Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006

2010 ◽  
Vol 12 (2) ◽  
pp. 131-140 ◽  
Author(s):  
Farhad Pirouzmand
Keyword(s):  
Spinal Cord ◽  
Trauma Center ◽  
Case Fatality Rate ◽  
Spinal Cord Injuries ◽  
Head Injuries ◽  
Case Fatality ◽  
Trauma Patients ◽  
Relative Distribution ◽  
Fatality Rate ◽  
Over Time

Object In this study the author documents the epidemiology of spine and spinal cord injuries (SCIs) over 2 decades at the largest Level I adult trauma center in Canada. He describes the current state of spine injuries (SIs), their changing patterns over the years, and the relative distribution of different demographic factors in a defined group of trauma patients. Methods Data on all trauma patients admitted to Sunnybrook Health Sciences Centre between 1986 and 2006 were collected from the Sunnybrook Trauma Registry Database. Aggregate data on SIs and SCIs, including demographic information, etiology, severity of injuries (injury severity score [ISS]), and associated injuries, were recorded. The data were analyzed in a main category of spinal fracture and/or dislocation with or without SI and in two subgroups of patients with SIs, one encompassing all forms of SCIs and the other including only complete SCIs (CSCIs). Collected data were evaluated using univariate techniques to depict the trend of variables over the years. The number of deaths per year and the length of stay (LOS) were used as crude measures of outcome. Several multivariate analysis techniques, including Poisson regression, were used to model the frequency of death and LOS as functions of various trauma variables. Results There were 12,192 trauma patients in the study period with 23.2% having SIs, 5.4% having SCIs, and 3% having CSCIs. The SCIs constituted 23.3% of all SIs. The respective characteristics of the SI, SCI, and CSCI groups were as follows: median age 36, 33, and 30 years; median LOS 18, 27, and 29 days; median ISS 29, 30, and 34; female sex ratio 34, 24, and 23%; and case fatality rate 16.7, 16.6, and 21%. Seventy-nine percent of patients had associated head injuries; conversely, 24% of patients with head injuries had SIs. The mean admission age of patients increased by ~ 10 years over the study period, from the early 30s to the early 40s. The relative incidence of SIs remained stable at ~ 23%, but the incidence of SCIs decreased ~ 40% over time to 4.5%. Motor vehicle accidents remained the principal etiology of trauma, although falling and violence became more frequent contributors of SIs. The average annual ISS remained stable over time, but the LOS was reduced by 50% in both the SI and SCI groups. Age, ISS, and SCIs were associated with a longer LOS. The case fatality rate remained relatively unchanged over time. Poisson analysis suggested that the presence of an SCI does not change the case fatality rate. Conclusions Data in this analysis will provide useful information to guide future studies on changing SI patterns, possible etiologies, and efficient resource allocation for the management of these diseases.

The epidemiological trends of head injury in the largest Canadian adult trauma center from 1986 to 2007

2011 ◽  
Vol 114 (6) ◽  
pp. 1502-1509 ◽  
Author(s):  
David W. Cadotte ◽  
Shobhan Vachhrajani ◽  
Farhad Pirouzmand
Keyword(s):  
Resource Allocation ◽  
Head Injury ◽  
Trauma Center ◽  
Case Fatality Rate ◽  
Injury Severity ◽  
Case Fatality ◽  
Trauma Patients ◽  
Relative Distribution ◽  
Fatality Rate ◽  
Level I

Object This study documents the epidemiology of head injury over the course of 22 years in the largest Level I adult trauma center in Canada. This information defines the current state, changing pattern, and relative distribution of demographic factors in a defined group of trauma patients. It will aid in hypothesis generation to direct etiological research, administrative resource allocation, and preventative strategies. Methods Data on all the trauma patients treated at Sunnybrook Health Sciences Centre (SHSC) from 1986 to 2007 were collected in a consecutive, prospective fashion. The authors reviewed these data from the Sunnybrook Trauma Registry Database in a retrospective fashion. The aggregate data on head injury included demographic data, cause of injury, and Injury Severity Score (ISS). The collected data were analyzed using univariate techniques to depict the trend of variables over years. The authors used the length of stay (LOS) and number of deaths per year (case fatality rate) as crude measures of outcome. Results A total of 16,678 patients were treated through the Level I trauma center at SHSC from January 1986 to December 2007. Of these, 9315 patients met the inclusion criteria (ISS > 12, head Abbreviated Injury Scale score > 0). The median age of all trauma patients was 36 years, and 69.6% were male. The median ISS of the head-injury patients was 27. The median age of this group of patients increased by 12 years over the study period. Motorized vehicle accidents accounted for the greatest number of head injuries (60.3%) although the relative percentage decreased over the study period. The median transfer time of patients sustaining a head injury was 2.58 hours, and there was an approximately 45 minute improvement over the 22-year study period. The median LOS in our center decreased from 19 to 10 days over the study period. The average case fatality rate was 17.4% over the study period. In multivariate analysis, more severe injuries were associated with increased LOS as was increasing time from injury to hospital presentation. Age and injury severity were independently predictive of mortality. Conclusions These data will provide useful information to guide future studies on the changing patterns of head injury, possible mechanisms of injury, and efficient resource allocation for management of this condition.

