Trends in Covid-19 risk-adjusted mortality rates in a single health system

Early reports showed high mortality from Covid-19; by contrast, the current outbreaks in the southern and western United States are associated with fewer deaths, raising hope that treatments have improved. However, in Texas for instance, 63% of diagnosed cases are currently under 50, compared to only 52% nationally in March-April. Current demographics in Arizona and Florida are similar. Therefore, whether decreasing Covid-19 mortality rates are a reflection of changing demographics or represent improvements in clinical care is unknown. We assessed outcomes over time in a single health system, accounting for changes in demographics and clinical factors. Methods We analyzed biweekly mortality rates for admissions between March 1 and June 20, 2020 in a single health system in New York City. Outcomes were obtained as of July 14, 2020. We included all hospitalizations with laboratory-confirmed Covid-19 disease. Patients with multiple hospitalizations (N=157, 3.3%) were included repeatedly if they continued to have laboratory-confirmed disease. Mortality was defined as in-hospital death or discharge to hospice care. Based on prior literature, we constructed a multivariable logistic regression model to generate expected risk of death, adjusting for age; sex; self-reported race and ethnicity; body mass index; smoking history; presence of hypertension, heart failure, hyperlipidemia, coronary artery disease, diabetes, cancer, chronic kidney disease, or pulmonary disease individually as dummy variables; and admission oxygen saturation, D-dimer, C reactive protein, ferritin, and cycle threshold for RNA detection. All data were obtained from the electronic health record. We then calculated the sum of observed and expected deaths in each two-week period and multiplied each period's observed/expected (O/E) risk by the overall average crude mortality to generate biweekly adjusted rates. We calculated Poisson control limits and indicated points outside the control limits as significantly different, following statistical process control standards. The NYU institutional review board approved the study and granted a waiver of consent. Results We included 4,689 hospitalizations, of which 4,661 (99.4%) had died or been discharged. The median age, and the proportion male or with any comorbidity decreased over time; median real-time PCR cycle threshold increased (indicating relatively less concentration of virus) (Table). For instance, median age decreased from 67 years in the first two weeks to 49 in the last two. Peak hospitalizations were during the fifth and sixth study weeks, which accounted for 40% of the hospitalizations. Median length of stay for patients who died or were discharged to hospice was 8 days (interquartile range, 4-16). Unadjusted mortality dropped each period, from 30.2% in the first two weeks to 3% in the last two weeks, with the last eight weeks being lower than the 95% control limits. Risk adjustment partially attenuated the mortality decline, but adjusted mortality rates in the second-to-last two weeks remained outside the control limits (Figure, Table). The O/E risk of mortality decreased from 1.07 (0.64-1.67) in the first two weeks to 0.39 (0.08-1.12) in the last two weeks. Discussion In this 16-week study of Covid-19 mortality at a single health system, we found that changes in demographics and severity of illness at presentation account for some, but not all, of the decrease in unadjusted mortality. Even after risk adjustment for a variety of clinical and demographic factors, mortality was significantly lower towards the end of the study period. Incremental improvements in outcomes are likely a combination of increasing clinical experience, decreasing hospital volume, growing use of new pharmacologic treatments (such as corticosteroids, remdesivir and anti-cytokine treatments), non-pharmacologic treatments (such as proning), earlier intervention, community awareness, and lower viral load exposure from increasing mask wearing and social distancing. It is also possible that earlier periods had a more virulent circulating strain. In summary, data from one health system suggest that Covid-19 remains a serious disease for high risk patients, but that outcomes may be improving.

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Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

Digestive Surgery ◽

10.1159/000438798 ◽

2015 ◽

Vol 32 (5) ◽

pp. 389-396 ◽

Cited By ~ 3

Author(s):

Adam Gyedu ◽

Francis Abantanga ◽

Ishmael Kyei ◽

Godfred Boakye ◽

Barclay T. Stewart

Keyword(s):

Intestinal Obstruction ◽

Surgical Care ◽

Tertiary Hospital ◽

Hospital Death ◽

Surgical Capacity ◽

Risk Of Death ◽

Surgical Workforce ◽

Hospital Stays ◽

Intestinal Obstructions ◽

Over Time

Introduction: This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. Methods: Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. Results: Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g. volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95). Conclusion: Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.

