Hospital Case-fatality Rates Research Articles

Hospital case fatality and mortality related to Chagas disease in Brazil over two decades

ObjectiveTo analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000–2019.MethodThis is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios.ResultsThere were a total of 4,376 HA due to CD resulting in death in Brazil, with a hospital case fatality rate of 0.11/100,000 inhabitants. The Southeast region had the highest rate (63.9%, n = 2,796; 0.17/100,000 inhabitants). The general trend for this indicator in Brazil is upwards (average annual percentage change [AAPC] 7.5; 95% confidence interval [CI] 5.3 to 9.9), with increases in the North, Northeast and Southeast regions. During the same period 122,275 deaths from CD were registered in DC, with a mortality rate of 3.14/100,000 inhabitants. The highest risk of CD-related death was found among men (relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was a downward trend in CD mortality in the country (AAPC − 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show an increase in mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease.ConclusionHospital case fatality and mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.

Patient characteristics and prediction of CoViD-19 in-hospital mortality: a retrospective cohort study in Crete, Greece before and after the onset of a targeted vaccination strategy in 2021

Background: CoviD-19 in-hospital mortality rates show variations across time, setting, patient populations and health-systems. Aim: The aim of the present study was to explore the association of patient characteristics with in-hospital mortality taking into consideration temporal changes of CoViD-19 prevention and treatment, focusing on the negative predictive value of specific biomarker thresholds for death and oxygen requirements. Methods: This retrospective study included a sample of 425 vaccine-naive patients hospitalized for CoViD-19 in Crete, Greece. Time-specific mortality rates and negative predictive values of biomarkers on admission were calculated. The association of patient characteristics with mortality was assessed using multivariate logistic regression models. Results: The overall in hospital case fatality rate (CFR) was 19.53%. The in-hospital CFR [95% CI] dropped from 22.74% [17.96-27.52] to 11.9% [6.17-17.63] before and after 31/03/2021, as did the mean age of hospitalized patients. LDH & D-dimers ≥240 or ≥0.5), CRP & D-dimers (≥3 or ≥0.5), CRP & Ferritin (≥3 or ≥205) had negative predictive values [95% CI] for mortality of 100% [86.7-100], 96.1% [80.3-99.9] and 95.4% [84.5-99.4] %, but the respective negative predictive values for oxygen requirements were 19.2% [6.5-39.3], 19.2% [6.5-39.3] and 27.2% [14.9-42.7] . Conclusion: A decreasing trend of in-hospital case fatality rates over the course of our study was associated with a decreasing age of hospitalized patients, which could be associated with community vaccination uptake in people over 60 in Greece through reduction of persons “susceptible” to severe disease. Mortality prediction formulas incorporating biomarkers should be used cautiously for the risk stratification of patients with CoViD-19 in the setting of the emergency department assessment.

Desigualdade socioeconômica na letalidade e no cuidado hospitalar de crianças e adolescentes internados por COVID-19 no Brasil

To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence. Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender. The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves. Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.

Results of the implementation of measures aimed at improving medical care for patients with vascular diseases in the Tomsk region

To study the dynamics of population indicators: the total number of deaths from diseases of the circulatory system, coronary heart disease, cerebrovascular diseases and strokes, hospitalization profile for strokes, their structure and mortality in the Tomsk region for several years in comparison with these indicators for the Russian Federation and the Siberian Federal District. A retrospective study was conducted using acute cerebrovascular accidents monitoring data and data of the Territorial body of state statistics of the Tomsk region in comparison with the literature data. The indicators of all causes of death, from circulatory diseases, coronary heart disease, cerebrovascular diseases and stroke in the territory of the Tomsk region, profile of hospitalization, structure of acute cerebrovascular accidents were analyzed for several years. Particular attention was paid to case fatality rate, one of the key indicators of the effectiveness of the system of care for patients with stroke. Typical for many regions of the Russian Federation predominance of chronic forms in the structure of mortality from circulatory diseases, the absence of significant differences in the structure of strokes, as well as the features of the Tomsk region in the form of high levels of hospitalization profile and hospital case fatality rate, were revealed. The dependence of hospital mortality on logistics is shown, on the basis of which assumptions are made about the possible causes of high fatality rates in the region: excessive centralization of the system of vascular centers and the absence of really working mechanisms for timely reevacuation from them. To bring chronic circulatory diseases structure in line with international standards, it is necessary to regulate the rules for formulating and coding diagnoses. In order to reduce hospital fatality rates in the Tomsk region, it is necessary to carry out organizational measures: opening a primary vascular department in the area of responsibility of the regional stroke center, as well as strengthening rehabilitation and palliative services for the timely reevacuation of patients from vascular centers.

