Incidence of hospital mortality in polytrauma patients in a tertiary center in Bosnia and Herzegovina

Introduction: In the late 70s of the last century, the mortality rate due to polytrauma amounted to 40%. This led to a new approach to this patient category with the goal of improving the treatment outcome. According to the German trauma register, the rate of mortality in polytrauma at the end of the last century was 18.6%. The goal of this study is to determine the incidence of hospital mortality in polytrauma patients in a tertiary institution in Bosnia and Herzegovina.Methods: We analyzed patient medical records from the Intensive Care Unit of the Clinic of Orthopedics and Traumatology at University Clinical Center Sarajevo, from January 1, 2012 to December 31, 2012.Results: There were 70 polytrauma patients in 2012, with average age 47.55 (range 8-77) years. Half of the patients were younger than 50 years. Age groups most frequently affected were 61 and older (25.7%), 51-60 years (24.3%), and 31-40 years (21.4%). Lethal outcome occurred in 10 patients (14.3%), while 60 patients (85.7%) survived and were treated until discharge or transfer to a different department. The average Injury Severity Score (ISS) in patients with lethal outcome was 71.50, while in survivors was 37. The largest percentage of lethal outcomes was recorded in cases of traffic accidents.Conclusion: The mortality rate among hospitalized polytrauma patients in the tertiary institution in Bosnia and Herzegovina is similar to reported mortality rates in other countries with developed healthcare system.

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Prevalence of Delayed Hemothorax in Blunt Thoracic Trauma

The American Surgeon ◽

10.1177/000313480507100606 ◽

2005 ◽

Vol 71 (6) ◽

pp. 481-486 ◽

Cited By ~ 16

Author(s):

Om P. Sharma ◽

Sara Hagler ◽

Michael F. Oswanski

Keyword(s):

Critical Care ◽

Mortality Rate ◽

Thoracic Trauma ◽

Injury Severity ◽

Age Groups ◽

Rib Fractures ◽

P Value ◽

Blunt Thoracic Trauma ◽

Younger Patients ◽

Current Report

Delayed hemothorax (DHTX) is rarely seen. On an 8-year retrospective analysis of blunt thoracic trauma (BTT), hemothorax (HTX) was diagnosed in 167 patients: 18 children, 113 adults, and 36 elderly. No statistical differences were seen in any age groups regarding Injury Severity Score (mean ISS, 30.54), critical care length of stay (CLOS, 9.0), and hospital LOS (HLOS, 11.21). Mortality rate was 18 per cent in adults and 28 per cent in elderly ( P value < 0.0001). HTX was acute in 160 and delayed in 7 patients. Two-thirds of HTX patients were males and 75 per cent had rib fractures. All of our DHTX patients were males (5 adults and 2 elderly) and had rib fractures. Acute HTX was seen in younger patients (43.3 vs 56.1 years, P value 0.46), with higher ISS (31.44 vs 14.43, P value < 0.001), CLOS (7.19 vs 3.0 days, P value 0.511) and HLOS (11.9 vs 11.6, P value 0.468). Mortality was 22.5 per cent in AHTX and none in DHTX. Eighty-six per cent of DHTX and 49 per cent of AHTX patients went home on discharge. DHTX was rare (5%) in the current report with lower ISS, HLOS, and no mortality. Patients with rib fractures should be watched for development of DHTX as timely diagnosis and treatment is essential for favorable outcome.

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Analysis of in-hospital mortality among people with and without Diabetes in Australian Public Hospitals (2014-2017)

10.21203/rs.3.rs-521628/v1 ◽

2021 ◽

Author(s):

Tina Gao ◽

Kingsley E Agho ◽

Milan K Piya ◽

David Simmons ◽

Uchechukwu L Osuagwu

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Age Groups ◽

Public Health Problem ◽

Binary Logistic Regression ◽

Population Based ◽

Public Hospitals ◽

Major Public Health Problem ◽

Factors Associated ◽

Cardiovascular Comorbidities

Abstract Background Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and there is paucity of data on hospital outcomes and/or what common factors influence mortality rate in people with diabetes in Australia. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 2014-15 to 2016-17). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results Over three years 8.7% (48,038 people) of admissions involved those with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: aged > 54years, men, the widowed, those who stayed longer than 4 days or received intensive care in admission and had respiratory and cardiovascular comorbidities. Conclusions The study found that in-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes in this region indicating that continued improved management of all inpatients is needed in order to minimise the persistent poor outcomes.

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Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014–2017)

BMC Public Health ◽

10.1186/s12889-021-12120-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tina Gao ◽

Kingsley E. Agho ◽

Milan K. Piya ◽

David Simmons ◽

Uchechukwu L. Osuagwu

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Age Groups ◽

Public Health Problem ◽

Binary Logistic Regression ◽

Population Based ◽

Public Hospitals ◽

Major Public Health Problem ◽

Factors Associated ◽

Patients With Diabetes

Abstract Background Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014–30 June 2015 to 1 July 2016–30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014–15 to 8.9% in 2016–17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49–35.02) but not in those with diabetes. Conclusions In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed.

