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Case Fatality (case + fatality)
Terms modified by Case Fatality Selected AbstractsTime Trends in Incidence, Mortality, and Case-Fatality after First Episode of Status EpilepticusEPILEPSIA, Issue 8 2001Giancarlo Logroscino Summary: ,Purpose: Status epilepticus (SE) is a medical emergency associated with a high mortality. Clinical series have suggested that mortality after SE has decreased. No studies have systematically examined trends in incidence, mortality, and case fatality after SE in a well-defined population. Methods: All first episodes of SE receiving medical attention between January 1, 1935, and December 31, 1984, were ascertained through the Rochester Epidemiology Project Records-Linkage System and followed up until death or study termination (February 1, 1996). We calculated incidence rates in the 50-year period (1935,1984), while we considered mortality and case-fatality in the last 30-year period (1955,1984). Results: Incidence of SE increased over time to 18.1/100,000 (1975 through 1984). The increase was related to an increased incidence in the elderly and to the advent of myoclonic SE after cardiac arrest, a condition not seen in the early decades. In the last decade, ,16% of the incidence was due to myoclonic SE. The mortality rates increased from 3.6 per year in the decade 1955,1965 to 4.0/100,000 per year between 1975 and 1984. The 30-day case-fatality (CF) was unchanged, although a trend toward improvement was shown after excluding myoclonic SE. Conclusions: Incidence and mortality rates of SE have increased in the last 30 years. Case fatality remained the same. The increased incidence and mortality are due to the occurrence in the last decade of myoclonic SE after cardiac arrest. The mortality in the elderly was twice that of the youngest age group, across all study periods. Changes in the age and cause distribution of SE over time are responsible for the stable survivorship. There is improvement in survivorship in the last decade when myoclonic SE is excluded. [source] A national stroke quality register: 12 years experience from a participating hospitalEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007P. Appelros Registration of all hospitalized stroke patients is practiced in Sweden in order to assess care quality. Data in this register, Riks-Stroke (RS), may be biased due to incomplete registration. The purpose of this paper was to report changes in stroke outcome in relation to fluctuations in registration. Patients registered in RS at a hospital during the period 1994,2005 were analyzed. Case fatality at 28 days, living conditions, and activities of daily living (ADL) performance at 3 months were correlated to the number of patients registered and follow-up frequency. A total of 4994 stroke cases were registered during the period. A high annual registration rate was significantly correlated to a high case fatality ratio. A low annual follow-up rate was associated with a low proportion of patients living in their own home without any need of help. Quality parameters are sensible for selection bias, which make them difficult to compare over time and between hospitals. We suggest that by weighing outcome data against stroke severity, safer conclusions may be drawn. Additionally, hospitals considering setting up quality registers should make every effort to attain complete case ascertainment at all times, including patients managed outside the hospital, in order to avoid selection bias. [source] The Debrecen Stroke Database: demographic characteristics, risk factors, stroke severity and outcome in 8088 consecutive hospitalised patients with acute cerebrovascular diseaseINTERNATIONAL JOURNAL OF STROKE, Issue 5 2009D. Bereczki Background High stroke mortality in central,eastern European countries might be due to higher stroke incidence, more severe strokes or less effective acute care than in countries with lower mortality rate. Hospital databases usually yield more detailed information on risk factors, stroke severity and short-term outcome than population-based registries. Patients and methods The Debrecen Stroke Database, data of 8088 consecutively hospitalised patients with acute cerebrovascular disease in a single stroke centre in East Hungary between October 1994 and December 2006, is analysed. Risk factors were recorded and stroke severity on admission was scored by the Mathew stroke scale. The modified Glasgow outcome scale was used to describe patient condition at discharge. Results Mean age was 68±13 years, 11·4% had haemorrhagic stroke. The rate of hypertension on admission was 79% in men, and 84% in women, 40·3% of men and 19·8% of women were smokers, and 34% of all patients had a previous cerebrovascular disease in their history. Case fatality was 14·9%, and 43% had some disability at discharge. Outcome at discharge was worse with higher age, higher glucose, higher blood pressure, higher white cell count and erythrocyte sedimentation rate and more severe clinical signs on admission. In multivariate analysis admission blood pressure lost its significance in predicting outcome. Conclusions In this large Hungarian stroke unit database