Risk Factors For Fatality Research Articles

Case–control study of fatal bicycle crashes in peri-urban areas of Delhi

ObjectivesThere is a lack of evidence on interventions to improve the safety of cycling use in low- and middle-income countries. We investigated the impact of road design and traffic characteristics...

Design of a Location-Based Case-Control Study of Built Environment Risk Factors for Pedestrian Fatalities in the U.S.

The location-based case-control design is a useful approach for studies where the exposures of interest are aspects of the environment around the location of a health event such as a pedestrian fatality. In this design locations are the unit of analysis and an enumerated cohort of locations are followed through time for the health events of interest and a case-control study of locations is nested within the cohort. Locations where events occurred (case-locations) are compared to matched locations where these events did not occur (control-locations). We describe the application of this design to the issue of pedestrian fatalities using a cohort of 9,612,698 intersections, 17,737,728 road segments, and 222,318 entrance/exit ramp segments that existed in 2017 across all 384 U.S. Metropolitan Statistical Areas. This cohort of locations was followed up from Jan 1, 2017 to Dec 31, 2018 for pedestrian fatalities using the National Highway Traffic Safety Administration Fatality Analysis Reporting System. In total, 10,587 fatalities were identified as having occurred on cohort locations and 21,174 matched control locations were selected using incidence density sampling. Geographic information systems, spatially linked administrative data sets and virtual neighborhood audits via Google Street View are underway to characterize study locations.

Burden of Respiratory Syncytial Virus (RSV) Infection Among Adults in Nursing and Care Homes: A Systematic Review.

Older adults in nursing and care homes (NCHs) are vulnerable to severe respiratory syncytial virus (RSV) infection, hospitalization, and death. This study aimed to gather data on RSV disease among older adults in NCHs and identify reported risk factors for RSV hospitalization and case fatality. The study protocol was registered in PROSPERO (CRD42022371908). We searched MEDLINE, EMBASE, and Global Health databases to identify articles published between 2000 and 2023. Observational and experimental studies conducted among older adults in NCHs requiring assistive care and reporting RSV illness were included and relevant data were extracted. Of 18,690 studies screened, 32 were selected for full-text review, and 20 were included. Overall, the number of NCH residents ranged from 42 to 1459 with a mean age between 67.6 and 85 years. Attack rates ranged from 6.7% to 47.6% and annual incidence ranged from 0.5% to 14%. Case fatality rates ranged from 7.7% to 23.1%. We found similar annual incidence rates of RSV-positive acute respiratory infection (ARI) of 4582 (95% CI: 3259-6264) and 4785 (95% CI: 2258-10,141) per 100,000 reported in two studies. Annual incidence rate of RSV-positive lower respiratory tract infection was 3040 (95% CI: 1986-4454) cases per 100,000 adults. Annual RSV-ARI hospital admission rates were between 600 (95% CI: 190-10,000) and 1104 (95% CI: 350-1930) per 100,000 person-years. Among all RSV disease cases, commonly reported chronic medical conditions included chronic obstructive pulmonary disease (COPD), heart failure, ischemic heart disease, coronary artery disease, hypertension, diabetes, kidney dysfunction, cerebrovascular accident, malignancies, dementia, and those with a Charlson comorbidity score > 6.5. Data on RSV infection among NCH residents are limited and largely heterogeneous but document a high risk of illness, frequent hospitalization, and high mortality. Preventive interventions, such as vaccination, should be considered for this high-risk population. Nationally representative epidemiologic studies and NCH-based viral pathogen surveillance could more precisely assess the burden on NCH residents.

PM2.5 chemical components are associated with in-hospital case fatality among acute myocardial infarction patients in China