Socioeconomic inequality in hospital case fatality rate and care among children and adolescents hospitalized for COVID-19 in Brazil

RESUMO Objetivo: Analisar a associação entre a letalidade e o cuidado hospitalar recebido por crianças e adolescentes internados por COVID-19 e o produto interno bruto (PIB) per capita dos municípios brasileiros e a região de residência. Métodos: Os dados foram extraídos do Sistema de Informação de Vigilância Epidemiológica da Gripe e do Instituto Brasileiro de Geografia e Estatística. Analisaram-se como desfechos dicotômicos a letalidade hospitalar por COVID-19, a coleta de amostra biológica para diagnóstico de COVID-19, a realização de exames raio X e tomografia, o uso de suporte ventilatório e a internação em unidade de terapia intensiva. As covariáveis foram o PIB municipal per capita e a região brasileira de residência. Foi realizada regressão de Poisson para os desfechos registrados em 2020 e 2021 no Brasil e segundo o período compreendido em duas ondas de COVID-19 no país, ajustando-a por idade e sexo. Resultados: A letalidade hospitalar foi de 7,6%. Nos municípios dos menores decis de PIB per capita a letalidade foi quase quatro vezes maior entre crianças e duas vezes mais elevada entre adolescentes quando comparada àquela dos maiores decis. Adicionalmente, os residentes de municípios com menor PIB per capita realizaram menos coleta de amostra biológica para diagnóstico, exames de raio X e tomografias. Foram encontradas disparidades regionais associadas à letalidade, com piores indicadores nas regiões Norte e Nordeste. Os achados mantiveram-se consistentes durante as duas ondas de COVID-19. Conclusão: Em municípios com menor PIB per capita e das regiões Norte e Nordeste houve piores indicadores de letalidade e cuidado hospitalar.

Comparative epidemiology of five waves of COVID-19 in Mexico, March 2020–August 2022

BackgroundThe Mexican Institute of Social Security (IMSS) is the largest health care provider in Mexico, covering about 48% of the Mexican population. In this report, we describe the epidemiological patterns related to confirmed cases, hospitalizations, intubations, and in-hospital mortality due to COVID-19 and associated factors, during five epidemic waves recorded in the IMSS surveillance system.MethodsWe analyzed COVID-19 laboratory-confirmed cases from the Online Epidemiological Surveillance System (SINOLAVE) from March 29th, 2020, to August 27th, 2022. We constructed weekly epidemic curves describing temporal patterns of confirmed cases and hospitalizations by age, gender, and wave. We also estimated hospitalization, intubation, and hospital case fatality rates. The mean days of in-hospital stay and hospital admission delay were calculated across five pandemic waves. Logistic regression models were employed to assess the association between demographic factors, comorbidities, wave, and vaccination and the risk of severe disease and in-hospital death.ResultsA total of 3,396,375 laboratory-confirmed COVID-19 cases were recorded across the five waves. The introduction of rapid antigen testing at the end of 2020 increased detection and modified epidemiological estimates. Overall, 11% (95% CI 10.9, 11.1) of confirmed cases were hospitalized, 20.6% (95% CI 20.5, 20.7) of the hospitalized cases were intubated, and the hospital case fatality rate was 45.1% (95% CI 44.9, 45.3). The mean in-hospital stay was 9.11 days, and patients were admitted on average 5.07 days after symptoms onset. The most recent waves dominated by the Omicron variant had the highest incidence. Hospitalization, intubation, and mean hospitalization days decreased during subsequent waves. The in-hospital case fatality rate fluctuated across waves, reaching its highest value during the second wave in winter 2020. A notable decrease in hospitalization was observed primarily among individuals ≥ 60 years. The risk of severe disease and death was positively associated with comorbidities, age, and male gender; and declined with later waves and vaccination status.ConclusionDuring the five pandemic waves, we observed an increase in the number of cases and a reduction in severity metrics. During the first three waves, the high in-hospital fatality rate was associated with hospitalization practices for critical patients with comorbidities.

