Coronary heart disease is the leading cause of mortality in the world. One of the outcome indicators recently used to measure hospital performance is 30-day mortality after acute myocardial infarction (AMI). This indicator has proven to be a valid and reproducible indicator of the appropriateness and effectiveness of the diagnostic and therapeutic process for AMI patients after hospital admission. The aim of this study was to examine the determinants of inter-hospital variability on 30-day in-hospital mortality after AMI in Tuscany. This indicator is a proxy of 30-day mortality that includes only deaths occurred during the index or subsequent hospitalizations. The study population was identified from hospital discharge records (HDRs) and included all patients with primary or secondary ICD-9-CM codes of AMI (ICD-9 codes 410.xx) that were discharged between January 1, 2009 and November 30, 2009 from any hospital in Tuscany. The outcome of interest was 30-day all-cause in-hospital mortality, defined as a
Methods and Results-We conducted a retrospective cohort study of Medicare beneficiaries who underwent CAS from July 2009 to June 2011 at 927 US hospitals. Thirty-day risk-standardized mortality rates were calculated using the Hospital Compare statistical method, a well-validated hierarchical generalized linear model that included both patient-level and hospital-level predictors. Claims were examined from 22 708 patients undergoing CAS, with a crude 30-day mortality rate of 2.0%. Risk-standardized 30-day mortality rates after CAS varied from 1.1% to 5.1% (P,0.001 for the difference). Thirteen hospitals had risk-standardized mortality rates that were statistically (P,0.05) higher than the national mean. Conversely, 5 hospitals had risk-standardized mortality rates that were statistically (P,0.05) lower than the national mean.. ...
Cardiac care is delivered by many different health care professionals, and the resulting outcomes are a reflection of the whole system of care, rather than being attributable to a particular physician in a centre. Quality outcomes depend not only on a physicians technical skills, but also on the structure and care processes that are found in the environment in which health care is delivered.3. - Some cardiac care centres are more specialized, perform interventions on more complex patients or accept higher-risk patients than average. CIHI is able to adjust for some of these differences across patient populations; however, the administrative data submitted is limited in its ability to capture and adjust for all differences associated with patient populations. Centres with more complex patients may have increased mortality and/or readmission rates because not all aspects of complexity can be adjusted for in the administrative data.. - Transferring patients to a different hospital following a ...
Cardiac care is delivered by many different health care professionals, and the resulting outcomes are a reflection of the whole system of care, rather than being attributable to a particular physician in a centre. Quality outcomes depend not only on a physicians technical skills, but also on the structure and care processes that are found in the environment in which health care is delivered.3. - Some cardiac care centres are more specialized, perform interventions on more complex patients or accept higher-risk patients than average. CIHI is able to adjust for some of these differences across patient populations; however, the administrative data submitted is limited in its ability to capture and adjust for all differences associated with patient populations. Centres with more complex patients may have increased mortality and/or readmission rates because not all aspects of complexity can be adjusted for in the administrative data.. - Transferring patients to a different hospital following a ...
The researchers performed univariate analyses by means of 2 tests.. The research team performed a multivariate logistic regression to determine which variables were independently predictive of in-hospital mortality.. The researchers assessed 50,738 patients who were discharged with the diagnosis of gastric neoplasm.. Of those patients, 26% underwent gastric resection during their hospitalization.. The team found that in-hospital mortality for patients undergoing surgery was 6%, without significant change from 1998 through 2003.. The researchers identified factors predictive of increased in-hospital mortality. The team observed that low annual hospital surgical volume, older patient age, male sex, and procedure type increased in-hospital mortality.. Dr Smiths team concluded, Higher annual surgical volume is predictive of lower in-hospital mortality for patients undergoing gastric resection for neoplasm. Other factors significantly associated with superior outcomes after gastric resection ...
Data & statistics on Unadjusted In-Hospital Mortality Rates by Early Catheterization Among Risk: Unadjusted In-Hospital Mortality Rates by Early Catheterization Among Risk Categories Determined From Presenting Clinical Characteristics, Risk of 30-day death (2000-2007; n ¼ 45 406 patients with an acute coronary syndrome) and 30-day myocardial (re)infarction (2003 -2007; n ¼ 26 126), adjusted for GRACE risk variables and treatment interventions (catheterization, PCI, fibrinolytics): patients with vs. without a major bleed and/or haemorrhagic stroke and/or subdural haematoma., Unadjusted In-Hospital Outcomes*...
