Chaitanya Pant

Kansas City VA Medical Center, Kansas City, Missouri, United States

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Publications (55)140.85 Total impact

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    ABSTRACT: We analyzed a national U.S. database to study the presentation of children with inflammatory bowel disease (IBD) to the emergency department (ED). Our results indicate that from 2006 - 2010 there was a significant increase in the number of ED visits related to children with IBD accompanied by a contemporaneous decline in the rate of hospitalization that followed these ED visits. Earlier published results have highlighted an increased overall rate of hospitalizations in the U.S. related to children with IBD. In this context, our results support the evidence for an increased prevalence of pediatric IBD in the U.S. in recent years.
    Journal of pediatric gastroenterology and nutrition 04/2015; DOI:10.1097/MPG.0000000000000815 · 2.87 Impact Factor
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    ABSTRACT: Nucleic acid amplification tests including real-time polymerase chain reaction and loop-mediated isothermal DNA amplification (LAMP) are currently used as standalone diagnostic tests of C. difficile infection (CDI) in the United States. These assays are reported to have similar sensitivity and specificity to toxigenic culture. We assessed the diagnostic accuracy and clinical value of LAMP for the diagnosis of CDI. We searched PubMed and 4 other databases to identify diagnostic accuracy studies that compared LAMP with culture cytotoxicity neutralization assay (CCNA) or anaerobic toxigenic culture (TC) of C. difficile from database inception to 2014. We used the random-effects model to calculate pooled sensitivities, specificities, likelihood ratios, diagnostic odds ratios and their 95% CIs. Hierarchical summary receiver operating characteristic curves were constructed. A search of the databases yielded 16 studies (6,979 samples) that met the inclusion criteria. When TC was used as the gold standard (6,572 samples), bivariate analysis yielded a mean sensitivity of 0.95 (95% CI, 0.93-0.97; I2 = 67.4) and a mean specificity of 0.99 (95% CI, 0.96-1.00; I2 = 97.0). With CCNA as a gold standard (407 samples), the mean sensitivity was 0.93 (95% CI, 0.85-0.97; I2 = 68.6) and mean specificity, 0.91 (95% CI, 0.87-0.94; I2 = 90.7). The studies had substantial heterogeneity. None of the subgroups investigated could account for the heterogeneity. LAMP is a useful diagnostic tool with high sensitivity and specificity for detecting CDI. The results should however be interpreted only in the presence of clinical suspicion and symptomatic diarrhoea. Keywords: Loop-mediated isothermal amplification, meta-analysis, C. difficile, specificity, sensitivity
    Diagnostic Microbiology and Infectious Disease 02/2015; IN PRESS. DOI:10.1016/j.diagmicrobio.2015.02.007 · 2.57 Impact Factor
  • Chaitanya Pant, Thomas J Sferra
    Journal of Pediatrics 02/2015; DOI:10.1016/j.jpeds.2014.12.052 · 3.74 Impact Factor
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    ABSTRACT: The objective of this study was to describe the epidemiology and trends in pediatric acute pancreatitis (AP)-associated emergency department (ED) visits in the United States. Estimates of AP-associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample. From 2006 to 2011, there were an estimated total of 78,787 ED visits associated with the diagnosis of AP. The greatest number of ED visits occurred in children 15 to 19 years of age (67.0%). A majority of patients were subsequently admitted to the hospital for further care (74.1%). Risk factors independently associated with an increased rate of hospital admission included 3 or more comorbid conditions (adjusted odds ratio [aOR] 12.81; 95% confidence interval [CI], 11.29-14.56), children younger than 5 years (aOR, 1.73; 95% CI, 1.58-1.89), presentation to a teaching hospital (aOR, 1.68; 95% CI, 1.62-1.74) or a hospital in the Western region of the United States (aOR, 1.48; 95% 1.42-1.54), and health coverage with Medicaid (aOR, 1.23; 95% CI, 1.17-1.29). Acute pancreatitis-associated ED visits increased from 14.5 per 100,000 children in 2006 to 16.1 per 100,000 children in 2011 (11.42% increase; P < 0.01). There has been an increasing incidence of AP-associated ED visits in children from 2006 to 2011.