Comorbidity and Its Impact on Mortality of COVID-19 in Yazd Province, a Central part of Iran: a Hospital-based study

Introduction: The World Health Organization on March 11, 2020 declared the outbreak of severe acute respiratory syndrome Corona virus 2 disease (COVID-19) a pandemic situation. The main aim of this study was investigating mortality of COVID-19 by considering chronic diseases.
 methods: This study was conducted as a cross-sectional in which all confirmed cases were examined. The variables considered in this study were age, sex, diabetes mellitus, cancers, hypertension, heart diseases, kidney diseases, and liver diseases. Independent sample t test, Chi-square and binary logistic regression were used for data analysis. All statistical analysis was done in SPSS 16 and significant level was set at 0.05.
 Results: Out of 22849 PCR and CT scan tests, 16061 were positive. According to the confirmed cases, prevalence of COVID-19 was calculated about 0.019. Also hospital case fatality rate and mortality rate were calculated 156 and about 8.2 per 100000 respectively. Hypertension, and age had significant relationship with morbidity of COVID-19, in other hand, age (OR: 4.51, p<0.001), kidney diseases (OR: 1.84, p<0.001), diabetes mellitus (OR: 1.31, p<0.001), cancer (OR: 2.73, p<0.001), liver diseases (OR: 2.27, p<0.001) had impact on mortality of covid-19. Population Attributable Fraction (PAF) showed the most fraction of death was due to diabetes mellitus, cancers, kidney diseases, and liver diseases.
 Conclusion: Age and some underlying diseases increase odds of death due to COVID-19. It seems that preventing high-risk people from being infected is an effective solution to reduce COVID-19 death rate. To do this, health protocols need to be implemented more seriously for these sensitive groups.

Hospital Costs and Fatality Rates of Traumatic Assaults by Mechanism in the US, 2016-2018

Estimates of the total economic cost of firearm violence are important in drawing attention to this public health issue; however, studies that consider violence more broadly are needed to further the understanding of the extent to which such costs can be avoided. To estimate the association of firearm assaults with US hospital costs and deaths compared with other assault types. The 2016-2018 US Nationwide Emergency Department Sample and National Inpatient Sample, Healthcare Cost and Utilization Project were used in this cross-sectional study of emergency department (ED) and inpatient admissions for assaults involving a firearm, sharp object, blunt object, or bodily force identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Differences in ED and inpatient costs (2020 US dollars) across mechanisms were estimated using ordinary least-squares regression with and without adjustments for year and hospital, patient, and injury characteristics. The Centers for Disease Control and Prevention underlying cause of death data were used to estimate national death rates and hospital case-fatality rates across mechanisms. Cost analysis used a weighted sample. National death rates and hospital case-fatality rates used US resident death certificates, covering 976 million person-years. Hospital case-fatality rates also used nationally weighted ED records covering 2.7 million admissions. Data analysis was conducted from March 1, 2021, to March 31, 2022. The primary exposure was the mechanism used in the assault. Emergency department and inpatient costs per record. National death rates and hospital case-fatality rates. Overall, 2.4 million ED visits and 184 040 inpatient admissions for assault were included. Across all mechanisms, the mean age of the population was 32.7 (95% CI, 32.6-32.9) years in the ED and 36.4 (95% CI, 36.2-36.7) years in the inpatient setting; 41.9% (95% CI, 41.2%-42.5%) were female in the ED, and 19.1% (95% CI, 18.6%-19.6%) of inpatients were female. Most assaults recorded in the ED involved publicly insured or uninsured patients and hospitals in the Southern US. Emergency department costs were $678 (95% CI, $657-$699) for bodily force, $861 (95% CI, $813-$910) for blunt object, $996 (95% CI, $925-$1067) for sharp object, and $1388 (95% CI, $1254-$1522) for firearm assaults. Corresponding inpatient costs were $14 702 (95% CI, $14 178-$15 227) for bodily force, $17 906 (95% CI, $16 888-$18 923) for blunt object, $19 265 (95% CI, $18 475-$20 055) for sharp object, and $34 949 (95% CI, $33 654-$36 244) for firearm assaults. National death rates per 100 000 were 0.04 (95% CI, 0.03-0.04) for bodily force, 0.03 (95% CI, 0.03-0.03) for blunt object, 0.54 (95% CI, 0.52-0.55) for sharp object, and 4.40 (95% CI, 4.36-4.44) for firearm assaults. Hospital case fatality rates were 0.01% (95% CI, 0.009%-0.012%) for bodily force, 0.05% (95% CI, 0.04%-0.06%) for blunt object, 1.05% (95% CI, 1.00%-1.09%) for sharp object, and 15.26% (95% CI, 15.04%-15.49%) for firearm assaults. In regression analysis, ED costs for firearm assaults were 59% to 99% higher than costs for nonfirearm assaults, and inpatient costs were 67% to 118% higher. The findings of this study suggest that it may be useful for policies aimed at reducing the costs of firearm violence to consider violence more broadly to understand the extent to which costs can be avoided.