scholarly journals SEIHCRD Model for COVID-19 spread scenarios, disease predictions and estimates the basic reproduction number, case fatality rate, hospital, and ICU beds requirement

2020 ◽  
Author(s):  
Avaneesh Singh ◽  
Manish Kumar Bajpai
Keyword(s):  
Basic Reproduction Number ◽  
Case Fatality Rate ◽  
Reproduction Number ◽  
Case Fatality ◽  
The United States ◽  
Fatality Rate ◽  
Hospital Beds ◽  
The Impact ◽  
Over Time ◽  
The Basic Reproduction Number

We have proposed a new mathematical method, SEIHCRD-Model that is an extension of the SEIR-Model adding hospitalized and critical twocompartments. SEIHCRD model has seven compartments: susceptible (S), exposed (E), infected (I), hospitalized (H), critical (C), recovered (R), and deceased or death (D), collectively termed SEIHCRD. We have studied COVID- 19 cases of six countries, where the impact of this disease in the highest are Brazil, India, Italy, Spain, the United Kingdom, and the United States. SEIHCRD model is estimating COVID-19 spread and forecasting under uncertainties, constrained by various observed data in the present manuscript. We have first collected the data for a specific period, then fit the model for death cases, got the values of some parameters from it, and then estimate the basic reproduction number over time, which is nearly equal to real data, infection rate, and recovery rate of COVID-19. We also compute the case fatality rate over time of COVID-19 most affected countries. SEIHCRD model computes two types of Case fatality rate one is CFR daily and the second one is total CFR. We analyze the spread and endpoint of COVID-19 based on these estimates. SEIHCRD model is time-dependent hence we estimate the date and magnitude of peaks of corresponding to the number of exposed cases, infected cases, hospitalized cases, critical cases, and the number of deceased cases of COVID-19 over time. SEIHCRD model has incorporated the social distancing parameter, different age groups analysis, number of ICU beds, number of hospital beds, and estimation of how much hospital beds and ICU beds are required in near future.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Lethality Did not Change Over Time in Two Italian Provinces

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Maria Elena Flacco ◽  
Cecilia Acuti Martellucci ◽  
Francesca Bravi ◽  
Giustino Parruti ◽  
Alfonso Mascitelli ◽  
...  
Keyword(s):  
Cohort Study ◽  
Severe Acute Respiratory Syndrome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Day Case ◽  
Italian Provinces ◽  
Over Time

Abstract This retrospective cohort study included all the subjects diagnosed with severe acute respiratory syndrome coronavirus 2 infection (n = 2493) in 2 Italian provinces. Two hundred fifty-eight persons died, after a median of 14.0 ± 11.0 days. Adjusting for age, gender, and main comorbidities, the ≥28-day case-fatality rate did not decrease from March to April 2020 (adjusted hazard ratio, 0.93; P = .6).

scholarly journals 1309. Incidence and Epidemiology of Invasive Pneumococcal Disease due to Serotype 3 in South-Central Ontario

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S743-S743
Author(s):  
Allison McGeer ◽  
Agron Plevneshi ◽  
Kazi Hassan ◽  
Wayne Gold ◽  
Larissa Matukas ◽  
...  
Keyword(s):  
Older Adults ◽  
Invasive Pneumococcal Disease ◽  
Case Fatality Rate ◽  
Pneumococcal Disease ◽  
Case Fatality ◽  
Population Based ◽  
Fatality Rate ◽  
South Central ◽  
Study Laboratory ◽  
Over Time