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Time Trends in Characteristics and Outcome of Twin Pregnancies

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000002622 ◽

1991 ◽

Vol 40 (2) ◽

pp. 181-192 ◽

Cited By ~ 6

Author(s):

L. Moreault ◽

S. Marcoux ◽

J. Fabia ◽

S. Tennina

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Low Birthweight ◽

Preterm Births ◽

Mortality Rates ◽

Fetal Mortality ◽

Neonatal Mortality Rate ◽

Risk Of Death ◽

Twin Pregnancies ◽

Over Time

AbstractThis study describes the evolution in fetal and neonatal mortality rates among twin pairs born in 22 hospitals located in the eastern regions of the province of Quebec in 1976-1978 (n = 776 pairs) and 1982-1985 (n = 712 pairs). It also assesses the contribution of maternal factors, obstetrical care and characteristics of twins in the variation of the risk of death over time. The fetal mortality rate did not improve from 1976-1978 (22.6 per 1000) to 1982-1985 (28.1 per 1000). However, the neonatal mortality rate declined from 44.7 to 34.7 per 1000 liveborn first twins and from 56.8 to 36.1 per 1000 liveborn second twins. For first twins as for second twins, birthweight-specific neonatal mortality rates decreased within birth weight categories under 2500 g. In the second period, 96.9% of twin pregnancies were detected before confinement compared to 59.6% in the earlier period. The proportion of twins delivered by obstetricians, the percentage of twin births occurring in ultraspecialized perinatal units and the frequency of caesarean sections increased markedly. The proportion of preterm births increased over time (34.5% vs 43.1%) whereas the percentage of low birthweight twins decreased but not significantly (54.3% 51.6%). In this study, changes in maternal age, parity, educational level, sex of pairs, qualification of the physician, and level of care available at the hospital of birth, did not account for the decrease in neonatal mortality rates among twins. The increase in the frequency of caesarean sections seemed to explain only a small proportion of the decrease in the neonatal mortality rate among second twins. In the second as well as in the first period, the neonatal mortality rate for twins was six times higher than that for singletons.

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Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

Cerebrovascular Diseases ◽

10.1159/000445526 ◽

2016 ◽

Vol 42 (3-4) ◽

pp. 213-223 ◽

Cited By ~ 5

Author(s):

Krishi Peddada ◽

Salvador Cruz-Flores ◽

Larry B. Goldstein ◽

Eliahu Feen ◽

Kevin F. Kennedy ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Clinical Characteristics ◽

