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37 results on '"Hospital Mortality/trends"'

1. Survival and causes of death in extremely preterm infants in the Netherlands

Author: René F. Kornelisse, Arno van Heijst, Frank A B A Schuerman, Ruben S G M Witlox, Jacqueline L. van Hillegersberg, Koen P. Dijkman, Wes Onland, Peter H. Dijk, Frank A. M. van den Dungen, Floris Groenendaal, Peter Andriessen, Lisa Broeders, Elke van Westering-Kroon, Pauline E. van Beek, Pediatrics, Neonatology, ARD - Amsterdam Reproduction and Development, Kindergeneeskunde, MUMC+: MA Medische Staf Kindergeneeskunde (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, Pediatric surgery, Amsterdam Reproduction & Development (AR&D), Eindhoven MedTech Innovation Center, Signal Processing Systems, and School of Med. Physics and Eng. Eindhoven
Subjects: Male, Pediatrics, Time Factors, Neonatal intensive care unit, Newborn/mortality, Infant, Premature, Diseases, SDG 3 – Goede gezondheid en welzijn, Cohort Studies, Cause of Death, Infant Mortality, Infant, Very Low Birth Weight, Respiratory Distress Syndrome, Newborn/mortality, LOW-BIRTH-WEIGHT, Hospital Mortality, Neonatal/statistics & numerical data, Netherlands, Original Research, Cause of death, Hospital Mortality/trends, Respiratory Distress Syndrome, OUTCOMES, BORN, Stillbirth/epidemiology, Obstetrics and Gynecology, Gestational age, Diseases/mortality, General Medicine, Stillbirth, Intensive Care Units, Necrotizing/mortality, Infant, Extremely Premature, Neonatal Sepsis/mortality, Female, Neonatal Sepsis, medicine.symptom, Cohort study, medicine.medical_specialty, Cause of Death/trends, Gestational Age, Netherlands/epidemiology, IMPROVEMENT, Extremely Premature, neonatology, WEEKS GESTATION, Intensive Care Units, Neonatal/statistics & numerical data, MORBIDITY, SDG 3 - Good Health and Well-being, Enterocolitis, Necrotizing, Intensive Care Units, Neonatal, medicine, Humans, Neonatology, Enterocolitis, Necrotizing/mortality, Premature, Survival analysis, Respiratory Distress Syndrome, Newborn, Enterocolitis, business.industry, Very Low Birth Weight, MORTALITY, Infant, Newborn, Infant, Guideline, CARE, Newborn, Survival Analysis, TRENDS, Infant, Premature, Diseases/mortality, Low birth weight, Pediatrics, Perinatology and Child Health, business
Abstract: ObjectiveIn the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks’ gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.DesignNational cohort study, using data from the Netherlands Perinatal Registry.PatientsThe study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.Main outcome measuresSurvival to discharge, as well as cause and timing of death.ResultsAfter guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks’ GA (27%–69%, pConclusionsImplementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks’ GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.
Published: 2021

2. Como a Presença de Doenças Cardiovasculares pode Impactar na Morbimortalidade em Pacientes com COVID-19?

Author: Soeiro, Alexandre de Matos
Subjects: Fatores de Risco, Hospital Mortality/trends, Cardiovascular Diseases/complications, SARS-CoV-2, Risk Factors, Mortalidade Hospitalar/tendências, Pulmonary Heart Disease/mortality, Troponina/efeitos adversos, Doenças Cardiovasculares/complicações, Covid-19, Doença Cardiopulmonar/mortalidade, Troponin/adverse effects
Published: 2022

3. Place and Underlying Cause of Death During the COVID-19 Pandemic: Retrospective Cohort Study of 3.5 Million Deaths in England and Wales, 2014 to 2020

Author: Mamas A. Mamas, Jianhua Wu, Muhammad Rashid, Mark A de Belder, M Mafham, Chris P Gale, John E. Deanfield, and Evangelos Kontopantelis
Subjects: Male, COVID-19/diagnosis, Underlying cause of death, Nursing Homes/statistics & numerical data, Disease, 030204 cardiovascular system & hematology, 0302 clinical medicine, Cause of Death, Neoplasms, Pandemic, Hospital Mortality, 030212 general & internal medicine, ONS, Office for National Statistics UK, Wales/epidemiology, Cause of death, Aged, 80 and over, Hospital Mortality/trends, Excess mortality, R735, ICD-10, General Medicine, Middle Aged, Home Care Services, England, Original Article, Female, Neoplasms/mortality, Adult, medicine.medical_specialty, Heart Diseases, Coronavirus disease 2019 (COVID-19), Diagnostic Errors/mortality, Cause of Death/trends, 03 medical and health sciences, RZ, medicine, Humans, Hospice Care/statistics & numerical data, Diagnostic Errors, England/epidemiology, Mortality, Wales, SARS-CoV-2, business.industry, Heart Diseases/mortality, ICD-10, International classification of diseases 10th version, COVID-19, Retrospective cohort study, Nursing Homes, COVID-19, Coronavirus disease, Hospice Care, Death toll, Home Care Services/statistics & numerical data, Emergency medicine, Medical certificate, business, RA, NHS, National Health Service UK, Demography
Abstract: BackgroundThe COVID-19 pandemic has resulted in a high death toll. We aimed to describe the place and cause of death during the COVID-19 pandemic.MethodsThis national death registry included all adult (aged ≥18 years) deaths in England and Wales between 1st January 2014 and 30th June 2020. Analyses were based upon ICD-10 codes corresponding to the underlying cause of death as stated on the Medical Certificate of Cause of Death. Daily deaths during COVID-19 pandemic were compared against the expected daily deaths estimated using Farrington surveillance algorithm for daily historical data between 2014 and 2020, by place and cause of death.FindingsBetween 2nd March and 30th June 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (86.2%) were COVID-19 related. Almost half the excess deaths occurred in care homes (25,611 deaths) where deaths were 55% higher than expected. One fifth of the excess deaths occurred in hospital (15,938 deaths; a proportional increase of 21%) with the remainder occurring at home (16,190 deaths; a proportional increase of 39%). At home, only 14% of 16,190 excess deaths were related to COVID-19, with 5,963 deaths due to cancer and 2,485 deaths due to cardiac disease, very few of which involved COVID-19. In care homes or hospices, 61% of the 25,611 excess deaths were related to COVID-19, 5,539 of which were due to respiratory disease and most of these (4,315 deaths) involved COVID-19. In hospital, there were 16,174 fewer deaths than expected which did not involve COVID-19, and there were 4,088 fewer deaths due to cancer and 1,398 fewer deaths due to cardiac disease than expected.InterpretationThe COVID-19 pandemic has resulted in a substantial increase in the absolute numbers of deaths occurring at home and care homes. There was a huge burden of excess deaths occurring in care homes, which were poorly characterised, and were likely to be, at least in part, the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, which suggests avoidance of hospital care for non-COVID-19 conditions.FundingThe study is unfunded.
Published: 2021

4. Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Author: Pisani, Luigi, Algera, Anna Geke, Neto, Ary Serpa, Azevedo, Luciano, Pham, Tài, Paulus, Frederique, de Abreu, Marcelo Gama, Pelosi, Paolo, Dondorp, Arjen M, Bellani, Giacomo, Laffey, John G, Schultz, Marcus J, Martinez, Amadeu, Leal, Livia, Jorge Pereira, Antonio, de Oliveira Maia, Marcelo, Neto, Josè Aires, Piras, Claudio, Caser, Eliana Bernadete, Moreira, Cora Lavigne, Braga Gusman, Pablo, Dalcomune, Dyanne Moysés, Ribeiro de Carvalho, Alexandre Guilherme, Gondim, Louise Aline Romão, Castelo Branco Reis, Lívia Mariane, da Cunha Ribeiro, Daniel, de Assis Simões, Leonardo, Campos, Rafaela Siqueira, Fernandez Versiani dos Anjos, José Carlos, Bruzzi Carvalho, Frederico, Alves, Rossine Ambrosio, Nunes, Lilian Batista, Réa-Neto, Álvaro, de Oliveira, Mirella Cristine, Tannous, Luana, Cardoso Gomes, Brenno, Rodriguez, Fernando Borges, Abelha, Priscila, Lugarinho, Marcelo E, Japiassu, Andre, de Melo, Hélder Konrad, Lopes, Elton Afonso, Varaschin, Pedro, de Souza Dantas, Vicente Cés, Freitas Knibel, Marcos, Ponte, Micheli, de Azambuja Rodrigues, Pedro Mendes, Costa Filho, Rubens Carmo, Saddy, Felipe, Wanderley Castellões, Théia Forny, Silva, Suzana Alves, Osorio, Luiz Antonio Gomes, Mannarino, Dora, Espinoza, Rodolfo, Righy, Cassia, Soares, Marcio, Salluh, Jorge, Tanaka, Lilian, Aragão, Daniel, Tavares, Maria Eduarda, Kehdi, Maura Goncalves Pereira, Rezende, Valéria Maria Campos, Carbonell, Roberto Carlos Cruz, Teixeira, Cassiano, de Oliveira, Roselaine Pinheiro, Maccari, Juçara Gasparetto, Castro, Priscylla Souza, Berto, Paula, Schwarz, Patricia, Torelly, André Peretti, Lisboa, Thiago, Moraes, Edison, Dal-Pizzol, Felipe, Tomasi Damiani, Cristiane, Ritter, Cristiane, Ferreira, Juliana Carvalho, Teixeira Costa, Ramon, Caruso, Pedro, Amendola, Cristina Prata, de Oliveira, Amanda Maria R R, Silva, Ulysses V A, Sanches, Luciana Coelho, Almeida, Rosana D S, Azevedo, Luciano Cesar, Park, Marcelo, Schettino, Guilherme, Assunção, Murillo Santucci, Silva, Eliezer, Barboza, Carlos Eduardo, Junior, Antonio Paulo Nassar, Marzocchi Tierno, Paulo Fernando G M, Malbouisson, Luis Marcelo, Oliveira, Lucas, Cristovao, Davi, Neto, Manoel Leitão, Rego, Ênio, Fernandes, Fernanda Eugênia, Romano, Marcelo Luz Pereira, Cavalcanti, Alexandre Biasi, de Souza Barros, Dalton, Suzumura, Érica Aranha, Meira, Karla Loureiro, de Oliveira, Gustavo Affonso, Luciano, Paula Menezes, Pacheco, Evelin Drociunas, Mazza, Bruno Franco, Machado, Flavia Ribeiro, Ferreira, Elaine, dos Santos, Ronaldo Batista, Colombo, Alexandra Siqueira, Nogueira, Antonio Carlos, Fernandes, Juliana Baroni, Nóbrega, Raquel Siqueira, do CS Martins, Barbara, Soriano, Francisco, Morsch, Rafaela Deczka, Nunes, Andre Luiz Baptiston, de Almeida, Juliano Pinheiro, Hajjar, Ludhmila, Moulin, Sílvia, Giannini, Fábio Poianas, Baptiston Nunes, Andre Luiz, Rios, Fernando, Van Haren, Frank, Sottiaux, T, Lora, Fredy S, Azevedo, Luciano C, Depuydt, P, Fan, Eddy, Bugedo, Guillermo, Qiu, Haibo, Gonzalez, Marcos, Silesky, Juan, Cerny, Vladimir, Nielsen, Jonas, Jibaja, Manuel, Wrigge, Hermann, Matamis, Dimitrios, Ranero, Jorge Luis, Hashemian, S M, Amin, Pravin, Clarkson, Kevin, Kurahashi, Kiyoyasu, Villagomez, Asisclo, Zeggwagh, Amine Ali, Heunks, Leo M, Laake, Jon Henrik, Palo, Jose Emmanuel, do Vale Fernandes, Antero, Sandesc, Dorel, Arabi, Yaasen, Bumbasierevic, Vesna, Lorente, Jose A, Larsson, Anders, Piquilloud, Lise, Abroug, Fekri, McAuley, Daniel F, McNamee, Lia, Hurtado, Javier, Bajwa, Ed, Démpaire, Gabriel, Francois, Guy M, Sula, Hektor, Nunci, Lordian, Cani, Alma, Zazu, Alan, Dellera, Christian, Insaurralde, Carolina S, Alejandro, Risso V, Daldin, Julio, Vinzio, Mauricio, Fernandez, Ruben O, Cardonnet, Luis P, Bettini, Lisandro R, Bisso, Mariano Carboni, Osman, Emilio M, Setten, Mariano G, Lovazzano, Pablo, Alvarez, Javier, Villar, Veronica, Milstein, Cesar, Pozo, Norberto C, Grubissich, Nicolas, Plotnikow, Gustavo A, Vasquez, Daniela N, Ilutovich, Santiago, Tiribelli, Norberto, Chena, Ariel, Pellegrini, Carlos A, Saenz, María G, Estenssoro, Elisa, Brizuela, Matias, Gianinetto, Hernan, Gomez, Pablo E, Cerrato, Valeria I, Bezzi, Marco G, Borello, Silvina A, Loiacono, Flavia A, Fernandez, Adriana M, Knowles, Serena, Reynolds, Claire, Inskip, Deborah M, Miller, Jennene J, Kong, Jing, Whitehead, Christina, Bihari, Shailesh, Seven, Aylin, Krstevski, Amanda, Rodgers, Helen J, Millar, Rebecca T, Mckenna, Toni E, Bailey, Irene M, Hanlon, Gabrielle C, Aneman, Anders, Lynch, Joan M, Azad, Raman, Neal, John, Woods, Paul W, Roberts, Brigit L, Kol, Mark R, Wong, Helen S, Riss, Katharina C, Staudinger, Thomas, Wittebole, Xavier, Berghe, Caroline, Bulpa, Pierre A, Dive, Alain M, Verstraete, Rik, Lebbinck, Herve, Depuydt, Pieter, Vermassen, Joris, Meersseman, Philippe, Ceunen, Helga, Rosa, Jonas I, Beraldo, Daniel O, Ampinelli, Adenilton M R, Nassar Jr, Antonio P, Mataloun, Sergio, Moock, Marcelo, Thompson, Marlus M, Gonçalves, Claudio H, Antônio, Ana Carolina P, Ascoli, Aline, Biondi, Rodrigo S, Fontenele, Danielle C, Nobrega, Danielle, Sales, Vanessa M, Shindhe, Suresh, Ismail, Dk Maizatul Aiman B Pg Hj, Laffey, John, Beloncle, Francois, Davies, Kyle G, Cirone, Rob, Manoharan, Venika, Ismail, Mehvish, Goligher, Ewan C, Jassal, Mandeep, Nishikawa, Erin, Javeed, Areej, Curley, Gerard, Rittayamai, Nuttapol, Parotto, Matteo, Ferguson, Niall D, Mehta, Sangeeta, Knoll, Jenny, Pronovost, Antoine, Canestrini, Sergio, Bruhn, Alejandro R, Garcia, Patricio H, Aliaga, Felipe A, Farías, Pamela A, Yumha, Jacob S, Ortiz, Claudia A, Salas, Javier E, Saez, Alejandro A, Vega, Luis D, Labarca, Eduardo F, Martinez, Felipe T, Carreño, Nicolás G, Lora, Pilar, Liu, Haitao, Liu, Ling, Tang, Rui, Luo, Xiaoming, An, Youzhong, Zhao, Huiying, Gao, Yan, Zhai, Zhe, Ye, Zheng L, Wang, Wei, Li, Wenwen, Li, Qingdong, Zheng, Ruiqiang, Yu, Wenkui, Shen, Juanhong, Li, Xinyu, Yu, Tao, Lu, Weihua, Wu, Ya Q, Huang, Xiao B, He, Zhenyang, Lu, Yuanhua, Han, Hui, Zhang, Fan, Sun, Renhua, Wang, Hua X, Qin, Shu H, Zhu, Bao H, Zhao, Jun, Liu, Jian, Li, Bin, Liu, Jing L, Zhou, Fa C, Li, Qiong J, Zhang, Xing Y, Li-Xin, Zhou, Xin-Hua, Qiang, Jiang, Liangyan, Gao, Yuan N, Zhao, Xian Y, Li, Yuan Y, Li, Xiao L, Wang, Chunting, Yao, Qingchun, Yu, Rongguo, Chen, Kai, Shao, Huanzhang, Qin, Bingyu, Huang, Qing Q, Zhu, Wei H, Hang, Ai Y, Hua, Ma X, Li, Yimin, Xu, Yonghao, Di, Yu D, Ling, Long L, Qin, Tie H, Wang, Shou H, Qin, Junping, Han, Yi, Zhou, Suming, Vargas, Monica P, Silesky Jimenez, Juan I, González Rojas, Manuel A, Solis-Quesada, Jaime E, Ramirez-Alfaro, Christian M, Máca, Jan, Sklienka, Peter, Gjedsted, Jakob, Christiansen, Aage, Villamagua, Boris G, Llano, Miguel, Burtin, Philippe, Buzancais, Gautier, Beuret, Pascal, Pelletier, Nicolas, Mortaza, Satar, Mercat, Alain, Chelly, Jonathan, Jochmans, Sébastien, Terzi, Nicolas, Daubin, Cédric, Carteaux, Guillaume, de Prost, Nicolas, Chiche, Jean-Daniel, Daviaud, Fabrice, Pham, Tai, Fartoukh, Muriel, Barberet, Guillaume, Biehler, Jerome, Dellamonica, Jean, Doyen, Denis, Arnal, Jean-Michel, Briquet, Anais, Hraiech, Sami, Papazian, Laurent, Follin, Arnaud, Roux, Damien, Messika, Jonathan, Kalaitzis, Evangelos, Dangers, Laurence, Combes, Alain, Au, Siu-Ming, Béduneau, Gaetan, Carpentier, Dorothée, Zogheib, Elie H, Dupont, Herve, Ricome, Sylvie, Santoli, Francesco L, Besset, Sebastien L, Michel, Philippe, Gelée, Bruno, Danin, Pierre-Eric, Goubaux, Bernard, Crova, Philippe J, Phan, Nga T, Berkelmans, Frantz, Badie, Julio C, Tapponnier, Romain, Gally, Josette, Khebbeb, Samy, Herbrecht, Jean-Etienne, Schneider, Francis, Declercq, Pierre-Louis M, Rigaud, Jean-Philippe, Duranteau, Jacques, Harrois, Anatole, Chabanne, Russell, Marin, Julien, Bigot, Charlene, Thibault, Sandrine, Ghazi, Mohammed, Boukhazna, Messabi, Ould Zein, Salem, Richecoeur, Jack R, Combaux, Daniele M, Grelon, Fabien, Le Moal, Charlene, Sauvadet, Elise P, Robine, Adrien, Lemiale, Virginie, Reuter, Danielle, Dres, Martin, Demoule, Alexandre, Goldgran-Toledano, Dany, Baboi, Loredana, Guérin, Claude, Lohner, Ralph, Kraßler, Jens, Schäfer, Susanne, Zacharowski, Kai D, Meybohm, Patrick, Reske, Andreas W, Simon, Philipp, Hopf, Hans-Bernd F, Schuetz, Michael, Baltus, Thomas, Papanikolaou, Metaxia N, Papavasilopoulou, Theonymfi G, Zacharas, Giannis A, Ourailogloy, Vasilis, Mouloudi, Eleni K, Massa, Eleni V, Nagy, Eva O, Stamou, Electra E, Kiourtzieva, Ellada V, Oikonomou, Marina A, Avila, Luis E, Cortez, Cesar A, Citalán, Johanna E, Jog, Sameer A, Sable, Safal D, Shah, Bhagyesh, Gurjar, Mohan, Baronia, Arvind K, Memon, Mohammedfaruk, Muthuchellappan, Radhakrishnan, Ramesh, Venkatapura J, Shenoy, Anitha, Unnikrishnan, Ramesh, Dixit, Subhal B, Rhayakar, Rachana V, Ramakrishnan, Nagarajan, Bhardwaj, Vallish K, Mahto, Heera L, Sagar, Sudha V, Palaniswamy, Vijayanand, Ganesan, Deeban, Mohammadreza Hashemian, Seyed, Jamaati, Hamidreza, Heidari, Farshad, Meaney, Edel A, Nichol, Alistair, Knapman, Karl M, O'Croinin, Donall, Dunne, Eimhin S, Breen, Dorothy M, Clarkson, Kevin P, Jaafar, Rola F, Dwyer, Rory, Amir, Fahd, Ajetunmobi, Olaitan O, O'Muircheartaigh, Aogan C, Black, Colin S, Treanor, Nuala, Collins, Daniel V, Altaf, Wahid, Zani, Gianluca, Fusari, Maurizio, Spadaro, Savino, Volta, Carlo A, Graziani, Romano, Brunettini, Barbara, Palmese, Salvatore, Formenti, Paolo, Umbrello, Michele, Lombardo, Andrea, Pecci, Elisabetta, Botteri, Marco, Savioli, Monica, Protti, Alessandro, Mattei, Alessia, Schiavoni, Lorenzo, Tinnirello, Andrea, Todeschini, Manuel, Giarratano, Antonino, Cortegiani, Andrea, Sher, Sara, Rossi, Anna, Antonelli, Massimo M, Montini, Luca M, Casalena, Paolo, Scafetti, Sergio, Panarello, Giovanna, Occhipinti, Giovanna, Patroniti, Nicolò, Pozzi, Matteo, Biscione, Roberto R, Poli, Michela M, Raimondi, Ferdinando, Albiero, Daniela, Crapelli, Giulia, Beck, Eduardo, Pota, Vincenzo, Schiavone, Vincenzo, Molin, Alexandre, Tarantino, Fabio, Monti, Giacomo, Frati, Elena, Mirabella, Lucia, Cinnella, Gilda, Fossali, Tommaso, Colombo, Riccardo, Terragni, Pierpaolo, Pattarino, Ilaria, Mojoli, Francesco, Braschi, Antonio, Borotto, Erika E, Cracchiolo, Andrea N, Palma, Daniela M, Raponi, Francesco, Foti, Giuseppe, Vascotto, Ettore R, Coppadoro, Andrea, Brazzi, Luca, Floris, Leda, Iotti, Giorgio A, Venti, Aaron, Yamaguchi, Osamu, Takagi, Shunsuke, Maeyama, Hiroki N, Watanabe, Eizo, Yamaji, Yoshihiro, Shimizu, Kazuyoshi, Shiozaki, Kyoko, Futami, Satoru, Ryosuke, Sekine, Saito, Koji, Kameyama, Yoshinobu, Ueno, Keiko, Izawa, Masayo, Okuda, Nao, Suzuki, Hiroyuki, Harasawa, Tomofumi, Nasu, Michitaka, Takada, Tadaaki, Ito, Fumihito, Nunomiya, Shin, Koyama, Kansuke, Abe, Toshikazu, Andoh, Kohkichi, Kusumoto, Kohei, Hirata, Akira, Takaba, Akihiro, Kimura, Hiroyasu, Matsumoto, Shuhei, Higashijima, Ushio, Honda, Hiroyuki, Aoki, Nobumasa, Imai, Hiroshi, Ogino, Yasuaki, Mizuguchi, Ichiko, Ichikado, Kazuya, Nitta, Kenichi, Mochizuki, Katsunori, Hashida, Tomoaki, Tanaka, Hiroyuki, Nakamura, Tomoyuki, Niimi, Daisuke, Ueda, Takeshi, Kashiwa, Yozo, Uchiyama, Akinori, Sabelnikovs, Olegs, Oss, Peteris, Haddad, Youssef, Liew, Kong Y, Ñamendys-Silva, Silvio A, Jarquin-Badiola, Yves D, Sanchez-Hurtado, Luis A, Gomez-Flores, Saira S, Marin, Maria C, Villagomez, Asisclo J, Lemus, Jordana S, Fierro, Jonathan M, Cervantes, Mavy Ramirez, Mejia, Francisco Javier Flores, Gonzalez, Daniel R, Dector, Dulce M, Estrella, Claudia R, Sanchez-Medina, Jorge R, Ramirez-Gutierrez, Alvaro, George, Fernando G, Aguirre, Janet S, Buensuseso, Juan A, Poblano, Manuel, Dendane, Tarek, Balkhi, Hicham, Elkhayari, Mina, Samkaoui, Nacer, Ezzouine, Hanane, Benslama, Abdellatif, Amor, Mourad, Maazouzi, Wajdi, Cimic, Nedim, Beck, Oliver, Bruns, Monique M, Schouten, Jeroen A, Rinia, Myra, Raaijmakers, Monique, Van Wezel, Hellen M, Heines, Serge J, Buise, Marc P, Simonis, Fabienne D, Goodson, Jennifer C, rowne, Troy S B, Navarra, Leanlove, Hunt, Anna, Hutchison, Robyn A, Bailey, Mathew B, Newby, Lynette, Mcarthur, Colin, Kalkoff, Michael, Mcleod, Alex, Casement, Jonathan, Hacking, Danielle J, Andersen, Finn H, Dolva, Merete S, Laake, Jon H, Barratt-Due, Andreas, Noremark, Kim Andre L, Søreide, Eldar, Sjøbø, Brit Å, Guttormsen, Anne B, Yoshido, Hector H Leon, Aguilar, Ronald Zumaran, Oscanoa, Fredy A Montes, Alisasis, Alain U, Robles, Joanne B, Pasanting-Lim, Rossini Abbie B, Tan, Beatriz C, Andruszkiewicz, Pawel, Jakubowska, Karina, Cox, Cristina M, Alvarez, António M, Oliveira, Bruno S, Montanha, Gustavo M, Barros, Nelson C, Pereira, Carlos S, Messias, António M, Monteiro, Jorge M, Araujo, Ana M, Catorze, Nuno T, Marum, Susan M, Bouw, Maria J, Gomes, Rui M, Brito, Vania A, Castro, Silvia, Estilita, Joana M, Barros, Filipa M, Serra, Isabel M, Martinho, Aurelia M, Tomescu, Dana R, Marcu, Alexandra, Bedreag, Ovidiu H, Papurica, Marius, Corneci, Dan E, Negoita, Silvius Ioan, Grigoriev, Evgeny, Gritsan, Alexey I, Gazenkampf, Andrey A, Almekhlafi, Ghaleb, Albarrak, Mohamad M, Mustafa, Ghanem M, Maghrabi, Khalid A, Salahuddin, Nawal, Aisa, Tharwat M, Al Jabbary, Ahmed S, Tabhan, Edgardo, Arabi, Yaseen M, Trinidad, Olivia A, Al Dorzi, Hasan M, Tabhan, Edgardo E, Bolon, Stefan, Smith, Oliver, Mancebo, Jordi, Aguirre-Bermeo, Hernan, Lopez-Delgado, Juan C, Esteve, Francisco, Rialp, Gemma, Forteza, Catalina, De Haro, Candelaria, Artigas, Antonio, Albaiceta, Guillermo M, De Cima-Iglesias, Sara, Seoane-Quiroga, Leticia, Ceniceros-Barros, Alexandra, Ruiz-Aguilar, Antonio L, Claraco-Vega, Luis M, Soler, Juan Alfonso, Lorente, Maria del Carmen, Hermosa, Cecilia, Gordo, Federico, Prieto-González, Miryam, López-Messa, Juan B, Perez, Manuel P, Pere, Cesar P, Allue, Raquel Montoiro, Roche-Campo, Ferran, Ibañez-Santacruz, Marcos, Temprano, Susana, Pintado, Maria C, De Pablo, Raul, Gómez, Pilar Ricart Aroa, Ruiz, Silvia Rodriguez, Moles, Silvia Iglesias, Jurado, Mª Teresa, Arizmendi, Alfons, Piacentini, Enrique A, Franco, Nieves, Honrubia, Teresa, Perez Cheng, Meisy, Perez Losada, Elena, Blanco, Javier, Yuste, Luis J, Carbayo-Gorriz, Cecilia, Cazorla-Barranquero, Francisca G, Alonso, Javier G, Alda, Rosa S, Algaba, Ángela, Navarro, Gonzalo, Cereijo, Enrique, Diaz-Rodriguez, Esther, Marcos, Diego Pastor, Montero, Laura Alvarez, Para, Luis Herrera, Sanchez, Roberto Jimenez, Blasco Navalpotro, Miguel Angel, Abad, Ricardo Diaz, Montiel González, Raquel, Toribio, Dácil Parrilla, Castro, Alejandro G, Artiga, Maria Jose D, Penuelas, Oscar, Roser, Tomas P, Olga, Moreno F, Curto, Elena Gallego, Sánchez, Rocío Manzano, Imma, Vallverdu P, Elisabet, Garcia M, Claverias, Laura, Magret, Monica, Pellicer, Ana M, Rodriguez, Lucia L, Sánchez-Ballesteros, Jesús, González-Salamanca, Ángela, Jimenez, Antonio G, Huerta, Francisco P, Diaz, Juan Carlos J Sotillo, Lopez, Esther Bermejo, Moya, David D Llinares, Alfonso, Alec A Tallet, Eugenio Luis, Palazon Sanchez, Cesar, Palazon Sanchez, Rafael, Sánchez I, Virgilio, Corcoles G, Recio, Noelia N, Adamsson, Richard O, Rylander, Christian C, Holzgraefe, Bernhard, Broman, Lars M, Wessbergh, 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Mark J, Hormis, Anil P, Kannan, Santhana G, Namih, Miriam, Reschreiter, Henrik, Camsooksai, Julie, Kumar, Alek, Rugonfalvi, Szabolcs, Nutt, Christopher, Oneill, Orla, Seasman, Colette, Dempsey, Ged, Scott, Christopher J, Ellis, Helen E, Mckechnie, Stuart, Hutton, Paula J, Di Tomasso, Nora N, Vitale, Michela N, Griffin, Ruth O, Dean, Michael N, Cranshaw, Julius H, Willett, Emma L, Ioannou, Nicholas, Gillis, Sarah, Csabi, Peter, Macfadyen, Rosaleen, Dawson, Heidi, Preez, Pieter D, Williams, Alexandra J, Boyd, Owen, De Gordoa, Laura Ortiz-Ruiz, Bramall, Jon, Symmonds, Sophie, Chau, Simon K, Wenham, Tim, Szakmany, Tamas, Toth-Tarsoly, Piroska, Mccalman, Katie H, Alexander, Peter, Stephenson, Lorraine, Collyer, Thomas, Chapman, Rhiannon, Cooper, Raphael, Allan, Russell M, Sim, Malcolm, Wrathall, David W, Irvine, Donald A, Zantua, Kim S, Adams, John C, Burtenshaw, Andrew J, Sellors, Gareth P, Welters, Ingeborg D, Williams, Karen E, Hessell, Robert J, Oldroyd, Matthew G, Battle, Ceri E, 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Yu D, Ling, Long L, Qin, Tie H, Wang, Shou H, Qin, Junping, Han, Yi, Zhou, Suming, Vargas, Monica P, Silesky Jimenez, Juan I, González Rojas, Manuel A, Solis-Quesada, Jaime E, Ramirez-Alfaro, Christian M, Máca, Jan, Sklienka, Peter, Gjedsted, Jakob, Christiansen, Aage, Villamagua, Boris G, Llano, Miguel, Burtin, Philippe, Buzancais, Gautier, Beuret, Pascal, Pelletier, Nicola, Mortaza, Satar, Mercat, Alain, Chelly, Jonathan, Jochmans, Sébastien, Terzi, Nicola, Daubin, Cédric, Carteaux, Guillaume, de Prost, Nicola, Chiche, Jean-Daniel, Daviaud, Fabrice, Pham, Tai, Fartoukh, Muriel, Barberet, Guillaume, Biehler, Jerome, Dellamonica, Jean, Doyen, Deni, Arnal, Jean-Michel, Briquet, Anai, Hraiech, Sami, Papazian, Laurent, Follin, Arnaud, Roux, Damien, Messika, Jonathan, Kalaitzis, Evangelo, Dangers, Laurence, Combes, Alain, Au, Siu-Ming, Béduneau, Gaetan, Carpentier, Dorothée, Zogheib, Elie H, Dupont, Herve, Ricome, Sylvie, Santoli, Francesco L, Besset, Sebastien L, Michel, Philippe, Gelée, 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H, Willett, Emma L, Ioannou, Nichola, Gillis, Sarah, Csabi, Peter, Macfadyen, Rosaleen, Dawson, Heidi, Preez, Pieter D, Williams, Alexandra J, Boyd, Owen, De Gordoa, Laura Ortiz-Ruiz, Bramall, Jon, Symmonds, Sophie, Chau, Simon K, Wenham, Tim, Szakmany, Tama, Toth-Tarsoly, Piroska, Mccalman, Katie H, Alexander, Peter, Stephenson, Lorraine, Collyer, Thoma, Chapman, Rhiannon, Cooper, Raphael, Allan, Russell M, Sim, Malcolm, Wrathall, David W, Irvine, Donald A, Zantua, Kim S, Adams, John C, Burtenshaw, Andrew J, Sellors, Gareth P, Welters, Ingeborg D, Williams, Karen E, Hessell, Robert J, Oldroyd, Matthew G, Battle, Ceri E, Pillai, Suresh, Kajtor, Istvan, Sivashanmugave, Mageswaran, Okane, Sinead C, Donnelly, Adrian, Frigyik, Aniko D, Careless, Jon P, May, Martin M, Stewart, Richard, Trinder, T John, Hagan, Samantha J, Wise, Matt P, Cole, Jade M, MacFie, Caroline C, Dowling, Anna T, Nin, Nicolá, Nuñez, Edgardo, Pittini, Gustavo, Rodriguez, Ruben, Imperio, María C, Santos, Cristina, 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Vesna, Jovanovic, Bojan, Surbatovic, Maja, Veljovic, Milic, Rodgers, Helen, Dixon, Barry, Smith, Roger, Kol, Mark, Wong, Helen, Schmid, Werner, Hermans, Greet, Bourgeois, Marc, Anquez, Nathalie, Decruyenaere, Johan, DeCrop, Luc, Souza dos Santos, Rafaella, Beraldo, Daniel, dos Santos, Moreno Calcagnotto, Pellegrini, Jose Augusto Santo, Oliveira, Vanessa, Munhoz, Carlo, Peçanha, Ana Carolina, da Silva Ramos, Fernando José, Maia, Israel, Bahl, Marina, Biondi, Rodrigo, Prado, Daniel, Pinto, Sérgio Felix, Salgado, Jean, Falcão, Luis Fernando, Macruz, Tiago, Ruas, Kessia, Mecatti, Giovana Colozza, Caser, Eliane Bernadete, Gava, Isabela Ambrósio, Carreño, Nicolá, Morales, Mauricio, Avendaño, Rossana, Aguirre, Stefania, Sribar, Andrej, Klaric, Vlasta, Skilijic, Sonja, Dvorscak, Matea Bogdanovic, Krkusek, Marijana, Jurjevic, Matija, Karanovic, Nenad, Simurina, Tatjana, Stourac, Petr, Kratochvil, Milan, Schlegel, Christian, Treschan, Tanja A, Schaefer, Maximilian, Aytulun, Akut, Kienbaum, Peter, Jaafar, Rola, Collins, Daniel, Plant, Robert, Melchionda, Giuseppe, Di Lauro, Eduardo, Russotto, Vincenzo, Caione, Raffaele, Mestria, Donatella, Volta, Carlo Alberto, Seghelini, Elisa, Sales, Gabriele, D'Antini, Davide, Severgnini, Paolo, Bacuzzi, Alessandro, Peluso, Lorenzo, Verrastro, Pasquale, Raimondo, Pasquale, Gecaj-Gashi, Agreta, Tuinman, Pieter Roel, Alberts, Erna, van den Hul, Ingrid, Kuiper, Michael, de Wilde, Robert BP, Koopmans, Matty, Kose, Isil, Zincircioglu, Çiler, Dogan, Nazim, Aydin, Demet, Denker, Ahmet Sukru, Buyukkocak, Unase, Akgun, Nur, Turan, Güldem, Senturk, Evren, Demirtürk, Zerrin, Özcan, Perihan Ergin, Ekinci, Osman, Saylan, Sedat, Eren, Gulay, Ulger, Fatma, Dilek, Ahmet, Ulusoy, Hulya, Goktas, Ugur, Soyoral, Lokman, Toman, Huseyin, Orak, Yavuz, Kahveci, Feda, Mills, Gary H, Pinder, Angela, Walker, Rachel, Harrison, Jonathan, Snell, Jane, Pearson, Rachel, Sharman, Michael, Kaloo, Claire, Bynorth, Natalie, Matthews, Kelly, Hughes, Chloe, Rose, Alastair, Simeson, Karen, Niska, Lotta, Huneke, Nathan, Adderly, Jane, Padilla-Harris, Cheryl, Oliver, Rebecca, Brohi, Farooq, Wilson, Natalie, Talbot, Helen, Wilson, Deborah, Smith, Deborah, Dark, Paulo, Evans, Tracey, Fisher, Nicola, Montgomery, Jane, Fitzell, Pauline, Muench, Christoph, Hugill, Keith, Cirstea, Emanuel, Bentley, Andrew, Lynch, Katie, White, Ian, Cooper, Jonathan, Brazier, Melinda, Devile, Michael, Parris, Michael, Gill, Pardeep, Patel, Tasmin, Criswell, John, Trodd, Dawn, Griffin, Denise, Martin, Jane, Wreybrown, Caroline, Bewley, Jeremy, Sweet, Katie, Grimmer, Lisa, Kozlowski, Marta, James, Shanaz, Limb, Jame, Cowton, Amanda, Rogerson, David, Downes, Charlotte, Melbourne, Susan, Humphries, Ryan, Pulletz, Mark, Moreton, Sarah, Janes, Stephanie, Corner, Andrew, Linnett, Vanessa, Ritzema, Jenny, Watters, Malcolm, Windebank, Steve, Chenna, Shailaja, Howard-Griffin, Richard, Turner, Kate, Suresh, Sheeba, Blaylock, Heather, Bell, Stephanie, Blenk, Karl, Everett, Lynn, Hadfield, Daniel, Harris, Clair, Chan, Alexandre, Birch, Sian, Pegg, Claire, Plowright, Catherine, Cooper, Lucy, Hatton, Tom, McCullagh, Iain, Wright, Stephen, Scott, Carmen, Boyd, Christine, Holliday, Mark, Poultney, Una, Crowther, Hannah, Thornthwaite, Sarah, Hollister, Nigel, Hunt, Jane, Skinner, Amanda, Matsa, Ramprasad, Salt, Ruth, Matthews, Claire, Venner, Nicola, Barcraft-Barnes, Helena, Tbaily, Lee, Pogson, David, Mouland, Johanna, Rose, Steve, Lamb, Nicola, Tarmey, Nichola, Knighton, John, Giles, Julian, Weller, Debbie, Reed, Isabelle, Hormis, Anil, Pearson, Sallyane, Harris, Meredith, Howe, Joanne, Paddle, Jonathan, Burt, Karen, Welters, Ingeborg, Walker, Anna, Youds, Laura, Hendry, Sam, Shaw, David, Williams, Karen, Hollands, Robin, Carnahan, Mandy, Stickley, Johanna, Miller, Claire, Donaldson, Denise, Tonks, Louise, Creagh-Brown, Ben, Hull, Daniel, Ortiz-Ruiz, Laura, Gopal, Shammer, Metherell, Stella, Spencer, Hazel, Frey, Christian, Brown, Carly, Clifford, Gayle, Leaver, Susannah, Ryan, Christine, Mellinghoff, Johannes Mellinghoff, Prudden, Sarah Prudden, Green, Helen Green, Roy, Alistair Roy, Furneval, Julie Furneval, Bell, Adam Bell, Lakhani, Sandeep Lakhani, Fasting, Lousie Fasting, Murray, Lorna Murray, Preller, Kobu, McInerney, Amy, Beavis, Sarah, Whileman, Amanda, Toms, Julie, Glenn, Sue, Ramali, Mohamed, Ghosh, Alison, Bullock, Clare, Barrell, Lisa, Young, Eoin, Robertson, Helen, Faulkner, Maria, MacNaughton, Peter, Tyson, Susan, Pulak, Paul, Sewell, Terri-Ann, Smalley, Christopher, Jacob, Reni, Alzugaray, Pedro, Vidal Melo, Marcos F, Joyce, Kristen, Needleman, Joseph, Ahsan, Areef, Faiz, Abul, Alam, AKM Shamsul, Khatoon, Syeda Nafisa, Nath, Ranjan Kumer, Rahman Chowdhury, Mohammed Abdur, Banik, Debabrata, Mondol, Montosh Kumar, Bhuiyan, Sakibur Rahman, Nazneed, Suraiya, Sultana, Rozina, Hamid, Tarikul, Hossain, Mozaffer, Reza, Syed Tariq, Asaduzzaman, Muhammad, Salim, Mohammad, Mostafa Kamal, Abu Hena, Taher, Sheikh Mohammed, Taohid, Taohidul Majid, Karmaker, Pranab, Roy, Sabyasachi, Das, Shantanu, Sarkar, Sohel Ahmed, Dutta, Monju Lal, Roy, Poulomi, Iyer, Shivakumar, Krishna, Bhuvana, Sampath, Sriram, Pattnaik, Rajyabardhan, Kasi, Chinni Krishna, Shah, Jignesh, Dongre, Anand, Reza Hashemian, Seyed Mohammad, Nooraei, Navid, Raessi Estabragh, Reza, Malekmohammad, Majid, Khoundabi, Batoul, Mobasher, Maziar, Mohd Yunos, Nor'azim, Kassim, Mahazir, Voon, Chern Min, Das, Stanis Sutharsa, Azauddin, Siti Nur Suhaila, Dorasamy, Dharshinie, Tai, Li Ling, Mat Nor, Mohd Basri, Zarudin, Nurhafizah, Hasan, Mohd Shahnaz, Jamaluddin, Mohamad Fadhil Hadi, Othman Jailani, Mohamad Irfan, Kayashta, Gyan, Adhikari, Aaradhana, Pangeni, Raju, Hashmi, Madiha, Joseph, Sonia, Akhtar, Aftab, Qadeer, Aayesha, Memon, Iqbal, Ali, Syed Muneeb, Idrees, Farah, Kamal, Saima, Hanif, Sadaf, Rehman, Atta Ur, Taqi, Arshad, Hussain, Tanveer, Farooq, Ahmed, Khaskheli, Saleh, Hayat, Muhammad, Indraratna, Kanishka, Beane, Abigail, Haniffa, Rashan, Samaranayake, Upeka, Mathanalagan, Sathiyamoorthy, Gunaratne, Asoka, Mithraratne, Nimangee, Thilakasiri, Kaushila, Pilimatalawwe, Chamila, Dilhani, Y A Hasitha, Fernando, Marie, Ranatunge, Kumudini, Samarasinghe, Loranthi, Vaas, Manori, Edirisooriya, Manoj, Sigera, Chathurani, Arumoli, Janaki, De Silva, Kesharie, Kudavidanage, Bimal, Pinto, Visanthi, Dissanayake, Lakshman, Chittawatanarat, Kaweesak, Kongpolprom, Napplika, Silachamroon, Udomsak, Pornsuriyasak, Prapaporn, Petnak, Tananchai, Singhatas, Pongsasit, Tangsujaritvijit, Viratch, Rungruanghiranya, Suthat, Piriyapatsom, Annop, Juntaping, Kanokkarn, Trongtrakul, Konlawij, Thungtitigul, Poungrat, Tajarernmuang, Pattraporn, Chatmongkolchart, Sunisa, Bhurayanontachai, Rungsun, Akaraborworn, Osaree, Navasakulpong, Asma, Surasit, Karjbundid, Thwaites, Louise, Nadjm, Behzad, Vu Quoc, Dat, Nguyen Thi Thanh, Ha, Nguyen Van, Kinh, Duong Bich, Thuy, Lam Minh, Yen, Anesthesiology, Intensive care medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, Graduate School, Intensive Care Medicine, AII - Inflammatory diseases, Nursing, and ACS - Microcirculation
Subjects: Male, Sociodemographic Factors, Respiration, Artificial/methods, ARDS, mechanical ventilation, Severity of Illness Index, NO, Settore MED/41 - ANESTESIOLOGIA, 80 and over, Tidal Volume, Humans, Hospital Mortality, Prospective Studies, ddc:610, Developing Countries, Aged, Hospital Mortality/trends, Aged, 80 and over, Developed Countries/statistics & numerical data, Developing Countries/statistics & numerical data, Respiration, Developed Countries, Articles, General Medicine, acute respiratory distress syndrome, Length of Stay, Middle Aged, Respiration, Artificial, Intensive Care Units, Observational Studies as Topic, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Length of Stay/statistics & numerical data, Artificial, Intensive Care Units/statistics & numerical data, Income, Female
Abstract: Contains fulltext : 252214.pdf (Publisher’s version ) (Open Access) BACKGROUND: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. METHODS: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. FINDINGS: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H(2)O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p
Published: 2022

5. COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction

Author: De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Jensen LO, Loh PH, Calmac L, Roura-Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong ASL, Kala P, Diez Gil JL, Carrillo X, Dirksen MT, Becerra-Muñoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld AO, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac A, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martìnez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Fores J, Vignali L, Pereira H, Manzo-Silberman S, Ordonez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Ylitalo A, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe C, Kanakakis J, Faurie B, Gabrielli G, Gutiérrez A, Bachini JP, Rocha A, Tam FC, Rodriguez A, Lukito A, Saint-Joy V, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M, ISACS-STEMI COVID-19, Collaborators, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, De Luca, G., Algowhary, M., Uguz, B., Oliveira, D. C., Ganyukov, V., Zimbakov, Z., Cercek, M., Jensen, L. O., Loh, P. H., Calmac, L., Roura-Ferrer, G., Quadros, A., Milewski, M., Scotto di Uccio, F., von Birgelen, C., Versaci, F., Ten Berg, J., Casella, G., Wong, A. S. L., Kala, P., Diez Gil, J. L., Carrillo, X., Dirksen, M. T., Becerra-Munoz, V. M., Kang-Yin Lee, M., Juzar, D. A., de Moura Joaquim, R., Paladino, R., Milicic, D., Davlouros, P., Bakraceski, N., Zilio, F., Donazzan, L., Kraaijeveld, A. O., Galasso, G., Lux, A., Marinucci, L., Guiducci, V., Menichelli, M., Scoccia, A., Yamac, A., Ugur Mert, K., Flores Rios, X., Kovarnik, T., Kidawa, M., Moreu, J., Flavien, V., Fabris, E., Lozano Martinez-Luengas, I., Boccalatte, M., Bosa Ojeda, F., Arellano-Serrano, C., Caiazzo, G., Cirrincione, G., Kao, H. -L., Sanchis Fores, J., Vignali, L., Pereira, H., Manzo-Silberman, S., Ordonez, S., Ozkan, A. A., Scheller, B., Lehtola, H., Teles, R., Mantis, C., Ylitalo, A., Brum Silveira, J. A., Zoni, R., Bessonov, I., Savonitto, S., Kochiadakis, G., Alexopoulos, D., Uribe, C., Kanakakis, J., Faurie, B., Gabrielli, G., Gutierrez, A., Bachini, J. P., Rocha, A., Tam, F. C., Rodriguez, A., Lukito, A., Saint-Joy, V., Pessah, G., Tuccillo, B., Cortese, G., Parodi, G., Bouraghda, M. A., Kedhi, E., Lamelas, P., Suryapranata, H., Nardin, M., and Verdoia, M.
Subjects: Registrie, Male, ST Elevation Myocardial Infarction/diagnosis, Time Factors, Percutaneous, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Coronary Artery Disease, Practice Patterns, 030204 cardiovascular system & hematology, Rate ratio, Time-to-Treatment/trends, Cardiologists, 0302 clinical medicine, Retrospective Studie, Heart Rate, Risk Factors, Pandemic, ST segment, Registries, Hospital Mortality, 030212 general & internal medicine, Myocardial infarction, Practice Patterns, Physicians', 10. No inequality, Percutaneous Coronary Intervention/adverse effects, Hospital Mortality/trends, COVID-19, myocardial infarction, percutaneous coronary intervention, Incidence, Incidence (epidemiology), Middle Aged, 3. Good health, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cardiologists/trends, Human, Aged, Humans, Percutaneous Coronary Intervention, Retrospective Studies, Risk Assessment, ST Elevation Myocardial Infarction, Time-to-Treatment, medicine.medical_specialty, Time Factor, Coronavirus disease 2019 (COVID-19), Cardiologist, 03 medical and health sciences, Internal medicine, medicine, Acute Coronary Syndrome, Pandemics, Physicians', SARS-CoV-2, business.industry, Risk Factor, COVID-19, myocardial infarction, percutaneous coronary intervention, Percutaneous coronary intervention, medicine.disease, Practice Patterns, Physicians'/trends, business
Abstract: ObjectiveThe initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days).MethodsThis is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality.ResultsIn 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (pConclusionPercutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic.Trial registration numberNCT04412655.
Published: 2022

6. Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry

Author: Gianluca Caiazzo, Giuseppe De Luca, Sébastien Levesque, Victor Becerra, Filippo Zilio, Gabriele Gabrielli, Xacobe Flores Rios, José Moreu, Tomas Kovarnik, Wojtek Wojakowski, Juan Sanchis Forés, Luca Donazzan, Dimitrios Alexopoulos, Gerard Rourai Ferrer, Luigi Vignali, Alessandra Scoccia, Giuseppe Uccello, Lucia Marinucci, Marco Boccalatte, Lisette Okkels Jensen, Enrico Fabris, Michał Kidawa, Miha Cercek, Ylitalo Antti, Stephane Manzo, Lucian Calmac, Gennaro Galasso, Vincenzo Guiducci, Iñigo Lozano Martínez-Luengas, Petr Kala, Elvin Kedhi, Bruno Scheller, Monica Verdoia, Bor Wilbert, Maurizio Menichelli, Benjamin Faurie, Thomas W Johnson, Alejandro Gutierrez Barrios, José Luis Díez Gil, Giuliana Cortese, Clemens von Birgelen, Guido Parodi, Raul Moreno, Francesco Versaci, Arpad Lux, Santiago Camacho-Freiere, Xavier Carrill, Periklis Davlouros, Mika Laine, Adriaan O. Kraaijeveld, Heidi Lehtola, Jurriën M. ten Berg, Gianni Casella, Vladimir Ganyukov, Ciro De Simone, Nikola Bakraceski, Rui Campante Teles, Maurits T. Dirksen, Francisco Bosa Ojeda, Marija Vavlukis, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, [De Luca,G, Verdoia,M] Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy. giuseppe.deluca@med.uniupo.it. [Cercek,M] Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia. [Jensen,LO] Division of Cardiology, Odense Universitets Hospital, Odense, Danemark. [Vavlukis,M] University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia. [Calmac,L] Clinic Emergency Hospital of Bucharest, Bucharest, Romania. [Johnson,T] Division of Cardiology, Bristol Heart Institute, University Hospitals Bristol, NHSFT & University of Bristol, Bristol, UK. [Roura i Ferrer,G] Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain. [Ganyukov,V] 8Division of Cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia. [Wojakowski,W] Division of Cardiology, Medical University of Silezia, Katowice, Poland. [von Birgelen,C] Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands. [Versaci,F] Division of Cardiology, Ospedale Santa Maria Goretti, Latina, Italy. [Ten Berg,J] Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands. [Laine,L] Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland. [Dirksen,M] Division of Cardiology, Northwest Clinic, Alkmaar, The Netherlands. [Casella,G] Division of Cardiology, Ospedale Maggiore, Bologna, Italy. [Kala,P] University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic. [Díez Gil,JL] H. Universitario y Politécnico La Fe, Valencia, Spain. [Becerra,V] Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. [De Simone,C] Division of Cardiology, Clinica Villa dei Fiori, Acerra, Italy. [Carrill,X] Hospital Germans Triasi Pujol, Badalona, Spain. [Scoccia,A] Division of Cardiology, Ospedale 'Sant'Anna', Ferrara, Italy. [Lux,A] Maastricht University Medical Center, Maastricht, The Netherlands. [Kovarnik,T] University Hospital Prague, Prague, Czech Republic. [Davlouros,P] Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece. [Gabrielli,G] Interventional Cardiology Unit, Azienda Ospedaliero Universitaria 'Ospedali Riuniti', Ancona, Italy. [Flores Rios,X] Complexo Hospitaliero Universitario La Coruna, La Coruna, Spain. [Bakraceski,N] Center for Cardiovascular Diseases, Ohrid, North Macedonia. [Levesque,S] Center Hospitalier, Universitaire de Poitiers, University Hospital, Poitiers, France. [Guiducci,V] AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy. [Kidawa,M] Central Hospital of Medical University of Lodz, Łódź, Poland. [Marinucci,L] Division of Cardiology, AziendaOspedaliera 'Ospedali Riuniti Marche Nord', Pesaro, Italy. [Zilio,F] Ospedale Santa Chiara di Trento, Trento, Italy. [Galasso,G] Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. [Fabris,E] Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Trieste, Italy. [Menichelli,M] Division of Cardiology, Ospedale 'F. Spaziani, Frosinone, Italy. [Manzo,S] Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France. [Caiazzo,G] Division of Cardiology, Ospedale 'G Moscati', Aversa, Italy. [Moreu,J] Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain. [Sanchis Forés,J] Division of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain. [Donazzan,L] Division of Cardiology, Ospedale 'S. Maurizio' Bolzano Ospedale 'S. Maurizio', Bolzano, Italy. [Vignali,L] Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy. [Teles,R] Division of Cardiology, Hospital de Santa Cruz, CHLO - Carnaxide, Carnaxide, Portugal. [Bosa Ojeda,F] Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. [Lehtola,H] Division of Cardiology, Oulu University Hospital, Oulu, Finland. [Camacho‑Freiere,S] Division of Cardiology, Juan Ramon Jimenez Hospital, Huelva, Spain. [Kraaijeveld,A] Division of Cardiology, UMC Utrecht, Utrecht, The Netherlands. [Antti,Y] Division of Cardiology, Heart Centre Turku, Turku, Finland. [Boccalatte,M] Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy. [Lozano Martínez‑Luengas,I] Division of Cardiology, Hospital Cabueñes, Gijon, Spain. [Scheller,B] Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Saarbrücken, Germany. [Alexopoulos,D] Division of Cardiology, Attikon University Hospital, Athens, Greece. [Faurie,B] Division of Cardiology, Ospedale 'A. Manzoni' Lecco, Lecco, Italy. [Gutierrez Barrios,A] Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France. [Wilbert,B] Division of Cardiology, Hospital Puerta del Mar, Cadiz, Spain. [Cortese,G] Department of Statistical Sciences, University of Padova, Padova, Italy. [Moreno,R] Division of Cardiology, Hospital la Paz, Madrid, Spain. [Parodi,G] Azienda Ospedaliero-Universitaria Sassari, Sassari, Italy. [Kedhi,E] Division of Cardiology, St-Jan Hospital, Brugge, Belgium. [Verdoia,M] Division of Cardiology, Ospedale degli Infermi, ASL Biella, Ponderano, Italy., HUS Heart and Lung Center, Kardiologian yksikkö, De Luca, G., Cercek, M., Jensen, L. O., Vavlukis, M., Calmac, L., Johnson, T., Roura i Ferrer, G., Ganyukov, V., Wojakowski, W., von Birgelen, C., Versaci, F., Ten Berg, J., Laine, M., Dirksen, M., Casella, G., Kala, P., Diez Gil, J. L., Becerra, V., De Simone, C., Carrill, X., Scoccia, A., Lux, A., Kovarnik, T., Davlouros, P., Gabrielli, G., Flores Rios, X., Bakraceski, N., Levesque, S., Guiducci, V., Kidawa, M., Marinucci, L., Zilio, F., Galasso, G., Fabris, E., Menichelli, M., Manzo, S., Caiazzo, G., Moreu, J., Sanchis Fores, J., Donazzan, L., Vignali, L., Teles, R., Bosa Ojeda, F., Lehtola, H., Camacho-Freiere, S., Kraaijeveld, A., Antti, Y., Boccalatte, M., Martinez-Luengas, I. L., Scheller, B., Alexopoulos, D., Uccello, G., Faurie, B., Gutierrez Barrios, A., Wilbert, B., Cortese, G., Moreno, R., Parodi, G., Kedhi, E., and Verdoia, M.
Subjects: Registrie, Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Infarto del miocardio con elevación del ST, Time Factors, COVID-19/diagnosis, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies [Medical Subject Headings], Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings], Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, PRIMARY ANGIOPLASTY, 030204 cardiovascular system & hematology, Rate ratio, Geographical Locations::Geographic Locations::Europe::Europe, Eastern [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Time-to-Treatment/trends, 0302 clinical medicine, Retrospective Studie, Risk Factors, Síndrome coronario agudo, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Registries, Diabetes Mellitus/diagnosis, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Time-to-Treatment [Medical Subject Headings], Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings], Original Investigation, Percutaneous Coronary Intervention/adverse effects, Aged, COVID-19, Diabetes Mellitus, Europe, Female, Humans, Hypertension, Middle Aged, Percutaneous Coronary Intervention, Retrospective Studies, ST Elevation Myocardial Infarction, Time-to-Treatment, Treatment Outcome, Hospital Mortality/trends, Health Care::Health Services Administration::Organization and Administration::Records as Topic::Registries [Medical Subject Headings], education.field_of_study, Incidence (epidemiology), Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Endovascular Procedures::Percutaneous Coronary Intervention [Medical Subject Headings], Diabetes Mellitu, Intervención coronaria percutánea, 3. Good health, surgical procedures, operative, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, ACUTE MYOCARDIAL-INFARCTION, Time Factor, Population, Health Care::Environment and Public Health::Public Health::Epidemiologic Factors::Causality::Risk Factors [Medical Subject Headings], Europe/epidemiology, Diseases::Cardiovascular Diseases::Vascular Diseases::Hypertension [Medical Subject Headings], 03 medical and health sciences, Hypertension/epidemiology, Internal medicine, Diabetes mellitus, medicine, cardiovascular diseases, education, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], Pandemia, Pandemic, Diseases::Endocrine System Diseases::Diabetes Mellitus [Medical Subject Headings], ST Elevation Myocardial Infarction/mortality, business.industry, Risk Factor, MORTALITY, Percutaneous coronary intervention, Persons::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Retrospective cohort study, medicine.disease, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings], lcsh:RC666-701, 3121 General medicine, internal medicine and other clinical medicine, Reperfusion, Conventional PCI, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Hospital Mortality [Medical Subject Headings], business
Abstract: Background It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes–ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19. Methods The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality. Results A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73–0.85, p p p Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients. Conclusions The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic. Trial registration number: NCT 04412655.
Published: 2020

7. Trends in Intensive Care for Patients with COVID-19 in England, Wales, and Northern Ireland

Author: David A Harrison, Karen Thomas, Doug W Gould, James C Doidge, Paul R Mouncey, Paloma Ferrando-Vivas, Kathryn M Rowan, and Manu Shankar-Hari
Subjects: Clinical audit, Comorbidity, Critical Care and Intensive Care Medicine, Logistic regression, Severity of Illness Index, 0302 clinical medicine, Risk Factors, Medicine, 030212 general & internal medicine, Hospital Mortality, Socioeconomics, Wales/epidemiology, intensive care, COVID-19/epidemiology, Hospital Mortality/trends, education.field_of_study, Critical Care/methods, Age Factors, Middle Aged, Intensive Care Units, England, England wales, Cohort, Intensive Care Units/statistics & numerical data, Female, COVID-19/Critical Care, Pulmonary and Respiratory Medicine, trends, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critical Care, Population, Northern Ireland, Northern ireland, 03 medical and health sciences, general_medical_research, Case mix index, Intensive care, Humans, England/epidemiology, education, Pandemics, Aged, Retrospective Studies, Northern Ireland/epidemiology, Wales, business.industry, SARS-CoV-2, Editorials, COVID-19, Original Articles, Length of Stay, medicine.disease, mortality, Confidence interval, United Kingdom, 030228 respiratory system, Emergency medicine, business
Abstract: Rationale: Examining trends in patient characteristics, processes of care and outcomes, across an epidemic, provides important opportunities for learning. Objectives: To report and explore changes in admission rates, patient characteristics, processes of care and outcomes for all patients with COVID-19 admitted to intensive care units (ICUs) in England, Wales and Northern Ireland. Methods: Population cohort of 10,287 patients with COVID-19 in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020. Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region. Multivariable logistic regression was used to estimate differences in 28-day mortality, adjusting for patient characteristics over time. Main results: Admissions to ICU peaked simultaneously across regions on 1 April, with ongoing admissions peaking ten days later. Compared with pre- and post-peak periods, patients admitted during the peak were slightly younger but had greater respiratory and renal dysfunction. Use of invasive ventilation and renal replacement reduced over time. Twenty-eight-day mortality reduced from 43.5% (95% CI 41.6% to 45.5%) pre-peak to 34.3% (95% CI 32.3% to 36.2%) post-peak; a difference of −8.8% (95% CI: −5.2%, −12.3%) after adjusting for patient characteristics. London experienced the highest admission rate and had higher mortality during the peak period but a greater reduction in post-peak mortality. Conclusion: This study highlights changes in patient characteristics, processes of care and outcomes, during the UK COVID-19 epidemic. After adjusting for the changes in patient characteristics and first 24-hour physiology, there was substantial improvement in 28-day mortality over the course of the epidemic.
Published: 2020

8. Sex Differences in Mortality Rates and Underlying Conditions for COVID-19 Deaths in England and Wales

Author: Jianhua Wu, Muhammad Rashid, Courtney Stephenson, Tom Denwood, Evangelos Kontopantelis, Thomas F. Lüscher, Mamas A. Mamas, John E. Deanfield, Mark A de Belder, Miqdad Asaria, Tim Doran, Mohamed O. Mohamed, Chris Roebuck, and Chris P Gale
Subjects: sex differences, Male, HA, Disease, 030204 cardiovascular system & hematology, outcomes, 0302 clinical medicine, CVD, Cardiovascular disease, ASMR, Age standardized mortality rate, Cause of Death, Pandemic, Hospital Mortality, 030212 general & internal medicine, Wales/epidemiology, Cause of death, Hospital Mortality/trends, Mortality rate, Age Factors, R735, Healthcare Disparities/statistics & numerical data, General Medicine, Middle Aged, England, Female, Coronavirus Infections, Coronavirus Infections/mortality, Adult, Acute coronary syndrome, Pneumonia, Viral, ACS, Acute coronary syndrome, Article, IHD, Ischemic heart disease, Betacoronavirus, 03 medical and health sciences, Age Distribution, Diabetes mellitus, medicine, Humans, Dementia, England/epidemiology, Healthcare Disparities, Sex Distribution, Pandemics, Aged, Retrospective Studies, Wales, ONS, Office for National Statistics, SARS-CoV-2, business.industry, COVID-19, Retrospective cohort study, medicine.disease, R1, United Kingdom, deaths, Socioeconomic Factors, Pneumonia, Viral/mortality, business, Demography
Abstract: OBJECTIVE: To address the issue of limited national data on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups.PATIENTS AND METHODS: All adult (≥18 years) deaths recorded in England and Wales (March 1, 2020, to May 12, 2020) were analyzed retrospectively. We compared the prevalence of underlying health conditions between COVID and non-COVID-related deaths during the COVID-19 pandemic and the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group.RESULTS: Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID deaths. Women represented 43.2% (n=15,731) of COVID deaths compared with 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger than non-COVID deaths (82 vs 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30 and 79 years. A linear relationship was observed between ASMR and age among COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease, and diabetes, and these were higher among COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths.CONCLUSION: In a nationwide analysis, COVID-19 infection was associated with higher age-standardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.
Published: 2020
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9. Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study

Author: Laurence Genton, Aline Mendes, Marie Claire Jacques, Thomas Fassier, Max Scheffler, Dina Zekry, Philippe Huber, Katharine Di Silvestro, Christine Serratrice, Véronique Trombert, Samuel Perivier, Christophe Graf, Xavier Roux, Virginie Prendki, François Herrmann, Stéphan Juergen Harbarth, and Gabriel Gold
Subjects: Coronavirus Infections/mortality, Male, medicine.medical_specialty, Pneumonia, Viral, Vital signs, Comorbidity, Logistic regression, ddc:616.0757, Original Studies, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Internal medicine, Fraction of inspired oxygen, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Mortality, Pandemics, General Nursing, Aged, Proportional Hazards Models, Retrospective Studies, Geriatrics, ddc:616, Aged, 80 and over, Hospital Mortality/trends, business.industry, Proportional hazards model, SARS-CoV-2, Health Policy, Medical record, COVID-19, Retrospective cohort study, General Medicine, medicine.disease, Prognosis, older patients, ddc:618.97, Pneumonia, Viral/mortality, Female, Geriatrics and Gerontology, business, Coronavirus Infections, 030217 neurology & neurosurgery, Forecasting
Abstract: Objective To determine predictors of in-hospital mortality related to COVID-19 in older patients. Design Retrospective cohort study. Setting and Participants Patients aged 65 years and older hospitalized for a diagnosis of COVID-19. Methods Data from hospital admission was collected from the electronic medical records. Logistic regression and Cox proportional-hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis and imaging results. Results Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Non-survivors had a shorter number of days from initial symptoms to hospitalization (p=0.007) and the length of stay in acute wards than survivors (p, Brief Summary: This study showed that male sex, functional decline, an increased fraction of inspired oxygen and the presence of crackles were the best predictors of mortality in the oldest old with COVID-19 and differences in age were not a significant prognostic factor within this very old group.
Published: 2020

10. QRS voltage is a predictor of in-hospital mortality of acutely ill medical patients

Author: John Kellett and Martin Otyek Opio
Subjects: Male, medicine.medical_specialty, Population, Clinical Investigations, QRS voltage, Vital signs, Pilot Projects, risk stratification, electrocardiogram, 030204 cardiovascular system & hematology, Logistic regression, Severity of Illness Index, vital signs, Electrocardiography, 03 medical and health sciences, QRS complex, Sex Factors, 0302 clinical medicine, Internal medicine, medicine, Humans, Uganda, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, education, Hospital Mortality/trends, Survival Rate/trends, education.field_of_study, ECG, business.industry, early warning scores, Uganda/epidemiology, General Medicine, Odds ratio, Middle Aged, Prognosis, Early warning score, acute medicine, Survival Rate, Acute Disease, Cardiology, Population study, Female, Observational study, Acute Disease/mortality, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND: Low QRS voltage has been shown to be associated with increased mortality in the general population and in a small pilot study the combined QRS voltage of ECG leads I and II was found to be associated with in-hospital mortality.HYPOTHESIS: Confirm that low QRS voltage predicts the in-hospital mortality of acutely ill patients, and compare QRS voltage with other predictors of mortality that can be easily, quickly and cheaply obtained at the bedside.METHODS: Prospective observational study of vital signs, QRS voltage and simple tools used to assess mental, functional and nutritional status at the bedside in unselected acutely ill patients admitted to a resource-poor hospital in sub-Saharan Africa.RESULTS: Out of 1486 patients, 77 died (5.2%) in hospital. A combined lead I + II voltage CONCLUSIONS: Low QRS voltage, male gender, NEWS, and impaired mobility were independent predictors of in-hospital mortality in the study population. These four variables, which are easily obtained at the bedside, could potentially provide a rapid, easy, and cheap risk stratification system.
Published: 2018

11. The impact of provider surgical volumes on survival in children with primary tumors of the central nervous system-a population-based study.

