The quality of the data in the Cause of Death Registry is crucial to produce reliable statistics on causes of death. The Cancer Registry of Norway uses data from the Norwegian Patient Register to request information from hospitals regarding patients registered with cancer in the patient registry, but not in the cancer registry. We wanted to investigate whether data from the Norwegian Patient Register can also be used to advantage in the Cause of Death Registry.
Data from the Cause of Death Registry on deaths that occurred during the period 2009?–?2011 (N = 124,098) were collated with data on contact with somatic hospitals and psychiatric institutions during the last year of life, retrieved from the Norwegian Patient Register. Causes of death were grouped in the same way as in standard statistics on causes of death.
Out of 124,098 deaths, altogether 34.9% occurred in somatic hospitals. A total of 80.9% of all deceased had been admitted to a somatic hospital and/or had attended an outpatient consultation during their last year of life. The proportion with hospital contact was highest for those whose cause of death was cancer. In cases of unknown/unspecified cause of death, more than half also had contact with hospitals, but the majority of these were registered with only outpatient consultations. Altogether 5.4% of all deceased had been admitted to and/or had an outpatient consultation in a psychiatric institution during their last year of life. For those whose cause of death was suicide, this proportion amounted to 41.8%.
In case of incomplete information on the cause of death, data from the Norwegian Patient Register can supply valuable information on where the patient has been treated, thus enabling the Cause of Death Registry to contact the hospitals in question. However, any potential benefit is restricted by the fact that deceased persons with unknown/unspecified causes of death had less frequently been admitted to hospital during their last year of life.
Ruptured infrarenal abdominal aortic aneurysms (rAAAs) represent both a life-threatening emergency for the affected patient and a considerable health burden globally. The aim of this study was to investigate the contemporary epidemiology of rAAA in a defined Norwegian population for which both hospital and autopsy data were available.
This was a retrospective, single-center population-based study of rAAA. The study includes all consecutively diagnosed prehospital and in-hospital cases of rAAA in the catchment area of Stavanger University Hospital between January 2000 and December 2012. Incidence and mortality rates (crude and adjusted) were calculated using national demographic data.
A total of 216 patients with primary rAAA were identified. The adjusted incidence rate for the study period was 11.0 per 100,000 per year (95% confidence interval [CI], 9.6-12.5). Twenty patients died out of the hospital, and 144 of the 196 patients (73%) admitted to the hospital underwent surgery. The intervention rate varied from 48% to 81% during the study period. The adjusted mortality rate was 7.5 per 100,000 per year (95% CI, 6.3-8.8). No differences in the incidence and mortality rates were found in comparing early and late periods. The 90-day standardized mortality ratio for the study period was 37.2 (95% CI, 31.6-43.7). The overall 90-day mortality was 68% (146 of 216 persons) and 51% (74 of 144 persons) for the patients treated for rAAA.
We found a stable incidence and mortality rate during a decade. The prehospital death rate was lower (9%), the intervention rate (73%) higher, and the total mortality (68%) lower than in most other studies. Geographic and regional differences may influence the epidemiologic description of rAAA and hence should be taken into consideration in comparing outcomes for in-hospital mortality and intervention rates.
This study aimed to determine the level of misattribution of prostate cancer deaths in Norway based on the county of Vestfold in the years 2009-2014.
The study included 328 patients registered as dead from prostate cancer (PCD; part I of death certificate), 126 patients with prostate cancer as other significant condition at death (OCD; part II of death certificate) and 310 patients who died with a diagnosis of prostate cancer not registered on the death certificate (PC-DCneg) in Vestfold County in 2009-2014. The complete cohort with patients' names and dates of birth was provided by the Norwegian Institute of Public Health and the Norwegian Cancer Registry. The true cause of death of all patients was evaluated based on patient journals.
Over-reporting of prostate cancer deaths in the PCD group was 33% while under-reporting in the OCD and PC-DCneg groups was 19% and 5%, respectively. The correlation between registered and observed causes of death was 0.81 (95% confidence interval 0.78-0.83). Misattribution of prostate cancer deaths increased significantly with patient age and decreasing Gleason score.
Prostate cancer mortality statistics in Norway are relatively accurate for patients aged ?75 years), who represent the large majority of prostate cancer deaths. Over-reporting of prostate cancer deaths among elderly people may not be an exclusively Norwegian phenomenon and may affect prostate cancer mortality statistics in other countries.
Extreme sports, including BASE (building, antenna, span, earth) jumping, are rapidly increasing in popularity. Associated with risk for injuries and deaths, this activity may pose a burden on the emergency system. Hitherto, no reports exist on accidents and deaths associated with BASE jumping.