hypertension on admission, smoking and previous cerebrovascular disease were more frequent than in most western databases. These findings indicate major opportunities for more efficient stroke prevention in this and probably other eastern European countries. [source] Case fatality among infants with congenital malformations by lethalityBIRTH DEFECTS RESEARCH, Issue 9 2004Kirk A. Bol Abstract OBJECTIVE Infant mortality rates continue to show that congenital anomalies are the leading cause of infant death in the United States. However, studies of factors contributing to increased mortality across different types of congenital anomalies have been limited. The objective of this study was to assess whether the likelihood of infant mortality varied by maternal race and ethnic group while considering the severity of the birth defect. METHODS A retrospective cohort analysis was conducted using data from Colorado's statewide, population-based birth defects surveillance system (CRCSN). The cohort included infants, born between 1995 and 2000 to Colorado resident mothers, who were diagnosed with major congenital malformations stratified by degree of lethality. Multiple logistic regression was performed for each level of lethality, and included the following potential explanatory variables: maternal race/ethnicity, clinical gestation, birth weight, maternal education level, maternal age, and sex of child. RESULTS Within the low/very low lethality cohort, maternal race/ethnicity of Black/non-Hispanic was associated with increased risk of infant mortality, OR 2.81 (1.41,5.19), as were low and very low birth weight, OR 2.21 (1.12,4.04) and 19.31 (11.84,31.01), respectively. Maternal race/ethnicity was not a significant risk factor in either high or very high lethality groups; however, the interaction between birth weight and gestational age significantly increased the risk of mortality. CONCLUSIONS Through the use of statewide, population-based birth defects surveillance data, a disparity in infant mortality has been identified in a specific subset of the population that could be investigated further and targeted for prevention activities. Birth Defects Research (Part A) 70:580,585, 2004. © 2004 Wiley-Liss, Inc. [source] Mortality in childhood progressive encephalopathy from 1985 to 2004 in Oslo, Norway: a population-based studyACTA PAEDIATRICA, Issue 1 2008Petter Strømme Abstract Aims: The aims were to estimate case fatality and survival rates, standardized mortality ratio (SMR), and independent prognostic factors for survival, in a population-based cohort of progressive encephalopathy (PE) patients. Methods: We divided onset of disease into neonatal and postneonatal groups and aetiology into metabolic (n = 55), neurodegenerative (n = 27) and HIV encephalopathy (n = 2) groups. Case fatality was the number of deaths divided by the number of patients. Cumulative survival probability at 10 years of follow-up and independent risk factors for mortality were analyzed using the Kaplan-Meier survival curve and the Cox model. Results: Case fatality was 36.9% and the mean and median follow-up times were 3109 and 2887 days. At 1 and 10 years, the cumulative probability of survival was 81% and 66%. Neonatal onset showed increased risk of death compared to postneonatal onset (RR 3.0; 95% CI 1.4,6.2). Metabolic aetiology showed increased risk of death compared to other aetiology (RR 1.25; 95% CI 1.10,1.46). The SMR of 37.7 for boys and 23.8 for girls was significantly increased (p < 0.001) compared to the total Norwegian population stratified by gender and age. Conclusions: Children with PE showed a vast excess in mortality compared to the general population stratified by gender and age. Neonatal presentation and metabolic aetiology were the most significant factors for increased risk of death. [source] Severe acute respiratory syndrome in childrenPEDIATRIC PULMONOLOGY, Issue 4 2003Gary W.K. Wong MD Abstract Severe acute respiratory syndrome (SARS) is a newly described and highly contagious respiratory infection. Many adult patients will develop progressive hypoxia, and a large proportion will develop respiratory distress syndrome (RDS), possibly related to massive and uncontrolled activation of the immune system. The mortality has been reported to be quite high, especially in the elderly with comorbid conditions. The causative agent has been identified as a novel coronavirus, and children appear to acquire the infection by close-contact household exposure to an infected adult. However, the severity is much milder and the clinical progression much less aggressive in young children. The exact pathophysiology of SARS is still unclear, and the medical treatment of SARS remains controversial. The main treatment regime used in Hong Kong is a combination of ribavirin and steroid. To date, there have been no reported case fatalities in children with this disease. The success of reducing the burden of this infection in children will depend on proper isolation of infected adults early in the course of illness. Strict public health policy and quarantine measures are the key in controlling the infection in the community. Pediatr Pulmonol. 