Recent studies have linked the cardiovascular events with the exposure to ambient fine particulate matter (PM2.5); however, the impact of PM2.5 chemical components on acute myocardial infarction (AMI) case fatality remains poorly understood. To address this gap, we included 178,340 hospitalised patients with AMI utilising the inpatient discharge database from Sichuan, Shanxi, Guangxi, and Guangdong, China spanning 2014–2019. We evaluated exposure to PM2.5 and its components (black carbon (BC), organic matter (OM), sulphate (SO42−), nitrate (NO3−), and ammonium (NH4+)) using bilinear interpolation based on the patient’s residential address. We used mixed-effects logistic regression models to investigate the associations of PM2.5 and its five components with in-hospital AMI case fatality. Per interquartile range (IQR) increment in short-term exposure (7-day average) to overall PM2.5 (odds ratio (OR): 1.086, 95 % confidence interval (CI): 1.045–1.128), SO42−(1.063, 1.024–1.104), BC (1.055, 1.023–1.089), OM (1.052, 1.019–1.086, and NO3− (1.045, 1.003–1.089) were significantly associated with high risk of in-hospital AMI case fatality. The ORs per IQR increment in long-term exposure (annual average) were 1.323 (95 % CI: 1.255–1.394) for PM2.5, followed by BC (1.271, 1.210–1.335), OM (1.243, 1.188–1.300), SO42− (1.212, 1.157–1.270), NO3− (1.116, 1.075–1.159), and NH4+ (1.068, 1.031–1.106). Our study suggests that PM2.5 chemical components might be important risk factors for in-hospital AMI case fatality, highlighting the importance of targeted reduction of PM2.5 emissions, particularly BC, OM, and SO42−.

Alcohol is a risk factor for helmet non-use and fatalities in off-road vehicle and motorcycle crashes.

Off-road vehicle (ORV) and motorcycle use is common in Canada; however, risk of serious injury is heightened when these vehicles are operated without helmets and under the influence of alcohol. This study evaluated the impact of alcohol intoxication on helmet non-use and mortality among ORV and motorcycle crashes. Using data collected from the Nova Scotia Trauma Registry, a retrospective analysis (2002-2017) of ORV and motorcycle crashes resulting in major traumatic brain injury was performed. Patients were grouped by blood alcohol concentration (BAC) as negative (< 2 mmol/L), legally intoxicated (2-17.3 mmol/L) or criminally intoxicated (> 17.3 mmol/L). Logistic regression models were constructed to test for helmet non-use and mortality. A total of 424 trauma patients were included in the analysis (220 ORV, 204 motorcycle). Less than half (45%) of patients involved in ORV crashes were wearing helmets and 65% were criminally intoxicated. Most patients involved in motorcycle crashes were helmeted at time of injury (88.7%) and 18% were criminally intoxicated. Those with criminal levels of intoxication had 3.7 times the odds of being unhelmeted and were 3 times more likely to die prehospital compared to BAC negative patients. There were significantly increased odds of in-hospital mortality among those with both legal (OR = 5.63), and criminal intoxication levels (OR = 4.97) compared to patients who were BAC negative. Alcohol intoxication is more frequently observed in ORV versus motorcycle crashes. Criminal intoxication is associated with helmet non-use. Any level of intoxication is a predictor of increased in-hospital mortality.

Fatal Hemoperitoneum Secondary to a Spontaneous Splenic Vein Rupture.

Spontaneous hemoperitoneum is rare and is often labeled as idiopathic because the source of bleeding is never found. We report the case of a 35-year-old male who died of a splenic vein rupture. The decedent was a chronic alcoholic with a reported history of cirrhosis and medication noncompliance. Internal examination revealed pale visceral organs, marked hemoperitoneum, a fibrotic/nodular liver, esophageal varices, and a ruptured splenic vein. Pertinent microscopic findings include liver parenchyma with bridging fibrous septa, nodules of regenerating hepatocytes, and the presence of Mallory-Denk bodies. The immediate cause of death was determined to be splenic vein rupture with the underlying cause of death being chronic alcoholism. This case is reported to emphasize the importance of correlating past medical history with thorough vascular dissection in cases of spontaneous hemoperitoneum. In a patient with fatal hemoperitoneum and risk factors for splenic vein pathology (ie, cirrhosis, portal vein hypertension), a high suspicion should be kept for splenic vein rupture.

