scholarly journals Seven-day services in surgery and weekend effect at a Japanese teaching hospital: a retrospective cohort study

2019 ◽  
Author(s):  
Masaaki Matoba ◽  
Takashi Suzuki ◽  
Hirotaka Ochiai ◽  
Takako Shirasawa ◽  
Takahiko Yoshimoto ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Weekend Effect ◽  
Emergency Setting ◽  
Academic Medical Centre ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Hospitals deliver 24-hour, 7-day care on a 5-day workweek model, as fewer resources are available on weekends. In prior studies, poorer outcome with weekend admission or surgery was observed. The purpose of this study was to investigate if 7-day service at a hospital affects the likelihood of the “weekend effect” in surgery. The 7-day service included outpatient consultations, diagnostic examinations, and elective surgeries. Methods This was a retrospective cohort study of patients who underwent surgery between April 2014 and October 2016 at an academic medical centre in Tokyo, Japan. The main outcome measure was thirty-day in-hospital mortality from the index surgery. The characteristics of the participants were compared using the Mann–Whitney U test or the chi-squared test as appropriate. Logistic regression was used to test for differences in the mortality rate between the two groups, and propensity score adjustments were made. Results A total of 7442 surgeries were identified, of which, 1386 (19%) took place on the weekend. Of the 947 emergency surgeries, 25% (235) were performed on the weekend. The mortality following emergency weekday surgery was 21‰ (15/712), compared with 55‰ (13/235) following weekend surgery. Of the 6495 elective surgeries, 18% (1151) were performed on the weekend. The mortality following elective weekday surgery was 2.3‰ (12/5344), compared with 0.87‰ (1/1151) following weekend surgery. After adjustment, weekend surgeries were associated with an increased risk of death, especially in the emergency setting (emergency odds ratio: 2.7, 95% confidence interval: 1.2–6.5 vs. elective odds ratio: 0.4, 95% confidence interval: 0.05–3.2). Conclusions Patients undergoing surgery on weekends had higher 30-day mortality than did those undergoing surgery on weekdays, especially in the emergency setting. These findings have potential implications for health administrators and policy makers who may try to restructure the hospital workweek or consider weekend elective surgery.

scholarly journals Understanding patterns and factors associated with place of death in patients with end-stage kidney disease: A retrospective cohort study

2016 ◽  
Vol 31 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Natasha Lovell ◽  
Chris Jones ◽  
Dawn Baynes ◽  
Sarah Dinning ◽  
Katie Vinen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Place Of Death ◽  
Renal Unit ◽  
End Stage Kidney Disease ◽  
End Stage

Background: Meeting place-of-death preferences is an important measure of the quality of end-of-life care. Systematic review shows that 42% of end-stage kidney disease patients prefer home death. Little research has been undertaken on place of death. Aim: To understand patterns of place of death in patients with end-stage kidney disease known in one UK renal unit. Design: A retrospective cohort study of all patients with chronic kidney disease stage 4–5, age ⩾75 and known to one UK renal unit, who died between 2006 and 2012. Patients were categorised into three management pathways: haemodialysis, conservative and pre-dialysis. Results: A total of 321 patients (mean age, 82.7; standard deviation, 5.21) died (61.7% male). In all, 62.9% died in hospital (95% confidence interval, 57.5%–68.1%), 21.8% died in their usual place of residence (95% confidence interval, 17.5%–26.6%) and 15.3% died in an inpatient palliative care unit (95% confidence interval, 11.6%–19.5%). Management pathway and living circumstances were most strongly associated with place of death. Patients on the conservative pathway had four times the odds of dying out of hospital (odds ratio, 4.0; 95% confidence interval, 2.1–7.5; p < 0.01). Patients living alone were less likely to die out of hospital (odds ratio, 0.3; 95% confidence interval, 0.1–0.6; p < 0.01). There were also changes in place of death over time, with more patients dying out of hospital in 2012 compared to 2006 (odds ratio, 3.1; 95% confidence interval, 1.0–9.7; p < 0.05). Conclusion: Most patients with end-stage kidney disease die in hospital, but patients managed without dialysis are significantly more likely to die outside of hospital. Planning ahead is key to be able to meet preference for place of death.