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ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients

Diagnostics ◽

10.3390/diagnostics11091548 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1548

Author(s):

Christopher Rugg ◽

Mirjam Bachler ◽

Robert Kammerlander ◽

Daniel Niederbrunner ◽

Johannes Bösch ◽

...

Keyword(s):

Hospital Mortality ◽

Injury Severity Score ◽

Tissue Damage ◽

Severity Score ◽

Injury Severity ◽

Strong Predictor ◽

Single Centre ◽

Icu Admission ◽

Single Centre Study ◽

Polytrauma Patients

Hyperphosphataemia can originate from tissue ischaemia and damage and may be associated with injury severity in polytrauma patients. In this retrospective, single-centre study, 166 polytrauma patients (injury severity score (ISS) ≥ 16) primarily requiring intensive care unit (ICU) treatment were analysed within a five-year timeframe. ICU-admission phosphate levels defined a hyperphosphataemic (>1.45 mmol/L; n = 56) opposed to a non-hyperphosphataemic group (n = 110). In the hyperphosphataemic group, injury severity was increased (ISS median and IQR: 38 (30–44) vs. 26 (22–34); p < 0.001), as were signs of shock (lactate, resuscitation requirements), tissue damage (ASAT, ALAT, creatinine) and lastly in-hospital mortality (35.7% vs. 5.5%; p < 0.001). Hyperphosphataemia at ICU admission was shown to be a risk factor for mortality (1.46–2.10 mmol/L: odds ratio (OR) 3.96 (95% confidence interval (CI) 1.03–15.16); p = 0.045; >2.10 mmol/L: OR 12.81 (CI 3.45–47.48); p < 0.001) and admission phosphate levels alone performed as good as injury severity score (ISS) in predicting in-hospital mortality (area under the ROC curve: 0.811 vs. 0.770; p = 0.389). Hyperphosphataemia at ICU admission is related to tissue damage and shock and indicates injury severity and subsequent mortality in polytrauma patients. Admission phosphate levels represent an easily feasible yet strong predictor for in-hospital mortality.

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Frequency and relevance of concomitant diseases in elderly patients hospitalized for community acquired pneumonia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0912619d ◽

2009 ◽

Vol 137 (11-12) ◽

pp. 619-626 ◽

Cited By ~ 3

Author(s):

Mirna Djuric ◽

Djordje Povazan ◽

Nevena Secen ◽

Branislav Perin

Keyword(s):

Mortality Rate ◽

Elderly Patients ◽

Hospital Mortality ◽

Arterial Hypertension ◽

Prognostic Score ◽

Age Groups ◽

Community Acquired Pneumonia ◽

Chronic Obstructive ◽

Obstructive Disease ◽

Significant Mortality

Introduction. Patients' age and concomitant diseases are relevant for the development and treatment outcome of pneumonia. Objective. To establish the frequency and relevance of concomitant diseases in patients over 65 years of age hospitalized for community acquired pneumonia. Methods. The research included 550 patients hospitalized at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica due to community acquired pneumonia. Data on concomitant diseases and mortality rate was correlated with the patients' age limit of 65 years, and then statistically analyzed and presented in tables. Results. There were 446 (81.45%) patients under and 102 (18.55%) over the age of 65 years. Dyspnea, impaired consciousness, cyanosis, tachycardia and arterial hypertension were significantly more common in patients over 65 years of age, who also had a higher prognostic score. Mortality was significantly higher (21.6% vs. 6.0%) in the patients aged over 65 years (p<0.001). Concomitant diseases were significantly more common (p<0.001) among the patients over 65 years (94.1%vs.69.2%), and the majority of the elderly patients had two or three comorbidities. The following comorbidities were significantly more common among the patients aged over 65 years: chronic obstructive disease, bronchiectasis, compensated and decompensated cardiomyopathy, cardiac arrhythmia, arterial hypertension and diabetes mellitus. The higher number of concomitant diseases was associated with a significantly elevated hospital mortality (p<0.001). A statistically significant mortality rate difference was found in both age groups regarding the comorbidity of chronic obstructive disease and decompensated cardiomyopathy. Conclusion. The patients aged over 65 years hospitalized due to community acquired pneumonia had a statistically significantly higher prognostic score, mortality rate and concomitant diseases than the patients below 65 yeas of age. Most subjects of the older group of patients had two or three comorbidities. Concomitant diseases resulted in a statistically significant hospital mortality elevation. When comborbitities involved chronic obstructive pulmonary disease and decompensated cardiomyopathy, a statistically significant mortality difference was registered in both age groups.

