scholarly journals Correlations of IL-6, IL-6R, IL-10 and IL-17 gene polymorphisms with the prevalence of COVID-2019 infection and its mortality rate 

2020 ◽  
Author(s):  
Lutfiye Karcıoğlu Batur ◽  
Nezih Hekim
Keyword(s):  
Mortality Rate ◽  
Inflammatory Response ◽  
Gene Polymorphisms ◽  
Public Awareness ◽  
Mortality Rates ◽  
Host Factors ◽  
Cytokine Storm ◽  
High Frequencies ◽  
Severity Of Disease ◽  
Immune Profiling

Abstract The pathogenesis of COVID-19 implicates a potent inflammatory response resulting in cytokine storm. We aimed to evaluate association between polymorphisms in IL-6 gene at rs1800796/rs1800795, IL-6R at rs2228145, IL-10 at rs1800896 and rs1800871, IL-17 at rs2275913 and rs76378, and the prevalence (per million) and mortality rates (per million) of COVID-19 among populations of China, Japan, India, Iran, Spain, Italy, Mexico, Netherlands, Sweden, Turkey, Finland, Brazil, Czechia, Russia, Poland. AG and GG genotypes of rs2275913 in IL-17A was found to be correlated with prevalence and mortality rates, especially in Spain and Brazil populations (p<0.05) while TT genotype of rs763780 in IL-17F was not dependent on the high frequencies in all populations. However, the polymorphisms in IL-6, IL-6R and IL-10 appear not to be correlated with prevalence and mortality rates. The variations in the prevalence of COVID-19 and its mortality rates among countries may be explained by cytokine storm differed by the polymorphisms of rs2275913 locus in IL-17A gene. However, the prevalence of infection differs from severity of COVID-19, based on many factors such as public awareness, behaviors and antiviral policy of countries. Yet, the severity of disease induced by viral infection might be associated with genetic host factors including immune profiling.

scholarly journals Association of inflammatory markers with severity of disease and mortality in COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Sara Khan ◽  
Pinki Mishra ◽  
Rizwana Parveen ◽  
Ram Bajpai ◽  
Mohd Ashif Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Disease Severity ◽  
Inflammatory Markers ◽  
Meta Analysis ◽  
Cytokine Storm ◽  
Severity Of Disease ◽  
Survivor Group ◽  
Tnf Α ◽  
Severe Group

Purpose: Literature suggests association of inflammatory markers with the severity and mortality related to COVID-19, but there are varying conclusions available. We aimed to provide an overview of the association of inflammatory markers with the severity and mortality of COVID-19 patients. Methods: We searched Medline (via PubMed), Cochrane, Clinicaltrials.gov databases until Sept 1, 2020. Results: A total of 21 studies comprising 4023 patients with COVID-19 were included in our analysis. Levels of IL-6 (WMD=18.17 95%CI 3.38 to 32.96, p=0.016), IL-8 (WMD=12.09 95%CI 4.41 to 19.77, p=0.002), MCP-1 (WMD=146.66 95%CI 88.16 to 205.16, p<0.001), CRP (WMD=31.09 95%CI 10.08 to 52.10, p=0.004), PCT (WMD= -31.23 95%CI -37.70 to -24.76, p<0.001), IL-2R (WMD=861.93 95%CI 275.45 to 1448.41, p=0.004), ferritin (WMD= 1083.34 95%CI 431.99 to 1734.70, p=0.001) were found significantly higher in the severe group compared with the non-severe group of COVID-19 patients. Moreover, non-survivors had a higher levels of IL-2R (WMD= -666.06 95%CI -782.54 to -549.59, p<0.001), IL-8 (WMD= -26.63 95%CI -33.031 to -20.236, p<0.001), IL-10 (WMD= -7.60 95%CI -8.93 to -6.26, p<0.001), TNF-α (WMD= -4.60 95%CI -5.71 to -3.48, p<0.001), IL- 1β (WMD=22.66 95%CI 8.13 to 37.19, p=0.002), CRP (WMD= -96.40 95%CI -117.84 to -74.97, p<0.001), and ferritin (WMD= -937.60 95%CI -1084.15 to -791.065, p<0.001) when compared to the non-survivor group. Conclusion: This meta-analysis highlights the association of inflammatory markers with the severity and mortality of COVID-19 patients. Measurement of these inflammatory markers may assist clinicians to monitor and evaluate the severity and prognosis of COVID-19 thereby reducing the mortality rate. Keywords: inflammatory markers, cytokine storm, interleukin, disease severity, COVID-19

scholarly journals Impact of Blood Group Type on Severity of Disease in COVID-19 Patients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-29
Author(s):  
Shivani Rao ◽  
Surbhi Warrior ◽  
Sefer Gezer ◽  
Parameswaran Venugopal ◽  
Shivi Jain
Keyword(s):  
Mortality Rate ◽  
General Population ◽  
Critically Ill ◽  
Mortality Rates ◽  
Blood Type ◽  
Blood Types ◽  
Severity Of Disease ◽  
Increased Risk ◽  
Significant Difference ◽  
Risk For Thrombosis

