Differences in pediatric ICU mortality risk over time

1998 ◽  
Vol 26 (10) ◽  
pp. 1737-1743 ◽  
Author(s):  
John M. Tilford ◽  
Paula K. Roberson ◽  
Shelly Lensing ◽  
Debra H. Fiser
Keyword(s):  
Mortality Risk ◽  
Icu Mortality ◽  
Pediatric Icu ◽  
Over Time

scholarly journals Effect of Perceived Social Support on Mortality Rate Among Older Chinese Americans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 198-199
Author(s):  
Charu Verma ◽  
Mengting Li ◽  
XinQi Dong
Keyword(s):  
Social Support ◽  
Mortality Risk ◽  
Perceived Social Support ◽  
Chinese Americans ◽  
Well Being ◽  
Time Of Death ◽  
All Cause Mortality ◽  
Older Chinese ◽  
Older Chinese Americans ◽  
Over Time

Abstract Most existing studies have examined the relationship between social support and health in cross-sectional data. However, the changing dynamics of social support over time and its relationship with all-cause mortality have not been well explored. Using data from the Pine Study (N = 3,157), this study examined whether social support was associated with time of death at an 8 years follow-up among older Chinese Americans. Social support from a spouse, family members and friend were collected at the baseline using an HRS social support scale. Perceived social support and time of death were ascertained from the baseline through wave 4. Cox proportional hazard models were used to assess associations of perceived support with the risk of all-cause mortality using time-varying covariate analyses. Covariates included age, sex, education, income, and medical comorbidities. All study participants were followed up for 8 years, during which 492 deaths occurred. In multivariable analyses, the results showed that positive family support [HR 0.91; 95% CI (0.86, 0.98)] and overall social support [HR 0.95; 95% CI (0.92,0.98)] were significantly associated with a lower risk of 8-year mortality. Results demonstrate robust association in which perceived positive family and overall social support over time had a protective effect on all-cause mortality risk in older Chinese Americans. Interventions could focus on older adults with low social support and protect their health and well-being. Future studies could further explore why social support from family is different from social support from other sources regarding mortality risk in older Chinese Americans.

CERTAINTY OF MORTALITY RISK ESTIMATES AND ITS EFFECT ON PREDICTION PERFORMANCE IN THE PEDIATRIC ICU

1999 ◽  
Vol 27 (Supplement) ◽  
pp. 149A
Author(s):  
James Marcin ◽  
Murray Pollack ◽  
Kanti Patel ◽  
Bruce Sprague ◽  
Urs Ruttimann
Keyword(s):  
Mortality Risk ◽  
Prediction Performance ◽  
Risk Estimates ◽  
Pediatric Icu

scholarly journals Modelling Local Patterns of Children Mortality. A Bayesian Spatio-Temporal Analysis.

2019 ◽  
Author(s):  
Alejandro Lome-Hurtado ◽  
Jacques Lartigue Mendoza ◽  
Juan Carlos Trujillo
Keyword(s):  
High Risk ◽  
Mortality Risk ◽  
Temporal Analysis ◽  
Health Concern ◽  
North West ◽  
The North ◽  
Policy Interventions ◽  
Medium Risk ◽  
Spatio Temporal ◽  
Over Time

Abstract Background: The number of death children at the international scale are still high, but with proper spatially-targeted health public policies this number could be reduced. In Mexico, children mortality is a particular health concern due to its alarming rate all throughout North America. The aims of this study are i) to model the change of children mortality risk at the municipality level, (ii) to identify municipalities with high, medium and low risk over time and (iii) to ascertain potential high-risk municipalities across time, using local trends of each municipality in Greater Mexico City. Methods: The study uses Bayesian spatio-temporal analysis to control for space-time patterns of data. This allow to model the geographical variation of the municipalities within the time span studied. Results: The analysis shows that most of the high-risk municipalities are in the north, west, and some in the east; some of such municipalities show an increasing children mortality risk over time. The outcomes highlight some municipalities which show a medium risk currently but are likely to become high risk along the study period. Finally, the odds of children mortality risk illustrate a decreasing tendency over the 7-year framework. Conclusions: Identification of high-risk municipalities may provide a useful input to policy-makers seeking out to reduce the incidence of children mortality, since it would provide evidence to support geographical targeting for policy interventions.

scholarly journals Changes Over Time in COVID-19 Severity and Mortality in Patients Undergoing Cancer Treatment in the United States: Initial Report From the ASCO Registry

2021 ◽  
Author(s):  
Kathryn F. Mileham ◽  
Suanna S. Bruinooge ◽  
Charu Aggarwal ◽  
Alicia L. Patrick ◽  
Christiana Davis ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cancer Treatment ◽  
B Cell ◽  
Solid Tumors ◽  
Mortality Risk ◽  
Older Patients ◽  
The United States ◽  
B Cell Malignancies ◽  
Increased Risk ◽  
Over Time