Causes Of Death ◽

Mortality Rates ◽

Hospital Death ◽

Stroke Patients ◽

Troponin Elevation ◽

Changes Over Time ◽

Over Time

Background: Among patients hospitalized for acute ischemic stroke, abnormal serum troponins are associated with higher risk of short-term mortality. However, most findings have been reported from European hospitals. Whether troponin elevation after stroke is independently associated with death among a more heterogeneous US population remains unclear. Furthermore, only a few studies have evaluated the association between the magnitude of troponin elevation and subsequent mortality, patterns of dynamic troponin changes over time, or whether troponin elevation is related to specific causes of death. Methods: Using data collected in the American Heart Association's ‘Get With The Guidelines' stroke registry between 2008 and 2012 at a tertiary care US hospital, we used logistic regression to evaluate the independent relationship between troponin elevation and mortality after adjusting for demographic and clinical characteristics. We then assessed whether the magnitude of troponin elevation was related to in-hospital mortality by calculating mortality rates according to tertiles of peak troponin levels. Dynamic troponin changes over time were evaluated as well. To better understand whether troponin elevation identified patients most likely to die due to a specific cause of death, investigators blinded from troponin values reviewed all in-hospital deaths, and the association between troponin elevation and mortality was evaluated among patients with cardiac, neurologic, or other causes of death. Results: Of 1,145 ischemic stroke patients, 199 (17%) had elevated troponin levels. Troponin-positive patients had more cardiovascular risk factors, more intensive medical therapy, and greater use of cardiac procedures. These individuals had higher in-hospital mortality rates than troponin-negative patients (27 vs. 8%, p < 0.001), and this association persisted after adjustment for 13 clinical and management variables (OR 4.28, 95% CI 2.40-7.63). Any troponin elevation was associated with higher mortality, even at very low peak troponin levels (mortality rates 24-29% across tertiles of troponin). Patients with persistently rising troponin levels had fewer anticoagulant and antiatherosclerotic therapies, with markedly worse outcomes. Furthermore, troponin-positive patients had higher rates of all categories of death: neurologic (17 vs. 7%), cardiac (5 vs. <1%), and other causes of death (5 vs. <1%; p < 0.001 for all comparisons). Conclusions: Ischemic stroke patients with abnormal troponin levels are at higher risk of in-hospital death, even after accounting for demographic and clinical characteristics, and any degree of troponin elevation identifies this higher level of risk. Troponins that continue to rise during the hospitalization identify stroke patients at markedly higher risk of mortality, and both neurologic and non-neurologically mediated mortality rates are higher when troponin is elevated.

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The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.706852 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhenjun Ji ◽

Guiren Liu ◽

Jiaqi Guo ◽

Rui Zhang ◽

Yamin Su ◽

...

Keyword(s):

Predictive Ability ◽

Electronic Medical Record System ◽

Neutrophil To Lymphocyte Ratio ◽

Smoking History ◽

Youden Index ◽

Hospital Death ◽

Record System ◽

Important Indicator ◽

Lymphocyte Ratio ◽

Risk Of Death

Objective: To explore the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the short-term prognosis of NSTEMI and STEMI.Methods: This study was a single-center, retrospective and observational study. 2618 patients including 1289 NSTMI and 1329 STEMI patients were enrolled from June 2013 to February 2018 in Zhongda Hospital, Southeast University. The demographic information, clinical characteristics, medical history, laboratory examination, treatment, and outcome of individuals at admission and during hospitalization were extracted from the electronic medical record system. Outcome was defined as the all-cause death during hospitalization.Results: (1) In the NSTEMI group, the ability of NLR in predicting in-hospital death (AUC = 0.746) was higher than the neutrophil-monocyte ratio (NMR) (AUC = 0.654), the platelet-lymphocyte ratio (PLR) (AUC = 0.603) and the lymphocyte-monocyte ratio (LMR) (AUC = 0.685), and also higher than AST (AUC = 0.621), CK (AUC = 0.595), LDH (AUC = 0.653) and TnI (AUC = 0.594). The AUC of NLR in the STEMI group was only 0.621. (2) The optimal cut-off value of NLR in NSTEMI group was 5.509 (Youden index = 0.447, sensitivity = 77.01%, specificity = 67.72%). After adjusting variables including age, sex, diabetes history, smoking history, LDL-C and Cr, the logistic regression showed that the patients with NLR>5.509 had higher hazard risk of death (HR4.356; 95%CI 2.552–7.435; P < 0.001) than the patients with NLR ≤ 5.509. (3) Stratification analysis showed that the in-hospital mortality of patients with NLR > 5.509 was 14.611-fold higher than those with NLR ≤ 5.509 in patients aged <76, much higher than the ratio in patients aged ≥ 76. For patients with creatinine levels ≤ 71, the in-hospital death risk in high NLR group was 10.065-fold higher than in low NLR group (95%CI 1.761–57.514, P = 0.009), while the HR was only 4.117 in patients with creatinine levels > 71. The HR in patients with or without diabetes were 6.586 and 3.375, respectively. The HR in smoking or no smoking patients were 6.646 and 4.145, respectively. The HR in patients with LDL-C ≥ 2.06 or <2.06 were 5.526 and 2.967 respectively.Conclusion: Compared to NMR, PLR, and LMR, NLR had the best ability in predicting in-hospital death after NSTEMI. Age, creatinine, LDL-C, diabetes and smoking history were all important factors affecting the predictive efficiency in NSTEMI. NLR had the limited predictive ability in STEMI.