Background The virus SARS-CoV-2, which causes COVID-19 has rapidly spread into a global pandemic. In critically ill patients with the disease, common symptoms include sepsis, severe pneumonia with acute respiratory distress syndrome (ARDS), and complications such as coagulopathy and thrombosis. Many patients with COVID-19 have sequelae such as venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) as well as arterial thromboembolism (ATE) including stroke. COVID-19 induced inflammation can induce a prothrombotic state by activating the coagulation cascade; coupled with the immobility of severe and critically ill patients in ICU, making thrombosis common in this patient population. Different blood types in patients include A, B, AB, and O. ABO carbohydrate moieties are genetically inherited and have been linked to predisposing patients to cardiovascular diseases, cancers, and even susceptibility of COVID-19. Blood type positivity and negativity are determined by the Rhesus (Rh) factor, which is a protein found on the surface of red blood cells and is also genetically inherited and linked to higher incidence of certain diseases such as diabetes. Studies have shown a relationship between blood types and increased severity of infection from COVID-19 including increased risk of thrombosis. Blood type A has been shown to have higher severity of disease with O blood type having a lower risk of infection or mortality. This study was done to evaluate if patients with different blood types have increased risk for thrombosis or higher mortality rates with COVID-19 infection. Methods A retrospective analysis was performed on COVID-19 positive hospitalized patients between March 1, 2020 and June 26, 2020 at our institution with reported blood typing. Patients who had a thromboembolism (VTE, DVT, PE, ATE, or stroke) verified by imaging were extracted from this cohort and included in the analysis. The prevalence of different blood types in COVID-19 patients was compared to the general population without COVID-19. The incidence of thrombosis and mortality rate based on blood type was analyzed to understand severity of COVID-19 disease. Statistical analysis was performed using chi-squared testing. Results Among 1265 COVID-19 positive patients during our time frame, 138 patients were identified to have a thrombosis. Of those, 102 patients with thrombosis and 402 without thrombosis had reported blood types that were used for analysis. There was no significant difference in prevalence of blood types in COVID-19 patients (A 34.3%, AB 2.9%, B 16.7%, O 46.1%) to the general nonCOVID-19 population (A32.7%, AB 4.2%, B 14.9%, O 48.1%) (p=0.8572). There was no significant difference in incidence of thrombosis between blood types: A (23.3%), AB (15%), B (20.7%), and O (18.7%) (p=0.6513). When stratifying by Rh factor, there was also no significant difference in incidence of thrombosis by blood types: A- (11.1%), A+ (24.1%), AB- (0%), AB+ (15.8%), B- (25%), B+ (20.3%), O- (18.2%), O+ (18.7%) (p=0.9054). There was also no significant difference in mortality rate between COVID-19 patients based on blood types in our cohort: A (20.7%), AB (15%), B (13.4%), and O (21.8%) (p=0.3747). Conclusion Our study demonstrates that there is no increased prevalence of one blood type over another between COVID-19 patients compared to the general population, showing that patients are not at higher risk for COVID-19 infection based on blood type. There was also no difference between blood types based on incidence of thrombosis. When further stratifying with Rh factor, there was also no difference in incidence of thrombosis based on blood types. This shows that regardless of Rh positivity or negativity, there is no increased risk for thrombosis in COVID-19 patients based on blood type. There is also no difference in mortality in COVID-19 patients based on blood type. Since COVID-19 patients who are critically ill and have more severe disease have higher incidence of thrombosis and higher mortality rates, our study suggests that patients are not at higher risk for severe COVID-19 disease based on blood type. However, this study is also limited due to small sample size, and prospective studies are needed to better understand the relationship between blood type and severity of disease in COVID-19+ patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals A genetic predisposition for Cytokine Storm in life-threatening COVID-19 infection

2020 ◽  
Author(s):  
Yin-Ling Woo ◽  
Adeeba Kamarulzaman ◽  
Yolanda Augustin ◽  
Henry Staines ◽  
Frederick Altice ◽  
...  
Keyword(s):  
Familial Mediterranean Fever ◽  
G6pd Deficiency ◽  
Gene Polymorphisms ◽  
Oxidant Stress ◽  
Clinical Manifestations ◽  
Mortality Rates ◽  
Cytokine Storm ◽  
Increased Risk ◽  
Life Threatening ◽  
Mediterranean Fever