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    ABSTRACT: OBJECTIVE An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI. DESIGN We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated. RESULTS A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001). CONCLUSIONS Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI. Infect Control Hosp Epidemiol 2015;00(0): 1-9.
    Infection Control and Hospital Epidemiology 01/2015; DOI:10.1017/ice.2014.88 · 3.94 Impact Factor
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    ABSTRACT: There is scant literature about cirrhosis and its associated complications in a non-hospitalized population.To study the epidemiology of cirrhosis-associated Emergency Department visits in the US.Estimates were calculated in patients' ≥18 years using the Nationwide Emergency Department Sample.The number of visits associated with an International Classification of Diseases-9 diagnosis code of cirrhosis increased non-significantly from 23.81/10,000 population (2006) to 23.9/10,000 population (2011; P = 0.05). A majority of these patients (75.30%) underwent hospital admission, the greatest risk factor for this was the presence of ≥3 comorbidities (adjusted odds ratio 30.8; 95% Confidence Interval 30.4-31.2). Infection was the most frequent concurrent complicating diagnosis associated with cirrhosis (20.1%). There was a decreased incidence in most of the complicating conditions except for hepatorenal syndrome and spontaneous bacterial peritonitis.Our results indicate a stable trend for cirrhosis-associated Emergency Department visits from 2006 to 2011. Further studies are required to investigate the increased incidence of spontaneous bacterial peritonitis and hepatorenal renal syndrome in the cirrhotic population.
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    ABSTRACT: Abstract Objective: To describe the epidemiology and trends in pediatric gastrointestinal (GI) bleeding-associated emergency department (ED) visits in the U.S. Methods: Estimates of GI bleeding-associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample (NEDS). Results: From 2006 - 2011, there were an estimated total of 437,283 ED visits associated with diagnosis of GI bleeding. Specifically, there were 88,675 cases of upper GI bleeding, 132,102 cases of lower GI bleeding and 217,008 cases of unspecified GI bleeding. GI bleeding-associated ED visits increased from 82.2/100,000 children in 2006 to 93.9/100,000 children in 2011 (14.3% increase; P<0.01). The rate of increase was chiefly noted for lower GI bleeding (31.3%) followed by unspecified GI bleeding (10.4%) with a relatively minor increase in upper GI bleeding (1.1%). The greatest number of visits occurred in children 15 - 19 years of age (39.2%). A majority of patients underwent routine discharge (80.8%). Risk factors independently associated with an increased rate of hospital admission included ≥3 comorbid conditions (adjusted odds ratio [aOR] 112.2; 95% CI 103.4 -121.7), presentation to a teaching hospital (aOR 3.2; 95% CI 3.1 - 3.2), the presence of upper GI bleeding (aOR 3.1; 95% 3.0 - 3.2), health coverage with private insurance (aOR 1.6; 95% CI 1.6 - 1.7) and children < 5 years of age (aOR 1.3; 95% CI 1.2 - 1.3). Conclusion: Our results indicate that there has been an increasing incidence of GI bleeding-associated ED visits in children from 2006 - 2011 with cases of lower GI bleeding accounting for the largest increase. Only a small number of children merited admission to the hospital, suggesting that a majority of visits involved non-life-threatening bleeds. These data represent important complementary information to the overall study of pediatric GI bleeding in the U.S.