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Establishment of Routine Clinical Indicators-Based Nomograms for Predicting the Mortality in Patients With COVID-19

Frontiers in Medicine ◽

10.3389/fmed.2021.706380 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jialin He ◽

Caiping Song ◽

En Liu ◽

Xi Liu ◽

Hao Wu ◽

...

Keyword(s):

Logistic Regression ◽

Clinical Manifestations ◽

Vital Signs ◽

Multivariate Logistic Regression Analysis ◽

Smoking History ◽

Hospital Death ◽

Multivariate Logistic Regression ◽

Clinical Indicators ◽

Risk Of Death ◽

Patients At Risk

This study aimed to establish and validate the nomograms to predict the mortality risk of patients with coronavirus disease 2019 (COVID-19) using routine clinical indicators. This retrospective study included a development cohort enrolled 2,119 hospitalized patients with COVID-19 and a validation cohort included 1,504 patients with COVID-19. The demographics, clinical manifestations, vital signs, and laboratory tests of the patients at admission and outcome of in-hospital death were recorded. The independent factors associated with death were identified by a forward stepwise multivariate logistic regression analysis and used to construct the two prognostic nomograms. The nomogram 1 was a full model to include nine factors identified in the multivariate logistic regression and nomogram 2 was built by selecting four factors from nine to perform as a reduced model. The nomogram 1 and nomogram 2 showed better performance in discrimination and calibration than the Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age (MuLBSTA) score in training. In validation, nomogram 1 performed better than nomogram 2 for calibration. We recommend the application of nomogram 1 in general hospitals which provide robust prognostic performance though more cumbersome; nomogram 2 in the out-patient, emergency department, and mobile cabin hospitals, which depend on less laboratory examinations to make the assessment more convenient. Both the nomograms can help the clinicians to identify the patients at risk of death with routine clinical indicators at admission, which may reduce the overall mortality of COVID-19.

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Previous hospital admissions in risk adjustment for mortality of elderly patients admitted with hip fracture

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.98 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Helen Machareth ◽

Cláudia Coeli ◽

Rejane Pinheiro

Keyword(s):

Information System ◽

Hip Fracture ◽

Health System ◽

Risk Adjustment ◽

Hospital Information System ◽

Hospital Admissions ◽

Hospital Death ◽

The Public ◽

Unified Health System ◽

Ischemic Diseases

ABSTRACTIntroductionThe Hospital Information System of the Brazilian Unified Health System (SIH-SUS) can be an important tool in evaluating care through comparisons of mortality rates among hospitals. However, the SIH-SUS has limited availability of data on comorbidities, which are needed in order to measure the severity of patients' condition for risk adjustment when comparing mortality among hospitals. ObjectivesTo analyze previous hospital admissions as an indicator of severity of patients' condition using as an example hip fracture admissions. ApproachWe analyzed 1984 patients with 62 years of age or older with hip fracture who were admitted to the public health system in Rio de Janeiro City between 2010 and 2011. The causes of previous hospital admissions were obtained through probabilistic record linkage with the SIH-SUS for all causes of admissions between 2008 and 2010. We analyzed the association between the patient having had a any previous admission, adjusted by sex and age, with hospital death, through a logistic regression model. We also analyzed the association between groups of causes of admission with hospital death. ResultsHaving had at least one previous hospital admission due to any cause before the admission for hip fracture was associated with a 77% increase in the odds of hospital death (CI 95% = 1.06 – 2.94). Among comorbidities, the most relevant were severe or moderate kidney disease with OR = 20.196 (CI 95% = 3.042 – 134.092), ischemic diseases with OR = 9.099 (CI 95% = 0.973 – 85.106), pneumonia with OR = 3.619 (CI 95% = 0.977 – 13.401) and diverse fractures and lesions with OR = 2.041 (CI 95% = 0.900 – 4.627). We were not able to analyze the association for some comorbidities due to an absence in outcome variability in some groups. ConclusionResults point to a promising use of previous hospital admissions in the Hospital Information System as a proxy for patient's risk adjustment.