Activated partial thromboplastin time predicts mortality in patients with severe fever with thrombocytopenia syndrome: A multicenter study in north China

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high lethality. This study aimed to determine whether prolonged activated partial thromboplastin time (APTT) predicted SFTS mortality. MethodsSFTS patients were enrolled from 6 hospitals in the north China. Subjects were divided into training cohort and 5 externally validation cohorts. The least absolute shrinkage and selection operator Cox regression model was performed to screen potential prognostic factors. Risk factors were analyzed using multivariable regression models. Prognostic models were established by Cox regression and random survival forest (RSF) methods, and evaluated regarding discrimination, validity and clinical benefit. Time-dependent receiver operating characteristic (ROC) curve was used to evaluate the predictive effectiveness of variables. Results1332 SFTS cases were included, in which 211 patients died. Six potential prognostic factors were screened, and pulse, breath, APTT and aspartic transaminase (AST) were independently associated with mortality in both training cohort (Yantai, N = 791) and external validation cohort (N = 541). APTT was steadily correlated with the fatality (HR: 1.039–1.144; all P < 0.01) in each five sub-validation cohorts (Dandong, Dalian, Tai'an, Qingdao and Beijing). RSF model with variables of APTT, AST, pulse and breath had considerable prognostic effectiveness, which APTT showed the highest prognostic ability with the area under the curve of 0.848 and 0.787 for 7-day and 14-day survival, respectively. Survival differences were found between high and low levels of APTT for mortality using 50s as the optimal cut-off. ConclusionsSFTS patients have prolonged APTT, which is an independent risk factor for fatality. APTT≥50s was recommended as a biomarker to remind physicians to monitor and treat patients more aggressively to improve clinical prognosis.

Clinical Characteristics and Fatality Risk Factors for Patients with Listeria monocytogenes Infection: A 12-Year Hospital-Based Study in Xi'an, China.

Listeriosis is a severe food-borne disease caused by Listeria monocytogenes infection. The data of listeriosis in Xi'an population are limited. The aim of this study is to evaluate the clinical features and fatality risk factors for listeriosis in three tertiary-care hospitals in Xi'an, China METHODS: The characteristics of demographic data, underlying diseases, clinical manifestations, laboratory indicators, cranial imaging examination, antibiotics therapeutic schemes, and clinical outcomes were collected between 2011 and 2023. Logistic regression analysis was performed. Seventy-one etiologically confirmed listeriosis patients were enrolled, including 12 neonatal and 59 non-neonatal cases. The majority of neonatal listeriosis presented as preterm (50%) and fetal distress (75%). The main clinical manifestations of non-neonatal listeriosis included fever (88%), headache (32%), disorder of consciousness (25%), vomiting (17%), abdominal pain (12%), and convulsions (8%). The fatality rate in neonatal cases was higher than in non-neonatal listeriosis (42 vs. 17%). Although no deaths were reported in maternal listeriosis, only two of 23 patients had an uneventful obstetrical outcome. Five maternal listeriosis delivered culture-positive neonates, three of whom decreased within 1week post-gestation due to severe complications. Twenty-eight cases were neurolisteriosis and 43 cases were bacteremia. Neurolisteriosis had a higher fatality rate compared with bacteremia listeriosis (36 vs. 12%). The main neuroradiological images were cerebral edema/hydrocephalus, intracranial infection, and cerebral hernia. Listeria monocytogenes showed extremely low resistance to ampicillin (two isolates) and penicillin (one isolate). The fatality risk factors were the involvement of the central nervous system, hyperbilirubinemia, and hyponatremia for all enrolled subjects. Hyperuricemia contributed to the elevation of fatality risk in non-neonatal listeriosis. When the patients suffered with symptoms of fever and central nervous system infection, they should be alert to the possibility of listeriosis. Early administration of ampicillin- or penicillin-based therapy might be beneficial for recovery of listeriosis.

Sex differences in prognosis factors in patients with lung cancer: A nationwide retrospective cohort study in Korea.

