses considered surrogates for acetaminophen use. When fever alone was inspected girls had a statistically different and greater odds ratio 3.663 (3.264 to 4.109), p-value < 0.0001, compared to boys with an odds ratio of 2.844 (2.664 to 3.036), p-value < 0.0001. The greater odds ratios for girls compared to boys appeared to be a consequence of fewer girls without ASD having acetaminophen exposure surrogates. The presence of less than four exposure surrogates was less well associated with ASD, suggesting that multiple exposure surrogates may carry the greatest relative risk of ASD, especially for girls.

The Louisiana Department of Health provided a dataset of 1,775 children who died before their 3rd birthday, between 2013 and 2024, and were matched to an immunization record. This study analyzes the children vaccinated in their 2nd month of life (60-90 days old) and the outcome of dying in the 3rd month of life (90-120 days old). Children vaccinated in their 2nd month of life were between 29%-74% (depending on vaccine) more likely to die in their 3rd month, between 28%-74% if black, and between 52%-98% if female. Compared collectively, children who received all 6 recommended 2-month vaccines were 68% (68% for blacks and 112% for females) more likely to die in their 3rd month. Not only are these mortality rates elevated, but the causes of death present differently based on vaccination. CDC recommendation-compliant female children were more likely to die of non-leading causes of death, and, in this analysis, included 3 infectious disease and 4 nervous system related mortalities in the vaccinated and zero, in either, for the unvaccinated.