2003; 36:261,266. © 2003 Wiley-Liss, Inc. [source] Time Trends in Incidence, Mortality, and Case-Fatality after First Episode of Status EpilepticusEPILEPSIA, Issue 8 2001Giancarlo Logroscino Summary: ,Purpose: Status epilepticus (SE) is a medical emergency associated with a high mortality. Clinical series have suggested that mortality after SE has decreased. No studies have systematically examined trends in incidence, mortality, and case fatality after SE in a well-defined population. Methods: All first episodes of SE receiving medical attention between January 1, 1935, and December 31, 1984, were ascertained through the Rochester Epidemiology Project Records-Linkage System and followed up until death or study termination (February 1, 1996). We calculated incidence rates in the 50-year period (1935,1984), while we considered mortality and case-fatality in the last 30-year period (1955,1984). Results: Incidence of SE increased over time to 18.1/100,000 (1975 through 1984). The increase was related to an increased incidence in the elderly and to the advent of myoclonic SE after cardiac arrest, a condition not seen in the early decades. In the last decade, ,16% of the incidence was due to myoclonic SE. The mortality rates increased from 3.6 per year in the decade 1955,1965 to 4.0/100,000 per year between 1975 and 1984. The 30-day case-fatality (CF) was unchanged, although a trend toward improvement was shown after excluding myoclonic SE. Conclusions: Incidence and mortality rates of SE have increased in the last 30 years. Case fatality remained the same. The increased incidence and mortality are due to the occurrence in the last decade of myoclonic SE after cardiac arrest. The mortality in the elderly was twice that of the youngest age group, across all study periods. Changes in the age and cause distribution of SE over time are responsible for the stable survivorship. There is improvement in survivorship in the last decade when myoclonic SE is excluded. [source] Modelling the burden of stroke in Finland until 2030INTERNATIONAL JOURNAL OF STROKE, Issue 5 2009J. Sivenius Background It is well known that increasing age is the strongest risk factor of stroke. Therefore, it has been a common belief in many countries including Finland that the numbers of stroke patients will increase considerably during the next two decades because the population is rapidly ageing. Methods The FINMONICA and FINSTROKE registers operated in Finland in the Kuopio area and city of Turku from 1983 to 1997. The results showed that the incidence, mortality and case fatality of stroke declined significantly during that period. Importantly, it was established that the trends in incidence and mortality were also declining among the elderly (>74 years). We used these results to create a model for the entire country. The model was based on the trends present in these registers from Turku and Kuopio area and age-specific population projections up to the year 2030 that were obtained from Statistics Finland. Results In the year 2000, the number of new first stroke cases was estimated to be 11 500. If the declining trend were to level off totally after the year 2000, the number of new strokes would be 20 100 in the year 2030 due to the ageing of the population. It would be 12 100 if the trend continued as favourable as during the years 1983,1997. Conclusions Ageing of the population will not inevitably increase the burden of stroke in Finland if the present declining trends are maintained, but the annual number of cases will almost double if the incidence remains at the level of the year 2000. [source] Agreement Between Nosologist and Cardiovascular Health Study Review of Deaths: Implications of Coding DifferencesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009Diane G. Ives MPH OBJECTIVES: To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS). DESIGN: Observational. SETTING: Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh). PARTICIPANTS: Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004. MEASUREMENTS: The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only. RESULTS: Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89,0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58,0.64; stroke, kappa=0.59, 95% CI=0.54,0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51,0.65; dementia, kappa=0.40, 95% CI=0.34,0.45; and pneumonia, kappa=0.35, 95% CI=0.29,0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause. CONCLUSION: Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause-specific mortality in older individuals may be a function of classification process rather than incidence and case fatality. [source] Pneumonia Versus Aspiration Pneumonitis in Nursing Home Residents: Prospective Application of a Clinical AlgorithmJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Joseph 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] The burden of coronary heart disease in M,ori: population-based estimates for 2000-02AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009Martin Tobias Abstract Objective: To estimate coronary heart disease (CHD) incidence, prevalence, survival, case fatality and mortality for M,ori, in order to support service planning and resource