Large-scale studies elucidating sex differences in factors impacting prognosis and sex-specific prognossis factors scoring in patients with lung cancer are insufficient. The present study aimed to develop a model to predict sex-specific prognosis factors in Korean patients with lung cancer. This nationwide cohort study included 96,255 patients aged ≥19 years diagnosed with lung cancer and underwent Korean National Health Insurance Service health examinations between January 1, 2005 and December 31, 2015 and followed until 2020. Factors associated with prognosis were estimated using multivariable Cox proportional hazards regression analyses, and separate prognosis scores were calculated for male and female patients. The sex-specific risk scoring models were validated with Kaplan-Meier survival curves and c-statistic. During a mean follow-up of 2.8 years, 60.5% of the patients died. In male patients with lung cancer, age ≥ 65 years (24 points) had the highest mortality risk score, followed by chemotherapy in combination with radiotherapy (16 points), chemotherapy (14 points), and radiotherapy (11 points). In female patients with lung cancer, chemotherapy in combination with radiotherapy (19 points) had the highest mortality risk score, followed by chemotherapy (16 points), age ≥ 65 years (13 points), and radiotherapy (13 points). The analysis of patients categorized into three risk groups based on risk scores revealed that the fatality rates within 5 years were 7%, 54%, and 89% in the low-, intermediate-, and high-risk groups for male patients and 3%, 46%, 85% in the low-, intermediate-, and high-risk groups for female patients, respectively. The c-statistic was 0.86 for male patients and 0.85 for female patients. The strongest fatality risk factors in lung cancer were age ≥ 65 years in male patients and chemotherapy in female patients. The present study developed sex-specific prognosis scoring models to predict fatality risk in patients with lung cancer.

Predicting Accident Severity using Machine Learning

Each year, millions of people are killed in automobile accidents. Predicting the severity of an occurrence allows local authorities to respond quickly and save many lives. Information and data on traffic accidents made available by public organizations can be used to categories these incidents based on their nature and severity, and then attempt to construct predictive models that can be further investigated to identify fatal accident risk factors. The study provides ways to develop a system for determining the severity of accidents. To evaluate the severity of the collision, we use a variety of weather-related characteristics such as temperature, humidity, visibility, and pressure, as well as several other circumstances, such as the presence of a traffic light or a junction. The Select-K-Best features selection algorithms were used to choose the best characteristics from a list of 47. The accuracy of both balanced and unbalanced data was measured, and the balanced data was chosen for further analysis. The balanced dataset is then trained, analyzed, and compared with a number of machine learning approaches, including the Random Forest Classifier (RFC), K closest neighbour (KNN) classifier, and Naive Bayes classifier. The RFC classifier outperformed with an AUC of 95%, whereas the naïve bayes underperformed. Furthermore, the accuracy is improved by using all of the aforementioned methods as base learners for stacking ensemble models with logistic regression as meta learner. This stacking ensemble strategy outperforms RFC with improved precision and accuracy, resulting in an AUC of 96.92%. The results revealed that the model has a 96.92% AUC in predicting accident severity. The work can be extended to investigate the complex correlations between a few key parameters and accident severity.

30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis.

Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.

Trends in fatalities from road traffic injuries and associated factors of patients admitted to the emergency department of St. Luke Hospital, South West Shewa Zone, Ethiopia

IntroductionRoad traffic injuries are a major global public health problem. They are fatal or non-fatal injuries resulting from a road traffic accident involving at least one moving vehicle on a path or road open to public traffic. Therefore, this study aimed to determine the trends in fatalities from road traffic injuries and the associated factors of patients admitted to the emergency department of St. Luke Hospital.MethodsAn institution-based cross-sectional study was conducted from July 10 to 30, 2019. The study on the trends in road traffic injuries was conducted monthly bases from January 1 to December 31, 2018. A total of 364 road traffic–injured victim records were included. A simple random sampling technique was used for the record selection. A structured data abstraction format was used to gather the required data. Binary logistic regression and multivariate logistic regression were used to determine the association between the outcome and explanatory variables. Adjusted odds ratios (AORs) at 95% confidence intervals were used to report independent variables.Results and conclusionsThe average annual fatalities from road traffic injuries was 8.34% deaths/month. The magnitude of road traffic injury fatalities was 8.79%. Of all victims who visited the hospital, 75.5% were male. The median age of the victims was 26 (51.6%), with a range from 6 to 70. The identified risk factors for road traffic injury fatalities were a lack of ambulance for transportation to the hospital after the accident (AOR = 7.093, 95% CI [1.950, 25.793], p = 0.003) and head injury (AOR = 2.515, 95% CI [1.075, 5.885], p = 0.034). Road traffic injury fatalities are an important public health problem that needs special attention. A shortage of ambulance service for transportation and injury sites related to head injury were associated factors. So it is important to establish and strengthen advanced prehospital care and an effective ambulance system for transporting victims with road traffic injuries.