Author: Solheim, Ole, Salvesen, Øyvind, Cappelen, Johan, and Johannesen, Tom Børge
Subjects: *PEDIATRIC surgery, *TUMORS in children, *SURVIVAL analysis (Biometry), *ONCOLOGIC surgery, *SURGERY, CENTRAL nervous system surgery, CENTRAL nervous system tumors
Abstract: Background: Provider volume is often a central topic in debates about centralization of procedures. In Norway, there is considerable variation in provider volumes of the neurosurgical centers treating children. We sought to explore long-term survival after surgery for central nervous system tumors in children in relation to regional provider volumes. Method: Based on data from the Norwegian Cancer Registry we analyzed survival in all reported central nervous system tumors in children under the age of 16 treated over two decades, between March 1988 and April 2008; a total of 816 patients with histologically confirmed disease. Results: There was no overall difference in survival between regions. In the subgroup of PNET/medulloblastomas, both living in the high-provider volume health region and receiving treatment in the high-volume region was significantly associated with inferior survival. Conclusions: In this population-based study of children operated over a period of two decades, we found no evidence of improved long-term survival in the high-provider volume region. Surprisingly, a subgroup analysis indicated that survival in PNET/medulloblastomas was significantly better if living outside the most populated health region with the highest provider volumes. One should, however, be careful of interpreting this directly as a symptom of quality of care, as there may be unseen confounders. Our study demonstrates that provider case volume may serve as an axiom in debates about centralization of cancer surgery while perhaps much more reliable and valid but less quantifiable factors are important for the final results. [ABSTRACT FROM AUTHOR]
Published: 2011
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12. Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience

Author: Karel T. Koch, José P.S. Henriques, Marcel A.M. Beijk, Mina Karami, Jan Baan, Marije M. Vis, Wim K. Lagrand, Joanna J. Wykrzykowska, Bas A.J.M. de Mol, Jan G.P. Tijssen, Robbert J. de Winter, Riccardo Cocchieri, Thomas G. V. Cherpanath, Krischan D. Sjauw, Jan J. Piek, Justin de Brabander, Dagmar M. Ouweneel, Annemarie E. Engström, Antoine H.G. Driessen, Graduate School, Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, ACS - Heart failure & arrhythmias, ACS - Microcirculation, Amsterdam Neuroscience - Neuroinfection & -inflammation, Intensive Care Medicine, and APH - Aging & Later Life
Subjects: Male, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Impella, 0302 clinical medicine, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Registries, Original Scientific Papers, Netherlands, Hospital Mortality/trends, Survival Rate/trends, Myocardial Infarction/complications, Cardiogenic shock, cardiogenic shock, Follow up studies, Shock, General Medicine, Middle Aged, Survival Rate, Circulatory system, Cardiology, Female, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Shock, Cardiogenic/etiology, acute heart failure, Shock, Cardiogenic, Netherlands/epidemiology, 03 medical and health sciences, Mechanical circulatory support, Cardiogenic/etiology, Internal medicine, medicine, Humans, Retrospective Studies, Mechanical ventilation, business.industry, Retrospective cohort study, medicine.disease, percutaneous left-ventricular assist device, Myocardial infarction complications, Heart-Assist Devices, business, Follow-Up Studies, Forecasting
Abstract: Aims: Mortality in cardiogenic shock patients remains high. Short-term mechanical circulatory support with Impella can be used to support the circulation in these patients, but data from randomised controlled studies and ‘real-world’ data are sparse. The aim is to describe real-life data on outcomes and complications of our 12 years of clinical experience with Impella in patients with cardiogenic shock after acute myocardial infarction and to identify predictors of 6-month mortality. Methods: We describe a single-centre registry from October 2004 to December 2016 including all patients treated with Impella for cardiogenic shock after acute myocardial infarction. We report outcomes and complications and identify predictors of 6-month mortality. Results: Our overall clinical experience consists of 250 patients treated with Impella 2.5, Impella CP or Impella 5.0. A total of 172 patients received Impella therapy for cardiogenic shock, of which 112 patients had cardiogenic shock after acute myocardial infarction. The mean age was 60.1±10.6 years, mean arterial pressure was 67 (56–77) mmHg, lactate was 6.2 (3.6–9.7) mmol/L, 87.5% were mechanically ventilated and 59.6% had a cardiac arrest before Impella placement. Overall 30-day mortality was 56.2% and 6-month mortality was 60.7%. Complications consisted of device-related vascular complications (17.0%), non-device-related bleeding (12.5%), haemolysis (7.1%) and stroke (3.6%). In a multivariate analysis, pH before Impella placement is a predictor of 6-month mortality. Conclusions: Our registry shows that Impella treatment in cardiogenic shock after acute myocardial infarction is feasible, although mortality rates remain high and complications occur.
Published: 2019

13. Influenza and associated co-infections in critically ill immunosuppressed patients

Author: Pål Klepstad, Andry Van de Louw, Pierce Geoghegan, Elie Azoulay, Benjamin Gaborit, Jordi Rello, Ignacio Martin-Loeches, Nicolas Terzi, Pleun Hemelaar, Virginie Souppart, Katerina Rusinova, Lene B. Nielsen, Ulysses V. A. Silva, Mary Aisling McMahon, Gastón Burghi, Tine Sylvest Meyhoff, Djamel Mokart, Christophe Girault, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Sangeeta Mehta, Peter Schellongowski, Frédéric Pène, Anne Sophie Moreau, Fabrice Bruneel, Massimo Antonelli, Jorge I. F. Salluh, Philippe R. Bauer, Marcio Soares, Precious Pearl Landburg, Peter Pickkers, Ramin Brandt Bukan, Victoria Metaxa, Anders Perner, Sylvie Chevret, Fabio Silvio Taccone, François Barbier, Luca Montini, Virginie Lemiale, Anestesiologian yksikkö, Clinicum, HUS Perioperative, Intensive Care and Pain Medicine, and University of Helsinki
Subjects: PNEUMONIA, Male, ARDS, Soins intensifs réanimation, IMPACT, medicine.medical_treatment, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Respiratory failure, Critical Care and Intensive Care Medicine, Cohort Studies, 0302 clinical medicine, Risk Factors, INFECTION, Intubation, Hospital Mortality, Prospective Studies, Prospective cohort study, Hospital Mortality/trends, Critical Illness/epidemiology, Aged, 80 and over, Coinfection, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Critical illness, Immunosuppression, Influenza, Sepsis, virus diseases, Middle Aged, 3. Good health, Hospitalization, Length of Stay/statistics & numerical data, Female, medicine.medical_specialty, RESPIRATORY-FAILURE, Immunocompromised Host, 03 medical and health sciences, Influenza, Human/epidemiology, Internal medicine, Influenza, Human, Settore MED/41 - ANESTESIOLOGIA, MANAGEMENT, medicine, Humans, Coinfection/epidemiology, Immunocompromised Host/immunology, Risk factor, Propensity Score, Hospitalization/statistics & numerical data, Aged, MALIGNANCY, Performance status, business.industry, Research, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Length of Stay, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, Pneumonia, 3121 General medicine, internal medicine and other clinical medicine, BACTERIAL COINFECTION, business
Abstract: Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2019

14. Diagnosis and management of postpancreatectomy hemorrhage: a systematic review and meta-analysis

Author: F. Jasmijn Smits, Hjalmar C. van Santvoort, I. Quintus Molenaar, Daniel A. F. van den Heuvel, and A. Floortje van Oosten
Subjects: Male, Review, Splenic artery, Cochrane Library, Conservative Treatment, Gastroduodenal artery, 0302 clinical medicine, Pancreaticoduodenectomy/adverse effects, Hospital Mortality, Hospital Mortality/trends, Common hepatic artery, medicine.diagnostic_test, Incidence (epidemiology), Hemostasis, Endoscopic, Gastroenterology, Middle Aged, Prognosis, Postoperative Hemorrhage/diagnosis, Endoscopic, 030220 oncology & carcinogenesis, Meta-analysis, 030211 gastroenterology & hepatology, Female, Reoperation, medicine.medical_specialty, Postoperative Hemorrhage, Risk Assessment, Pancreaticoduodenectomy, 03 medical and health sciences, Pancreatectomy, medicine.artery, Pancreatectomy/adverse effects, Pancreatic Neoplasms/surgery, medicine, Journal Article, Humans, Aged, Hemostasis, Hepatology, business.industry, Hemostatic Techniques, Reoperation/methods, Survival Analysis, Endoscopy, Surgery, Pancreatic Neoplasms, business, Complication, Meta-Analysis
Abstract: Background Postpancreatectomy hemorrhage is a potentially lethal complication after pancreatic resection. The objective of this systematic review is to provide insight in the current status of incidence, detection, management and clinical outcomes of late postpancreatectomy hemorrhage. Methods A systematic search was conducted on the literature from February 2007 to July 2018 in PubMed, Embase and the Cochrane library. Included were clinical studies with clinical outcomes on late postpancreatectomy hemorrhage defined according to the International Study Group of Pancreatic Surgery definition (i.e. occurring >24 h after pancreatic resection). Results A total of 14 studies on 467 patients with late postpancreatectomy hemorrhage were included. The incidence of late postpancreatectomy hemorrhage ranged from 3% to 16% (weighted mean: 5%). Seventy-four patients received conservative treatment; 252 patients underwent primary endovascular intervention; 82 patients underwent primary relaparotomy; 56 patients underwent primary endoscopic intervention; and three patients died before any intervention could be performed. CT-scan and diagnostic angiography were able to identify the source of hemorrhage in 67% (66/98) and 69% (114/166) of patients, respectively. The most frequent origin of the hemorrhage was the gastroduodenal artery stump (79/275; 29%), followed by the common hepatic artery (51/275; 19%) and splenic artery (32/275; 12%). Overall mortality was 21% (98/464 patients; range 0%–38%). Mortality was lower after primary interventional angiography as compared to primary relaparotomy (16% vs 37% respectively). Conclusions This systematic review provides a comprehensive overview of the current literature for severe late postpancreatectomy hemorrhages. CT-scan and diagnostic angiography are equally sensitive in detecting the bleeding source. Interventional angiography appears to be associated to lower mortality as compared to relaparotomy and endoscopy as first intervention for postpancreatectomy hemorrhage.
Published: 2018

15. Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs

Author: Virginie Prendki, Gabriel Gold, Jérôme Stirnemann, Nathalie Vernaz, Angèle Gayet-Ageron, Stéphanie Baggio, Dina Zekry, Thomas Agoritsas, Fabienne Picard, Caroline Flora Samer, Arnaud Perrier, Pauline Vetter, Alexandra Calmy, Marie Céline Zanella, and Jean-Luc Reny
Subjects: Comorbidity, Severity of Illness Index, Lopinavir, immune system diseases, Medicine, Hospital Mortality, Child, Antiviral Agents/administration & dosage/adverse effects/therapeutic use, ddc:616, Aged, 80 and over, Hospital Mortality/trends, ddc:618, ddc:617, Therapies, Investigational, Age Factors, virus diseases, General Medicine, Middle Aged, Early warning score, Drug Combinations, Length of Stay/statistics & numerical data, Child, Preschool, Ritonavir/administration & dosage/adverse effects/therapeutic use, Drug Therapy, Combination, Lopinavir/administration & dosage/adverse effects/therapeutic use, Hydroxychloroquine, Cohort study, medicine.drug, Adult, medicine.medical_specialty, Adolescent, COVID-19/drug therapy/epidemiology/mortality, Antiviral Agents, Therapies, Investigational/methods, Young Adult, Sex Factors, Internal medicine, Severity of illness, Humans, Pandemics, ddc:613, Aged, Retrospective Studies, Ritonavir, SARS-CoV-2, business.industry, COVID-19, Infant, Retrospective cohort study, Length of Stay, COVID-19 Drug Treatment, ddc:616.8, Socioeconomic Factors, ddc:618.97, Propensity score matching, Health Expenditures, business, Hydroxychloroquine/administration & dosage/adverse effects/therapeutic use
Abstract: AIMS OF THE STUDY Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p
Published: 2020

16. Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients

Author: Obling, Laust, Frydland, Martin, Hansen, Rikke, Møller-Helgestad, Ole Kristian, Lindholm, Matias Greve, Holmvang, Lene, Ravn, Hanne Berg, Wiberg, Sebastian, Thomsen, Jakob Hartvig, Jensen, Lisette Okkels, Kjærgaard, Jesper, Møller, Jacob Eifer, Hassager, Christian, Obling, Laust, Frydland, Martin, Hansen, Rikke, Møller-Helgestad, Ole Kristian, Lindholm, Matias Greve, Holmvang, Lene, Ravn, Hanne Berg, Wiberg, Sebastian, Thomsen, Jakob Hartvig, Jensen, Lisette Okkels, Kjærgaard, Jesper, Møller, Jacob Eifer, and Hassager, Christian
Abstract: BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown.AIM: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS.METHODS: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries.RESULTS: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS.CONCLUSION: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.
Published: 2018

17. Persistent sex disparities in clinical outcomes with percutaneous coronary intervention:Insights from 6.6 million PCI procedures in the United States

Author: Potts, Jessica, Sirker, Alex, Martinez, Sara C, Gulati, Martha, Alasnag, Mirvat, Rashid, Muhammad, Kwok, Chun Shing, Ensor, Joie, Burke, Danielle L, Riley, Richard D, Holmvang, Lene, Mamas, Mamas A, Potts, Jessica, Sirker, Alex, Martinez, Sara C, Gulati, Martha, Alasnag, Mirvat, Rashid, Muhammad, Kwok, Chun Shing, Ensor, Joie, Burke, Danielle L, Riley, Richard D, Holmvang, Lene, and Mamas, Mamas A
Abstract: BACKGROUND: Prior studies have reported inconsistencies in the baseline risk profile, comorbidity burden and their association with clinical outcomes in women compared to men. More importantly, there is limited data around the sex differences and how these have changed over time in contemporary percutaneous coronary intervention (PCI) practice.METHODS AND RESULTS: We used the Nationwide Inpatient Sample to identify all PCI procedures based on ICD-9 procedure codes in the United States between 2004-2014 in adult patients. Descriptive statistics were used to describe sex-based differences in baseline characteristics and comorbidity burden of patients. Multivariable logistic regressions were used to investigate the association between these differences and in-hospital mortality, complications, length of stay and total hospital charges. Among 6,601,526 patients, 66% were men and 33% were women. Women were more likely to be admitted with diagnosis of NSTEMI (non-ST elevation acute myocardial infarction), were on average 5 years older (median age 68 compared to 63) and had higher burden of comorbidity defined by Charlson score ≥3. Women also had higher in-hospital crude mortality (2.0% vs 1.4%) and any complications compared to men (11.1% vs 7.0%). These trends persisted in our adjusted analyses where women had a significant increase in the odds of in-hospital mortality men (OR 1.20 (95% CI 1.16,1.23) and major bleeding (OR 1.81 (95% CI 1.77,1.86).CONCLUSION: In this national unselected contemporary PCI cohort, there are significant sex-based differences in presentation, baseline characteristics and comorbidity burden. These differences do not fully account for the higher in-hospital mortality and procedural complications observed in women.
Published: 2018