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COVID-19 hospitalizations in Brazil's Unified Health System (SUS)

10.1101/2020.09.03.20187617 ◽

2020 ◽

Author(s):

Carla Lourenço Tavares de Andrade ◽

Claudia Cristina de Aguiar Pereira ◽

Mônica Martins ◽

Sheyla Maria Lemos Lima ◽

Margareth Crisóstomo Portela

Keyword(s):

Health System ◽

Protective Factor ◽

Secondary Data ◽

Cross Sectional Study ◽

Care Process ◽

Independent Effect ◽

Hospital Death ◽

Cross Sectional ◽

Risk Of Death ◽

Unified Health System

Objective: To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with hospital mortality related to the disease. Methods: Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in SUS, between the last days of February and June. Patients aged 18 years or older, with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization. Results: 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in SUS were predominantly male (56.5%), with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (STD=6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The chances of hospital death among men were 16.8% higher than among women and increased with age. Black individuals had a higher chance of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states had a higher risk of hospital death from COVID-19, such as Amazonas and Rio de Janeiro. The chances of hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants and being hospitalized in the municipality of residence was a protective factor. Conclusion: There was wide variation in hospital COVID-19 mortality in the SUS, associated with demographic and clinical factors, social inequality and differences in the structure of services and quality of health care.

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All-cause and cause-specific mortality during and following incarceration in Brazil: a retrospective cohort study

10.1101/2021.07.28.21261263 ◽

2021 ◽

Author(s):

Yiran E Liu ◽

Everton Ferreira Lemos ◽

Crhistinne Cavalheiro Maymone Gonçalves ◽

Roberto Dias de Oliveira ◽

Andrea da Silva Santos ◽

...

Keyword(s):

Prison Population ◽

Mortality Rates ◽

Communicable Diseases ◽

Violent Death ◽

Mato Grosso ◽

Risk Of Death ◽

Increased Risk ◽

All Cause Mortality ◽

Specific Mortality ◽

Over Time

Background Mortality during and after incarceration is poorly understood in low- and middle-income countries. The need to address this knowledge gap is especially urgent in South America, which has the fastest growing prison population in the world. In Brazil, data on mortality during and after incarceration are lacking. Methods and Findings We linked incarceration and mortality databases for the Brazilian state of Mato Grosso do Sul to obtain a cohort of 114,751 individuals with recent incarceration. Between January 1, 2009 and December 31, 2018, we identified 3127 deaths of individuals with recent incarceration (705 in detention; 2422 following release). We analyzed age- standardized, all-cause and cause-specific mortality rates among individuals detained in different facility types and following release, compared to non-incarcerated residents. Deaths in custody were 2.2 times the number reported by the national prison administration (n = 317). Incarcerated men and boys experienced elevated mortality, compared with the non-incarcerated population, due to increased risk of death from violence, suicide, and communicable diseases, with the highest standardized incidence rate ratio (IRR) in semi-open prisons (2.4; 95% CI, 2.0-2.8), police stations (3.1; 95% CI, 2.5-3.9), and youth detention (8.1; 95% CI, 5.9-10.8). Incarcerated women had increased mortality from suicide (IRR = 6.0, 95% CI 1.2-17.7) and communicable diseases (IRR = 2.5, 95% CI 1.1-5.0). We additionally modeled mortality rates over time during and after incarceration from all causes, violence, or suicide. Following release from prison, mortality was markedly elevated for men (IRR=3.0; 95% CI, 2.8- 3.1) and women (IRR=2.4; 95% CI, 2.1-2.9). The risk of violent death and suicide was highest immediately post-release and declined over time; however, all-cause mortality remained elevated eight years post-release. The limitations of this study include inability to establish causality, uncertain reliability of data during incarceration, and underestimation of mortality rates due to imperfect database linkage. Conclusions Incarcerated individuals in Brazil experienced increased mortality from violence, suicide, and communicable diseases. Mortality was heightened following release for all leading causes of death, with particularly high risk of early violent death and elevated all-cause mortality up to eight years post-release. These disparities may have been under-recognized in Brazil due to underreporting and insufficient data.