Abstract Background In our population, the most common serotype (ST) of S. pneumoniae causing invasive pneumococcal disease (IPD) is now ST 3. We undertook an analysis of population based surveillance for IPD to examine the incidence and epidemiology of ST 3 disease over the last 25 years. Methods The Toronto Invasive Bacterial Diseases Network has performed population-based surveillance for IPD in Toronto/Peel region (pop’n 4.5M) since 1995. All sterile site isolates of S. pneumoniae are reported to a central study laboratory, isolates are serotyped, and clinical and vaccination data are collected via patient and physician interview and chart review. Population data are obtained from Statistics Canada. Results From 1995-2020, 11032 episodes of IPD occurred; 10015 had STs available, and 10484 clinical data. Overall, ST 3 comprised 9.2% of cases (N=931). Compared to other patients with IPD, those with ST 3 IPD were older (median age 65 vs. 58.5, P< .001), more likely to have underlying lung (22.7% v 16.0%, P< .0001) and cardiac (21.7 v 18.4, P=.02) disease and less likely to be immunocompromised (IC) (23.1% v 29.0% P< .0001). ST3 episodes were more likely to be pneumonia (81% v 65%), less likely to be bacteremia without focus (7.6% v 18.9%), and more likely to require ICU admission (42.3% v 25.1%) and to die (27.1% v 16.6%). In multivariable analysis, patients with ST 3 disease remained more likely to die (OR 1.65; 95%CI1.3-2.0). Over time, the proportion of patients with ST 3 IPD who were nursing home (NH) residents (18/171 in 1995-2000 vs. 4/215 in 2016-2020, P=.0002), and who were IC (46/169 in 1995-2000 vs 39/204 in 2016-2020, P=.007) decreased significantly; in IPD due to other STs, the proportion who were NH residents declined, but the proportion IC increased significantly. The case fatality rate (CFR) declined significantly in IPD due to ST3 but not other STs (Figure 1). Changes in incidence are shown in Figure 2. Figure 2: Incidence of serotype 3 IPD over time, Toronto/Peel, 1995-2020 The incidence of ST3 IPD in children and adults under 65 did not change significantly from 1995/96 to 2019/20. In older adults, the annual incidence of disease declined from 4.98 per 100,000 per year in 1995-2000 to 3.53 per 100,000 per year in 2001-2010 (IRR 0.71, 95%CI 0.56-0.90), then to 2.23 per 100,000 per year in 2011-2020 (IRR compared to 2001-2010 0.63, 95%CI 0.50-0.79) FIgure 2: Case fatality rate of IPD due to serotype 3 and other serotypes over time, 1995-2020, Toronto-Peel The case fatality rate of IPD due to ST3 declined from 37.6% (56/149) in 1995-2000 to 50/235 (21.3%) in 2015-2020 (P<.0001). The CFR in other serotypes did not change. Conclusion The epidemiology of IPD due to ST3 has changed significantly over time and the CFR has declined. The incidence of ST3 disease in children and younger adults has not changed significantly, although the power to detect change is low in children. In older adults the incidence of ST3 disease declined significantly after PPV23 introduction in 1995/6 and again after PCV13 introduction for children. Disclosures All Authors: No reported disclosures

scholarly journals A Time-dependent mathematical model for COVID-19 transmission dynamics and analysis of critical and hospitalized cases with bed requirements

2020 ◽  
Author(s):  
Avaneesh Singh ◽  
Manish Kumar Bajpai ◽  
Shyam Lal Gupta
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
The United States ◽  
Time Dependent ◽  
Fatality Rate ◽  
Proposed Model ◽  
The Social ◽  
Death Cases ◽  
Daily Hospitalization ◽  
Over Time

AbstractA time-dependent SEAIHCRD model is the extension of the SEIR model, which includes some new compartment that is asymptomatic infectious people, hospitalized people, critical people, and dead compartments. In this article, we analyzed six countries, namely the United States, Brazil, India, South Africa, Russia, and Mexico. A time-dependent SEAIHCRD model calculates the magnitude of peaks for exposed people, asymptomatic infectious people, symptomatic infectious people, hospitalized people, the number of people admitted to ICUs, and the number of COVID-19 deaths over time. It also computes the spread scenario and endpoints of disease. The proposed model also involves asymptomatic infectious individuals. To estimate the various parameters, we first collect the data and fit that using the Lavenberg-Marquardt model for death cases. Then we calculate infection rate, recovery rate, case fatality rate, and the basic reproduction number over time. We calculate two types of case fatality rates: one is the daily case fatality rate, and the other is the total case fatality rate. The proposed model includes the social distance parameter, various age classes, hospital beds for severe cases, and ICU beds or ventilators for critical cases. This model will be useful to determine various essential parameters such as daily hospitalization rate, daily death rates, including the requirement of normal and ICU beds during peak days of infection.

scholarly journals The Comparison of Epidemiological Characteristics Between Confirmed and Clinically Diagnosed Cases With COVID-19 in Wuhan, China