18. The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis

Author: Christian Torp-Pedersen, Marianne Rix, Louise Bruun Oestergaard, Lauge Østergaard, Trine K. Lauridsen, Niels Eske Bruun, Christian Hassager, Anne-Lise Kamper, Gunnar Gislason, Anders Bjorholm Dahl, Mavish S. Chaudry, and Emil L. Fosbøl
Subjects: Male, Denmark, medicine.medical_treatment, 030204 cardiovascular system & hematology, lcsh:RC870-923, 0302 clinical medicine, Risk Factors, Cause of Death, Hospital Mortality, Registries, 030212 general & internal medicine, Cause of death, Hospital Mortality/trends, education.field_of_study, Renal Dialysis/mortality, Staphylococcus aureus endocarditis, Mortality rate, Hazard ratio, Staphylococcal Infections, Middle Aged, Mortality/trends, Kidney Failure, Chronic/diagnosis, Nephrology, Hemodialysis, Infective endocarditis, Endocarditis, Bacterial/diagnosis, Female, Research Article, Adult, Staphylococcus aureus, medicine.medical_specialty, Population, Cause of Death/trends, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Humans, Endocarditis, Mortality, education, Aged, Retrospective Studies, business.industry, Staphylococcal Infections/diagnosis, Endocarditis, Bacterial, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Denmark/epidemiology, Kidney Failure, Chronic, business, Follow-Up Studies, Kidney disease
Abstract: Background The risk of infective endocarditis (IE) is markedly increased in patients receiving chronic hemodialysis compared with the general population, but outcome data are sparse. The present study investigated causes and risk factors of mortality in a hemodialysis-treated end-stage kidney disease- (ESKD) and a non-ESKD population with staphylococcus (S.) aureus endocarditis. Methods Hemodialysis-treated ESKD patients with S. aureus endocarditis were identified from Danish National Registries and Non-ESKD patients from The East Danish Database on Endocarditis. For establishing the cause of death The Danish Registry of Cause of Death was used. Independent risk factors of outcome were identified in multivariable Cox regression models. Results One hundred twenty-one hemodialysis patients and 190 non-ESKD patients with S. aureus endocarditis were included during 1996–2012 and 2002–2012, respectively. The all-cause in-hospital mortality was 22.3% in hemodialysis- and 24.7% in non-ESKD patients. One-year mortality, excluding in-hospital mortality, was 26.4% in hemodialysis patients and 15.2% in non-ESKD patients. The hazard ratio of all-cause mortality in hemodialysis was 2.64 (95% CI 1.70–4.10) at > 70 days after admission compared with non-ESKD. Age (HR 1.03 (95% CI 1.02–1.04)) and diabetes mellitus (HR 2.17 (95% CI 1.54–3.10)) were independent risk factors of all-cause mortality. The hazard ratio of cardiovascular death in hemodialysis was 3.20 (95% CI 1.78–5.77) at > 81 days after admission compared with non-ESKD. Age and diabetes mellitus were independently related to cardiovascular death. Conclusion All-cause in-hospital mortality rates were similar in hemodialysis and non-ESKD patients with S. aureus endocarditis whereas one-year mortality rates were significantly increased in the hemodialysis population. Electronic supplementary material The online version of this article (10.1186/s12882-018-1016-0) contains supplementary material, which is available to authorized users.
Published: 2018

19. Persistent sex disparities in clinical outcomes with percutaneous coronary intervention:Insights from 6.6 million PCI procedures in the United States

Author: Mirvat Alasnag, Danielle L. Burke, Muhammad Rashid, Jessica Potts, Alex Sirker, Joie Ensor, Mamas A. Mamas, Lene Holmvang, Richard D Riley, Sara C. Martinez, Chun Shing Kwok, and Martha Gulati
Subjects: Male, Postoperative Complications/epidemiology, Multivariate analysis, Non-ST Elevated Myocardial Infarction/surgery, medicine.medical_treatment, lcsh:Medicine, Comorbidity, 030204 cardiovascular system & hematology, 0302 clinical medicine, Postoperative Complications, Comorbidity/trends, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, lcsh:Science, Non-ST Elevated Myocardial Infarction, Percutaneous Coronary Intervention/adverse effects, Hospital Mortality/trends, Multidisciplinary, Mortality rate, Age Factors, Healthcare Disparities/statistics & numerical data, Middle Aged, RC666, United States/epidemiology, Treatment Outcome, Cohort, Female, medicine.medical_specialty, 03 medical and health sciences, Percutaneous Coronary Intervention, Sex Factors, Internal medicine, medicine, Humans, Healthcare Disparities, Aged, Retrospective Studies, business.industry, lcsh:R, Percutaneous coronary intervention, Retrospective cohort study, medicine.disease, United States, Logistic Models, Conventional PCI, Multivariate Analysis, lcsh:Q, business
Abstract: Background\ud Prior studies have reported inconsistencies in the baseline risk profile, comorbidity burden and their association with clinical outcomes in women compared to men. More importantly, there is limited data around the sex differences and how these have changed over time in contemporary percutaneous coronary intervention (PCI) practice.\ud \ud Methods and results\ud We used the Nationwide Inpatient Sample to identify all PCI procedures based on ICD-9 procedure codes in the United States between 2004–2014 in adult patients. Descriptive statistics were used to describe sex-based differences in baseline characteristics and comorbidity burden of patients. Multivariable logistic regressions were used to investigate the association between these differences and in-hospital mortality, complications, length of stay and total hospital charges. Among 6,601,526 patients, 66% were men and 33% were women. Women were more likely to be admitted with diagnosis of NSTEMI (non-ST elevation acute myocardial infarction), were on average 5 years older (median age 68 compared to 63) and had higher burden of comorbidity defined by Charlson score ≥3. Women also had higher in-hospital crude mortality (2.0% vs 1.4%) and any complications compared to men (11.1% vs 7.0%). These trends persisted in our adjusted analyses where women had a significant increase in the odds of in-hospital mortality men (OR 1.20 (95% CI 1.16,1.23) and major bleeding (OR 1.81 (95% CI 1.77,1.86).\ud \ud Conclusion\ud In this national unselected contemporary PCI cohort, there are significant sex-based differences in presentation, baseline characteristics and comorbidity burden. These differences do not fully account for the higher in-hospital mortality and procedural complications observed in women.
Published: 2018

20. Association between volume of severely injured patients and mortality in German trauma hospitals

Author: Rolf Lefering, K.-G. Kanz, Peter Biberthaler, Marc Hanschen, M.T. Zacher, V. Bühren, Stefan Huber-Wagner, M. van Griensven, and Sandra Häberle
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Hospitals, Low-Volume, Germany/epidemiology, Poison control, Logistic regression, Occupational safety and health, Trauma Centers, Germany, Injury prevention, 80 and over, Humans, Medicine, Hospital Mortality, Trauma Centers/statistics & numerical data, Survival rate, High-Volume/statistics & numerical data, Aged, Retrospective Studies, Aged, 80 and over, Hospital Mortality/trends, Survival Rate/trends, Trauma Severity Indices, Wounds and Injuries/diagnosis, business.industry, Glasgow Coma Scale, Retrospective cohort study, Original Articles, Low-Volume/statistics & numerical data, Middle Aged, Hospitals, Survival Rate, Hospitals, High-Volume/statistics & numerical data, Wounds and Injuries, Injury Severity Score, Original Article, Female, Surgery, Hospitals, Low-Volume/statistics & numerical data, business, Hospitals, High-Volume
Abstract: Background The issue of patient volume related to trauma outcomes is still under debate. This study aimed to investigate the relationship between number of severely injured patients treated and mortality in German trauma hospitals. Methods This was a retrospective analysis of the TraumaRegister DGU® (2009–2013). The inclusion criteria were patients in Germany with a severe trauma injury (defined as Injury Severity Score (ISS) of at least 16), and with data available for calculation of Revised Injury Severity Classification (RISC) II score. Patients transferred early were excluded. Outcome analysis (observed versus expected mortality obtained by RISC‐II score) was performed by logistic regression. Results A total of 39 289 patients were included. Mean(s.d.) age was 49·9(21·8) years, 27 824 (71·3 per cent) were male, mean(s.d.) ISS was 27·2(11·6) and 10 826 (29·2 per cent) had a Glasgow Coma Scale score below 8. Of 587 hospitals, 98 were level I, 235 level II and 254 level III trauma centres. There was no significant difference between observed and expected mortality in volume subgroups with 40–59, 60–79 or 80–99 patients treated per year. In the subgroups with 1–19 and 20–39 patients per year, the observed mortality was significantly greater than the predicted mortality (P < 0·050). High‐volume hospitals had an absolute difference between observed and predicted mortality, suggesting a survival benefit of about 1 per cent compared with low‐volume hospitals. Adjusted logistic regression analysis (including hospital level) identified patient volume as an independent positive predictor of survival (odds ratio 1·001 per patient per year; P = 0·038). Conclusion The hospital volume of severely injured patients was identified as an independent predictor of survival. A clear cut‐off value for volume could not be established, but at least 40 patients per year per hospital appeared beneficial for survival., No clear volume cut‐off
Published: 2015

21. Use of noninvasive and invasive mechanical ventilation in cardiogenic shock:A prospective multicenter study

Author: Hongisto, Mari, Lassus, Johan, Tarvasmaki, Tuukka, Sionis, Alessandro, Tolppanen, Heli, Lindholm, Matias Greve, Banaszewski, Marek, Parissis, John, Spinar, Jindrich, Silva-Cardoso, Jose, Carubelli, Valentina, Di Somma, Salvatore, Masip, Josep, Harjola, Veli-Pekka, Hongisto, Mari, Lassus, Johan, Tarvasmaki, Tuukka, Sionis, Alessandro, Tolppanen, Heli, Lindholm, Matias Greve, Banaszewski, Marek, Parissis, John, Spinar, Jindrich, Silva-Cardoso, Jose, Carubelli, Valentina, Di Somma, Salvatore, Masip, Josep, and Harjola, Veli-Pekka
Abstract: BACKGROUND: Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV.METHODS: 219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24h into MV (n=137; 63%) , NIV (n=26; 12%), and supplementary oxygen (n=56; 26%) groups. We compared the clinical characteristics and 90-day outcome between the MV and the NIV groups.RESULTS: Mean age was 67years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO2/FiO2 ratio, baseline hemodynamics or LVEF. MV patients predominantly presented with hypoperfusion, with more severe metabolic acidosis, higher lactate levels and greater need for vasoactive drugs, whereas NIV patients tended to be more often congestive. 90-day outcome was significantly worse in the MV group (50% vs. 27%), but after propensity score adjustment, mortality was equal in both groups. Confusion, prior CABG, ACS etiology, higher lactate level, and lower baseline PaO2 were independent predictors of mortality, whereas ventilation strategy did not have any influence on outcome.CONCLUSIONS: Although MV is generally recommended mode of ventilatory support in CS, a fair number of patients were successfully treated with NIV. Moreover, ventilation strategy was not associated with outcome. Thus, NIV seems a safe option for properly chosen CS patients.
Published: 2017

22. The impact of provider surgical volumes on survival in children with primary tumors of the central nervous system—a population-based study

Author: Ole Solheim, Øyvind Salvesen, Johan Cappelen, and Tom Børge Johannesen
Subjects: Pediatrics, medicine.medical_specialty, education.field_of_study, Neurology, Clinical Article, business.industry, Population, Clinical Neurology, Subgroup analysis, Disease, Survival analysis, Cancer registry, Brain neoplasms, Medicine, Surgery, Neurology (clinical), Neurosurgery, business, Intensive care medicine, education, Child, Hospital mortality/trends, Neuroradiology
Abstract: Background Provider volume is often a central topic in debates about centralization of procedures. In Norway, there is considerable variation in provider volumes of the neurosurgical centers treating children. We sought to explore long-term survival after surgery for central nervous system tumors in children in relation to regional provider volumes. Method Based on data from the Norwegian Cancer Registry we analyzed survival in all reported central nervous system tumors in children under the age of 16 treated over two decades, between March 1988 and April 2008; a total of 816 patients with histologically confirmed disease. Results There was no overall difference in survival between regions. In the subgroup of PNET/medulloblastomas, both living in the high-provider volume health region and receiving treatment in the high-volume region was significantly associated with inferior survival. Conclusions In this population-based study of children operated over a period of two decades, we found no evidence of improved long-term survival in the high-provider volume region. Surprisingly, a subgroup analysis indicated that survival in PNET/medulloblastomas was significantly better if living outside the most populated health region with the highest provider volumes. One should, however, be careful of interpreting this directly as a symptom of quality of care, as there may be unseen confounders. Our study demonstrates that provider case volume may serve as an axiom in debates about centralization of cancer surgery while perhaps much more reliable and valid but less quantifiable factors are important for the final results.
Published: 2011

23. Red blood cell transfusion in critically ill children is independently associated with increased mortality

Author: Dick G. Markhorst, Martin C. J. Kneyber, Mohammed I Hersi, Frans B. Plötz, Jos W. R. Twisk, Methodology and Applied Biostatistics, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
Subjects: Male, medicine.medical_specialty, Resuscitation, Critical Illness, Observation, Critical Care and Intensive Care Medicine, Intensive Care Units, Pediatric, Cohort Studies, Outcome Assessment (Health Care), SDG 3 - Good Health and Well-being, Anesthesiology, Intensive care, Cause of Death, Outcome Assessment, Health Care, medicine, Humans, Hospital Mortality, Intensive care medicine, Child, Preschool, Cause of death, Netherlands, Proportional Hazards Models, Retrospective Studies, Hospital Mortality/trends, Pediatric, Proportional hazards model, business.industry, Retrospective cohort study, Length of Stay, Erythrocyte Transfusion/adverse effects, Red blood cell, Intensive Care Units, medicine.anatomical_structure, Child, Preschool, Female, business, Erythrocyte Transfusion, Cohort study
Abstract: OBJECTIVE: To test the hypothesis that RBC transfusion in critically ill children is independently associated with increased mortality and morbidity.DESIGN: Retrospective, descriptive epidemiologic cohort study.SETTING: Single-center experience of a nine-bed pediatric intensive care unit (PICU) facility.PATIENTS: Critically ill children without ongoing active blood loss aged 0[Symbol: see text]months to 18[Symbol: see text]years, excluding prematurely born infants or patients after cardiothoracic surgery, and patients with chronic anemia.INTERVENTIONS: None.MEASUREMENTS AND RESULTS: Data of 295 consecutive patients was studied. Of these patients, 13.4% had a Hb concentration less than 9.6 g/dl. Sixty-seven (22.7%) of all patients were transfused, 39 only once. Transfused patients had a higher mortality (16.4 vs. 2.6%, p < 0.001). Mortality seemed related to the number of transfusion (p = 0.002) rather than the pre-transfusion Hb concentration (p = 0.10). Transfused patients required prolonged ventilatory support (11.1 +/- 1.8 vs. +/- 0.3 days, p < 0.001), infusion of vaso-active agents (8.2 +/- 1.8 vs. 2.8 +/- 0.6 days, p < 0.001) and PICU stay (13.0 +/- 1.8 vs. 3.2 +/- 0.2 days, p < 0.001). After multivariate analysis adjusting for age, PIM probability of death, mean TISS-28 score during the first 48 h, post-operative admission, diagnosis of sepsis or trauma or malignancy, pre-transfusion Hb concentration, and RBC transfusion remained independently associated with mortality and morbidity.CONCLUSIONS: RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged PICU stay.
Published: 2007

