Case Fatality Rate (case + fatality_rate)

Distribution by Scientific Domains


Selected Abstracts


Trends in mortality and hospital admission rates for abdominal aortic aneurysm in England and Wales, 1979,1999

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2005
M. Filipovic
Background: The aim of this study was to investigate trends in population-based mortality, hospital admission and case fatality rates for abdominal aortic aneurysm (AAA) from 1979 to 1999. Methods: This was an analysis of routine statistics from 79 495 death certificates in England and Wales and 3217 hospital inpatient admissions in the Oxford Region. Results: Mortality rates for all AAAs increased between 1979 and 1999 from 13 to 25 per million in women and from 80 to 115 per million in men. Admission rates increased in the same time interval from three to 22 admissions per million per year in women, and from 52 to 149 per million per year in men. Case fatality rates for all non-ruptured AAAs that were operated on decreased from 258 to 90 per cent and for all ruptured AAAs from 699 to 544 per cent. Conclusion: Mortality rates and hospital admission rates for AAA rose in men and even more so in women between 1979 and 1999. Perioperative mortality for ruptured AAA declined a little during the study but nonetheless was still very high at the end. This reinforces the importance of detecting and treating AAA before rupture occurs. Copyright 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]


Treatment of Immune-Mediated Hemolytic Anemia with Individually Adjusted Heparin Dosing in Dogs

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2010
S.E. Helmond
Background: A major cause of death in dogs with immune-mediated hemolytic anemia (IMHA) is thromboembolism. Previous studies suggest unfractionated heparin (UH) is not effective in preventing thromboembolism in IMHA; however, subtherapeutic dosing could explain the seeming lack of efficacy. Hypothesis: Providing therapeutic plasma concentration of UH by individually adjusting doses based on antifactor Xa activity would improve survival in IMHA. Animals: Fifteen dogs with primary IMHA. Methods: Randomized, prospective, controlled clinical trial. Dogs received standardized therapy for IMHA and either constant dose (CD) (150 U/kg SC) (n = 7) or individually adjusted dose (IAD) (n = 8) UH, monitored via an anti-Xa chromogenic assay, adjusted according to a nomogram. UH was administered every 6 hours until day 7, and every 8 hours thereafter. UH dose was adjusted daily in IAD dogs until day 7, weekly until day 28, then tapered over 1 week. Dogs were monitored for 180 days. Results: At day 180, 7 dogs in the IAD group and 1 in the CD group were alive (P= .01). Median survival time for the IAD group was >180 days, and 68 days for the CD group. Thromboembolic events occurred in 5 dogs in the CD group and 2 dogs in the IAD group. Doses of UH between 150 and 566 U/kg achieved therapeutic anti-Xa activity (0.35,0.7 U/mL). Conclusions and Clinical Importance: This study suggests that IAD UH therapy using anti-Xa monitoring reduced case fatality rate in dogs with IMHA when compared with dogs receiving fixed low dose UH therapy. [source]


Sequential Plasma Lactate Concentrations as Prognostic Indicators in Adult Equine Emergencies

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010
B.S. Tennent-Brown
Background: Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate. Hypothesis: Prognosis for survival is decreased in horses with a delayed return to normal [LAC]. Animals: Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement. Methods: Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC],T) was calculated from changes in [LAC] between sampling points. Results: Median [LAC] was significantly (P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60,18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30,13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17,1.43) at admission to 49.90 (6.47,384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC],T was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24,72 hours (, 0.47, P= .001) and 48,72 hours (, 0.07, P= .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors. Conclusions and Clinical Importance: These results indicate that lactate metabolism is impaired in critically ill horses and [LAC],T can be a useful prognostic indicator in horses. [source]


The impact of ageing on stroke subtypes, length of stay and mortality: study in the province of Teruel, Spain

