BACKGROUND: To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. METHODS: A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980), voluntary detoxification (n = 75, 1980/1981) or both (n = 17). Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs) were computed for mortality, in general, and in particular, for different causes of death. RESULTS: During a period of 20 years, 70 opioid addicts died (37.8%), with a standardized mortality ratio (SMR) equal to 23.6 (95% CI, 18.7-29.9). The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%), suicide (7.1%), cancer (4.3%), cardiovascular disease (2.9%), other violent deaths (2.9%), other diseases (71.4%). Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total). SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9-86.9). The SMR was 5.4 (95% CI, 1.3-21.5) for cardiovascular diseases, and 4.3 (95% CI, 1.4-13.5) for cancer. The SMR was 13.2 (95% CI, 6.6-26.4) for accidents, 10.7 (95% CI, 4.5-25.8) for suicides, and 28.6 (95% CI, 7.1-114.4) for other violent deaths. CONCLUSION: The risk of death among opioid addicts was significantly higher for all causes of death compared with the general population, implying a poor prognosis over a 20-year period for this young patient group.
Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.
This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.
The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT
The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.
The outcome status for 91 elderly (=75 years) and 659 nonelderly (18-74 years) ICU patients treated in the course of a one year period was obtained. A total of 36 of 37 eligible elderly survivors were interviewed about their health related quality of life (HRQOL), social services and their wish for intensive care.
The mortality (54% at follow-up and 64% after one year) was higher in the elderly ICU patients than in non-elderly ICU patients (33% and 37%, respectively, p
to compare data on pre- and in hospital treatment of non ST-elevation (NSTE) acute coronary syndromes (ACS) in Russian ACS registers RECORD (recruitment from 11.2007 to 02.2008) and RECORD-2 (from 04/2009 to 04.2011).
Four of 7 hospitals participating in RECORD-2 were invasive (57.1% vs. 55.6% in RECORD). In RECORD-2 10-30 consecutive patients with NSTEACS were included monthly in each center; recruitment in RECORD was described elsewhere.
Mean age of patients was similar in two registries. Portion of women was significantly higher in RECORD-2 (42.9% vs. 26.0% in RECORD; 140) gave results close to those in all patients except mortality which was statistically similar but numerically higher in RECORD-2 (9.3 vs. 7.9% in RECORD; p=0.68).
Comparison of data of 2 limited NSTEACS registers conducted with interval of about 2 years showed only modest shift towards fulfillment of contemporary recommendations which was not associated with increase in rates of PCI and improvement of outcomes especially in high risk patients.
OBJECTIVES. The changing pattern of acute poisoning may affect complications and outcome in these patients. An update study on acute poisonings was therefore performed and compared to similar data from 1980. DESIGN. A prospective cross-sectional multi-center study of all adult patients (> or = 16 years) hospitalized in Oslo with a main diagnosis of acute poisoning, irrespective of intention, over a one-year period. RESULTS. Of 947 admissions, 222 (23%) were comatose. Complications were observed in 173 (18%), slightly reduced from 1980 (22%). Ten (1.1%) died and six (0.6%) got permanent sequelae, of which seven and five were drug- or alcohol-related, respectively. Seventy-five percent received treatment besides observation; 39% received antidotes, increased from 21% in 1980, most frequently flumazenil (23%) and naloxone (14%). CONCLUSIONS. In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.
RATIONAL, AIMS AND OBJECTIVES: The study aims to determine the extent to which the addition of post-admission information via time-dependent covariates improved the ability of a survival model to predict the daily risk of hospital death.
Using administrative and laboratory data from adult inpatient hospitalizations at our institution between 1 April 2004 and 31 March 2009, we fit both a time-dependent and a time-fixed Cox model for hospital mortality on a randomly chosen 66% of hospitalizations. We compared the predictive performance of these models on the remaining hospitalizations.