2020 ◽  
Author(s):  
Fang Shi ◽  
Haoyu Wen ◽  
Rui Liu ◽  
Jianjun Bai ◽  
Fang Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Clinical Diagnosis ◽  
Case Fatality Rate ◽  
Reproduction Number ◽  
Case Fatality ◽  
Fatality Rate ◽  
Elderly Men ◽  
Epidemiological Characteristics ◽  
Over Time

Abstract Background: To put COVID-19 patients into hospital timely, the clinical diagnosis had been implemented in Wuhan in the early outbreak. Here we compared the epidemiological characteristics of laboratory-confirmed and clinically diagnosed cases with COVID-19 in Wuhan.Methods: Demographics, case severity and outcomes of 29886 confirmed cases and 21960 clinically diagnosed cases reported between December 2019 and February 24, 2020, were compared. The risk factors were estimated, and the effective reproduction number of SARS-CoV-2 (Rt) was also calculated.Results: The interval between symptom onset and diagnosis of confirmed and clinically diagnosed cases reduced gradually as time went by, and the proportion of severe and critical cases as well as case fatality rates of the two groups all decreased over time. The proportion of severe and critical cases (21.5% vs 14.0%, P<0.0001) and case fatality rates (5.2% vs 1.2%, P<0.0001) of confirmed cases were all higher than those of clinically diagnosed cases. Risk factors for death we observed in all two groups were older age, male, severe or critical cases. Rt showed a downward trend after the lockdown of Wuhan, it dropped below 1.0 on February 6 among confirmed cases, and February 8 among clinically diagnosed cases.Conclusion: Public health responses taken in Wuhan, including clinical diagnosis, have contributed to slow transmission. In cases where testing kits are insufficient, clinical diagnosis is effective, which is helpful to quarantine or treat infected cases as soon as possible, and prevent the epidemic from worsening. To decrease the case fatality rate of COVID-19, it is necessary to strengthen early warning and intervention of severe and critical elderly men.

Dynamics of case-fatalilty rates of recurrent thromboembolism and major bleeding in patients treated for venous thromboembolism

2013 ◽  
Vol 110 (10) ◽  
pp. 834-843 ◽  
Author(s):  
Ana Alfonso ◽  
David Jiménez ◽  
Carmen Fernández Capitán ◽  
Paolo Prandoni ◽  
Philip S. Wells ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Case Fatality Rate ◽  
Real Life ◽  
Case Fatality ◽  
Fatality Rate ◽  
Duration Of Therapy ◽  
Fatal Bleeding ◽  
Recurrent Vte ◽  
Over Time

SummaryIn patients with venous thromboembolism (VTE), assessment of the risk of fatal recurrent VTE and fatal bleeding during anticoagulation may help to guide intensity and duration of therapy. We aimed to provide estimates of the case-fatality rate (CFR) of recurrent VTE and major bleeding during anticoagulation in a ‘real life’ population, and to assess these outcomes according to the initial presentation of VTE and its etiology. The study included 41,826 patients with confirmed VTE from the RIETE registry who received different durations of anticoagulation (mean 7.8 ± 0.6 months). During 27,110 patient-years, the CFR was 12.1% (95% CI, 10.2–14.2) for recurrent VTE, and 19.7% (95% CI, 17.4–22.1) for major bleeding. During the first three months of anticoagulant therapy, the CFR of recurrent VTE was 16.1% (95% CI, 13.6–18.9), compared to 2.0% (95% CI, 0–4.2) beyond this period. The CFR of bleeding was 20.2% (95% CI, 17.5–23.1) during the first three months, compared to 18.2% (95% CI, 14.0–23.2) beyond this period. The CFR of recurrent VTE was higher in patients initially presenting with PE (18.5%; 95% CI, 15.3–22.1) than in those with DVT (6.3%; 95% CI, 4.5–8.6), and in patients with provoked VTE (16.3%; 95% CI, 13.6–19.4) than in those with unprovoked VTE (5.5%; 95% CI, 3.5–8.0). In conclusion, the CFR of recurrent VTE decreased over time during anticoagulation, while the CFR of major bleeding remained stable. The CFR of recurrent VTE was higher in patients initially presenting with PE and in those with provoked VTE.

scholarly journals 56. Could Maturation Effect Contribute to In-hospital Mortality Improvement During COVID-19 Pandemic?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Gina Maki ◽  
Amit T Vahia ◽  
Mayur Ramesh ◽  
Samia Arshad ◽  
Anne Chen ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Disease Process ◽  
Case Fatality ◽  
Care Facility ◽  
Fatality Rate ◽  
Tertiary Care Facility ◽  
Over Time