ACTA NEUROLOGICA SCANDINAVICA, Issue 6 2003
P. J. Modrego
Background and purpose , During the last three decades, there have been important advances in the diagnosis and treatment of stroke leading to a decline in mortality rates in western countries. However, the longer life expectancy and the higher proportion of elderly people in the structure of the population may partially counteract this positive trend in stroke-related mortality. The purpose of this study was to analyse the impact of a high ageing index of the population on stroke-related variables such as stroke subtypes, length of hospital stay and mortality from stroke. Methods , We analysed the data of 1850 consecutive patients with first-ever stroke retrieved from a prospective registry over a period of 8 years (1994,2001) in the province of Teruel, Spain, with two public hospitals in the catchment area. The mean age was 75.5 years (SD: 9.4) and the sex was male in 62% of cases. The variables included in the study were vascular risk factors, stroke subtypes, fatality rate, length of stay and mortality. Mortality was assessed from 1990 to 2000. Results , Arterial hypertension and atrial fibrillation were the most frequent risk factors, with an observed high frequency of cardioembolic stroke. The mean 28-day case fatality rate was 16.6%, ranging from 11.9% in 1994 to 23.4% in 1999. We found complications in 38% of patients, especially in the elderly. Fatality occurred in 20.3% of elderly subjects (65 or over) in comparison to 7.25% for those younger (Relative risk: 2.8; 95% CI: 1.47,5.3). Crude mortality rates were higher than for the general population in Spain and ranged from 169 in 1991 to 139/100,000 in 2000 with higher rates for women. However, the age-adjusted mortality rate to the standard European population was 56.6/100,000 (95% CI: 46,64) in 1999, which was similar to that found in Spain (61/100,000). Conclusions , The impact of ageing on case fatality and mortality by stroke was substantial. Whereas mortality by stroke stabilized after decreasing in our province and in Spain in the last decade, fatality rates have significantly increased in our province because of the high proportion of elderly people and to the high rate of post-stroke complications. [source]


Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited

CLINICAL MICROBIOLOGY AND INFECTION, Issue 6 2006
O. Ergonul
Abstract The aim of this study was to determine the predictors of mortality among patients infected with Crimean-Congo haemorrhagic fever (CCHF) virus. Among patients with acute febrile syndrome, characterised by malaise, bleeding, leukopenia and thrombocytopenia, who were admitted to hospital during the spring and summer of 2002,2004, 54 had positive IgM and/or PCR results for CCHF virus in blood or tissue. The overall case fatality rate was 7.4%. Among the fatalities, haematemesis (p 0.009), melaena (p 0.001) and somnolence (p 0.022) were more common, the median platelet count was significantly lower (10 600/mL vs. 20 000/mL; p 0.038), the mean prothrombin time (27 s vs. 16 s; p 0.002) and mean activated partial thromboplastin time (73 s vs. 44 s; p < 0.001) were longer, and the mean alanine transferase (ALT) level (1125 vs. 331; p < 0.001), the mean aspartate transferase (AST) level (3118 vs. 913; p 0.004) and the mean fibrinogen level (119 vs. 340; p 0.012) were higher. Serum IgM and IgG against CCHF virus was detected in 25% and 0%, respectively, of fatal cases, compared with 94% and 62%, respectively, of cases with favourable outcomes. Oral ribavirin was prescribed to 22 (41%) patients. Of the four fatal cases, it was the intention to prescribe ribavirin to three patients, but this was not possible because of haematemesis and melaena. Higher levels of AST (, 700 U/L) and ALT (, 900 U/L) are suggested for use as severity criteria. Oral ribavirin was not effective for patients with haematemesis, and intravenous ribavirin is necessary for treatment of CCHF. [source]


Invasive group A, B, C and G streptococcal infections in Denmark 1999,2002: epidemiological and clinical aspects

CLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2005
K. Ekelund
Abstract Group A streptococci (GAS) have been described frequently as an emerging cause of severe invasive infections in population-based surveillance studies, whereas the descriptions of group B, C and G streptococci (GBS, GCS and GGS) have been less frequent. Enhanced surveillance for invasive GAS, GBS, GCS and GGS was performed in Denmark in 1999,2002. A detailed questionnaire was completed for 1237 (98%) of 1260 invasive infections. GAS infections dominated (40%), followed by GGS (32%), GBS (23%) and GCS (6%). Most (74%) patients had predisposing factors, and there were no significant differences between the four serogroups when comparing the prevalence of cancer, diabetes mellitus, chronic heart or lung diseases, immunodeficiency or alcohol abuse. The overall case fatality rate at day 30 was 21%, increasing significantly to 59% for patients with streptococcal toxic shock syndrome (STSS). STSS was significantly more frequent in GAS patients (10%) than in GCS (4%), GBS (2%) and GGS (2%) patients. Regression analyses showed that, despite a younger median age among GAS patients, the probability of developing septic shock and mortality was significantly higher among GAS patients than among GBS and GGS patients. These analyses showed no significant differences between GAS and GCS infections. Invasive infections caused by GAS, GBS, GCS and GGS are still a major challenge for clinicians. Continued epidemiological and microbiological surveillance is important to assess the development of these infections and to improve preventative strategies. [source]


Pneumonia Versus Aspiration Pneumonitis in Nursing Home Residents: Prospective Application of a Clinical Algorithm