Our study has three major findings. First, it confirms that ICU patients face a high risk of treatment related injury. Close to 20% of the patients in our study experienced an AE while in the ICU and one in five AEs was considered preventable. Second, we quantified the impact that ICU-based AEs have on patients and the health system. We estimated that AEs were independently associated with an average increase in hospital length of stay of 31 days. This association was similar in magnitude and significance for preventable and non-preventable AEs. We did not find a significant statistical association of AEs and mortality. Third, we described the types of AEs that affect ICU patients. In doing so, we found several classes of AEs and preventable AEs. Not one of these classes represented more than a third of all AEs.. This study reaffirms the importance of improving patient safety in the ICU by measuring the risk of AEs and more accurately quantifying their impact. Rothschild et. al. used a ...
The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS), today announced important additions to the Hospital Compare consumer web site that will give consumers even better insight into the quality of care provided by their local hospitals. The improvements include the addition of a mortality measure for pneumonia and, for the first time on Hospital Compare, publicly reported measures for hospital care of children. Previously, Hospital Compare had provided only quality information based on hospitalizations of adult patients.
The researchers found that most infants allocated to delayed clamping were assigned a delay of ≥60 seconds. Delayed clamping was associated with a reduction in hospital mortality (risk ratio [RR], 0.69; risk difference [RD], 0.02). Delayed clamping was also correlated with reduced hospital mortality in three trials with 996 infants aged ≤28 weeks gestation (RR, 0.7; RD, −0.05). Delayed clamping was correlated with a 2.73 percent increase in peak hematocrit and a 10 percent reduction in the proportion of infants having blood transfusion.. "This systematic review provides high-quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants," the authors write. ...
Percutaneous coronary intervention without surgical backup did not increase the risk of inhospital mortality or need for emergency bypass surgery, according to a systematic review of published literat
The research focused on Advancing Quality, a scheme introduced in 2008 at all 24 NHS hospitals providing emergency care in the North West. The first of its kind in England, the initiative required each hospital to submit data on 28 quality measures concerning five clinical conditions.. The researchers examined mortality rates for three of these five specified clinical conditions - pneumonia, heart failure and myocardial infarction. They compared the figures for in-hospital deaths within 30 days of admission in the 18 months before and after the schemes introduction.. The combined decrease for all three conditions was 1.3%, the equivalent of a 6% relative reduction - or some 890 lives. The study concludes that the possibility of incentives having a "substantial" effect on reducing deaths in NHS hospitals cannot be ruled out.. Co-author Ruth McDonald, Professor of Health Innovation and Learning at Nottingham University Business School, claimed the findings could have major policy ...
Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said.
A method and system suitable for automated surveillance of intensive care unit patients for information denoting likelihood of in-hospital survival or mortality, represented in the timeseries of scoring systems such as APACHE III. Techniques from digital signal processing and Lyapunov stability analysis are combined in a method that allows for optimization of statistical hypothesis testing that is robust against short time series of as few as five time points. Once optimized, the method and system can achieve high-sensitivity high-specificity classification of survivorship, while avoiding false-positive prediction of mortality.
This work has been made available to the staff and students of the University of Sydney for the purposes of research and study only. It constitutes material that is held by the University for the purposes of reporting for HERDC and the ERA. This work may not be downloaded, copied and distributed to any third party ...