24. Trends in Risk Factors, Patterns and Causes in Hospitalized Strokes over 25 Years: The Lausanne Stroke Registry

Author: Andrea O. Rossetti, Malin Maeder-Ingvar, Julien Bogousslavsky, Gérald Devuyst, and Emmanuel Carrera
Subjects: Male, Pediatrics, Stroke registry, Time Factors, Neurology, Hospitals, University/statistics & numerical data, Stroke care, Stroke mortality, Brain Ischemia/complications/epidemiology, Brain Ischemia, Hospitals, University, Switzerland/epidemiology, Risk Factors, Smoking/adverse effects, Hospital Mortality, Registries, Hypertension/complications/epidemiology, Stroke, Hospital Mortality/trends, Aged, 80 and over, Smoking, Registries/statistics & numerical data, Age Factors, Middle Aged, Prognosis, University hospital, humanities, Hospitalization, Diabetes Complications/etiology/mortality, Hypertension, Female, Age distribution, Cardiology and Cardiovascular Medicine, Intracranial Hemorrhages, Switzerland, Adult, medicine.medical_specialty, Hypercholesterolemia/complications/epidemiology, Hypercholesterolemia, Hyperglycemia/complications/epidemiology, Diabetes Complications, Age Distribution, medicine, Humans, cardiovascular diseases, Hospitalization/statistics & numerical data, Aged, Intracranial Hemorrhages/complications/epidemiology, business.industry, Stroke/etiology/mortality/therapy, medicine.disease, Hyperglycemia, Hypertension complications, Neurology (clinical), business
Abstract: Background and Objective: The Lausanne Stroke Registry includes, from 1979, all patients admitted to the department of Neurology of the Lausanne University Hospital with the diagnosis of first clinical stroke. Using the Lausanne Stroke Registry, we aimed to determine trends in risk factors, causes, localization and inhospital mortality over 25 years in hospitalized stroke patients. Methods: We assessed temporal trends in stroke patients characteristics through the following consecutive periods: 1979–1987, 1988–1995 and 1996–2003. Age-adjusted cardiovascular risk factors, etiologies, stroke localizations and mortality were compared between the three periods. Results: Overall, 5,759 patients were included. Age was significantly different among the analyzed periods (p < 0.001), showing an increment in older patients throughout time. After adjustment for age, hypercholesterolemia increased (p < 0.001), as opposed to cigarette smoking (p < 0.001), hypertension (p < 0.001) and diabetes and hyperglycemia (p < 0.001). In patients with ischemic strokes, there were significant changes in the distribution of causes with an increase in cardioembolic strokes (p < 0.001), and in the localization of strokes with an increase in entire middle cerebral artery (MCA) and posterior circulation strokes together with a decrease in superficial middle cerebral artery stroke (p < 0.001). In patients with hemorrhagic strokes, the thalamic localizations increased, whereas the proportion of striatocapsular hemorrhage decreased (p = 0.022). Except in the older patient group, the mortality rate decreased. Conclusions: This study shows major trends in the characteristics of stroke patients admitted to a department of neurology over a 25-year time span, which may result from referral biases, development of acute stroke management and possibly from the evolution of cerebrovascular risk factors.
Published: 2007

25. Effect of frailty on short- and mid-term outcomes in vascular surgical patients

Author: Manjit S. Gohel, Patrick A. Coughlin, Jonathan R. Boyle, Paul D. Hayes, Amjad Ali, Graeme K. Ambler, D.E. Brooks, Kevin Varty, and N Al Zuhir
Subjects: Male, Postoperative Complications/epidemiology, medicine.medical_specialty, Time Factors, Frail Elderly, Vascular Diseases/surgery, Risk Assessment, Postoperative Complications, Risk Factors, Internal medicine, medicine, Humans, Hospital Mortality, Vascular Diseases, Risk Assessment/methods, Aged, Retrospective Studies, Aged, 80 and over, Hospital Mortality/trends, Receiver operating characteristic, business.industry, United Kingdom/epidemiology, Incidence (epidemiology), Mortality rate, Incidence, Age Factors, Retrospective cohort study, Regression analysis, Length of Stay, Vascular surgery, United Kingdom, Surgery, ROC Curve, Cohort, Length of Stay/trends, Female, business, Vascular Surgical Procedures, Surgical patients, Follow-Up Studies
Abstract: Background Frailty is a multidimensional vulnerability resulting from age-associated decline. The impact of frailty on outcomes was assessed in a cohort of vascular surgical patients. Methods The study included patients aged over 65 years with length of hospital stay (LOS) greater than 2 days, who were admitted to a tertiary vascular unit over a single calendar year. Demographics, mode of admission, diagnosis, mortality, LOS and discharge destination were recorded, as well as a variety of frailty-specific characteristics. The impact of frailty on LOS, discharge destination, survival and readmission rate was assessed using multivariable regression techniques. The ability of the models to predict these outcomes was also assessed. Results In total, 413 patients of median age 77 years were followed for a median of 18 (range 12–24) months. The in-hospital, 3- and 12-month mortality rates were 3·6, 8·5 and 13·8 per cent respectively. Receiver operating characteristic (ROC) curve analysis revealed that frailty-based regression models were excellent predictors of 12-month mortality (area under the ROC curve (AUC) = 0·81), prolonged LOS (AUC = 0·79) and discharge to a care institution (AUC = 0·84). A simple additive frailty score using six key features retained strong predictive power for 12-month mortality (AUC = 0·83), discharge to a care institution (AUC = 0·78) and prolonged LOS (AUC = 0·74). This frailty score was also strongly associated with readmission rates (P < 0·001). Conclusion Frailty in vascular surgery patients predicts a multiplicity of poorer outcomes. Optimal management should include identification of at-risk patients and treatment of modifiable risk factors.
Published: 2015

26. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®)

Subjects: Adult, Hospital Mortality/trends, Male, Survival Rate/trends, Adolescent, Germany/epidemiology, Middle Aged, Wounds, Nonpenetrating/diagnosis, Thoracic Injuries/diagnosis, Young Adult, Injury Severity Score, Risk Factors, Humans, Multiple Trauma/diagnosis, Female, Registries, Trauma Centers/statistics & numerical data, Aged, Follow-Up Studies, Retrospective Studies
Abstract: BACKGROUND: Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. METHODS: All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002-2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. RESULTS: 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. CONCLUSIONS: We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt chest trauma.
Published: 2014

27. The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

Author: Meacock, R., Kristensen, Søren Rud, and Sutton, M.
Subjects: Length of Stay/economics, Hospital Mortality/trends, Pay-for-performance, Motivation, Pay-for-performance Cost-effectiveness PAY-FOR-PERFORMANCE HOSPITAL PAY HEALTH-CARE MORTALITY MEDICARE PROGRAM IMPACT STATE, Cost-Benefit Analysis, Heart Failure/economics, Pneumonia/economics, England, Myocardial Infarction/economics, Humans, Cost-effectiveness, Quality-Adjusted Life Years, Quality Indicators, Health Care, Reimbursement, Incentive/economics
Abstract: Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the £13m total programme costs. By generating approximately 5200 quality-adjusted life years and £4.4m of savings in reduced length of stay, we find that the programme was a cost-effective use of resources in its first 18 months.
Published: 2014

28. Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002-2012

Author: Dragana, Radovanovic, Burkhardt, Seifert, Philip, Urban, Franz R, Eberli, Hans, Rickli, Osmund, Bertel, Milo A, Puhan, Paul, Erne, S, Buchholz, University of Zurich, and Radovanovic, Dragana
Subjects: Male, Myocardial Infarction, Comorbidity, Switzerland/epidemiology, Epidemiology, Myocardial Revascularization, Myocardial Revascularization/methods, Myocardial infarction, Hospital Mortality, Prospective Studies, Registries, Prospective cohort study, Hospital Mortality/trends, Survival Rate/trends, education.field_of_study, Incidence (epidemiology), Incidence, Middle Aged, Prognosis, Survival Rate, Diabetes Mellitus/epidemiology, Female, Cardiology and Cardiovascular Medicine, Switzerland, medicine.medical_specialty, Acute coronary syndrome, Population, 610 Medicine & health, 2705 Cardiology and Cardiovascular Medicine, Acute Coronary Syndrome/epidemiology/therapy, Internal medicine, mental disorders, Myocardial Infarction/epidemiology, medicine, Diabetes Mellitus, Humans, Acute Coronary Syndrome, Intensive care medicine, education, ddc:613, Aged, Heart Failure, Inpatients, business.industry, 10060 Epidemiology, Biostatistics and Prevention Institute (EBPI), medicine.disease, ROC Curve, Heart failure, Heart Failure/epidemiology, business, Follow-Up Studies
Abstract: Objective This study aimed to assess the impact of individual comorbid conditions as well as the weight assignment, predictive properties and discriminating power of the Charlson Comorbidity Index (CCI) on outcome in patients with acute coronary syndrome (ACS). Methods A prospective multicentre observational study (AMIS Plus Registry) from 69 Swiss hospitals with 29 620 ACS patients enrolled from 2002 to 2012. The main outcome measures were in-hospital and 1-year follow-up mortality. Results Of the patients, 27% were female (age 72.1±12.6 years) and 73% were male (64.2±12.9 years). 46.8% had comorbidities and they were less likely to receive guideline-recommended drug therapy and reperfusion. Heart failure (adjusted OR 1.88; 95% CI 1.57 to 2.25), metastatic tumours (OR 2.25; 95% CI 1.60 to 3.19), renal diseases (OR 1.84; 95% CI 1.60 to 2.11) and diabetes (OR 1.35; 95% CI 1.19 to 1.54) were strong predictors of in-hospital mortality. In this population, CCI weighted the history of prior myocardial infarction higher (1 instead of −0.4, 95% CI −1.2 to 0.3 points) but heart failure (1 instead of 3.7, 95% CI 2.6 to 4.7) and renal disease (2 instead of 3.5, 95% CI 2.7 to 4.4) lower than the benchmark, where all comorbidities, age and gender were used as predictors. However, the model with CCI and age has an identical discrimination to this benchmark (areas under the receiver operating characteristic curves were both 0.76). Conclusions Comorbidities greatly influenced clinical presentation, therapies received and the outcome of patients admitted with ACS. Heart failure, diabetes, renal disease or metastatic tumours had a major impact on mortality. CCI seems to be an appropriate prognostic indicator for in-hospital and 1-year outcomes in ACS patients. ClinicalTrials.gov Identifier NCT01305785
Published: 2013

29. EURObservational Research Programme:regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot)

Author: Maggioni, A. P., Dahlstrom, U., Filippatos, G., Chioncel, O., Leiro, M. C., Drozdz, J., Fruhwald, F., Gullestad, L., Logeart, D., Fabbri, G., Urso, R., Metra, M., Parissis, J., Persson, H., Ponikowski, P., Rauchhaus, M., Voors, A. A., Nielsen, O. W., Zannad, F., Tavazzi, L., Alonso, A., Ferrari, R., Komajda, M., Wood, D., Manini, M., Taylor, C., Laroche, C., Fiorucci, E., Lucci, D., Gonzini, L., Auer, J., Oberrauner, A., Schumacher, M., Ebner, C., Hallas, A., Espersen, G., Gustafsson, F., Mattsson, N., Egstrup, K., Aagaard, S., Gohr, T., Huld, K., Knudsen, A., Refsgaard, J., Charniot, J., Juillard, A., Pon-Gabrielsen, P., Douna, F., Jondeau, G., Jourdain, P., Michel, L., Hamm, C., Lehinant, S., Rieth, A., Goeing, O., Schultheiss, H. P., Von-Schlippenbach, J., Knollmann, R., Neubuser, C., Katus, H. A., Taeger, T., Zugck, C., Fink, H., Schulz, J., Held, S., Karmann, W., Kreuzer, J., Nitsche, K., Winter, K., Fahnrich, A., Bruederlein, K., Turan, C. H., Berentelg, J., Ittel, T., Rubens, C., Hanke, M., Stoerk, S., Chrysohoou, C., Kaldara, E., Karavidas, A., Margari, R., Matzaraki, V., Nanas, J., Pozios, I., Psarogiannakopoulos, P., Pyrgakis, V., Stefanadis, C., Terrovitis, J., Trikas, A., Xydonas, S., Patrianakos, A., Vardas, P., Douras, A., Nastas, J., Ntertsas, K., Tsaknakis, T., Midi, P., Pajes, G., Moretti, L., Partemi, M., Barberini, F., Branzi, A., Gallelli, I., Grigioni, F., Ionico, T., Pasquale, F., Cas, L., Delmagro, F., Tanghetti, E., Vaccari, A., Mercuro, G., Arcuri, G. M., Marinacci, L., Severini, D., Cosmi, F., Bosi, S., Di Tano, G., Pirelli, S., Fucili, A., Minneci, C., Santoro, G. M., Correale, M., Di Biase, M., Buccolieri, M., Mandorla, S., Martinelli, S., Barbiero, M., Giordano, A., Zanelli, E., Agostoni, P., Fiorentini, C., Salvioni, E., Leuzzi, C., Modena, M. G., Reggianini, L., Cobelli, F., Opasich, C., Baldini, P., Romei, M., Pulitano, G., Ruggeri, A., Bologna, F., Piovaccari, G., Brasolin, B., Fedele, F., Merlo, M., Sinagra, G., Albanese, M. C., Miani, D., Linssen, G., Rodijk, E., Pinto, Y., Van Donk, P., Dunselman, P., Lok, D., Brouwers, F., De Jong, R. M., Boen, R., Hole, T., Rasmussen, L., Christiansen, E. M., Gjertsen, E., Lyng, J., German, M., Hogalmen, G., Skardal, R., Apelland, T., Borgen, M., Forfang, E., Baak, T., Dickstein, K., Olsen, I., Stachurski, D., Juszczyk, Z., Stankala, S., Gilewski, W., Sinkiewicz, W., Kasztelowicz, P., Gabryel, J., Kardaszewicz, P., Lazorko-Piega, M., Bellwon, J., Mosakowska, K., Rynkiewicz, A., Olczyk, S., Pagorek, M., Bartlinski, R., Borej, G., Tarchalski, J., Bartkowiak, R., Sosnowska-Pasiarska, B., Wozakowska-Kaplon, B., Krzeminski, A., Bury, K., Grzegorzko, A., Mirek-Bryniarska, E., Nessler, J., Zabojszcz, M., Broncel, M., Poliwczak, A., Retwinski, A., Soska, K., Grajek, S., Straburzynska-Migaj, E., Kuzniar, J., Rzeszuto, T., Bednarczyk, G., Ruszkowski, P., Piasecka-Krysiak, E., Zambrzycki, J., Nowak, T., Szelemej, R., Balsam, P., Folga, A., Kaplon-Cieslicka, A., Kowalewski, S., Mamcarz, A., Marchel, M., Opolski, G., Welnicki, M., Jankowska, E., Nowak, J., Nowalany-Kozielska, E., Rozentryt, P., Zembala, M., Kleinrok, A., Prokop-Lewicka, G., Kudlinska, B., Radoi, M., Macarie, C., Vinereanu, D., Capalneanu, R., Giuca, A., Ionescu, D. D., Nechita, E., Datcu, M., Istrate, C., Vladoianu, M., Christodorescu, R., Salguero, R., Blanco, V. M., Lavilla, M. A., Comin-Colet, J., Cantillo, D., Bernal, J., del Prado, J. M., Pita, A., Aguero, J., Jimenez, J. F., Calvo, F., Gonzalez, R., Molina, B., Luengos, D., Lostal, C., Bonet, L., Gonzalez, P., Soriano, F., Campos, M. J., Karlstrom, P., Nyrinder, I., Olsson, B., Pettersson, T., Stenberg, A., Lindmark, K., Asserlund, B., Faculteit Medische Wetenschappen/UMCG, Cardiovascular Centre (CVC), ACS - Amsterdam Cardiovascular Sciences, Cardiology, Maggioni, Aldo P, Dahlström, Ulf, Filippatos, Gerasimo, Chioncel, Ovidiu, Leiro, Marisa Crespo, Drozdz, Jaroslaw, Fruhwald, Friedrich, Gullestad, Lar, Logeart, Damien, Fabbri, Gianna, Urso, Renato, Metra, Marco, Parissis, John, Persson, Han, Ponikowski, Piotr, Rauchhaus, Mathia, Voors, Adriaan A., Nielsen, Olav Wendelboe, Zannad, Faiez, Tavazzi, Luigi, on behalf of the Heart Failure Association of the European Society of Cardiology (HFA): [.., F. Barberini, A. Branzi, I. Gallelli, F. Grigioni, T. Ionico, F. Pasquale, and ]
Subjects: Registrie, Male, Time Factors, Peripartum cardiomyopathy, Pilot Projects, Cardiovascular Agents/therapeutic use, Acute heart failure, Chronic heart failure, Observational studies, Pharmacological treatments, Prognosis, Aged, Cardiovascular Agents, Europe, Female, Follow-Up Studies, Heart Failure, Hospital Mortality, Hospitalization, Humans, Middle Aged, Prospective Studies, Inpatients, Registries, GUIDELINES, CLINICAL CHARACTERISTICS, Medicine, Prospective cohort study, POPULATION, Hospital Mortality/trends, education.field_of_study, OUTCOMES, Ejection fraction, Mortality rate, HOSPITALIZATION, Inpatient, Cardiology and Cardiovascular Medicine, Pharmacological treatment, Human, medicine.medical_specialty, acute heart failure, chronic heart failure, observational studies, pharmacological treatments, prognosis, aged, cardiovascular agents, female, follow-up studies, heart failure, hospital mortality, hospitalization, humans, male, middle aged, pilot projects, prospective studies, time factors, inpatients, registries, cardiology and cardiovascular medicine, EUROPE, Time Factor, Prognosi, Population, DIAGNOSIS, Follow-Up Studie, Europe/epidemiology, ONE-YEAR MORTALITY, Pilot Project, education, Hospitalization/statistics & numerical data, business.industry, medicine.disease, Heart Failure/drug therapy, Observational studie, Prospective Studie, Cardiovascular Agent, Heart failure, REGISTRY, Cardiovascular agent, Emergency medicine, Physical therapy, Observational study, QUALITY-OF-CARE, business
Abstract: AIMS: The ESC-HF Pilot survey was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). The pilot phase was also specifically aimed at validating structure, performance, and quality of the data set for continuing the survey into a permanent Registry.METHODS: The ESC-HF Pilot study is a prospective, multicentre, observational survey conducted in 136 Cardiology Centres in 12 European countries selected to represent the different health systems across Europe. All outpatients with HF and patients admitted for acute HF on 1 day per week for eight consecutive months were included. From October 2009 to May 2010, 5118 patients were included: 1892 (37%) admitted for acute HF and 3226 (63%) patients with chronic HF. The all-cause mortality rate at 1 year was 17.4% in acute HF and 7.2% in chronic stable HF. One-year hospitalization rates were 43.9% and 31.9%, respectively, in hospitalized acute and chronic HF patients. Major regional differences in 1-year mortality were observed that could be explained by differences in characteristics and treatment of the patients.CONCLUSION: The ESC-HF Pilot survey confirmed that acute HF is still associated with a very poor medium-term prognosis, while the widespread adoption of evidence-based treatments in patients with chronic HF seems to have improved their outcome profile. Differences across countries may be due to different local medical practice as well to differences in healthcare systems. This pilot study also offered the opportunity to refine the organizational structure for a long-term extended European network.
Published: 2013