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005
Joseph M. Mylotte MD
Objectives: To prospectively evaluate a clinical algorithm for the diagnosis of pneumonitis and pneumonia in nursing home residents. Design: Prospective cohort study. Setting: Inpatient geriatrics unit. Participants: Nursing home residents admitted to the hospital with suspected pneumonia. Measurements: Identification of pneumonitis and pneumonia using the algorithm; medical record review and abstraction of clinical data; hospital outcome and length of stay. Results: One hundred seventy episodes of suspected pneumonia were screened with the algorithm and classified into four groups: 25% pneumonia, 28% aspiration pneumonitis of 24 hours or less duration, 12% aspiration pneumonitis of more than 24 hours' duration, and 35% an aspiration event without pneumonitis. Presenting symptoms and signs, laboratory tests, severity of illness measures, or serum C-reactive protein levels did not distinguish between the four groups. Those with an aspiration event without pneumonitis tended to be treated less often with antibiotic therapy after admission (P=.004) and after discharge (P=.01). Of those who survived, there was no significant difference in mean hospital length of stay between the four groups. There was no significant difference in the percentage of case fatality between the four groups, but those with aspiration pneumonitis of 24 hours or less duration and with an aspiration event without pneumonitis had a lower mortality than the other two groups. Conclusion: Distribution of episodes of suspected pneumonia by clinical category as determined using the algorithm was similar to that of the derivation study, as were case fatality rates in each category. These findings suggest that the algorithm may be useful for making the distinction between pneumonitis and pneumonia in nursing home residents; further studies are warranted. [source]


Antenatal pulmonary embolism: risk factors, management and outcomes

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2008
M Knight
Objectives, To estimate the incidence of antenatal pulmonary embolism and describe the risk factors, management and outcomes. Design, A national matched case,control study using the UK Obstetric Surveillance System (UKOSS). Setting, All hospitals with consultant-led maternity units in the UK. Participants, A total of 143 women who had an antenatal pulmonary embolism between February 2005 and August 2006. Two hundred and fifty nine matched control women. Methods, Prospective case and control identification through the UKOSS monthly mailing. Main outcome measures, Incidence and case fatality rates with 95% CIs. Adjusted odds ratio estimates. Results, One hundred per cent of UK consultant-led obstetric units contributed data to UKOSS. A total of 143 antenatal pulmonary embolisms were reported, representing an estimated incidence of 1.3 per 10 000 maternities (95% CI 1.1,1.5). Seventy per cent of women had identifiable classical risk factors for thromboembolic disease. The main risk factors for pulmonary embolism were multiparity (adjusted odds ratio [aOR] 4.03, 95% CI 1.60,9.84) and body mass index , 30 kg/m2 (aOR 2.65, 95% CI 1.09,6.45). Nine women who had a pulmonary embolism should have received antenatal thromboprophylaxis with low-molecular-weight heparin (LMWH) according to national guidelines; only three (33%) of them did. Six women (4%) had a pulmonary embolism following antenatal prophylaxis with LMWH; three of these women (50%) were receiving lower than recommended doses. Two women had recurrent pulmonary emboli (1.4%, 95% CI 0.2,5.1%). Five women died (case fatality 3.5%, 95% CI 1.1,8.0%). Conclusions, Significant severe morbidity from thromboembolic disease underlies the maternal deaths from pulmonary embolism in the UK. This study has shown some cases where thromboprophylaxis was not provided according to national guidelines, and there may be scope for further work on guideline implementation. [source]


Trends in mortality and hospital admission rates for abdominal aortic aneurysm in England and Wales, 1979,1999

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2005
M. Filipovic
Background: The aim of this study was to investigate trends in population-based mortality, hospital admission and case fatality rates for abdominal aortic aneurysm (AAA) from 1979 to 1999. Methods: This was an analysis of routine statistics from 79 495 death certificates in England and Wales and 3217 hospital inpatient admissions in the Oxford Region. Results: Mortality rates for all AAAs increased between 1979 and 1999 from 13 to 25 per million in women and from 80 to 115 per million in men. Admission rates increased in the same time interval from three to 22 admissions per million per year in women, and from 52 to 149 per million per year in men. Case fatality rates for all non-ruptured AAAs that were operated on decreased from 258 to 90 per cent and for all ruptured AAAs from 699 to 544 per cent. Conclusion: Mortality rates and hospital admission rates for AAA rose in men and even more so in women between 1979 and 1999. Perioperative mortality for ruptured AAA declined a little during the study but nonetheless was still very high at the end. This reinforces the importance of detecting and treating AAA before rupture occurs. Copyright 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]