In this paper, we explore the application of motif discovery (i.e., the discovery of short characteristic patterns in a time series) to the clinical challenge of predicting intensive care unit (ICU) mortality. As part of the Physionet/CinC 2012 challenge, we present an approach that identifies and integrates information in motifs that are statistically over-or under-represented in ICU time series of patients experiencing in-hospital mortality. This is done through a three step process, where ICU time series are first discretized into sequences of symbols (by segmenting and partitioning them into periods of low, medium and high measurements); the resulting sequences of symbols are then searched for short subsequences that are associated with in-hospital mortality; and the information in many such clinically useful subsequences is integrated into models that can assess new patients. When evaluated on data from the Physionet/CinC 2012 challenge, our approach outperformed existing clinical scoring systems
Health,...Quicker discharge tied to more readmissions at-home deaths study fin...TUESDAY June 1 (HealthDay News) -- Americans hospitalized for heart f...While in-hospital death rates have decreased the results are very mi...In the study of nearly 7 million Medicare-financed hospitalizations fo...,Shorter,Hospital,Stays,May,Hinder,Heart,Failure,Patients,medicine,medical news today,latest medical news,medical newsletters,current medical news,latest medicine news
A brand new study by the University of Birmingham suggests that the system used by the Government to inform key decisions about the performance of NHS hospitals is inadequate.
A new study suggests that women aged 40 to 60 with asthma are admitted to hospital more than twice as often as males in the same age group. Drawing on a decades worth of data from the National Inpatient Sample databases, researchers from New Yorks Downtown Hospital and Weill Cornell Medical College found that for… Read more ». ...
Downloadable! The Centre for Health Economics and National Institute of Economic and Social Research have recently completed a project funded by the Department of Health to improve measurement of the productivity of the NHS. The researchers have suggested better ways of measuring both outputs and inputs to improve estimates of productivity growth. Past estimates of NHS output growth have not taken account of changes in quality. The CHE/NIESR team conclude that the routine collection of health outcome data on patients is vital to measure NHS quality. They also propose making better use of existing data to quality adjust output indices to capture improvements in hospital survival rates and reductions in waiting times. With these limited adjustments the team estimate that annual NHS output growth averaged 3.79% between 1998/99 and 2003/04.The research team has also developed improved ways of measuring NHS inputs, particularly by drawing on better information about how many people are employed in the NHS
Objective. To determine the factors leading to in-hospital mortality within 28 days in hospitalized patients with ARDS. It was a prospective observational cohort study conducted in Intensive Care Unit of Aga Khan University Hospital Karachi from March to August 2011. Methodology. Data was collected from patients admitted in the intensive care unit on the basis of inclusion and exclusion criteria. The patients were followed daily for 28 days to record any in-hospital complications and the outcome of patients. Results. Total of 46 patients were included during this period out of which 56% (26) were males and 43% (20) were females. Mean age was 44 ± 19 years. There were 11 (23.9%) patients with age |65 and 35 (76%) had age |65 years. There were 21|(45.6%) patients with pulmonary ARDS and 25 (54.3%) had extrapulmonary ARDS. APACHE II score of |20 was present in 23 (50%) patients while the rest had score of |20. Regarding in-hospital complications, 23 (50%) patients developed sepsis, 31 (67.4%) had
Results Between 2007 and 2014, there were 374,152 admissions for CS due to either TC or AMI, of which 4,614 patients (1.2%) had TC-CS. TC-CS admission patients were more likely to be younger, white females with fewer comorbidities. Rates of respiratory failure and mechanical ventilation were higher in TC-CS, but cardiac arrest and acute kidney injury were lower. There were no differences between cohorts in use of intra-aortic balloon pumps. TC-CS admissions had lower in-hospital mortality (15% vs. 37%, respectively) and hospital costs (U.S. dollars: $135,397 ± $127,617 vs. $154,827 ± $186,035, respectively) and were discharged home more often (45% vs. 36%, respectively) compared to AMI-CS admissions (all: p , 0.001). After adjustments for potential confounders, TC-CS was associated with lower in-hospital mortality (odds ratio [OR]: 0.35; 95% confidence interval [CI]: 0.32 to 0.38; p , 0.001). Similar findings were observed in the propensity-matched cohort (OR: 0.32; 95% CI: 0.25 to 0.39; p , ...