    Current Medical Research and Opinion 12/2014; 31(2):1-17. DOI:10.1185/03007995.2014.986569 · 2.37 Impact Factor
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    ABSTRACT: Objectives The objective was to estimate emergency department (ED) visits for Clostridium difficile infection in the United States for the years 2006 through 2010.Methods Estimates of ED visits for C. difficile infection were calculated in patients 18 years and older using the Nationwide Emergency Department Sample.ResultsDuring the calendar years 2006 through 2010, there were an estimated total of 491,406,018 ED visits. Of these, 462,160 ED visits were associated with a primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of C. difficile. The C. difficile infection ED visit rate (visits/100,000 census population) increased from 34.1 in 2006 to 42.3 in 2010, an increase of 24% (p < 0.01). There was also a significant overall increased trend in the number of ED visits for C. difficile from 2006 through 2010 (p < 0.01). The highest ED visit rate for C. difficile was observed for patients 65 years and older (163.18 per 100,000), while the lowest visit rate was for patients aged 18 to 24 years (5.10 per 100,000). The greatest increase in C. difficile infection visits occurred in the age group 18 to 24 years.Conclusions These results indicate an increased trend of ED visits for C. difficile in the period 2006 through 2010 with an overall population-adjusted increase of 24%. This represents important complementary data to previous studies reporting an increase in the rate of C. difficile infections in the U.S. hospitalized population.
    Academic Emergency Medicine 12/2014; 22(1). DOI:10.1111/acem.12552 · 2.20 Impact Factor
  • Infection Control and Hospital Epidemiology 12/2014; 35(12):1547-8. DOI:10.1086/678607 · 3.94 Impact Factor
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    ABSTRACT: Background: Patients with cystic fibrosis (CF) are reported to have a high asymptomatic carriage rate of Clostridium difficile (C. difficile). However, most reports are limited to case reports and case series. The objective of this study was to investigate the incidence of C. difficile infection (CDI) in hospitalized patients with CF in the United States. Methods: Data were obtained from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2002 to 2010. Data were weighted to generate national-level estimates. Results: For the year 2010, there were a total of 9,706,097 weighted hospital discharges in the 18 – 44 year age group. In this age cohort, 32,541 patients had a diagnosis of CDI and 19,278 patients had a diagnosis of CF. The incidence of CDI in the hospitalized CF population was 1.6% compared to an incidence of 0.3% in the non-CF hospitalized population (P<0.05). After matching to control for demographic factors and comorbidities; patients with CF continued to have a higher risk for CDI than their matched counterparts (OR 3.0 95% CI 2.6-3.5). Patients with CF + CDI had an overall worse outcome than patients with CDI only (P<0.05). Utilizing a multiple variable regression model, patients in the CF + CDI group continued to demonstrate poor outcomes compared to patients in the CDI only group. This was evident as a higher risk of death (adjusted odds ratio (aOR) 3.1 95% CI 1.9-5.1), colectomy (aOR 2.6 95% CI 1.3-5.3) and higher hospital charges (adjusted regression coefficient $42,000 95% CI $22,000- $62,000). The difference in LOS between the two groups was not significant (adjusted regression coefficient 3.3 days 95% CI 0.81-5.8 days). Between the years 2002 – 2010, the incidence of CDI in the hospitalized CF population (ages 18 – 44 years) increased from 0.9% to 1.6% whereas the incidence of CDI in the corresponding non-CF population increased from 0.2% to 0.3%. For both these groups, this represented a significant increasing trend in the incidence of CDI (P<0.05). Conclusion: There was an increasing trend in the incidence of CDI complicating CF in the years 2002 - 2010. CDI had worse outcomes (higher risk of death, colectomy and hospital charges) in the setting of CF.