PURPOSE: People with cancer are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ASCO's COVID-19 registry promotes systematic data collection across US oncology practices. METHODS: Participating practices enter data on patients with SARS-CoV-2 infection in cancer treatment. In this analysis, we focus on all patients with hematologic or regional or metastatic solid tumor malignancies. Primary outcomes are 30- and 90-day mortality rates and change over time. RESULTS: Thirty-eight practices provided data for 453 patients from April to October 2020. Sixty-two percent had regional or metastatic solid tumors. Median age was 64 years. Forty-three percent were current or previous cigarette users. Patients with B-cell malignancies age 61-70 years had twice mortality risk (hazard ratio = 2.1 [95% CI, 1.3 to 3.3]) and those age > 70 years had 4.5 times mortality risk (95% CI, 1.8 to 11.1) compared with patients age ≤ 60 years. Association between survival and age was not significant in patients with metastatic solid tumors ( P = .12). Tobacco users had 30-day mortality estimate of 21% compared with 11% for never users (log-rank P = .005). Patients diagnosed with SARS-CoV-2 before June 2020 had 30-day mortality rate of 20% (95% CI, 14% to 25%) compared with 13% (8% to 18%) for those diagnosed in or after June 2020 ( P = .08). The 90-day mortality rate for pre-June patients was 28% (21% to 34%) compared with 21% (13% to 28%; P = .20). CONCLUSION: Older patients with B-cell malignancies were at increased risk for death (unlike older patients with metastatic solid tumors), as were all patients with cancer who smoke tobacco. Diagnosis of SARS-CoV-2 later in 2020 was associated with more favorable 30- and 90-day mortality, likely related to more asymptomatic cases and improved clinical management.

Surgical treatment for infective endocarditis over three decades: a nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Dalsgaard Jensen ◽  
M.H Smerup ◽  
H Bundgaard ◽  
J.H Butt ◽  
N.E Bruun ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mortality Risk ◽  
Temporal Trends ◽  
Valve Surgery ◽  
Annual Number ◽  
Nationwide Study ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
First Time ◽  
Over Time

Abstract Background An increasing number of patients with infective endocarditis (IE) are treated surgically over time. It is important to know how this affects patient outcome. Current studies are mainly from tertiary centres which may bias estimations of outcomes. We have therefore conducted a nationwide study of surgical outcomes during admission for IE over three decades. Purpose We set out to examine temporal trends in use of valve surgery for IE and these patients' characteristics and related outcomes in Denmark in the period 1998–2017. Methods Using Danish nationwide registries, we included patients with first-time IE (1998–2017). The study population was categorized into four groups of five-year intervals (1998–2002, 2003–2007, 2008–2012, 2012–2017). Annual number of patients with IE and the proportion who underwent valve surgery during admission were reported. Kaplan-Meier estimates and multivariable logistic regression analyses were used to compare the associated 30-day mortality risk between calendar periods. Kaplan-Meier estimates and multivariable adjusted Cox proportional hazard analyses were used compare the associated 1-year mortality risk between calendar periods. Results A total of 8,455 patients with first-time IE were identified in the period of 1998–2017 of which 1,906 (22.5%) underwent valve surgery (1998–2002; N=320, 2003–2007; N=468, 2008–2012; N=528, 2013–2017; N=595). The proportion of patients who underwent surgery was 21.5% in 1998 and 19.4% in 2017 (P=0.02 for trend). See figure. For patients undergoing surgery, the median age and proportion of males increased from 58.3 years (P25-P75: 48.2–67.4) and 69.1% to 66.7 years (P25-P75: 55.2–73.0) and 73.1% in 1998–2002 and 2013–2017, respectively. Patients had an increasing burden of comorbidities including diabetes (10.3% to 14.3%), hypertension (16.9% to 37.5%) and renal disease (9.1% to 9.6%) across calendar periods. The 30-day mortality risk for patients with IE who underwent valve surgery was 10.0% (1998–2002), 10.8% (2003–2007), 6.4% (2008–2012) and 8.5% (2013–2017), respectively (P=0.09). One-year mortality risk for patients with IE who underwent valve surgery was 16.7% (1998–2002), 21.2% (2003–2007), 15.2% (2008–2012) and 16.6% (2013–2017), respectively (P=0.08). The declining 30-day and 1-year mortality was statistically significant over time when adjusting for patient characteristics (P=0.01 and P≤0.0001, respectively). Conclusion From a nationwide, unselected cohort of patients with first-time IE, around 1/5 undergo surgery during admission. Surgical IE-cases are older and sicker now compared to 10–20 years ago. In spite of this, there was a trend towards a decreased associated 30-day and 1-year mortality over time. Our data show a lower rate of surgery in IE than in most prior studies and we believe that this is due to the nationwide, unselected nature of our study. Infective endocarditis and surgery Funding Acknowledgement Type of funding source: None

Acute Severe Asthma: Changes in Patient Characteristics, Management, and Outcomes over a Period of 20 Years (1997 to 2017), Insights from Cub-Réa Network.