Obesity and diabetes mellitus are well-defined risk factors for cardiovascular mortality. The impact of antecedent hyperglycemia and body size on mortality in critical ill patients in intensive care units (ICUs) may vary across their range of values. Therefore, we prospectively analyzed the relationship between in-hospital mortality and preexisting hyperglycemia and body size in critically ill ICU patients to understand how mortality varied among normal, overweight, and obese patients and those with low, intermediate, and high glycated hemoglobin (HbA1c) levels. Medical history, weight, height, physiologic variables, and HbA1c were obtained during the first 24 h for patients who were consecutively admitted to the high complexity ICU of Hospital de Clínicas de Porto Alegre, Brazil, from April to August 2011. The relationships between mortality and obesity and antecedent hyperglycemia were prospectively analyzed by cubic spline analysis and a Cox proportional hazards model. The study comprised 199
Obesity and diabetes mellitus are well-defined risk factors for cardiovascular mortality. The impact of antecedent hyperglycemia and body size on mortality in critical ill patients in intensive care units (ICUs) may vary across their range of values. Therefore, we prospectively analyzed the relationship between in-hospital mortality and preexisting hyperglycemia and body size in critically ill ICU patients to understand how mortality varied among normal, overweight, and obese patients and those with low, intermediate, and high glycated hemoglobin (HbA1c) levels. Medical history, weight, height, physiologic variables, and HbA1c were obtained during the first 24 h for patients who were consecutively admitted to the high complexity ICU of Hospital de Clínicas de Porto Alegre, Brazil, from April to August 2011. The relationships between mortality and obesity and antecedent hyperglycemia were prospectively analyzed by cubic spline analysis and a Cox proportional hazards model. The study comprised 199
Prevalence, Predictors, and Impact of Low High-Density Lipoprotein Cholesterol on in-Hospital Outcomes Among Acute Coronary Syndrome Patients in the Middle East
The results of the study indicated that the medical record is a good source of information on functional status prior to admission. The level of agreement in the difficulty experienced by the patient in performing at least 1 of 7 basic care skills (feeding, bathing, grooming, dressing, toileting, transferring and walking) was found to be higher than that reported by Bogardus et al.[6]. (к = 0.64 versus 0.48). Variations in institutional emphasis on documentation could have influenced the difference in the extent of missing documentation, and in turn, the level of agreement between the two data sources. The inclusion of specific functional status checkboxes for history taking in the medical records at the study hospital resulted in missing documentation of only 1.1%, compared to 9% reported by Bogardus et al.[6].. In contrast to pre-admission information, the extent of concordance between interview and documented impairment in at least 1 of the 7 ADLs on-admission was low (к = 0.28). While ...
Background. Standardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality.. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort.. Methods. A retrospective study on patients ,15 years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of ...
In the present study, the immediate- and long-term outcomes after reoperative coronary surgery have been presented in a large patient population. The in-hospital mortality was 7%, and 1-, 5-, and 10-year mortality was 11%, 23%, and 45%. The major correlate of in-hospital mortality was emergency surgery, and of long-term mortality, older age. The other major complications in-hospital were acute Q-wave myocardial infarction in 5.6% and neurological events in 2.8%. The constancy of in-hospital results despite an older and more severely diseased population in recent years suggests gradually improving techniques. The high in-hospital mortality with emergency surgery suggests that control or prevention of perioperative ischemia may be useful in lowering in-hospital mortality. There was a continuing incidence of myocardial infarction after hospital discharge as well as additional revascularization procedures. The in-hospital mortality rate was higher and long-term survival rate was lower than in ...
TY - JOUR. T1 - Regional variation in hospital mortality and 30-day mortality for injured medicare patients. AU - Gorra, Adam S.. AU - Clark, David E.. AU - Mullins, Richard. AU - DeLorenzo, Michael A.. PY - 2008/6. Y1 - 2008/6. N2 - Background: We sought to evaluate how survival of older patients with injuries differs by geographic region within the United States. Methods: We analyzed Medicare fee-for-service records for patients aged 65 years and older with principal injury diagnoses (ICD-9 800-959, excluding 905, 930-939, 958). Cases were classified by Maximum Abbreviated Injury Score (AISmax) and Charlson Comorbidity score (0, 1, 2, ≥3). Hospital mortality and 30-day mortality were modeled as functions of age, sex, AISmax, comorbidity, and geographic region (northeast, midwest, south, west). Results: Hospital and 30-day mortality were both higher with male sex and increased age, AISmax, or Charlson score. Adjusted hospital mortality was highest in the northeast and south, but 30-day ...