Comparing fatal crash risk factors by age and crash type by using machine learning techniques.

This study aims to use machine learning methods to examine the causative factors of significant crashes, focusing on accident type and driver's age. In this study, a wide-ranging data set from Jeddah city is employed to look into various factors, such as whether the driver was male or female, where the vehicle was situated, the prevailing weather conditions, and the efficiency of four machine learning algorithms, specifically XGBoost, Catboost, LightGBM and RandomForest. The results show that the XGBoost Model (accuracy of 95.4%), the CatBoost model (94% accuracy), and the LightGBM model (94.9% accuracy) were superior to the random forest model with 89.1% accuracy. It is worth noting that the LightGBM had the highest accuracy of all models. This shows various subtle changes in models, illustrating the need for more analyses while assessing vehicle accidents. Machine learning is also a transforming tool in traffic safety analysis while providing vital guidelines for developing accurate traffic safety regulations.

Analysis of post-COVID symptoms and predisposing factors for chronic post-COVID syndrome.

While there is sufficient information about acute COVID-19, which can cause a multisystemic and fatal disease, post-COVID syndrome and risk factors for this condition remain poorly known. We aimed to identify postCOVID symptoms and risk factors for chronic post-COVID syndrome through this study. This prospective cross-sectional study was conducted on 254 out of 384 COVID-19 patients admitted to our COVID-19 polyclinic between February and April 2021. The patients were questioned with a list of 37 symptoms at the fifth and twelfth weeks after disease onset via phone review, and their acute post-COVID (APC) and chronic post-COVID (CPC) symptoms were recorded. Data on risk factors were collected from the hospital's medical records system. Associations between symptom count in the CPC phase and age, sex, hospitalization, RT-PCR result, specific radiological findings, comorbidities, and long-term medications were evaluated. Two hundred twenty-one patients had APC symptoms, and 138 patients had CPC symptoms. While the most common symptom was fatigue at week five, it was hair loss at week 12. Symptoms were observed significantly less in the CPC phase than in the APC phase (Z= -12.301, p= 0.00). Female sex and the presence of specific radiological findings were significantly associated with the occurrence of CPC symptoms (p= 0.03, p= 0.00, respectively). Long-term use of angiotensin-2 receptor blockers (ARBs) was correlated with a low symptom count in the CPC phase (p= 0.00). Female sex and the presence of specific radiological findings were risk factors for developing CPC. Long-term use of ARBs was associated with a low chronic post-COVID symptom burden. A substantial cluster of multisystemic symptoms was observed in both phases, and this condition highlights the requirement for customized outpatient management that includes long-term follow-up and treatment of COVID-19 patients. Identifying the high-risk patients that will develop persistent symptoms can guide this management.

The Performance of the Exclusive Motorcycle Lane (EMCL) in Reducing Fatal Crashes Among Motorcyclists after 20 Years of Operation

When the first exclusive motorcycle lane (EMCL) was built in the early 70s, and after it was entirely built along Kuala Lumpur to Klang in 1993, it was studied to be very effective in preventing crashes by up to 34%. However, that was more than 20 years ago. This study aimed to investigate the effectiveness of the current EMCL in terms of its potential to reduce fatal crashes among motorcyclists, its fatal risk factors, and its benefit-to-cost ratio to the government. This study uses secondary data from the Royal Police of Malaysia (PDRM) and primary data from the second Penang Bridge highway. The results show that EMCL is still an effective measure to reduce the fatalities among motorcyclists, with an effectiveness rate of 74% fatal reduction and a benefit-to-cost ratio of four times to the government. This study also finds that motorcyclists riding along EMCL who are not under substance influence, motorcyclists travelling during daytime and weekends (Saturdays and Sundays), and EMCL that are situated along Urban and EMCL with unpaved shoulders are predicted to be risky. However, when measured with traffic volume, EMCL may or may not be effective when evaluated based on the number of its utilisation or exposure. In conclusion, EMCL will save motorcyclists' lives and perform in the long term, albeit with strict enforcement of its usage and proper maintenance to accommodate safe motorcycle travel.

