Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

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Incidence and prognosis of tuberculosis in patients with cirrhosis of the liver. A Danish nationwide population based study

Epidemiology and Infection ◽

10.1017/s0950268899003593 ◽

2000 ◽

Vol 124 (2) ◽

pp. 221-225 ◽

Cited By ~ 30

Author(s):

A. M. THULSTRUP ◽

I. MØLLE ◽

N. SVENDSEN ◽

H. T. SØRENSEN

Keyword(s):

Liver Cirrhosis ◽

Incidence Rate ◽

Case Fatality Rate ◽

Case Fatality ◽

Population Based ◽

Study Cohort ◽

Fatality Rate ◽

Day Case ◽

Population Based Study ◽

Increased Risk

We examined the incidence rate and prognosis of tuberculosis in a cohort of patients with liver cirrhosis in Denmark. In a study cohort of 22675 patients with liver cirrhosis, we identified 151 cases of tuberculosis from 1977 to 1993. The incidence rate was 168·6 per 100000 person-years of risk, and the highest incidence rate was among men above 65 years of age, with an incidence rate of 246·0 per 100000 person-years of risk. The 30-day case-fatality rate was 27·3% and the 1-year case fatality rate was 47·7%. The results demonstrate that patients with liver cirrhosis are at increased risk of tuberculosis. Additionally, it is suggested that liver cirrhosis is an independent risk factor for tuberculosis, and that patients with liver cirrhosis who acquire tuberculosis have a poor prognosis.

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Time trends and case fatality rate of in-hospital treated pulmonary embolism during 11 years of observation in Northwestern Italy

Thrombosis and Haemostasis ◽

10.1160/th15-02-0172 ◽

2016 ◽

Vol 115 (02) ◽

pp. 399-405 ◽

Cited By ~ 41

Author(s):

Walter Ageno ◽

Fulvio Pomero ◽

Luigi Fenoglio ◽

Alessandro Squizzato ◽

Matteo Bonzini ◽

...

Keyword(s):

Pulmonary Embolism ◽

Incidence Rate ◽

Time Trends ◽

Case Fatality Rate ◽

Case Fatality ◽

Population Based ◽

Fatality Rate ◽

Entire Study ◽

Mortality And Morbidity ◽

Hospital Case

SummaryPulmonary embolism (PE) is a common disorder with high mortality and morbidity rates. However, population-based information on its incidence and prognosis remains limited. We conducted a large epidemiology study collecting data on hospitalisation for PE (from 2002 to 2012) in a population of about 13 million people in Northwestern Italy. Patients were identified using the ICD-9-CM codes: 415.11, 415.19; gender and age specific incidence rate of PE during the study period were estimated using the resident population for each year of the study. Furthermore, time trends in the in-hospital PE-related mortality and case fatality rate were calculated. Results were adjusted for possible confounders. A total of 60,853 patients (mean age 72.8 years, ± 14.1, 59.6 % females) with PE were included; the overall crude incidence rate for the entire study period was 55.4 and 40.6 events per year per 100,000 inhabitants for women and men, respectively (p < 0.001). However, this difference was completely lost after standardisation for age. The incidence of PE significantly increased in both genders during the study period. In-hospital case fatality rate significantly decreased throughout the study period (p < 0.001) in women (from 15.6 % to 10.2 %) and in men (from 17.6 % to 10.1 %). The observed decrease of the in-hospital case-fatality throughout the study period remained significant also after adjustment for possible confounders. In conclusion, time trends over an 11-year period show an increasing incidence of PE, but a significant reduction in mortality during hospitalisation. Reduction in the case fatality rate remained significant after adjustment for these possible confounders.Supplementary Material to this article is available online at www.thrombosis-online.com.

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Outcome After Clipping and Coiling for Aneurysmal Subarachnoid Hemorrhage in Clinical Practice in Europe, USA, and Australia

Neurosurgery ◽

10.1093/neuros/nyy223 ◽

2018 ◽

Vol 84 (5) ◽

pp. 1019-1027 ◽

Cited By ~ 10

Author(s):

Antti Lindgren ◽

Ellie Bragan Turner ◽

Tomas Sillekens ◽

Atte Meretoja ◽

Jin-Moo Lee ◽

...