All comparative measures clearly indicated that the addition of time-dependent covariates improved model discrimination and prominently improved model calibration. The time-dependent model had a significantly higher concordance probability (0.879 versus 0.811) and predicted significantly closer to the number of observed deaths within all risk deciles. Over the first 32 admission days, the integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were consistently above zero (average IDI of +0.0200 and average NRI of 62.7% over the first 32 days).
The addition of time-dependent covariates significantly improved the ability of a survival model to predict a patient's daily risk of hospital death. Researchers should consider adding time-dependent covariates when seeking to improve the performance of survival models.
Elevated base deficit (BD) and lactate levels at admission in patients with injury have been shown to be associated with increased mortality. This relationship is undefined in the Canadian experience. The goal of this study was to define the association between arterial blood gas (ABG) values at admission and mortality for Canadians with severe blunt injury.
A retrospective review of 3,000 consecutive adult major trauma admissions (Injury Severity Score, = 12) to a Canadian academic tertiary care referral center was performed. ABG values at the time of arrival were analyzed with respect to associated mortality and length of stay.
A total of 2,269 patients (76%) had complete data available for analysis. After exclusion of patients who sustained a penetrating injury or were admitted for minor falls (ground levels or low height), 445 had an ABG drawn within 2 hours of arrival. Patients who died displayed a higher median lactate (3.6 vs. 2.2, p
The relationship between spontaneous admission hypoglycemia and mortality in patients hospitalized with community-acquired pneumonia is unclear.
From 2000 to 2002, clinical data were prospectively collected on all patients with community-acquired pneumonia who were admitted to all 6 hospitals in Edmonton, Alberta, Canada. Patients with admission glucose greater than 6.1 mmol/L (n=1996) were excluded; the remaining patients were categorized as having admission hypoglycemia (.4 for interaction).
In a population-based sample of patients with community-acquired pneumonia, spontaneous admission hypoglycemia was independently associated with increased mortality during hospitalization that persisted to 1 year. Patients with hypoglycemia are an easily identified group that may warrant more intensive inpatient and postdischarge follow-up.
Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages.
A registry of all hospitalized stroke patients in Denmark included 40,155 patients with evaluations of stroke severity, computed tomography, and cardiovascular risk factors. Data on mortality were used to construct age trajectories of 3-day, 1-week, 1-month, and 1-year case-fatality rates in men and women.
Of the 40,155 patients, 19,301 (48%) were women (mean age, 74.5 years) and 20,854 (52%) were men (mean age, 69.7 years). In both women and men, 3-day case-fatality rates leveled off, beginning in the patients' mid-70s. In women, 1-week case-fatality rates leveled off further in their early 80s, whereas in men, 1-week case-fatality rates accelerated with age. One-month and 1-year case-fatality rates accelerated with age for both sexes.
It is an apparent paradox that case-fatality rates in the acute state of stroke level off at the highest ages. Heterogeneity, innate or acquired, in regard to survival capacity may explain the phenomenon.
To make a comparative analysis of the data available in the accounting medical documents drawn up at a multidisciplinary hospital on the level and structure of alcohol-related mortality (ARM) and to evaluate the efficiency of its accounting.
Accounting medical documents, such as 453 inpatient cards (Form 003/y), 453 postmortem protocols (cards) (Form 013/H-80), and 453 death certificates (Form 106/y-08), were chosen as the basis for the study. The data of the final clinical and postmortem diagnoses in the patients who had died at hospital and their primary cause of death were comparatively analyzed.
According to Form 003/y, ARM was 5.5%; the detection rate of alcohol-related disease (ARD) was 11% (95% confidence interval (CI), 8.3 to 14.3%); according to Form 013/H-80, ARM was 7.1% (95% CI, 4.9 to 9.8%) and the detection rate of ARD was 12.6% (95% CI, 9.7 to 16%). The consistency of the diagnoses of ARD as a main cause of death, made by hospital unit physicians and pathologists, is estimated as the mean--the Cohen's kappa coefficient (kappa) is 0.570) (p