Understanding Sociodemographic Factors among Hispanics Through a Population-Based Study on Testicular Cancer in Mexico

AbstractTesticular cancer (TCa) is a rare malignancy affecting young men worldwide. Sociodemographic factors, especially socioeconomic level (SEL) and healthcare access, seem to impact TCa incidence and outcomes, particularly among Hispanic populations. However, limited research has explored these variables in Hispanic groups. This study aimed to investigate sociodemographic and clinical factors in Mexico and their role in health disparities among Hispanic TCa patients. We retrospectively analyzed 244 Mexican TCa cases between 2007 and 2020 of a representative cohort with diverse social backgrounds from a national reference cancer center. Logistic regression identified risk factors for fatality: non-seminoma histology, advanced stage, and lower education levels. Age showed a significant trend as a risk factor. Patient delay and healthcare distance lacked significant associations. Inadequate treatment response and chemotherapy resistance were more likely in advanced stages, while higher education positively impacted treatment response. Cox regression highlighted non-seminoma histology, below-median SEL, higher education, and advanced-stage survival rates. Survival disparities emerged based on tumor histology and patient SEL. This research underscores the importance of comprehensive approaches that integrate sociodemographic, biological, and environmental factors to address health disparities improving outcomes through personalized interventions in Hispanic individuals with TCa.

Risk Factors for Bleeding in Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation and Effects of Transcatheter Arterial Embolization for Hemostasis.

To evaluate risk factors for bleeding events in coronavirus disease 2019 (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) and to share the initial results of transcatheter arterial embolization (TAE) for hemostasis. Forty-three COVID-19 patients who received ECMO from May 2020 to September 2021 were enrolled in this study. Patients with sudden onset anemia immediately underwent computed tomography to assess bleeding. We compared laboratory data, duration of ECMO, hospitalization period, and fatality of patients' groups with and without significant hemorrhagic events using the chi-square test and Mann-Whitney U test. We also assessed the results of TAE in patients who received hemostasis. A total of 25 bleeding events occurred in 24 of the 43 patients. Age was a risk factor for bleeding events and fatality. The average duration of ECMO and hospitalization period were significantly longer in those with bleeding events (42.9 and 54.3 days) than in those without bleeding events (16.2 and 25.0 days) (p < 0.05). In addition, those with bleeding had higher fatality (45.8%) than those without (15.8%) (p < 0.05). Active extravasation was confirmed for 5 events in 4 of 24 patients. TAE was attempted and performed successfully in all but one of these four cases, in whom bleeding ceased spontaneously. Elderly COVID-19 patients on ECMO had a greater risk of bleeding complications and fatal outcomes. TAE was effective in providing prompt hemostasis for patients who have the treatment indication.

Risk Factors for Horse Fatality in Thoroughbred Jumps Racing in New Zealand.

The aim of this study was to examine the race-, horse- and jockey-level risk factors for race day fatality in New Zealand Thoroughbred jumps racing using retrospective race day data from the 2011/12 to 2021/22 seasons (n=8,970 starts). There were 51 race day fatalities resulting in an incidence rate of 5.7 per 1,000 starts (95% C.I. 4.3-7.5). The majority of fatalities were the result of fractures (44/51, 4.9 per 1,000 starts, 95% C.I. 3.7-6.6). Steeplechase and hurdle races had the same incidence of fatal fractures of 4.9 per 1,000 starts (95% C.I. 3.7-6.6, P > .05). Most (70.5%) of the fatal fractures were due to a horse falling during the race. In steeplechase races, horses running in races over 4,201 m were 5.0 times (95% C.I. 1.2-33.0) more likely to sustain a fatal fracture than horses in racing over shorter distances. In hurdle races, horses racing during spring were 2.2 times (95% C.I. 1.0-4.8) more likely to sustain a fatal fracture compared to winter. Due to the low number of suspected cardiac failures and fatal soft tissue injuries, risk factors for these fatalities could not be identified. These data provide a baseline to enable evidence-based regulatory changes and prospectively monitor the effectiveness of changes made.