The COVID-19 pandemic is a cause of serious morbidity and mortality and is placing a significant burden on healthcare systems globally. The clinical manifestations of COVID-19 disease form a wide spectrum, from mild symptoms to life threatening disease. A small subset of patients develop Cytokine Release Syndrome (CRS)/Cytokine Storm (CS) that results in hyper inflammation, clinical deterioration and multi-organ failure. There is growing evidence that Interleukin-6 (IL-6) is a central mediator of CS. Evidence of an inflammatory Kawasaki-like syndrome in children with severe COVID-19 is also emerging. Familial Mediterranean Fever (FMF) and Glucose-6-phosphate Dehydrogenase (G6PD) deficiency are 2 common gene polymorphisms that predispose to hyper inflammatory states. Countries with high mortality rates for COVID-19 deaths (such as Spain, Italy and France) or the Middle East (Iran) also have a high number of carriers of mutations in the Mediterranean Fever gene (MEFV), which causes Familial Mediterranean Fever (FMF). G6PD deficiency, a common enzymopathy caused by X-linked gene polymorphisms that reduce the ability of cells to deal with oxidant stress also has a global distribution affecting Black, Asian and Minority Ethnic (BAME) groups. In combination with acquired causes of inflammation such as obesity, these genetic variations may predispose to increased risk of severe COVID-19. Mendelian randomisation studies are needed to establish if there is a contribution to higher mortality rates in certain populations due to genetic factors such as MEFV or G6PD mutations and related genes and if these may represent predictive and prognostic biomarkers.

scholarly journals Trends in mortality related to pulmonary embolism in the DACH countries: data from the WHO Mortality Database

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
L Hobohm ◽  
T Sebastian ◽  
L Valerio ◽  
H Mahmoudpour ◽  
G Vatsakis ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Cause Of Death ◽  
Public Awareness ◽  
Treatment Options ◽  
Total Mortality ◽  
Mortality Rates ◽  
Registration Data ◽  
Superficial Vein Thrombosis ◽  
Related Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Little is known about the burden imposed by pulmonary embolism for Germany, Austria and Switzerland (DACH countries). Purpose We aimed to assess pulmonary embolism-related mortality and time trends for the DACH countries based on data from the WHO Mortality Database. Methods We analysed vital registration data from the WHO Mortality Database (2000–2016) covering subregions of the WHO European Region: Germany, Switzerland and Austria (DACH countries). Deaths were considered pulmonary embolism-related if International Classification of Disease-10 code for acute pulmonary embolism or any code for deep or superficial vein thrombosis was listed as the primary cause of death. Results Between 2000 and 2016, age-standardised annual pulmonary embolism-related mortality rates decreased linearly from 15.6 to 7.8 deaths per 1000 population. In the 5-year period between 2012 and 2016 an average of 9127 pulmonary embolism-related deaths occurred annually in the DACH countries with a population of 98 273 329. Interestingly, pulmonary embolism-related mortality rates were considerable higher among women aged 15-55 years compared to age-matched men. Between 2012 and 2016, Germany showed the highest age-adjusted mortality rate (9.2 to 10.8 per 100000 inhabitants) compared to Switzerland 4.9-5.3 per 100000 inhabitants) and Austria (5.2 to 6.0 per 100000 inhabitants). Moreover, this means that the age-adjusted mortality rate in Germany was higher than the West-European average. Conclusion The observed decreasing trends in pulmonary embolism-related mortality might reflect improved management of the disease including new treatment options as well as advances in imaging technologies. However, pulmonary embolism remains a substantial contributor to total mortality, especially among women aged 15–55 years. For this reason, campaigns to increase physician and public awareness are urgently required for further improvement of the management and treatment of this preventable thrombotic disorder, which still remains the leading preventable cause of death.