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: There has been an alarming uptrend in the number of cases of C. difficile infection (CDI) after the introduction of real-time PCR based diagnostic testing. The objective of this study was to interrogate a nationwide emergency department (ED) database to determine the trend of ED visits related to CDI for the years 2006-2010. Methods: Data were obtained from the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2006-2010. Data were weighted to generate national-level estimates. Results: For years 2006–2010, a weighted total of 462,160 patients were discharged from the ED with a primary diagnosis of CDI. The rate (cases/100,000 population) of ED visits with CDI as a primary diagnosis increased from 34.08 in 2006 to 42.37 in 2010; this represented an increase of 24.32% (P<0.01). There was an increased trend in the number of ED visits with CDI as a primary diagnosis from 2006–2010 (P<0.01). The highest incidence rate of CDI related ED visits was observed patients ≥ 65 years, while the lowest incidence was in patients 18–24 years. Of the 462,160 patient cohort, 92.48% of cases were admitted as inpatients to the hospital. 17,638 of these patients (4.1%) died during the hospital admit. Inpatient and ED charges increased during the period of the study, from a median of $20,000 (interquartile range [IQR] $25,000) to $24,000 (IQR $27,000) (P<0.01). LOS remained constant at a median of 5 days (IQR 5 days) for this period. Factors associated with an increased risk of hospital admission included female sex, a comorbid burden of ≥3 (aOR 8.25 95% CI 7.89 – 8.62), age ≥65 years (aOR 3.13 95% CI 2.95 – 3.32) and presentation to a metropolitan facility (aOR 2.77 95% CI 2.69 – 2.85). Much smaller risks were associated with female gender (aOR 1.12 95%CI 1.09 – 1.15), Medicaid or Medicare insurance (aOR 1.21 95% CI 1.18 – 1.25), and presentation to a facility in the Southern region of the United States (aOR 1.06 95% CI 1.02 – 1.09). Conclusion: CDI related ED visits represent a considerable burden on the healthcare system in the United States. Additionally, an increasing trend in the incidence of these cases was observed for the years 2006–2010.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Single-center studies suggest an increasing incidence of acute pancreatitis (AP) in children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States. We used the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality for the years 2000 to 2009. Extracted data were weighted to generate national-level estimates. We used the Cochrane-Armitage test to analyze trends; cohort-matching to evaluate the association of AP and in-hospital mortality, length of stay, and charges; and multivariable logistic regression to test the association of AP and demographics and comorbid conditions. We identified 55,012 cases of AP in hospitalized children (1-20 years of age). The incidence of AP increased from 23.1 to 34.9 (cases per 10,000 hospitalizations per year; P<0.001) and for all-diagnoses 38.7 to 61.1 (P<0.001). There was an increasing trend in the incidence of both primary and all-diagnoses of AP (P<0.001). In-hospital mortality decreased (13.1 to 7.6 per 1,000 cases, P<0.001), median length of stay decreased (5 to 4 days, P<0.001), and median charges increased ($14,956 to $22,663, P<0.001). Children with AP compared to those without the disease had lower in-hospital mortality (adjusted odds ratio, aOR 0.86, 95% CI, 0.78-0.95), longer lengths of stay (aOR 2.42, 95% CI, 2.40-2.46), and higher charges (aOR 1.62, 95% CI, 1.59-1.65). AP was more likely to occur in children older than 5 years of age (aORs 2.81 to 5.25 for each 5-year age interval). Hepatobiliary disease was the comorbid condition with the greatest association with AP. These results demonstrate a rising incidence of AP in hospitalized children. Despite improvements in mortality and length of stay, hospitalized children with AP have significant morbidity.
    PLoS ONE 05/2014; 9(5):e95552. DOI:10.1371/journal.pone.0095552 · 3.53 Impact Factor
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    ABSTRACT: http://www.journal-of-hepatology.eu/pb/assets/raw/Health%20Advance/journals/jhepat/EASL2014_abstracts.pdf
    Journal of Hepatology 04/2014; 60(4):S484. DOI:10.1016/S0168-8278(14)61353-2 · 10.40 Impact Factor
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    ABSTRACT: We investigated the volume of endoscopic retrograde cholangiopancreatographies (ERCPs) performed in hospitalized children in the United States utilizing a nationwide healthcare administrative database for the years 2000 to 2009. 22,153 cases of ERCP were identified: 6,372 diagnostic and 17,314 therapeutic (1,533 cases were recorded as undergoing both types during a single hospitalization). The number of ERCPs increased from 5,337 to 6,733 per year; diagnostic ERCPs decreased 43% and therapeutic increased 69% (significant decreasing trends for diagnostic and increasing for therapeutic ERCPs, P < 0.001 for each analysis). Our results define a recent increase in the utilization of therapeutic ERCPs in hospitalized children.