Keyword(s):

Clinical Practice ◽

Subarachnoid Hemorrhage ◽

Case Fatality Rate ◽

Randomized Clinical Trials ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Tertiary Care ◽

Case Fatality ◽

Fatality Rate ◽

Administrative Dataset ◽

Clinical Dataset

Abstract BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. METHODS In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. RESULTS In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1–2.7), for 90-d case-fatality 1.28 (95% CI 0.91–1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6–1.01). CONCLUSION In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs.

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A Population-Based Study of the Incidence and Case Fatality of Non-aneurysmal Subarachnoid Hemorrhage

Neurocritical Care ◽

10.1007/s12028-014-0084-7 ◽

2014 ◽

Vol 22 (3) ◽

pp. 409-413 ◽

Cited By ~ 3

Author(s):

Adnan I. Qureshi ◽

Nauman Jahangir ◽

Mushtaq H. Qureshi ◽

Archie Defillo ◽

Ahmed A. Malik ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Population Based ◽

Population Based Study

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Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort

Epidemiology and Infection ◽

10.1017/s0950268815000369 ◽

2015 ◽

Vol 144 (1) ◽

pp. 198-206 ◽

Cited By ~ 1

Author(s):

R.-F. WANG ◽

S.-H. SHEN ◽

A. M.-F. YEN ◽

T.-L. WANG ◽

T.-N. JANG ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Incidence Rate ◽

Case Fatality Rate ◽

Tertiary Care ◽

Case Fatality ◽

Healthcare Associated Infections ◽

Fatality Rate ◽

Infection Site ◽

Healthcare Associated

SUMMARYInformation is lacking on the integrated evaluation of mortality rates in healthcare-associated infections (HAIs). Our aim was to differentiate the risk factors responsible for the incidence from those for the case-fatality rates in association with HAIs. We therefore examined the time trends of both incidence and case-fatality rates over a 20-year period at a tertiary-care teaching medical centre in Taiwan and the mortality rate was expressed as the product of the incidence rate and the case-fatality rate. During the study period the overall mortality rate fell from 0·46 to 0·32 deaths/1000 patient-days and the incidence rate fell from 3·41 to 2·31/1000 patient-days, but the case-fatality rate increased marginally from 13·5% to 14·0%. The independent risk factors associated with incidence of HAIs were age, gender, infection site, admission type, and department of hospitalization. Significant prognostic factors for HAI case-fatality were age, infection site, intensive care, and clinical department. We conclude that the decreasing trend for the HAI mortality rate was accompanied by a significant decline in the incidence rate and this was offset by a slightly increasing trend in the case-fatality rate. This deconstruction approach could provide further insights into the underlying complex causes of mortality for HAIs.

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Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Part II: management and surgical outcome

Journal of Neurosurgery ◽

10.3171/jns.2000.93.6.0967 ◽

2000 ◽

Vol 93 (6) ◽

pp. 967-975 ◽

Cited By ~ 46

Author(s):

Tetsuji Inagawa ◽

Masaaki Shibukawa ◽

Futoshi Inokuchi ◽

Yoshio Tokuda ◽

Yoshikazu Okada ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Survival Rates ◽

Case Fatality ◽

Epidemiological Studies ◽

Day Case ◽

Content Type ◽

Gcs Score ◽

Fine Print

Object. The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japan.Methods. During 1991 through 1996, 267 patients with ICH and 123 with SAH were treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma removal by open craniotomy or suboccipital craniectomy and 34 underwent stereotactic evacuation of the hematoma, whereas aneurysm clipping was performed in 71 of the 123 patients with SAH; operability rates were thus 22% for ICH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73% and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30-day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.0262), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case-fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding, and midline shifting, whereas those for 2-year survival were the GCS score, age, rebleeding, and hematoma volume. In patients with SAH, the most important determinants of 30-day case-fatality rates were the GCS score and age, whereas only the GCS score had a significant impact on 2-year survival.Conclusions. The overall survival rates for patients with ICH or SAH in Izumo were more favorable than those in previously published epidemiological studies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.

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Pediatric Stroke Rates Over 17 Years: Report From a Population-Based Study

Journal of Child Neurology ◽

10.1177/0883073818767039 ◽

2018 ◽

Vol 33 (7) ◽

pp. 463-467 ◽

Cited By ~ 10

Author(s):

Laura L. Lehman ◽

Jane C. Khoury ◽

J. Michael Taylor ◽

Samrat Yeramaneni ◽

Heidi Sucharew ◽

...