Initial Report of Off-Pump Coronary Artery Bypass Surgery as Sole Therapy for Moderate Ischemic Mitral Regurgitation: Operative and Intermediate-Term Outcome

2005 ◽  
Vol 8 (2) ◽  
pp. 89 ◽  
Author(s):  
Kevin M. Harris ◽  
Avinash Reddy ◽  
Dorothee Aepplii ◽  
Betsy Wilson ◽  
Robert W. Emery
Keyword(s):  
Coronary Artery ◽  
Mortality Rate ◽  
Mitral Regurgitation ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Mortality Rates ◽  
Off Pump ◽  
Moderate Ischemic Mitral Regurgitation ◽  
Pump Coronary Artery Bypass

Background: Patients undergoing on-pump coronary artery bypass surgery (CAB) with coexistent moderate ischemic mitral regurgitation (IMR) have a significant mortality rate compared to patients without MR. The mortality rate is elevated both perioperatively (0%-12% mortality), as well as over a 1- and 2-year postoperative period (15%-25%). It is thought that some patients are best served by off-pump CAB (OPCAB); however, outcomes have not been reported for such patients with coexistent moderate IMR. Methods: We reviewed the independent database of patients undergoing OPCAB between 1995 and 2002 to find 989 patients, 17 (1.7%) of whom had moderate or moderately severe MR. Patients were contacted and clinical and echocardiographic data were obtained. Results: The patient group consisted of 11 men and 6 women (age, 65 15 years). The study group had a PA pressure of 52 14, creatinine of 1.6 0.7, and left ventricular ejection fraction of 43 18. Nine patients (53%) had advanced New York Heart Association (class III-IV) heart failure. Mortality rates perioperatively and at 1, 2, and 3 years were 0%, 6.25% (1/16), 12.5% (2/16), and 38% (4/8), respectively. At the time of this report, no patient had returned for a reparative procedure. Conclusion: In patients felt to be best served by OPCAB with ischemic MR, operative and intermediate mortality rates are remarkably similar to those previously reported for on-pump series. These data underscore the continued need to understand which patients undergoing CAB require mitral valve problems to be addressed at the time of surgery.

scholarly journals Effects of some bioinsecticides on the tomato leaf miner, Tuta absoluta (Meyrick, 1917) (Lepidoptera: Gelechiidae)

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Alime Bayindir Erol ◽  
Oktay Erdoğan ◽  
İsmail Karaca
Keyword(s):  
Mortality Rate ◽  
Active Ingredient ◽  
Metarhizium Anisopliae ◽  
Mortality Rates ◽  
Tomato Leaf ◽  
Tuta Absoluta ◽  
Leaf Miner ◽  
Verticillium Lecanii ◽  
Main Body ◽  
Tomato Leaf Miner

Abstract Background In this study, commercial bioinsecticides including entomopathogenic fungi, Beauveria bassiana, Metarhizium anisopliae, and Verticillium lecanii, and Spinetoram active ingredient insecticide were evaluated against the tomato leaf miner, Tuta absoluta (Meyrick, 1917) (Lepidoptera: Gelechiidae) larvae. Main body The active ingredients were prepared at the recommended concentrations under laboratory conditions and applied to the 2nd instar larvae of T. absoluta by spraying with a hand sprayer. On the 1st, 3rd, 5th, and 7th days of the application, evaluations were made by counting survived individuals. The findings showed that the highest mortality rates were detected in the case of Spinetoram with 56, 60, 88, and 100% on all counting days of the experiments, respectively. The highest mortality rate among bioinsecticides was recorded for M. anisopliae, with 87% mortality on the 7th day of application. Short conclusion As a result, Spinetoram was found the most effective insecticide when applied to T. absoluta, followed by M. anisopliae.

scholarly journals Long-Term Exposure to Fine and Coarse Particulate Matter and COVID-19 Incidence and Mortality Rate in Chile during 2020

2021 ◽  
Vol 18 (14) ◽  
pp. 7409
Author(s):  
Macarena Valdés Salgado ◽  
Pamela Smith ◽  
Mariel Opazo ◽  
Nicolás Huneeus
Keyword(s):  
Mortality Rate ◽  
Incidence Rate ◽  
Air Pollutants ◽  
Negative Binomial ◽  
Transport Model ◽  
Surface Concentration ◽  
Mortality Rates ◽  
Incidence And Mortality ◽  
Pm2.5 And Pm10

Background: Several countries have documented the relationship between long-term exposure to air pollutants and epidemiological indicators of the COVID-19 pandemic, such as incidence and mortality. This study aims to explore the association between air pollutants, such as PM2.5 and PM10, and the incidence and mortality rates of COVID-19 during 2020. Methods: The incidence and mortality rates were estimated using the COVID-19 cases and deaths from the Chilean Ministry of Science, and the population size was obtained from the Chilean Institute of Statistics. A chemistry transport model was used to estimate the annual mean surface concentration of PM2.5 and PM10 in a period before the current pandemic. Negative binomial regressions were used to associate the epidemiological information with pollutant concentrations while considering demographic and social confounders. Results: For each microgram per cubic meter, the incidence rate increased by 1.3% regarding PM2.5 and 0.9% regarding PM10. There was no statistically significant relationship between the COVID-19 mortality rate and PM2.5 or PM10. Conclusions: The adjusted regression models showed that the COVID-19 incidence rate was significantly associated with chronic exposure to PM2.5 and PM10, even after adjusting for other variables.