While neuromuscular blockade is often avoided in the ICU setting for fear of inducting critical illness myopathy, a recent randomized controlled trial comparing cisatracurium-based paralysis to no paralysis in patients with severe ARDS showed a significant decrease in overall mortality rates with no increase in myopathy [2) of less than 150, with a positive end-expiratory pressure of 5 cm or more of water and a tidal volume of 6 to 8 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died either before hospital discharge or within 90 days after study enrollment (i.e., the 90-day in-hospital mortality rate), adjusted for predefined covariates and baseline differences between groups with the use of a Cox model. RESULTS: The hazard ratio for death at 90 days in the cisatracurium group, as compared with the placebo group, was 0.68 (95% confidence interval [CI], 0.48 to 0.98; P=0.04), after adjustment for both the baseline PaO2:FIO2 and plateau pressure ...
Younger women hospitalized with an acute myocardial infarction (MI) have a poorer prognosis than men. Whether this is true for patients with acute ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) is not extensively studied. Using the MarketScan 2004 to 2007 Commercial and Medicare supplemental admission databases, we assessed gender differences in in-hospital mortality according to age in 91,088 patients (35,899 with STEMI, 55,189 with NSTEMI) who were 18 to 89 years old and had acute MI as their primary diagnosis. Patients with STEMI had significantly higher in-hospital mortality than those with NSTEMI (4.35% vs 3.53%, p ,0.0001). Compared to men women were older, had higher co-morbidity scores, and were less likely to undergo revascularization during hospitalization in the STEMI and NSTEMI populations. In patients with STEMI the unadjusted women-to-men odds ratio for in-hospital mortality was 2.29 (95% confidence interval 1.48 to 3.55) for the 18- to 49-year age group, 1.68 (1.28 to ...
OBJECTIVE: We tested the hypothesis that diabetes is an independent determinant of outcome after intracerebral hemorrhage (ICH). RESEARCH DESIGN AND METHODS: This was a hospital-based prospective study The setting was an acute care 350-bed hospital in the city of Barcelona, Spain. Spontaneous ICH was diagnosed in 229 (11%) of 2,000 consecutive stroke patients included in a prospective stroke registry during a 10-year period. Main outcome measures were frequency of demographic variables, risk factors, clinical events, neuroimaging data, and outcome in ICH patients with and without diabetes. Variables related to vital status at discharge (alive or dead) in the univariate analysis plus age were studied in 4 logistical regression models. RESULTS: A total of 35 patients (15.3%) had diabetes. The overall in-hospital mortality rate was 54.3% in the diabetic group and 26.3% in the nondiabetic group (P , 0.001). Previous cerebral infarction, altered consciousness, sensory symptoms, cranial nerve palsy, ...
TY - JOUR. T1 - Does Low Body Mass Index Predict the Hospital Mortality of Adult Western or Asian Patients?. AU - Compher, Charlene. AU - Higashiguchi, Takashi. AU - Yu, Jianchun. AU - Jensen, Gordon L.. PY - 2018/2/1. Y1 - 2018/2/1. N2 - Background: Some strategies for screening and assessment of malnutrition include a low but variable body mass index (BMI) cutoff, while others do not. The purpose of this systematic review was to investigate published data for Western and Asian hospital samples to determine how the prevalence of low BMI is associated with increased hospital mortality. Method: A PubMed search of the past 10 years (2006-2016) was conducted with the terms "BMI," "malnutrition," "adult," "outcome," and "hospital" or "ICU" for articles published in English. Studies that examined BMI levels among Western or Asian populations were included. Forest plots were constructed to determine the odds of hospital mortality in low versus normal BMI groups. Results: Twenty studies met inclusion ...
BACKGROUND: A higher early mortality rate after STEMI has been reported in women before the widespread use of PCI in STEMI. PCI improves the prognosis of STEMI; however, the effect of primary PCI on early outcomes in women is controversial. In a large regional prospective registry, we examined in-hospital mortality after PCI for STEMI in women and men to determine if female gender was still an independent predictor of in-hospital mortality.. METHODS: The Greater Paris area comprises 11 million inhabitants and accounts for 18% of the French population. Data from all PCIs performed in the 42 centers of this area is entered in a mandatory registry with internal and external audits held by the hospital governmental agency. Clinical status at discharge (dead or alive) is also recorded in another hospital-based database and a cross-check performed to validate all deaths. From 2003 to 2007, 16063 patients were treated by PCI for STEMI within 24 hours of the onset of chest pain, 3542 (22.0%) were women ...