Keyword(s):

Case Fatality Rate ◽

Case Fatality ◽

Population Based ◽

Pediatric Stroke ◽

Stroke Rate ◽

Fatality Rate ◽

Population Based Study ◽

Study Region ◽

Stroke Study ◽

Stroke Type

We previously published rates of pediatric stroke using our population-based Greater Cincinnati Northern Kentucky Stroke Study (GCNK) for periods July 1993–June 1994 and 1999. We report population-based rates from 2 additional study periods: 2005 and 2010. We identified all pediatric strokes for residents of the GCNK region that occurred in July 1, 1993–June 30, 1994, and calendar years 1999, 2005, and 2010. Stroke cases were ascertained by screening discharge ICD-9 codes, and verified by a physician. Pediatric stroke was defined as stroke in those <20 years of age. Stroke rates by study period, overall, by age and by race, were calculated. Eleven children died within 30 days, yielding an all-cause case fatality rate of 15.7% (95% confidence interval 1.1%, 26.4%) with 3 (27.3%) ischemic, 6 (54.5%) hemorrhagic, and 2 (18.2%) unknown stroke type. The pediatric stroke rate of 4.4 per 100 000 in the GCNK study region has not changed over 17 years.

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Stroke in Isfahan, Iran: Hospital Admission and 28-Day Case Fatality Rate

Cerebrovascular Diseases ◽

10.1159/000110418 ◽

2007 ◽

Vol 24 (6) ◽

pp. 495-499 ◽

Cited By ~ 18

Author(s):

Shahram Oveisgharan ◽

Nizal Sarrafzadegan ◽

Shahin Shirani ◽

Shidokht Hosseini ◽

Parisa Hasanzadeh ◽

...

Keyword(s):

Hospital Admission ◽

Case Fatality Rate ◽

Case Fatality ◽

Fatality Rate ◽

Day Case

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Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project)

The Lancet ◽

10.1016/s0140-6736(05)66779-7 ◽

2005 ◽

Vol 365 (9478) ◽

pp. 2206-2215 ◽

Cited By ~ 132

Author(s):

Pablo M Lavados ◽

Claudio Sacks ◽

Liliana Prina ◽

Arturo Escobar ◽

Claudia Tossi ◽

...

Keyword(s):

Prospective Study ◽

Case Fatality Rate ◽

Case Fatality ◽

Fatality Rate ◽

Day Case ◽

Community Based

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Profile of acute poisoning in three health districts of Botswana

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v1i1.10 ◽

2009 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Mary Kasule ◽

Ntambwe Malangu

Keyword(s):

Incidence Rate ◽

Case Fatality Rate ◽

Case Fatality ◽

Acute Poisoning ◽

Fatality Rate ◽

Urban District ◽

Natural Toxins ◽

Household Products ◽

Age Category ◽

Health Districts

Background: This study sought to characterise acute poisoning cases seen in three health districts of Botswana.Method: A retrospective review of patients’ records was conducted and included patients treated from January 2004 to December 2005. Data on the demographic status of the patients, information about the poisonous agent(s) involved, and the circumstances and outcomes of the poisoning incidents were recorded on a pre-tested data collection form.Results: A total of 590 cases of acute poisoning were included in the analysis. The most affected age category was that of children aged less than six years, who constituted 33.4% of the cases. Most incidents were recorded in the urban district of Gaborone. Seventy-eight percent (78%) of the incidents were accidental, with the remainder being intentional. The poisonous agents involved were pharmaceuticals (26.6%), natural toxins (25.6%), household products (14.6%), foods (14.4%), alcohol (6.9%), traditional medicines (4.7%), unspecified agents (3.2%), and agrochemicals (2.7%). The most common route of poison exposure was by oral (82.2%), followed by dermal contact (16.5%), while the inhalation of gases occurred in 1.2% of cases. An incidence rate of 4.7/1000, a case fatality rate of 3.8/100, and 1.5% of deaths were recorded over the two-year period.Conclusion: In conclusion, it can be stated that acute poisoning involved mainly young children and resulted in an incidence rate of 4.7/1000, a case fatality rate of 3.8/100, and 1.5% of deaths over the two-year period. There were differences based on age category, gender and residence of the victims, the types of toxic agents involved, as well as the circumstances and the outcomes of the poisoning incidents. Given the fact that pharmaceuticals, natural toxins, household products and foods were the agents most commonly involved, targeted interventions should take these differences into account in addressing the problem of acute poisoning.

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