scholarly journals Mortality in Patients with Brainstem Cavernous Malformations

2021 ◽  
pp. 1-7
Author(s):  
Julia Velz ◽  
Marian Christoph Neidert ◽  
Yang Yang ◽  
Kevin Akeret ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Cavernous Malformations ◽  
Patient Cohort ◽  
Actual Risk ◽  
Single Center Study

<b><i>Objective:</i></b> Brainstem cavernous malformations (BSCM)-associated mortality has been reported up to 20% in patients managed conservatively, whereas postoperative mortality rates range from 0 to 1.9%. Our aim was to analyze the actual risk and causes of BSCM-associated mortality in patients managed conservatively and surgically based on our own patient cohort and a systematic literature review. <b><i>Methods:</i></b> Observational, retrospective single-center study encompassing all patients with BSCM that presented to our institution between 2006 and 2018. In addition, a systematic review was performed on all studies encompassing patients with BSCM managed conservatively and surgically. <b><i>Results:</i></b> Of 118 patients, 54 were treated conservatively (961.0 person years follow-up in total). No BSCM-associated mortality was observed in our conservatively as well as surgically managed patient cohort. Our systematic literature review and analysis revealed an overall BSCM-associated mortality rate of 2.3% (95% CI: 1.6–3.3) in 22 studies comprising 1,251 patients managed conservatively and of 1.3% (95% CI: 0.9–1.7) in 99 studies comprising 3,275 patients with BSCM treated surgically. <b><i>Conclusion:</i></b> The BSCM-associated mortality rate in patients managed conservatively is almost as low as in patients treated surgically and much lower than in frequently cited reports, most probably due to the good selection nowadays in regard to surgery.

scholarly journals POS1225 INFLUENCE OF COLCHICINE PRESCRIPTION IN COVID19-RELATED HOSPITAL ADMISSIONS: A SURVIVAL ANALYSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 896.2-896
Author(s):  
M. P. Álvarez ◽  
A. Madrid García ◽  
I. Perez-Sancristobal ◽  
J. I. Colomer ◽  
L. León ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Rheumatic Diseases ◽  
Hospital Admissions ◽  
Musculoskeletal Diseases ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
P Value ◽  
Inflammatory Rheumatic Diseases ◽  
Cytokine Storm ◽  
Observation Period

Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggers the innate immune system, leading in severe cases, an excessive immune response, which can lead to high levels of pro-inflammatory cytokines promoting a “cytokine storm”.To modulate this exaggerated inflammatory response, several clinical trials with already approved and well-known therapeutic agents that inhibit the inflammatory response, are being carried out. However, none of these drugs seems to achieve the desired results when treating COVID19.Colchicine, a drug often used in the management of patients with Rheumatic and Musculoskeletal diseases (RMDs), is one of the several drugs that are being currently tested for efficacy in COVID19 due to its anti-inflammatory effects.Objectives:To analyze association between colchicine prescription and COVID19-related hospital admissions in patients with Rheumatic and Musculoskeletal diseases (RMDs).Methods:Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1st September 2019 to 29th February 2020 were included.Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID19-related hospital admissions occurring between March 1st and May 20th, 2020. Secondary outcome included COVID19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes.Results:9,379 patients entered in the study, with 406 and 9,002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBM) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing (p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis.Conclusion:Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis.References:[1]Fernandez-Gutierrez B. COVID-19 with Pulmonary Involvement. An Autoimmune Disease of Known Cause. Reumatol Clin 2020; 16: 253–254.[2]Coperchini F, Chiovato L, Croce L, et al. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev 2020; 53: 25–32.[3]Shaffer L. 15 drugs being tested to treat COVID-19 and how they would work. Nat Med. Epub ahead of print 15 May 2020. DOI: 10.1038/d41591-020-00019-9.[4]Fernandez-Gutierrez B, Leon L, Madrid A, et al. Hospital admissions in inflammatory rheumatic diseases during the COVID-19 pandemic: incidence and role of disease modifying agents. medRxiv 2020; 2020.05.21.20108696.[5]Freites Nuñez DD, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020; 1–7.Disclosure of Interests:None declared

Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care

1995 ◽  
Vol 10 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Michael J. VanRooyen ◽  
Edward P. Sloan ◽  
John A. Barrett ◽  
Robert F. Smith ◽  
Hernan M. Reyes
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Age Groups ◽  
Mortality Rates ◽  
Trauma Centers ◽  
Field Triage ◽  
Pediatric Trauma Center

AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

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