We reviewed records of 20,850 BASE jumps from 1995 to 2005 at the Kjerag massif in Norway. Frequency of deaths, accidents, and involvement of helicopter and climbers in rescue are analyzed. Fatalities were scored for injury severity scores (Abbreviated Injury Scale score, Injury Severity Score, New Injury Severity Score) on autopsy.
During an 11-year period, a total of 20,850 jumps (median, 1,959; range, 400-3,000) resulted in 9 fatal (0.04% of all jumps; 1 in every 2,317 jumps) and 82 nonfatal accidents (0.4% of all jumps; 1 in every 254 jumps). Accidents increased with the number of jumps (r=0.66; p=0.007), but fatalities did not increase, nor did activation of helicopter or climbers in rescue (p>0.05). Helicopter activation (in one-third of accidents) in rescue correlated with number of accidents (r=0.76, p=0.007), but not climbers. Postmortem examination (n=7) of fatalities revealed multiple, severe injuries (Abbreviated Injury Scale score>or=3) sustained in several body regions (median, Injury Severity Score 75; range, 23-75). Most nonfatal accidents were related to ankle sprains/fracture, minor head concussion, or a bruised knee.
BASE jumping appears to hold a five- to eightfold increased risk of injury or death compared with that of skydiving. The number of accidents and helicopter activation increases with the annual number of jumps. Further analysis into the injury severity spectrum and associated hospital burden is required.
Institutt for laboratoriemedisin, barne- og kvinnesykdommer, Norges teknisk-naturvitenskapelige universitet og Avdeling for klinisk farmakologi, St. Olavs hospital, Olav Kyrres gate 17, 7006 Trondheim, Norway. firstname.lastname@example.org
BACKGROUND: At the turn of 2007/2008, four Norwegian men died after ingestion of commercially available supposedly denatured ethanol. MATERIAL AND METHODS: The four deaths are presented and discussed. RESULTS: Methanol concentrations, consistent with lethal methanol poisoning, were detected in blood and urine for all four. The imbibed mixture was subsequently shown to contain a 70/30 mixture of methanol/ethanol. INTERPRETATION: The events emphasize the importance of investigating methanol findings from deceased to identify the source, and that investigations are instigated promptly to prevent further exposure.
BACKGROUND: Routines for requesting autopsies in hospitals in Norway differ. At the Central Hospital in Rogaland, physicians usually fill out a form requesting an autopsy when a patient dies. The physician can choose between "high", "ordinary" or "low priority". In this study we investigated which patients were given highest priority and which factors influenced the priority made by the referring physician. MATERIAL AND METHODS: This was a retrospective study. All requests for an autopsy during the year 2000 were reviewed, except forensic medicine cases and perinatal deaths. We included 785 requests in the study. 237 autopsies were performed: an autopsy rate of 30.2%. RESULTS AND INTERPRETATION: The requesting physicians considered 17% "high priority", 44% "ordinary priority" and 39% "low priority". Significantly higher priorities were set for those who died young, those who died after a short stay in hospital, and for those who died in intensive care units. Sex and time of death did not influence priorities. The recommendation required on the autopsy request form leads to more appropriate decisions by pathologists and strengthens the relationship between clinicians and pathologists.
Ischemic heart disease is the most common cause of sudden death of natural causes in most western countries. By autopsy, there may be no gross or histologic evidence of acute myocardial damage unless the patient survived for several hours following the event. Cardiac troponin in serum has become the recommended biochemical marker for myocardial injury in the clinical setting. We performed a prospective study on 102 autopsied subjects at the Central Hospital of Rogaland, Stavanger, Norway. Femoral blood was sampled for subsequent analysis of cardiac troponin T (cTnT). In the subjects with morphologic evidence of recent myocardial injury (n = 34), the mean serum cTnT level was 1.95 microg/L compared with 0.16 microg/L in the subjects with a noncardiac cause of death (n = 35) and 0.61 microg/L in the group with probable sudden cardiac death without morphologic signs of acute myocardial injury (n = 33). The observed differences in mean serum cTnT levels between the groups were statistically significant (P
One hundred years ago, forensic examination of deceased infants was not an uncommon task for doctors in Norway. The key questions were whether the infant had been born alive and whether the manner of death could be explained. The decomposition of the corpses, which had often lain hidden long before they were examined, posed a considerable problem. Notwithstanding the known shortcomings in the criteria used for assessment of breathing (the lung flotation test), and the fact that the bodies were often severely decomposed, the lung flotation test and the supposed signs of asphyxiation were used indiscriminately. This absence of association between theoretical knowledge and practice may have had its origin in societal conditions in which clandestine birth and the killing of newborns was not uncommon.
Comment In: Tidsskr Nor Laegeforen. 2013 Dec 10;133(23-24):2444-524326486