Abstract Background The surge of COVID-19 cases overwhelms hospital systems necessitating rapid learning of the disease process and management. During the course of a novel pandemic, multiple interventions are rapidly implemented to improve patient outcomes. When evaluating efficacy of individual interventions, one should account for the simultaneous improvements in knowledge and experience of healthcare providers (HCP), known as the maturation effect. We hypothesized that multiple processes rapidly implemented, along with the maturation effect would result in improved survival of COVID-19 patients hospitalized over the course of the pandemic. Methods This retrospective study was done at Henry Ford Hospital (HFH), a 900-bed tertiary care facility in Detroit, Michigan. The first COVID-19 patient was hospitalized on March 10, 2020 followed by a rapid surge of cases. We evaluated the trends of in-hospital case fatality rate of COVID-19 PCR positive patients through April 28, 2020. Time-points of sequential implementation of key measures for the management of COVID-19 patients were recorded. Results A total of 1023 COVID-19 patients were hospitalized during the study period with 165 deaths (16 %). Case fatality rate during week one was 42% and down trended over time (Figure 1). Key measures were sequentially implemented over the course of the study period as shown in Figure 1. These included development and implementation of in-house PCR testing, dedicated infectious diseases COVID-19 rounding teams, treatment guidelines and algorithms, and early steroid use in hypoxic patients. Figure 2 demonstrates that despite the surge of COVID-19 admissions, mortality continued to improve over time. Figure 1. Trend line of all-cause in-house morality over time Figure 2. Mortality by admission date over time Conclusion Maturation effect takes into consideration that regardless of individual interventions, HCP improve their knowledge of the disease process and treatment over time leading to better outcomes. Our study shows the possibility of the maturation effect leading to improved survival in hospitalized COVID-19 patients. The maturation effect should be accounted for when evaluating the effect of specific interventions for COVID-19. Disclosures Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

scholarly journals SARS-CoV-2 lethality decreased over time in two Italian Provinces

2020 ◽  
Author(s):  
Maria Elena Flacco ◽  
Cecilia Acuti Martellucci ◽  
Francesca Bravi ◽  
Giustino Parruti ◽  
Alfonso Mascitelli ◽  
...  
Keyword(s):  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
List Type ◽  
Fatality Rate ◽  
Italian Provinces ◽  
Over Time

AbstractBackgroundSome experts recently reported that SARS-CoV-2 lethality decreased considerably, but no evidence is yet available. This retrospective cohort study aimed to evaluate whether SARS-CoV-2 case-fatality rate decreased with time, adjusting for main potential confounders.Methods and findingsWe included all SARS-CoV-2 infected subjects diagnosed in Ferrara and Pescara provinces, Italy. Information were collected from local registries, clinical charts, and electronic health records. We compared the case-fatality rate of the subjects diagnosed during April and March, 2020. We used Cox proportional hazards analysis and random-effect logistic regression, adjusting for age, gender, hypertension, type II diabetes, major cardiovascular diseases (CVD), chronic obstructive pulmonary diseases (COPD), cancer and renal disease. The sample included 1946 subjects (mean age 58.8y; 45.7% males). 177 persons deceased, after a mean of 11.7 days of follow-up. From March to April, the case-fatality rate significantly decreased in the total sample (10.8% versus 6.0%; p<0.001), and in any subgroup of patients. Large reductions of the lethality were observed among the elderly (from 30.0% to 13.4%), and subjects with hypertension (23.0% to 12.1%), diabetes (30.3% to 8.4%), CVD (31.5% to 12.1%), COPD (29.7% to 11.4%), and renal disease (32.3% to 11.5%). In April, the adjusted hazard ratio of death was 0.42 (95% Confidence Interval: 0.29-0.60). The mean age of those who died substantially increased from March (77.9±10.8y) to April (86.9±7.7y).ConclusionsIn this sample, SARS-CoV-2 case-fatality rate decreased considerably over time, supporting recent claims of a substantial improvement of SARS-CoV-2 clinical management. The findings are inevitably preliminary and require confirmation.Author summaryWhy was this study done?Some experts recently reported that SARS-CoV-2 lethality decreased considerably, but no evidence is yet available.What did the researchers do and find?We carried out a retrospective cohort study on 1946 SARS-CoV-2 infected subjects from two Italian provinces, evaluating the potential variation of the case-fatality rate over time.From March to April, in both univariate and multivariable analyses, SARS-CoV-2 case-fatality rate significantly and substantially decreased, overall and in any subgroup of subjects.What do these findings mean?The therapies and clinical management of SARS-CoV-2 infected subjects might have substantially improved over time.

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