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Prior investigations have evaluated the association between time of ICU discharge and outcomes [8, 12-15]. While most studies demonstrate that nighttime discharge is associated with unfavorable outcomes [7, 12-14], others have failed to confirm these findings [1, 8, 16]. In a landmark study from the ICNARC database in the United Kingdom, Goldfrad and Rowan showed that nighttime discharge from ICU increased risk for hospital mortality [3]. However, after adjustment for "premature discharge" in their analysis, the independent effect of nighttime discharge was lost [3], suggesting that the attributable risk for mortality was more related to the untimely discharge rather than the specific time of day. In a subsequent study of Finnish ICU patients, Uusaro et al failed to show "out-of-office" hour discharges (defined as those occurring from 1600 h to 0800 h) were associated with post-ICU mortality [8]. However, their definition for out-of-office hours was more liberal than ours and those of other ...
The article presents a case study of the outcomes-based perfomance measures for hospital mortality for specific conditions and procedures. Strategies have been proposed to measure and improve hospital performance efforts have included national patient safety agencies, mandatory accreditation and financial incentives. The article discusses the validity of the hospitals standardized mortality ratio wherein it must correlate with accepted measures of quality. The precise measurement of hospital performance that will provide similar quality of care where quality remained constant. The recommendation of supporters the use of the hospital standardized mortality ratio to monitor quality of care over time ...
Median APACHE score stood at 19 (interquartile range 13 to 26) and median VACS score at 57 (interquartile range 34 to 80). Every 5 point higher APACHE or VACS score was significantly associated with hospital mortality (odds ratio [OR] 1.722 for APACHE and 1.114 for VACS), 30-day mortality (OR 1.652 for APACHE and 1.144 for VACS), and 1-year mortality (OR 1.323 for APACHE and 1.132 for VACS) (P < 0.001 for all associations). ROC AUC analysis discerned little difference in predictive value with APACHE versus VACS for in-hospital mortality or 30-day mortality. But there was a trend toward greater discrimination with VACS than APACHE for 1-year mortality (ROC AUC 0.702, 95% confidence interval 0.637 to 0.766, for VACS and 0.634, 95% confidence interval 0.568 to 0.701, for APACHE, P = 0.0661 ...
Results We reviewed 58 336 ED patient encounters occurring between 1 October 2012 and 30 September 2013. SI ,1.2 was associated with a large increase in the likelihood of hospital admission, with a positive LR (+LR) of 11.69 (95% CI 9.50 to 14.39) and a moderate increase in the likelihood of inpatient mortality with a +LR of 5.82 (95% CI 4.31 to 7.85). SI ,0.7 and ,0.9, the traditional normal cut-offs cited in the literature, were only associated with minimal to small increases in the likelihood of admission and inpatient mortality. ...
Between 1983 and 1995, 546 Blalock-Taussig shunt procedures were performed in 472 patients: 128 (23.0%) were classical shunts, 90 of them on the same side as to the aortic arch, and 418 (77.0%) were modified shunts, 182 on the same side of the arch. At the time of surgery, 78 patients were aged below one week, 270 from one week to 12 months, and 198 patients were over one year of age. The mean pre-operative arterial saturation (71.7%±16.5%) was significantly increased to 83%±17.9% imme-diately after the procedure (p=0.017). The overall hospital mortality rate was 2.9% (16/546), with rates of 2.3% (3/128) for the classical, and 3.1% (13/418) for the modified shunts (p= not significant). The rate was significantly higher, however, for classical shunts when the pulmonary arterial diameter was less than 4 mm (15.4% versus zero; p=0.047), though this relationship was reversed for modified shunts (zero versus 3.6%; p=0.338). Early mortality was significantly influenced by the age at surgery, 5/78 ...
Wilson et al reported the NaURSE (sodium, urea, respiratiory rate and shock index in the elderly) for evaluating a very old person who has been admitted with acute illness to the hospital. This can help to identify a patient at risk for in-hospital mortality who may benefit from more aggressive management. The authors are from Norfolk and Norwich University Hospital, University of South Manchester, Woodend Hospital and University of Aberdeen in the UK.