Characteristics, in-hospital management, and complications of acute myocardial infarction in northern and Central Vietnam

IntroductionContemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited. MethodsWe established population-based registries of residents from 2 provinces in a northern urban (Hai Phong), and a central rural (Thanh Hoa), province of Vietnam hospitalized with a validated first AMI in 2018. We described patient characteristics, in-hospital management and clinical complications, and estimated incidence rates of AMI in these two registries. ResultsA total of 785 patients (mean age = 71.2 years, 64.7% men) were admitted to the two hospitals with a validated first AMI. Approximately 64% of the AMI cases were ST-segment-elevation AMI. Patients from Thanh Hoa compared with Hai Phong were more likely to delay seeking acute hospital care. The incidence rates (per 100,000 population) of initial AMI in Thanh Hoa and Hai Phong were 16 and 30, respectively. Most patients were treated with aspirin (Thanh Hoa: 96%; Hai Phong: 90%) and statins (both provinces: 91%) during their hospitalization. A greater proportion of patients in Hai Phong (69%) underwent percutaneous revascularization than those in Thanh Hoa (58%). The most common in-hospital complications were heart failure (both provinces:12%), cardiogenic shock (Thanh Hoa: 10%; Hai phong: 7%); and cardiac arrest (both provinces: 9%). The in-hospital case-fatality rates for patients from Thanh Hoa and Hai Phong were 6.8% and 3.8%, respectively. ConclusionsThe incidence and hospital case-fatality rates of AMI were low in two Vietnamese provinces. Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal, being more prominent in the rural province.

Is intensive care unit mortality a valid survival outcome measure related to critical illness?

RationaleUse of death as an outcome of intensive care unit (ICU) admission may be biased by differential discharge decisions. ObjectiveTo determine the validity of ICU survival status as an outcome measure of all cause case-fatality. MethodsA retrospective cohort of first admissions among adults to four ICUs in North Brisbane, Australia was assembled. Death in ICU (censored at discharge or 30 days) was compared with 30-day overall case-fatality. ResultsThe 30-day overall case-fatality was 8.1% (2436/29,939). One thousand six hundred and thirty-one deaths occurred within the ICU stay and 576 subsequent during hospital post-ICU discharge within 30-days; ICU and hospital case-fatality rates were 5.4% and 7.4%, respectively. An additional 229 patients died after hospital separation within 30 days of ICU admission of which 110 (48.0%) were transferred to another acute care hospital, 80 (34.9%) discharged home, and 39 (17.0%) transferred to an aged care/chronic care/rehabilitation facility. Patients who died after ICU discharge were older, had higher APACHE III scores, were more likely to be elective surgical patients, and were less likely to be out of state residents or managed in a tertiary referral hospital. Limiting determination of case-fatality to ICU information alone would correctly detect 95% (780/821) of all-cause mortality at day 3, 90% (1093/1213) at day 5, 75% (1524/2019) at day 15, 72% (1592/2244) at day 21, and 67% (1631/2436) at day 30 of follow-up. ConclusionsUse of ICU case-fatality significantly underestimates the true burden and biases assessment of determinants of critical illness-related mortality in our region.