30. Aortic aneurysm disease vs. aortic occlusive disease: differences in outcome and intensive care resource utilisation after elective surgery: an observational study

Author: Ebbe Rønholm, J Bisgaard, Torben Gilsaa, and Palle Toft
Subjects: Male, medicine.medical_specialty, Critical Care, Arterial Occlusive Diseases, Cohort Studies, Aortic aneurysm, Aneurysm, Postoperative Complications, Aortic Aneurysm, Abdominal/mortality, Intensive care, medicine, Humans, Hospital Mortality, Prospective Studies, Registries, Elective surgery, Prospective cohort study, Aged, Hospital Mortality/trends, Elective Surgical Procedures/mortality, business.industry, Critical Care/statistics & numerical data, Organ dysfunction, Postoperative Complications/diagnosis, Perioperative, Middle Aged, medicine.disease, Abdominal aortic aneurysm, Surgery, Intensive Care Units, Anesthesiology and Pain Medicine, Treatment Outcome, Elective Surgical Procedures, Intensive Care Units/statistics & numerical data, cardiovascular system, Arterial Occlusive Diseases/mortality, Female, medicine.symptom, business, Aortic Aneurysm, Abdominal
Abstract: CONTEXT Abdominal aortic surgery is a high-risk procedure, with aortic aneurysm and aortic occlusive diseases being the main indications. These groups are often regarded as having equal perioperative risk profiles. Previous reports suggest that the haemodynamic and inflammatory response to aortic clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN Cohort observational study based on prospective registrations from national databases. SETTING Eight Danish hospitals, including four university and four non-university centres, from 1 January 2007 to 1 March 2010. PATIENTS One thousand two hundred and ninety-three patients scheduled for primary open elective, aortoiliac bypass or aortofemoral bypass procedures or abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES Mechanical ventilation, acute dialysis, use of vasopressors or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P
Published: 2012

31. A clinical pathway in a post-anaesthesia care unit to reduce length of stay, mortality and unplanned intensive care unit admission

Author: Bernhard Walder, Alain-S Eichenberger, Vincent Lechappe, Philippe Garnerin, Nicole Cheseaux, and Guy Haller
Subjects: Male, medicine.medical_specialty, Context (language use), law.invention, Cohort Studies, Clinical pathway, Patient Admission, Interquartile range, law, Critical Pathways/trends, medicine, Humans, Hospital Mortality, Aged, Retrospective Studies, Hospital Mortality/trends, ddc:617, business.industry, Retrospective cohort study, Odds ratio, Length of Stay, Middle Aged, Intensive care unit, Intensive Care Units/trends, Confidence interval, ddc:616.8, Intensive Care Units, Anesthesiology and Pain Medicine, Patient Admission/trends, Emergency medicine, Anesthesia Recovery Period, Length of Stay/trends, Critical Pathways, Female, business, Cohort study
Abstract: CONTEXT The immediate post-operative period is critical with regard to post-operative outcomes. OBJECTIVE To assess the impact of a clinical pathway implemented in a post-anaesthesia care unit on post-operative outcomes. DESIGN A retrospective cohort study based on electronic patient records. SETTING A post-anaesthesia care unit in a Swiss University Hospital. PATIENTS Adult patients after elective and non-elective surgery. INTERVENTION Implementation of a clinical pathway with a nurse-driven fast-track programme for uncomplicated patients (systematic use of Aldrete score and systematic discharge without physician) and a physician-driven slow-track programme for complicated patients (systematic handover between operating theatre and post-anaesthesia care unit, and between post-anaesthesia care unit and ward, systematic rounds, systematic use of standardised care for post-operative events, strict discharge criteria). MAIN OUTCOME MEASURES Post-anaesthesia care unit length of stay, in-hospital mortality and unplanned admission to the ICU after post-anaesthesia care unit stay. METHODS Comparison of the periods before and after implementation using median and interquartile range (IQR) and rates (%). STATISTICAL ANALYSIS unpaired Student's t-test, χ test, Wilcoxon rank test. Differences were adjusted through multivariate analyses with linear and logistic regression (level of significance: P
Published: 2011

32. Adverse events with medical devices in anesthesia and intensive care unit patients recorded in the French safety database in 2005-2006

Author: Laurent Beydon, Gérard Laguenie, François Clergue, Pierre Yves Ledenmat, Frédéric Lebreton, Dan Benhamou, Christophe Soltner, and Vincent Hardin
Subjects: medicine.medical_specialty, Intensive Care, Critical Care, Databases, Factual, computer.software_genre, France/epidemiology, law.invention, Equipment and Supplies/*adverse effects, law, Anesthesia, Conduction, Anesthesiology, Intensive care, Health care, medicine, Product Surveillance, Postmarketing, Humans, Anesthesia, Hospital Mortality, Adverse effect, Anesthesiology/*instrumentation, Hospital Mortality/trends, Database, ddc:617, Medical Errors, business.industry, Event (computing), Mortality rate, Intensive care unit, Anesthesia, Conduction/adverse effects, Equipment failure, Intensive Care Units, Anesthesiology and Pain Medicine, Equipment and Supplies, Medical Errors/*statistics & numerical data/trends, Equipment Failure, France, Safety, business, computer, Anesthesia/*adverse effects
Abstract: Background French regulations require that adverse events involving medical devices be reported to the national healthcare safety agency. The authors evaluated reports made in 2005-2006 for patients in anesthesiology and critical care. Methods For each type of device, the authors recorded the severity and cause of the event and the manufacturer's response where relevant. The authors compared the results with those obtained previously from the reports (n = 1,004) sent in 1998 to the same database. Results The authors identified 4,188 events, of which 91% were minor, 7% severe, and 2% fatal. The cause was available for 1,935 events (46%). Faulty manufacturing was the main cause of minor events. Inappropriate use was the cause in a significantly larger proportion of severe events than minor events (P < 0.001) and was usually considered preventable via improved knowledge or device verification before use. Compared to with that in 1998, the annual number of reported events doubled and the rate of severe events decreased slightly (12-10%, P = 0.03). The rate of events related to manufacturing problems remained stable (59-60%, P = nonsignificant), and the rate of events caused by human errors was 32-42% (P = 0.01). There were no changes in the mortality rate (2% in both studies). Conclusions The number of adverse events related to medical devices indicates a need for greater attention to these complex pieces of equipment that can suffer from faulty design and manufacturing and from inappropriate use. Improvements in clinician knowledge of medical devices, and to a lesser extent improvement in manufacturing practices, should improve safety.
Published: 2010

33. Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Author: Jean-Charles Cetre, Alain Lepape, Robert Allard, Dominique Chassard, I. Mohammedi, R. Girard, Dominique Robert, Jean-Marie Januel, François Artru, Didier Jacques, Jacqueline Grando, Marie-Christine Nicolle, Paul Petit, Marc-Olivier Robert, Stéphan Juergen Harbarth, Pierre-Yves Gueugniaud, Nicolas Voirin, Gerard Fournier, Claude Guérin, Philippe Vanhems, Bernard Allaouchiche, Jacques Fabry, Jean-Jacques Lehot, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Microbiology (medical), Risk, medicine.medical_specialty, Pediatrics, [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], Epidemiology, Intensive Care Units/*statistics & numerical data, medicine.medical_treatment, Critical Illness, law.invention, Hospitals, University, law, Hospital Mortality/*trends, Intensive care, Internal medicine, Cause of Death, medicine, Humans, Hospital Mortality, Cause of death, ddc:616, Cross Infection, business.industry, Incidence (epidemiology), Incidence, Case-control study, Length of Stay, Intensive care unit, Confidence interval, 3. Good health, Case-Control Studies, Cross Infection/epidemiology, Cross Infection/mortality, France, Hospital Mortality/trends, Intensive Care Units/statistics & numerical data, Population Surveillance/methods, Cross Infection/epidemiology/*mortality, Intensive Care Units, Infectious Diseases, Population Surveillance, Relative risk, business, Central venous catheter
Abstract: Background.The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.Objective.TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.Setting.Eleven ICUs of a French university hospital.Design.We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.Results.Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, –0.4% to 0.4%) for urinary tract infection.Conclusions.ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.
Published: 2010

34. Patient outcomes with teaching versus nonteaching healthcare: A systematic review

Author: Papanikolaou, P. N., Christidi, G. D., and Ioannidis, J. P.
Subjects: Delivery of Health Care/trends, volume, Treatment Outcome, Hospital Mortality/trends, Hospitals, Teaching/trends, Humans, academic medicine, quality-of-care, hospitals, metaanalysis
Abstract: BACKGROUND: Extensive debate exists in the healthcare community over whether outcomes of medical care at teaching hospitals and other healthcare units are better or worse than those at the respective nonteaching ones. Thus, our goal was to systematically evaluate the evidence pertaining to this question. METHODS AND FINDINGS: We reviewed all studies that compared teaching versus nonteaching healthcare structures for mortality or any other patient outcome, regardless of health condition. Studies were retrieved from PubMed, contact with experts, and literature cross-referencing. Data were extracted on setting, patients, data sources, author affiliations, definition of compared groups, types of diagnoses considered, adjusting covariates, and estimates of effect for mortality and for each other outcome. Overall, 132 eligible studies were identified, including 93 on mortality and 61 on other eligible outcomes (22 addressed both). Synthesis of the available adjusted estimates on mortality yielded a summary relative risk of 0.96 (95% confidence interval [CI], 0.93-1.00) for teaching versus nonteaching healthcare structures and 1.04 (95% CI, 0.99-1.10) for minor teaching versus nonteaching ones. There was considerable heterogeneity between studies (I(2) = 72% for the main analysis). Results were similar in studies using clinical and those using administrative databases. No differences were seen in the 14 studies fully adjusting for volume/experience, severity, and comorbidity (relative risk 1.01). Smaller studies did not differ in their results from larger studies. Differences were seen for some diagnoses (e.g., significantly better survival for breast cancer and cerebrovascular accidents in teaching hospitals and significantly better survival from cholecystectomy in nonteaching hospitals), but these were small in magnitude. Other outcomes were diverse, but typically teaching healthcare structures did not do better than nonteaching ones. CONCLUSIONS: The available data are limited by their nonrandomized design, but overall they do not suggest that a healthcare facility's teaching status on its own markedly improves or worsens patient outcomes. Differences for specific diseases cannot be excluded, but are likely to be small. PLoS Med
Published: 2006

35. Changing surgical management for acute aortic dissections type a improves immediate outcomes

Author: Jorge Sierra, Jan T. Christenson, and Afksendiyos Kalangos
Subjects: Male, Cardiac Surgical Procedures/methods, Brain Ischemia, Cohort Studies, Postoperative Complications, Hospital Mortality, Surgical treatment, Aortic dissection, Aged, 80 and over, Hospital Mortality/trends, Acute aortic dissections, ddc:617, Critical Care/methods, Middle Aged, Cerebrovascular Circulation, Acute Disease, Female, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Critical Care, Critical Illness, Cerebrovascular Circulation/physiology, Hospital mortality, Postoperative Complications/mortality, Risk Assessment, Statistics, Nonparametric, Blood Vessel Prosthesis Implantation, medicine, Humans, Blood Vessel Prosthesis Implantation/methods/mortality, Cardiac Surgical Procedures, Aged, Probability, Retrospective Studies, Aortic Aneurysm, Thoracic, business.industry, Aneurysm, Dissecting/mortality/radiography/surgery, medicine.disease, Survival Analysis, Surgery, Radiography, Aortic Dissection, Critical Illness/mortality, Aortic Aneurysm, Thoracic/diagnosis/mortality/surgery, sense organs, business, Brain Ischemia/prevention & control, Follow-Up Studies
Abstract: Surgical treatment of acute aortic dissection type A is well established. This study analyzes the impact of changing surgical management of Type A dissections on hospital mortality and postoperative complications.Between January 1980 and December 2002, 141 consecutive patients were operated for acute Type A aortic dissection. Patients were analyzed in 3 time periods; 1980-1989, n = 26, 1990-1999, n = 71 and 2000-2002, n = 44). Antegrade cerebral perfusion via subclavian cannulation, a more extensive resection as well as valvar repair was introduced as routine procedures from January 2000.Mortality and neurological complications decreased over time; from 31% to 9.1% and from 27% to 2.5%, respectively. During follow-up, 14 patients (12%) required surgical re-intervention for aneurysms (1 to 17 years later) with associated hospital mortality of 21%.Antegrade cerebral perfusion reduces neurological complications and more extensive surgical approach did not increase mortality and morbidity.
Published: 2005

36. Predictors of poor outcomes after significant chest trauma in multiply injured patients

Subjects: Adult, Hospital Mortality/trends, Male, Survival Rate/trends, Adolescent, Germany/epidemiology, Middle Aged, Thoracic Injuries/diagnosis, Young Adult, Injury Severity Score, Risk Factors, Wounds, Humans, Multiple Trauma/diagnosis, Female, Registries, Nonpenetrating/diagnosis, Trauma Centers/statistics & numerical data, Aged, Follow-Up Studies, Retrospective Studies
Abstract: BACKGROUND: Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality.METHODS: All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002-2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma.RESULTS: 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval.CONCLUSIONS: We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt chest trauma.
Published: 2014

37. 'Avoidable' deaths in two areas of sweden - Analysis of deaths in hospital after injury

Author: Boman, Helena, Björnstig, Ulf, Hedelin, Annika, Eriksson, Anders, Boman, Helena, Björnstig, Ulf, Hedelin, Annika, and Eriksson, Anders
Abstract: OBJECTIVE: To describe causes of death and other characteristics of "avoidable" deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied. DESIGN: Retrospective analysis of medico legal autopsy material. SETTING: One northern and one western area in Sweden 1988-1996. SUBJECTS: 335 cases who died in hospital after trauma. MAIN OUTCOME MEASURES: Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS) head of 4 or less and cause of death. RESULTS: We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved. CONCLUSION: The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people.
Published: 1999

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