2021 ◽  
Author(s):  
Romy Younan ◽  
Jean Loup Augy ◽  
Bertrand Hermann ◽  
Bertrand Guidet ◽  
Philippe Aegerter ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Survival Rate ◽  
Severe Asthma ◽  
Emergency Department Visits ◽  
Adult Patients ◽  
Acute Severe Asthma ◽  
Icu Mortality ◽  
Non Invasive ◽  
Over Time

Abstract Background: While acute severe asthma (ASA) is the leading cause of emergency department visits and the third cause of hospitalization in children younger than 18 years old, there is a lack of data regarding adult patients admitted in intensive care units (ICU) for ASA. We aimed to describe the evolutions in epidemiology, management, and outcomes of ASA in adult patients, over a period of twenty years in the Greater Paris area ICUs (CUB-Réa Database). Methods: Demographics, severity and supportive treatments were collected from the CUB-Réa Database. The primary endpoint was the prevalence of ASA by periods of 5 years. The secondary endpoints were in-ICU survival, in-hospital survival, use of mechanical ventilation including non-invasive and invasive and catecholamine. Multivariate analysis was performed to assess correlating factors of ICU Mortality. Results: Of the 475 357 ICU admissions from January 1997 to January 2016, 7049 were admitted for ASA with a decreasing prevalence over time, respectively 2.8%, 1.7%, 1.1%, and 1.1% of total ICU admissions (p <0.001). The median age was 46 years old [IQR: 25%-75%: 32-59], 3906 (55%) were female, the median SAPS II was 20 [IQR: 13-28], and 1501 (21%) had mechanical ventilation. Over time, age, the SAPSII and the Charlson Comorbidity Index tended to increase. The use of invasive and non-invasive mechanical ventilation increased (p < 0.001), whereas the use of catecholamine decreased (p <0.001). The in-ICU survival rate improved from 97% to 99% (p=0.008). In the multivariate analysis, factors associated with in-ICU mortality were SAPSII (p < 0.001), renal replacement therapy (p < 0.001), catecholamine (p < 0.001), cardiac arrest (p < 0.001), pneumothorax (p < 0.001), ARDS (p < 0.001), sepsis (p < 0.001) and IMV (p < 0.001). Conclusion: ICU admission for ASA remains uncommon and decreases over time. Despite an increasing severity of patients and the use of mechanical ventilation, the use of catecholamine decreases with high in-ICU survival rate which could be related to a better management of mechanical ventilation.

Pentobarbital for Sedation during Mechanical Ventilation in the Pediatric ICU Patient

2000 ◽  
Vol 15 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Joseph D. Tobias
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Adverse Effects ◽  
Pediatric Intensive Care ◽  
Medical Illness ◽  
Prolonged Administration ◽  
Control Pain ◽  
Pediatric Icu ◽  
Current Report ◽  
Over Time

In most pediatric intensive care units (PICUs), sedation is provided using opioids and benzodiazepines, either alone or in combination. While these agents are effective in most patients, certain situations may arise in which this usual combination is ineffective. There are no large series outlining the use of pentobarbital for sedation in the PICU population. The current report is a retrospective review of the use of pentobarbital for sedation of 50 patients in the PICU and provides information concerning the use of phenobarbital to prevent withdrawal symptoms following the prolonged administration of pentobarbital. The 50 patients ranged in age from 1 month to 14 years and in weight from 3.1 to 56 kg. All required sedation during mechanical ventilation. Prior to changing to pentobarbital, sedation was inadequate despite midazolam doses of ≥0.4 mg/kg/hr, fentanyl doses of ≥10 μg/kg/hr, and morphine doses of ≥100 μg/kg/hr. The duration of pentobarbital infusion ranged from 2 to 37 days (median 4 days) in doses ranging from 1 to 6 mg/kg/hr (median 2 mg/kg/hr). Twelve patients also received an ongoing opioid infusion for more than 48 hours after starting the pentobarbital infusion to control pain related to a surgical procedure or an acute medical illness. There was an increase in pentobarbital infusion requirements over time. In the 14 patients that received pentobarbital for 5 days or more, the requirements increased from 1.2 ± 0.4 mg/kg/hr on day 1 to 3.4 ± 0.7 mg/kg/hr on day 5 ( p < 0.01). Pentobarbital was effective in all 50 patients without significant adverse effects.

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