Examining socio-economic factors to understand the hospital case fatality rates of COVID-19 in the city of São Paulo, Brazil.

BackgroundUnderstanding differences in hospital case fatality rates (HCFRs) of coronavirus disease 2019 (COVID-19) may help evaluate its severity and the capacity of the healthcare system to reduce mortality.MethodsWe examined the variability in HCFRs of COVID-19 in relation to spatial inequalities in socio-economic factors, hospital health sector and patient medical condition across the city of São Paulo, Brazil. We obtained the standardized hospital case fatality ratio adjusted indirectly by age and sex, which is the ratio between the HCFR of a specific spatial unit and the HCFR for the entire study area. We modelled it using a generalized linear mixed model with spatial random effects in a Bayesian context.ResultsWe found that HCFRs were higher for men and for individuals ≥60 y of age. Our models identified per capita income as a significant factor that is negatively associated with the HCFRs of COVID-19, even after adjusting for age, sex and presence of risk factors.ConclusionsSpatial analyses of the implementation of these methods and of disparities in COVID-19 outcomes may help in the development of policies for at-risk populations in geographically defined areas.

Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020.

Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission. The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.

Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data

BackgroundReducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years.MethodsThe study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004–2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables.ResultsBFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81–0.95), 0.84 (0.75–0.96) and 0.83 (0.71–0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67–0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69–0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66–0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04–1.07).ConclusionOur findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.

Impact of obesity on outcome of severe bacterial infections

IntroductionObesity is a rapidly growing global health concern with considerable negative impact on life-time expectancy. It has yet not been clarified if and how obesity impacts outcomes of severe bacterial infections. The aim of this study was to determine how body mass index impacts outcome of severe bacterial infections in a well-defined population-based cohort.MethodsThis study is based on a cohort of 2196 patients included in a Swedish prospective, population-based, consecutive observational study of the incidence of community-onset severe sepsis and septic shock in adults. All patients with weight and height documented in the medical records on admission were included.ResultsThe case fatality rate (CFR) was negatively correlating with increasing BMI. Outcomes included 28-day CFR (p-value = 0.002), hospital CFR (p-value = 0.039) and 1-year CFR (p-value<0.001). When BMI was applied as continuous variable in a multiple logistic regression together with other possible covariates, we still could discern that BMI was associated with decreasing 28-day CFR (OR = 0.93, 95% CI 0.88–0.98, p-value = 0.009) and 1-year CFR (OR = 0.94, 95% CI 0.91–0.97, p-value<0.001).ConclusionThe hypothesis and paradox of obesity being associated with higher survival rates in severe bacterial infections was confirmed in this prospective, population-based observational study.

Utilization of Guidelines for Management of Severe Acute Malnutrition in Children Aged 6-59 Months in Busia County Referral Hospital

Background: Malnutrition is responsible for 35% of deaths among children under five years of age globally. The prevalence of severe acute malnutrition in Kenya is estimated to be 6%. In Busia County Referral Hospital case fatality rate for children with severe acute malnutrition in 2014 was 26%. World Health Organization (WHO) has developed guidelines for the management of severe acute malnutrition in children. The use of these guidelines in treatment of children with malnutrition reduces mortality related to malnutrition. Objective: The objective of the study was to assess the utilization of guidelines for management of severe acute malnutrition in children aged 6-59 months in Busia County Referral Hospital. Methods: This was cross-sectional, descriptive study. Purposive sampling was used to select the study sample. A checklist was used to verify documentation of guidelines for management of malnutrition in children from the in-patient files. An overall guidelines utilization scoring tool was developed and used to rate the overall utilization of the guidelines. Data on the supply of essential nutritional commodities was obtained through key informant interviews. Descriptive data was analysed using mean, mode and median. Findings were presented in form of frequency tables and bar charts. Results: A total of ninety-six (96) participants were recruited for the study. The mean age of the participants was 21.85 months. There was significantly higher proportion of children with MUAC less than 11.5cm among 6 to 12 months 20(69.0%) [OR=9.26; 95%CI=2.82-30.39; P&lt;0.001] and 13 to 24 months 16(44.4%) [OR=3.33; 95%CI=1.10-10.09; P=0.033] compared to those aged 25 to 59 months 6(19.4%). Mean weight had increased from 7.97Kg at admission to 8.45Kg at 7 days and this difference was significant (p&lt;0.0001) after paired samples t test was computed. The average utilization of the guidelines was 86.4%. Conclusion and recommendations : Guidelines for management of severe acute malnutrition were adequately utilized in Busia County Referral Hospital. Periodic training of all health workers involved in the care of children with severe acute malnutrition was recommended to ensure optimum utilization of the guidelines for management of severe acute malnutrition. Keywords: Utilization, Guidelines, Severe acute malnutrition, management, under five years. DOI: 10.7176/JHMN/86-03 Publication date: February 28 th 2021