allocation. Methods: Incidence was defined as first occurrence of a major coronary event, i.e. the sum of first CHD hospital admissions and out-of-hospital CHD deaths in people without a hospital admission for CHD in the preceding five years. Data for the years 2000-02 were sourced from the New Zealand Health Information Service and record linkage was carried out using a unique national identifier, the national health index. Results: Compared to the non-M,ori population, M,ori had both elevated CHD incidence and higher case fatality. Median age at onset of CHD was younger for M,ori, reflecting both higher age specific risks and younger population age structure. The lifetable risk of CHD for M,ori was estimated at 37% (males) and 34% (females), only moderately higher than the corresponding estimates for the non-M,ori population, despite higher M,ori CHD incidence. This reflects the offsetting effect of the higher ,other cause' mortality experienced by M,ori. Median duration of survival with CHD was similar to that of the non-M,ori population for M,ori males but longer for M,ori females, which is most likely related to the earlier age of onset. Conclusions: This study has generated consistent estimates of CHD incidence, prevalence, survival, case fatality and mortality for M,ori in 2000-02. The inequality identified in CHD incidence calls for a renewed effort in primary prevention. The inequality in CHD case fatality calls for improvement in access for M,ori to secondary care services. [source] Bladder cancer survivals in New South Wales, Australia: why do women have poorer survival than men?BJU INTERNATIONAL, Issue 4 2009Elizabeth Tracey OBJECTIVE To investigate factors that most influenced survival from bladder cancer in New South Wales, Australia (NSW) and to consider the impact of changes in coding practices on the reporting the of bladder cancer outcomes. PATIENTS AND METHODS All NSW cases of bladder cancer diagnosed between 1980 and 2003 were followed to the end of 2004 (17 923 cases). Survival analysis was undertaken using Kaplan,Meier unadjusted disease-specific survival and adjusted disease-specific survival using Cox proportional hazards regression modelling. This analysis was unique in that it modelled the effect of sex, age, country of birth, socio-economic status (SES), histological type, extent of disease and period of diagnosis on survival from bladder cancer in NSW. RESULTS After adjusting for sex, age, extent of disease, SES, period of diagnosis and histological type, the likelihood of death was 11% (95% confidence interval, CI 5,18%) higher in females than in males, with case fatality most influenced by age at diagnosis, extent of disease, and histological type. When the analysis was repeated for cases with a method 6 (i.e. coding undertaken in the registry after examination of the pathology report, which would enhance accuracy), the likelihood of death was 13% (95% CI 5,21%) higher in females than in males. CONCLUSIONS The NSW analysis controls for variability in coding, extent of disease at diagnosis and histological type of cancer. The analysis shows significantly lower survival from bladder cancer in NSW women compared with men, with no improvement in survival from 1980 to 2003. Possible reasons for the lower survivals in women, the lack of improvement in survival and coding differences in jurisdictions are discussed. [source] The impact of ageing on stroke subtypes, length of stay and mortality: study in the province of Teruel, SpainACTA NEUROLOGICA SCANDINAVICA, Issue 6 2003P. 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] Mortality in childhood progressive encephalopathy from 1985 to 2004 in Oslo, Norway: a population-based studyACTA PAEDIATRICA, Issue 1 2008Petter Strømme Abstract Aims: The aims were to estimate case fatality and survival rates, standardized mortality ratio (SMR), and independent prognostic factors for survival, in a population-based cohort of progressive encephalopathy (PE) patients. Methods: We divided onset of disease into neonatal and postneonatal groups and aetiology into metabolic (n = 55), neurodegenerative (n = 27) and HIV encephalopathy (n = 2) groups. Case fatality was the number of deaths divided by the number of patients. Cumulative survival probability at 10 years of follow-up and independent risk factors for mortality were analyzed using the Kaplan-Meier survival curve and the Cox model. Results: Case fatality was 36.9% and the mean and median follow-up times were 3109 and 2887 days. At 1 and 10 years, the cumulative probability of survival was 81% and 66%. Neonatal onset showed increased risk of death compared to postneonatal onset (RR 3.0; 95% CI 1.4,6.2). Metabolic aetiology showed increased risk of death compared to other aetiology (RR 1.25; 95% CI 1.10,1.46). The SMR of 37.7 for boys and 23.8 for girls was significantly increased (p < 0.001) compared to the total Norwegian population stratified by gender and age. Conclusions: Children with PE showed a vast excess in mortality compared to the general population stratified by gender and age. Neonatal presentation and metabolic aetiology were the most significant factors for increased risk of death. [source] | ||||||||||