scholarly journals Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

2020 ◽  
Author(s):  
María. E. García Guzzo ◽  
María Sol Fernandez ◽  
Delfina Sánchez Novas ◽  
Sandra S. Salgado ◽  
Sergio A. Terrasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Gastrointestinal Endoscopy ◽  
Oxygen Desaturation ◽  
Endoscopic Procedures ◽  
Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

scholarly journals Smoking increases the risk of surgical site infection after hydrocelectomy in adults: a retrospective cohort study in Brazil

2018 ◽  
Vol 11 (12) ◽  
pp. 950-956
Author(s):  
Thiago Silva Da Costa ◽  
Paulo José De Medeiros ◽  
Mauro José Costa Salles
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Univariate Analysis ◽  
Smoking Habits ◽  
Site Infection

Introduction: Surgical site infection (SSI) following hydrocelectomy is relatively uncommon, but it is one of the main post-operative problems. We aimed to describe the prevalence of SSI following hydrocelectomy among adult patients, and to assess predisposing risk factors for infection. Methodology: This retrospective cohort study was carried out at a university hospital and included hydrocelectomies performed between January 2007 and December 2014. Diagnosis of SSI was performed according to the Center for Diseases Control (CDC) guidelines. Multivariable logistic regression analysis was used to identify independent risk factors. Results: A total of 196 patients were included in the analysis. Overall, 30 patients were diagnosed with SSI (15.3%) and of these, 63.3% (19/30) were classified as having superficial SSI, while 36.7% (11/30) had deep SSI. The main signs and symptoms of infection were the presence of surgical wound secretion (70%) and inflammatory superficial signs such as hyperemia, edema and pain (60%). Among the 53 patients presenting chronic smoking habits, 26.4% (14⁄53) developed SSI, which was associated with a higher risk for SSI (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.27 to 6.35, p < 0.01) in the univariate analysis. In the adjusted multivariable analysis, smoking habits were also statistically associated with SSI after hydrocelectomy (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.30 to 6.24, p = 0.01). No pre-, intra-, or post-operative variable analyzed showed an independent association to SSI following hydrocelectomy. Conclusions: Smoking was the only independent modifiable risk factor for SSI in the multivariate analysis.

scholarly journals Deep Sedation using Propofol Target-Controlled Infusion for Gastrointestinal Endoscopic Procedures: A Retrospective Cohort Study*

2020 ◽  
Author(s):  
MARIA EUGENIA GARCIA GUZZO ◽  
María Sol Fernandez ◽  
Delfina Sánchez Novas ◽  
Sandra S. Salgado ◽  
Sergio A. Terrasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Gastrointestinal Endoscopy ◽  
Oxygen Desaturation ◽  
Endoscopic Procedures ◽  
Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

Iron Packaging Regulations in the United States and Pediatric Morbidity: A Retrospective Cohort Study

2020 ◽  
Vol 59 (4-5) ◽  
pp. 375-379 ◽  
Author(s):  
James B. Leonard ◽  
Elizabeth Quaal Hines ◽  
Wendy Klein-Schwartz
Keyword(s):  
United States ◽  
Cohort Study ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Early Time ◽  
The United States ◽  
Morbidity And Mortality ◽  
Pediatric Morbidity

Iron poisoning was a leading cause of pediatric morbidity and mortality. We sought to assess whether the removal of strict iron packaging requirements in 2003 resulted in an increase in iron-related morbidity and mortality in pediatric exposures. We performed a retrospective cohort study utilizing the National Poison Data System from 2000 to 2017. A total of 4110 exposures met inclusion criteria: 847 from before (2000-2003) and 3263 after removal of unit-dose package regulations (2004-2017). The incidence of any marker of severity (7.2% vs 3.8%; odds ratio = 0.51, 95% confidence interval = 0.37-0.69) and frequency of deferoxamine use were both higher in the early time period (2.6% vs 1.0%; odds ratio = 0.38, 95% confidence interval = 0.22-0.66). There was no difference in the frequency of key serious effects (acidosis, elevated transaminases, hypotension). Despite removal of iron packaging regulations in the United States, there continues to be a decrease in the incidence of severe iron exposures in children.