COVID-19: Spatial analysis of hospital case-fatality rate in France.

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate (CFR) between French districts. In theory, the hospital age-standardized CFR should not display significant differences between districts, since hospital lethality depends on the virulence of the pathogen (the SARS-CoV-2 virus), the vulnerability of the population (mainly age-related), the healthcare system quality, and cases and deaths definition and the recording accuracy. We analyzed hospital data on COVID-19 hospitalizations, severity (admission to intensive care units for reanimation or endotracheal intubation) and mortality, from March 19 to May 8 corresponding to the first French lockdown. All rates were age-standardized to eliminate differences in districts age structure. The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity. Time analysis shows that the case-fatality rate has decreased over time, globally and in almost all districts, showing an improvement in the management of severe patients during the epidemic. In conclusion, it appears that during the first critical phase of COVID-19 ramping epidemic in metropolitan France, the higher case-fatality rates were generally related to the higher level of hospitalization, then potentially related to the overload of healthcare system. Also, low hospitalization with high case-fatality rates were mostly found in districts with low population density, and could due to some limitation of the local healthcare access. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate, and this variation is small compared to much greater variation across countries reported in the literature.

Hospitalised traumatic brain injury victims in France: An analysis of the French hospital discharge database for 2011-2016.

Traumatic brain injury (TBI) is a major public health problem because of its severity and frequency. No recent national epidemiological study on TBI victims is currently available in France. This study aimed to quantify and characterise TBI victims and analyse temporal trends. French hospitalisation data were used in this study. All hospitalised patients residing in France with at least one International Classification of Disease, 10th revision, code S06.0 to S06.9 during 2011-2016 were selected. Incidence and hospital case-fatality rates were calculated. Quasi-Poisson models were used to analyse temporal trends. In 2016, the incidence rate was 230.6/100,000 people, higher among men than women regardless of age. Incidence and hospital case-fatality rates were also higher among older than younger people. Incidence rates increased during 2011-2016, mainly due to the higher incidence rate with age ≥65 years than younger age. During 2011-2016, hospital case-fatality rates decreased, mainly due to the decrease in the older age group (≥65 years old). To our knowledge, this is the first national study in France to provide recent data on hospitalised TBI victims. Our study shows that TBI is a major public health concern in France. As a priority, older people represent a risk group that should be targeted with preventive actions because they have both the highest incidence and case-fatality rates and had the largest increase in incidence rates over the study period.

Effects of cholestasis and hypoxic hepatitis on prognosis of ICU patients: a retrospective study based on MIMIC Ⅲ database