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Geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01567-y ◽

2020 ◽

Author(s):

Karlijn J. P. van Wessem ◽

Luke P. H. Leenen

Keyword(s):

Injury Severity ◽

Age Groups ◽

Infectious Complications ◽

Older Age ◽

Morbidity And Mortality ◽

Complication Rates ◽

Severely Injured ◽

Age Related ◽

Injury Treatment ◽

Polytrauma Patients

Abstract Purpose Age in severely injured patients has been increasing for decades. Older age is associated with increasing mortality. However, morbidity and mortality could possibly be reduced when accurate and aggressive treatment is provided. This study investigated age-related morbidity and mortality in polytrauma including age-related decisions in initial injury management and withdrawal of life-sustaining therapy (WLST). Methods A 6.5-year prospective cohort study included consecutive severely injured trauma patients admitted to a Level-1 Trauma Center ICU. Demographics, data on physiology, resuscitation, MODS/ARDS, and infectious complications were prospectively collected. Patients were divided into age subgroups (< 25, 25–49, 50–69, and ≥ 70 years) to make clinically relevant comparisons. Results 391 patients (70% males) were included with median ISS of 29 (22–36), 95% sustained blunt injuries. There was no difference in injury severity, resuscitation, urgent surgeries, nor in ventilator days, ICU-LOS, and H-LOS between age groups. Adjusted odds of MODS, ARDS and infectious complications were similar between age groups. 47% of patients ≥ 70 years died, compared to 10–16% in other age groups (P < 0.001). WLST increased with older age, contributing to more than half of deaths ≥ 70 years. TBI was the most common cause of death and decision for treatment withdrawal in all age groups. Conclusions Patients ≥ 70 years had higher mortality risk even though injury severity and complication rates were similar to other age groups. WLST increased with age with the vast majority due to brain injury. More than half of patients ≥ 70 years survived suggesting geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone.

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Darmkrebs-OP: Auf die Erfahrung kommt es an

Deutsche Zeitschrift für Onkologie ◽

10.1055/a-1246-7878 ◽

2020 ◽

Vol 52 (04) ◽

pp. 162-164

Author(s):

Frank Lichert

Keyword(s):

Rectal Cancer ◽

Mortality Rate ◽

Hospital Mortality ◽

Hospital Volume ◽

Rectum Resection

Diers J et al. Nationwide in-hospital mortality rate following rectum resection for rectal cancer according to annual hospital volume in Germany. BJS Open 2020; doi:10.1002/bjs5.50254

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Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

BMC Emergency Medicine ◽

10.1186/s12873-021-00446-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feng Qi ◽

Hao Zhou ◽

Peng Gu ◽

Zhi-He Tang ◽

Bao-Feng Zhu ◽

...

Keyword(s):

Injury Severity ◽

Early Stage ◽

Endothelial Glycocalyx ◽

Control Group ◽

Metabolic System ◽

Metabolic Systems ◽

Organ Systems ◽

Severity Scores ◽

Polytrauma Patients ◽

Trauma Group

Abstract Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

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NCOG-65. MR-GUIDED LASER INTERSTITIAL THERMAL THERAPY FOR BRAIN TUMORS IN GERIATRIC PATIENTS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.603 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii144-ii144

Author(s):

Elizabeth Ginalis ◽

Shabbar Danish

Keyword(s):

Mortality Rate ◽

Neurological Symptom ◽

Geriatric Patients ◽

Age Groups ◽

Postoperative Mortality ◽

Thermal Therapy ◽

Partial Recovery ◽

Intracranial Tumors ◽

Laser Interstitial Thermal Therapy ◽

Significant Difference

Abstract INTRODUCTION There is a paucity of studies assessing the use of magnetic resonance-guided laser interstitial thermal therapy (LITT) in the elderly population. METHODS Geriatric patients (≥65 years) treated with LITT for intracranial tumors at a single institution from January 2011 to November 2019 were retrospectively identified. We grouped patients into two cohorts: 65-74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded. RESULTS There were 55 patients who underwent 64 distinct LITT procedures. The majority of tumors (62.5%) treated were recurrent brain metastasis/radiation necrosis. The median hospital length of stay was 1 day, with no significant difference between age groups. Hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (68.3%) were discharged to their preoperative accommodation. Rate of discharge to home was not significantly different between age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1%) were found to have acute neurological complications, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (n = 1). The complication and 30-day postoperative mortality rate were not significantly different between age groups. CONCLUSIONS LITT can be considered as a minimally invasive and safe neurosurgical procedure for treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential as neurosurgeons treat an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT.

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All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study

European Heart Journal ◽

10.1093/eurheartj/ehab028 ◽

2021 ◽

Cited By ~ 1

Author(s):

Jawad H Butt ◽

Emil L Fosbøl ◽

Thomas A Gerds ◽

Charlotte Andersson ◽

Kristian Kragholm ◽

...

Keyword(s):

Cardiovascular Disease ◽

Mortality Rate ◽

Hospital Mortality ◽

Location Of Death ◽

All Cause Mortality ◽

History Of ◽

Adjusted Incidence Rate ◽

Artery Disease ◽

Adjusted Incidence ◽

Overall Mortality

Abstract Background On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures. Methods and results Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87–0.95; IRR 0.95, 95% CI 0.89–1.02; and IRR 0.87, 95% CI 0.83–0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97–1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88–0.96; out-of-hospital, IRR 1.04, 95% CI1.01–1.08). These trends were consistent irrespective of sex and age. Conclusions Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.

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