scholarly journals Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

2019 ◽  
Vol 4 (5) ◽  
pp. e001715 ◽  
Author(s):  
Liana Macpherson ◽  
Morris Ogero ◽  
Samuel Akech ◽  
Jalemba Aluvaala ◽  
David Gathara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
Older Age ◽  
Who Criteria ◽  
Risk Of Death ◽  
Increased Risk

IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population.

scholarly journals Association Between Use of Preoperative Antihypertensive Medication and 90-Day Mortality After Noncardiac Surgery: A Retrospective Cohort Study

2020 ◽  
Vol 33 (6) ◽  
pp. 534-542
Author(s):  
Chami Im ◽  
Tak Kyu Oh ◽  
In-Ae Song
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cohort Study ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Antihypertensive Medication ◽  
Noncardiac Surgery ◽  
Hypertensive Patients

Abstract Background This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery. Methods In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. Results Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41–0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41–0.72; P &lt; 0.001). Conclusions This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.

scholarly journals Association of abnormal placental perfusion with the risk of male hypospadias: a hospital-based retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chen Zhu ◽  
Bin Zhang ◽  
Ting Peng ◽  
Ming-Qing Li ◽  
Yun-Yun Ren ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Cumulative Risk ◽  
Second Trimester ◽  
Singleton Pregnancy ◽  
Placental Perfusion ◽  
Increased Risk

Abstract Background The effect and extent of abnormal placental perfusion (APP) on the risk of male hypospadias are poorly understood. We compared the prevalence of male hypospadias in the offspring of women with APP and quantify the extent of the APP effect on the anomaly. Methods A hospital-based retrospective analysis of births from 2012 to 2016 was conducted in 2018. Women of singleton pregnancy and male infants born to them were included (N = 21,447). A multivariate analysis was performed to compare the prevalence of male hypospadias in infants exposed to APP with those that were not exposed to APP. Results Compared with the infants of women without APP, infants of women with APP showed an increased risk of male hypospadias (odds ratio, 2.40; 95% confidence interval, 1.09–5.29). The male hypospadias cumulative risk increased with the severity of APP. Infants exposed to severe APP had a significantly higher risk of male hypospadias than those without APP exposure (9.2 versus 1.7 per 1000 infants, P < 0.001). A path analysis indicated that 28.18–46.61% of the risk of hypospadias may be attributed to the effect of APP. Conclusions Male hypospadias risk was associated with APP and increased with APP severity, as measured in the second trimester. APP had an important role in the development of the anomaly.

scholarly journals Inpatient patient safety events in vulnerable populations: a retrospective cohort study

2020 ◽  
pp. bmjqs-2020-011920 ◽  
Author(s):  
Lucy B Schulson ◽  
Victor Novack ◽  
Patricia H Folcarelli ◽  
Jennifer P Stevens ◽  
Bruce E Landon
Keyword(s):  
Patient Safety ◽  
Cohort Study ◽  
Vulnerable Populations ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Negative Binomial ◽  
Academic Medical Centre ◽  
Increased Risk ◽  
Safety Event ◽  
Race Ethnicity

BackgroundWidespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased risk of patient safety events.ObjectiveTo examine differences in inpatient patient safety events for vulnerable populations defined by race/ethnicity, insurance status and limited English proficiency (LEP).DesignRetrospective cohort study.SettingSingle tertiary care academic medical centre.ParticipantsInpatient admissions of those aged ≥18 years from 1 October 2014 to 31 December 2018.MeasurementsPrimary exposures of interest were self-identified race/ethnicity, Medicaid insurance/uninsured and LEP. The primary outcome of interest was the total number of patient safety events, defined as any event identified by a modified version of the Institute for Healthcare Improvement global trigger tool that automatically identifies patient safety events (‘automated’) from the electronic record or by the hospital-wide voluntary provider reporting system (‘voluntary’). Negative binomial models were used to adjust for demographic and clinical factors. We also stratified results by automated and voluntary.ResultsWe studied 141 877 hospitalisations, of which 13.6% had any patient safety event. In adjusted analyses, Asian race/ethnicity was associated with a lower event rate (incident rate ratio (IRR) 0.89, 95% CI 0.83 to 0.96); LEP patients had a lower risk of any patient safety event and voluntary events (IRR 0.91, 95% CI 0.87 to 0.96; IRR 0.89, 95% CI 0.85 to 0.94). Asian and Latino race/ethnicity were also associated with a lower rate of voluntary events but no difference in risk of automated events. Black race was associated with an increased risk of automated events (IRR 1.11, 95% CI 1.03 to 1.20).LimitationsThis is a single centre study.ConclusionsA commonly used method for monitoring patient safety problems, namely voluntary incident reporting, may underdetect safety events in vulnerable populations.