Abnormalities of liver-related indices are common in ICU patients, but the effects of cholestasis and hypoxic hepatitis in critically ill patients remains unclarified. The purpose of this study was to investigate the effects of cholestasis and hypoxic liver dysfunction on the prognosis of ICU patients. A retrospective study was conducted based on the data of patients admitted to the ICU for the first time between 2001 and 2011 archived in the MIMIC-Ⅲ database. The patients were divided into cholestasis, hypoxic hepatitis and control groups, and their 28-day case fatality rate as the primary outcome was compared among the groups. A total of 5852 ICU patients were included in the analysis. The incidence of cholestasis and hypoxic liver dysfunction was 31.9% (1869/5852) and 17.9% (1046/5852), respectively. There was no significant difference in 28-day case fatality rate between cholestasis group and the control group. Compared with the control group, the patients with hypoxic hepatitis had a significantly higher 28-day case fatality rate (46% vs 35%, P &lt; 0.01), a higher hospital case fatality rate (40% vs 31%, P &lt; 0.01), and a higher ICU case fatality rate (35.7% vs 22.2%, P &lt; 0.01). Logistic regression analysis showed that lactic acid (LAC), aspartate transaminase (AST), and international standard ratio (INR) were independent risk factors for 28-day case fatality rate. The incidence of cholestatic liver dysfunction is higher than that of hypoxic hepatitis, but it does not increase the 28-day case fatality rate of the ICU patients, suggesting that cholestatic liver dysfunction may be the early adaptation of the liver to critical diseases.

Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines

BackgroundCoronavirus disease 2019 (COVID-19) has spread to almost every region and country in the world, leading to widespread travel restrictions and national lockdowns. Currently, there are limited epidemiological and clinical data on COVID-19 patients from low and middle-income countries. We conducted a retrospective single-center study of the first 100 individuals with suspected COVID-19 (between Jan. 25 and Mar. 29, 2020) admitted to San Lazaro Hospital (SLH), the national infectious diseases referral hospital in Manila, Philippines.ResultsDemographic data, travel history, clinical features, and outcomes were summarized and compared between COVID-19 confirmed and non-confirmed cases. The first two confirmed cases were Chinese nationals, admitted on Jan. 25. The third confirmed case was a Filipino, admitted on Mar. 8. Trends toward confirmed COVID-19 cases not reporting international travel and being admitted to SLH from the densely populated area of Manila city were observed during Mar. 8-29. All 42 of the 100 confirmed COVID-19 cases were adults, 40% were aged 60 years and above and 55% were male. Three were health workers. Among individuals with suspected COVID-19, confirmed cases were more likely to be older, Filipino, not report international travel history and have at least one underlying disease, particularly diabetes, report difficulty in breathing, and a longer duration of symptoms. In over 90% of non-COVID-19 cases, the alternative diagnosis was respiratory. Nine (21%) confirmed cases died. The median duration from symptoms onset to death was 11.5 (range: 8–18) days.ConclusionsImported COVID-19 cases have reduced but local transmission persists and there is a trend toward cases being admitted to SLH from densely populated areas. This study highlights the difficulty in diagnosing COVID-19 on clinical grounds and the importance of diagnostic capacity in all settings. Difficulty of breathing was the only symptom associated with COVID-19 infection and should alert clinicians to the possibility of COVID-19. Clinical characteristics of confirmed COVID-19 cases and a hospital case fatality rate of 21% are comparable with other settings.

Twenty-five year trends (1986-2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular fibrillation complicating acute myocardial infarction

Long-term trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of ventricular tachycardia (VT) and ventricular fibrillation (VF) among patients hospitalized with acute myocardial infarction (AMI) have not been recently examined. We used data from 11,825 patients hospitalized with AMI at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. Multivariable adjusted logistic regression modeling was used to examine trends in hospital IRs and CFRs of VT and VF complicating AMI. The median age of the study population was 71 years, 57.9% were men, and 94.7% were white. The hospital IRs declined from 14.3% in 1986/1988 to 10.5% in 2009/2011 for VT and from 8.2% to 1.7% for VF. The in-hospital CFRs declined from 27.7% to 6.9% for VT and from 49.6% to 36.0% for VF between 1986/1988 and 2009/2011, respectively. The IRs of both early (<48 hours) and late VT and VF declined over time, with greater declines in those of late VT and VF. The incidence rates of VT declined similarly for patients with either an ST-segment elevation myocardial infarction (STEMI) or non-STEMI, whereas they only declined in those with VF and a STEMI. The hospital IRs and CHRs of VT and VF complicating AMI have declined over time, likely because of changes in acute monitoring and treatment practices. Despite these encouraging trends, efforts remain needed to identify patients at risk for these serious ventricular arrhythmias so that preventive and treatment strategies might be implemented as necessary.