    Journal of pediatric gastroenterology and nutrition 02/2014; DOI:10.1097/MPG.0000000000000333 · 2.87 Impact Factor
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    ABSTRACT: Abstract Objective: To investigate the epidemiology of GI bleeding in hospitalized children in the United States. Methods: Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality for the year 2009. The data were weighted to generate national-level estimates. Results: There were 23,383 pediatric discharges with a diagnosis of GI bleeding accounting for 0.5% of all discharges. Children with a GI bleed as compared to those without were more likely to be male (54.5% vs. 45.8%; P < 0.001), older (children ≥ 11 years; 50.8% vs. 38.7%; P < 0.001), and admitted to a teaching hospital (70.5% vs. 56.4%; P < 0.001). Children 11-15 years of age had the highest incidence of GI bleeding (84.2 per 10,000 discharges) and children less than 1 year of age the lowest (24.4 per 10,000 discharges). The highest incidence of GI bleeding was attributable to cases coded as blood in stool (17.6 per 10,000 discharges) followed by hematemesis (11.2 per 10,000 discharges). Those with a GI bleed had a higher co-morbid burden (12.3% vs. 2.3%; P < 0.001) and severity of illness (40.1% vs. 14.5%; P < 0.001). The highest mortality rates associated with GI bleeding were observed in cases with intestinal perforation (8.7%) and esophageal perforation (8.4%). GI bleeding was independently associated with a higher risk of mortality (aOR 1.68, CI 1.53-1.84). Conclusions: Our results describe the epidemiology of GI bleeding in hospitalized children within the United States. We found a substantial risk of mortality attributable to GI bleeding in this patient population. Our study is limited by the exclusion of non-hospitalized children, the reliance on ICD-9-CM codes and the absence of longitudinal follow up of patients.
    Current Medical Research and Opinion 01/2014; DOI:10.1185/03007995.2014.887003 · 2.37 Impact Factor
  • Current Medical Research and Opinion 01/2014; · 2.37 Impact Factor
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    37th Annual meeting of Society of General Internal Medicine, SGIM 2014; 01/2014
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    Annual meeting of Central Society of Clinical and Translational Research, CSCTR 2014; 01/2014
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    ID Week 2014; 01/2014
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    ABSTRACT: The incidence and prevalence of pediatric inflammatory bowel disease (IBD) seems to be increasing in North America and Europe. Our objective was to evaluate hospitalization rates in children with IBD in the United States during the decade 2000 to 2009. We analyzed cases with a discharge diagnosis of Crohn disease (CD) and ulcerative colitis (UC) within the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality. We identified 61,779 pediatric discharges with a diagnosis of IBD (CD, 39,451 cases; UC, 22,328 cases). The number of hospitalized children with IBD increased from 11,928 to 19,568 (incidence, 43.5-71.5 cases per 10,000 discharges per year; P < 0.001). For CD, the number increased from 7757 to 12,441 (incidence, 28.3-45.0; P < 0.001) and for UC, 4171 to 7127 (15.2-26.0; P < 0.001). Overall, there was a significant increasing trend for pediatric hospitalizations with IBD, CD, and UC (P < 0.001). In addition, there was an increase in IBD-related complications and comorbid disease burden (P < 0.01). There was a significant increase in the number and incidence of hospitalized children with IBD in the United States from 2000 to 2009.
    Journal of Investigative Medicine 06/2013; · 1.50 Impact Factor

Publication Stats

268 Citations
140.85 Total Impact Points

Institutions

  • 2014–2015
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
    • University of Kansas
      • Division of Gastroenterology, Hepatology and Motility
      Lawrence, Kansas, United States
    • Kansas City University of Medicine and Biosciences
      Kansas City, Missouri, United States
  • 2013
    • Case Western Reserve University School of Medicine
      • Department of Pediatrics
      Cleveland, Ohio, United States
  • 2011–2013
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 2010–2013
    • University of Oklahoma Health Sciences Center
      • Department of Pediatrics
      Oklahoma City, Oklahoma, United States
    • Louisiana State University in Shreveport
      Shreveport, Louisiana, United States
  • 2012
    • Cleveland Clinic
      Cleveland, Ohio, United States
  • 2009–2011
    • Louisiana State University Health Sciences Center Shreveport
      • School of Medicine
      Shreveport, Louisiana, United States