scholarly journals POS0339 PREDICTORS OF DEATH IN PATIENTS DIAGNOSED WITH GIANT CELL ARTERITIS IN WESTERN NORWAY 1972-2012

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 397.2-398
Author(s):  
L. K. Brekke ◽  
B. T. Svanes Fevang ◽  
J. Assmus
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Risk Of Death ◽  
Western Norway ◽  
Increased Risk ◽  
Traditional Risk Factors

Background:Giant cell arteritis (GCA) is the most common systemic vasculitis in adults, and the number of incident cases worldwide is projected to increase [1]. Evidence as to whether or not GCA confers a mortality risk is conflicting, and many studies have been limited by inadequate or lacking adjustment for confounders.Objectives:To investigate possible predictors of death in a large and well characterized Norwegian cohort of GCA-patients.Methods:This is a hospital-based retrospective cohort study including patients diagnosed with GCA during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding system. Clinical information was extracted from patients’ medical journals. Further details about the inclusion process have been published previously [2]. Information on time of death was obtained from the Norwegian Cause of Death Registry. We investigated predicting factors using Cox regression. Selected variables were first analyzed in univariate and block regression models (block 1: clinical features including histology, block 2: laboratory and treatment factors, block 3: demographic and traditional risk factors). Variables included in the final multivariate model were selected on the following basis: P-value <0.1 in univariate or block regression or otherwise deemed clinically significant.Results:881 patients were included of which 626 (71.1%) were females. Mean age was 73 years (SD 9). 490 patients (55.6%) died during the study period (1 January 1972 – 31 December 2012). Characteristics and mortality for the GCA-cohort compared to matched controls have been published previously [3]. Within the GCA-cohort we found that presenting with visual disturbance (any) or scalp necrosis was associated with increased risk of death in univariate analysis (Figure 1). However, in multivariate analysis the traditional risk factors (age, smoking, hypertension and previous cardiovascular disease) were more strongly associated with risk of death. Among laboratory parameters only Hemoglobin (Hb) levels were significantly associated with risk of death with increasing Hb-levels indicating decreased risk. Neither temporal artery biopsy result nor initial or maximal (before first tapering) Prednisolone dose were found to be associated with risk of death. Results from univariate and the final multivariate models are presented in Figure 1.Figure 1.Conclusion:In our large cohort of GCA-patients the risk of death was found to be predominantly predicted by age (HR 2.81) and traditional risk factors (smoking (HR 1.61), hypertension (HR 1.48) and previous cardiovascular disease (HR 1.26)). Visual disturbance (HR 1.40), visual loss in particular (HR 2.37), and scalp necrosis (HR 3.42) were found to be the clinical features most associated with risk of death. However, we note that our material lacked information about extra-cranial (large vessel) vasculitis, which may also carry increased risk of death.References:[1]De Smit E, Palmer AJ, Hewitt AW. Projected worldwide disease burden from giant cell arteritis by 2050. J Rheumatol 2015;42:119-25.[2]Brekke LK, Diamantopoulos AP, Fevang BTS, Assmus J, Esperø E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther. 2017;19(1):278.[3]Brekke LK, Fevang BTS, Diamantopoulos AP, Assmus J, Esperø E, Gjesdal CG. Survival and death causes of patients with giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther. 2019;21(1):154.Disclosure of Interests:Lene Kristin Brekke Grant/research support from: Unrestricted research grant from MSD, Bjørg Tilde Svanes Fevang Consultant of: Been part of advisory board for Lilly, Jörg Assmus: None declared

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