There is considerable debate about the value of using hospital mortality rates adjusted for case mix as an indicator of the quality and safety of care provided by hospitals. A linked paper by Pouw and colleagues (doi:10.1136/bmj.f5913) investigates the inclusion of post-discharge deaths in these mortality indicators.1 The main doubts about their value are that standardisation for differences between hospitals in the characteristics of their patients (the case mix) doesnt work, and that these indicators do not measure performance because they are not related to avoidable mortality. There is no doubt that the case mix adjustment is problematic. We know that different adjustment models lead to different results,2 and that important measures of case mix are missing from models based on routine data.3 We also know that these measures are at best weakly related to avoidable mortality-models show that they would begin to be useful for identifying poor quality of care only when at least 16% of hospital ...
The indication of NIV in the context of exacerbation of COPD is based on 16 published randomized control studies that compared this ventilation modality versus standard of care, including oxygen therapy, bronchodilators, and corticosteroids1-3,5-7,16,17 Overall, these trials revealed a lower incidence of endotracheal intubation and hospital mortality in the NIV group. However, most of these studies included patients with severe exacerbations, defined by admission pH lower than 7.35. Among the group of patients with mild exacerbations (higher pH values), no benefits in clinical outcomes were observed with NIV.18 Treatment of CPE with CPAP and NIV has also been extensively studied. Particularly, a large study that accounted for 70% of all patients with CPE who have been studied in randomized controlled trials of NIV,19 plus 5 systematic reviews addressing this treatment,4,20-23 demonstrated a trend toward reduction in endotracheal intubation and hospital mortality. Among subjects with ...
Guthrie is committed to providing our patients the most recent quality data on our hospital. This information, and information on other hospitals, can be found on www.hospitalcompare.hhs.gov. Patients should talk with their physicians and our hospital staff if they have questions about our quality scores or quality improvement initiatives.
Objectives : To measure the health status of critically ill patients prior to hospital admission and to study the relationship between prior health status PHS and hospital mortality. Design : 523 patients admitted to the intensive care department from October 1994 to June 1995 were included consecutively in the study. Health status 3 months...
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Demand for hospital resources may increase over time; we have examined all emergency admissions (51,136 episodes) from 2005 to 2013 for underlying trends and whether resource utilization and clinical risk are correlated. We used logistic regression of the resource indicator against 30-day in-hospital mortality and adjusted this risk estimate for other outcome predictors. Generally, resource indicators predicted an increased risk of a 30-day in-hospital death. For CT Brain the Odds Ratio (OR) was 1.37 (95% CI: 1.27, 1.50), CT Abdomen 3.48 (95% CI: 3.02, 4.02) and CT Chest, Thorax, Abdomen and Pelvis 2.50 (95% CI: 2.10, 2.97). Services allied to medicine including Physiotherapy 2.57 (95% CI: 2.35, 2.81), Dietetics 2.53 (95% CI: 2.27, 2.82), Speech and Language 5.29 (95% CI: 4.57, 6.05), Occupational Therapy 2.65 (95% CI: 2.38, 2.94) and Social Work 1.65 (95% CI: 1.48, 1.83) all predicted an increased risk. The in-hospital 30-day mortality increased with resource utilization, from 4.7% (none) to 27.0%
In the current propensity‐matched analysis of contemporary real‐life data, an early invasive strategy was associated with an increased in‐hospital survival in NSTE‐ACS patients with concomitant DM. These results support the 2014 ACCF/AHA guideline recommendations for an early invasive strategy in diabetics, especially those with high‐risk features (eg, NSTEMI and cardiogenic shock).10 Meanwhile, the use of this strategy in lower risk patients, such as those with UA, may not be associated with improved survival.. The survival benefit of an early invasive strategy in the NSTE‐ACS population remains a matter of ongoing debate.20, 21, 22 Whereas none of the landmark trials comparing an early invasive with an initial conservative strategy illustrated a statistically significant reduction in mortality, these trials were not statistically powered to answer that question.21, 22, 23, 24 We calculated the minimal sample size required by a randomized trial to detect the difference in ...