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Mortality after hospital admission for heart failure: improvement over time, equally strong in women as in men

BMC Public Health ◽

10.1186/s12889-019-7934-3 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

J. Buddeke ◽

◽

G. B. Valstar ◽

I. van Dis ◽

F. L. J. Visseren ◽

...

Keyword(s):

Heart Failure ◽

Absolute Risk ◽

Mortality Rates ◽

Dutch Hospital ◽

Term Survival ◽

Risk Of Death ◽

Over Time ◽

Age And Sex ◽

New Onset

Abstract Background To assess the trend in age- and sex-stratified mortality after hospitalization for heart failure (HF) in the Netherlands. Methods Two nationwide cohorts of patients, hospitalized for new onset heart failure between 01.01.2000–31.12.2002 and between 01.01.2008–31.12.2010, were constructed by linkage of the Dutch Hospital Discharge Registry and the National Cause of Death registry. 30-day, 1-year and 5 -year overall and cause-specific mortality rates stratified by age and sex were assessed and compared over time. Results We identified 40,230 men and 41,582 women. In both cohorts, men were on average younger than women (74–75 and 78–79 years, respectively) and more often had comorbid conditions (37 and 30%, respectively). In the 2008–10 cohort, mortality rates for men were 13, 32 and 64% for respectively 30-day, 1-year and 5-year mortality and 14, 33 and 66% for women. Mortality rates increased considerably with age similarly in men and women (e.g. from 10.5% in women aged 25–54 to 46.1% in those aged 85 and older after 1 year). Between the two time periods, mortality rates dropped across all ages, equally strong in women as in men. The 1-year absolute risk of death declined by 4.0% (from 36.1 to 32.1%) in men and 3.2% (from 36.2 to 33.0%) in women. Conclusions Mortality after hospitalization for new onset HF remains high, however, both short-term and long-term survival is improving over time. This improvement was similar across all ages and equally strong in women as in men.

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An Early Warning Score Predicts Risk of Death after In-hospital Cardiopulmonary Arrest in Surgical Patients

The American Surgeon ◽

10.1177/000313481508101001 ◽

2015 ◽

Vol 81 (10) ◽

pp. 916-921 ◽

Cited By ~ 3

Author(s):

Alexander P. Stark ◽

Robert C. Maciel ◽

William Sheppard ◽

Greg Sacks ◽

O. Joe Hines

Keyword(s):

Early Warning ◽

Cardiopulmonary Arrest ◽

Vital Signs ◽

Clinical Intervention ◽

Mortality Rates ◽

University Hospital ◽

Early Warning Score ◽

Surgical Patients ◽

Hospital Death ◽

Risk Of Death

In-hospital cardiopulmonary arrest can contribute significantly to publicly reported mortality rates. Systems to improve mortality are being implemented across all specialties. A review was conducted for all surgical patients >18 years of age who experienced a “Code Blue” event between January 1, 2013 and March 9, 2014 at a university hospital. A previously validated Modified Early Warning Score (MEWS) using routine vital signs and neurologic status was calculated at regular intervals preceding the event. In 62 patients, the most common causes of arrest included respiratory failure, arrhythmia, sepsis, hemorrhage, and airway obstruction, but remained unknown in 27 per cent of cases. A total of 56.5 per cent of patients died before hospital discharge. In-hospital death was associated with American Society of Anesthesiologists status ( P = 0.039) and acute versus elective admission ( P = 0.003). Increasing MEWS on admission, 24 hours before the event, the event-day, and a maximum MEWS score on the day of the event increased the odds of death. Max MEWS remained associated with death after multivariate analysis (odds ratio 1.39, P = 0.025). Simple and easy to implement warning scores such as MEWS can identify surgical patients at risk of death after arrest. Such recognition may provide an opportunity for clinical intervention resulting in improved patient outcomes and hospital mortality rates.

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