Влияние диаметра инфраренальной аневризмы брюшной аорты на исход лечения

INTRODUCTION: Abdominal aortic aneurysm (AAA) is usually asymptomatic, and its first manifestation in most cases is a dissection or rupture, with a mortality rate exceeding 90%. Until now, the aspect of the possible effect of the diameter of the AAA on mortality after surgical treatment has not been practically studied. AIM: To study the influence of the size of AAA as a risk factor for fatality in its surgical treatment. MATERIALS AND METHODS: This study is retrospective. The study included 226 patients who underwent open and endovascular procedures for an infrarenal abdominal aortic aneurysm (iAAA) in the period 2011–2015 on the basis of the Department of Cardiovascular Surgery of the Ryazan State Medical University (Ryazan, Russia) and in 2011–2017 at the Republican Scientific Center of Cardiovascular Surgery (RSCSC) (Dushanbe, Tajikistan). There were 60 patients from Dushanbe and 166 from Ryazan. The work is part of a study on the treatment of patients with AAA and registered on the platform ClinicalTrials.gov (NCT04935268). RESULTS: Of the total number of patients with iAAA (n = 226), the number of males and females was 174 (77%) and 52 (23%), respectively, and the average age was 69.4 ± 2.6 years. The diameters of aneurysms in the RT and in the RF did not differ statistically significantly, the comorbidity rate per patient reached 1.84. In the RF and RT the number of operated patients for AAA was 31.3% and 26.7% (p &gt; 0.05), respectively. The average diameter of the AAA in patients who survived surgery for the treatment of iAAA was 57.0 mm [53.5; 60.5] and 59.0 mm [48.0; 73.0] (p &gt; 0.05, U = 2953.5; Z = 0.91), respectively. The diameter of the AAA in deceased patients after surgery (planned and rupture) in the RT and the RF is 60.0 mm [55.0; 65.5] and 72.0 mm [53.5; 80.5] (p &gt; 0.05, U = 129.0; Z = 1.14), respectively. In the RT, the size of the AAA is not associated with a fatal outcome (57.0 mm [53.5; 60.5] and 60.0 mm [55.0; 65.5]; p &gt; 0.05 (U = 207.0; Z = 1.49)). In the RF the size of the AAA in deceased patients was statistically significantly larger than in survivors — 72.0 mm [53.5; 80.5] and 59.0 mm [48.0; 73.0], respectively; p = 0.029 (U = 1394.5; Z = 2.18). The 30-day mortality rate after planned and emergency operations was comparable between the patients of the two clinics. CONCLUSION: The diameter of the AAA is a risk factor for the development of a fatal outcome after treatment.

Factors associated with the development of a lethal hospital outcome in patients with pulmonary embolism in different age groups

Background. The study of the tactics of managing patients with pulmonary embolism in the hospital period allows to find new approaches to treatment to reduce mortality. At the same time, it is known that the risk factors for death in patients of different age categories differ.&#x0D; Aim. To study the features of the course of the disease and risk factors for a fatal hospital outcome in patients with pulmonary embolism in different age groups of participants in the All-Russian registry, which was named SIRENA (RusSIan REgister of pulmoNAry embolism).&#x0D; Material and methods. The study included 570 patients with pulmonary embolism (database of the SIRENA multicenter registry in 20182019), who underwent a standard examination. They were divided into two groups according to age: the first group was 1869 years old inclusive (n=369), the second group was 70 years and older (n=201). Differences in clinical history, laboratory and instrumental parameters in the studied groups of patients were assessed. Statistical comparison of data was performed using the MannWhitney test, Pearson test, and Fisher's exact test. For a quantitative description of the closeness of the association of a sign with the outcome of the disease, the odds ratio with a 95% confidence interval was determined.&#x0D; Results. In the group of patients aged 1869 years, deaths occurred 3 times less frequently than in the group of patients aged 70 years and older (8.9 vs 26.3%; p 0.0001). The risk of death increases in the presence of atrial fibrillation by 2.6 times (p=0.032), anemia with hemoglobin 113 g/l by 4.3 times (p=0.0002), chronic kidney disease by 5.5 times (p=0.001), increase in blood creatinine 125 mmol/l 5.8 times (p 0.001). Additional risk factors in patients aged 70 years and older are ischemic heart disease (p=0.02), a history of stroke (p=0.003), and immobilization for 12 months prior to hospitalization (p 0.0001).&#x0D; Conclusion. In patients aged 1869 years, atrial fibrillation, anemia, and impaired renal function are fatal risk factors; at the age of 70 years and older, along with these, previous immobilization and comorbid cardiovascular pathology have an adverse effect.