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Berli S, Barbagallo M, Keller E, Esposito G, Pagnamenta A, Brandi G. Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:2781. [PMID: 38792323 PMCID: PMC11122382 DOI: 10.3390/jcm13102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objective: Sex-related differences among patients with aneurysmal subarachnoid hemorrhage (aSAH) and their potential clinical implications have been insufficiently investigated. To address this knowledge gap, we conduct a comprehensive systematic review and meta-analysis. Methods: Sex-specific differences in patients with aSAH, including mortality, delayed cerebral ischemia (DCI), and functional outcomes were assessed. The functional outcome was dichotomized into favorable or unfavorable based on the modified Rankin Scale (mRS), Glasgow Outcome Scale (GOS), and Glasgow Outcome Scale Extended (GOSE). Results: Overall, 2823 studies were identified in EMBASE, MEDLINE, PubMed, and by manual search on 14 February 2024. After an initial assessment, 74 studies were included in the meta-analysis. In the analysis of mortality, including 18,534 aSAH patients, no statistically significant differences could be detected (risk ratio (RR) 0.99; 95% CI, 0.90-1.09; p = 0.91). In contrast, the risk analysis for DCI, including 23,864 aSAH patients, showed an 11% relative risk reduction in DCI in males versus females (RR, 0.89; 95% CI, 0.81-0.97; p = 0.01). The functional outcome analysis (favorable vs. unfavorable), including 7739 aSAH patients, showed a tendency towards better functional outcomes in men than women; however, this did not reach statistical significance (RR, 1.02; 95% CI, 0.98-1.07; p = 0.34). Conclusions: In conclusion, the available data suggest that sex/gender may play a significant role in the risk of DCI in patients with aSAH, emphasizing the need for sex-specific management strategies.
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Affiliation(s)
- Sarah Berli
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Massimo Barbagallo
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Emanuela Keller
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
| | - Giuseppe Esposito
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Alberto Pagnamenta
- Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Intensive Care, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Division of Pneumology, University of Geneva, 1211 Geneva, Switzerland
| | - Giovanna Brandi
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
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Otoki K, Parker AS, Many HR, Parker RK. Gender Disparities in Complications, Costs, and Mortality After Emergency Gastrointestinal Surgery in Kenya. J Surg Res 2024; 295:846-852. [PMID: 37543494 DOI: 10.1016/j.jss.2023.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Little is known about the impact of gender on emergency surgery within Kenya. Therefore, we aimed to investigate the association of gender on outcomes of postoperative complications, health care costs, and mortality. METHODS We evaluated an established cohort of patients undergoing emergency gastrointestinal surgery in rural Kenya between January 1st, 2016 and June 30th, 2019. Utilizing logistic regression, we examined the association between self-reported patient gender and the outcomes of postoperative complications and mortality. A generalized linear model was created for total hospital costs, inflation-adjusted in international dollars purchasing power parity, to examine the impact of gender. Confounding factors were controlled by Africa Surgical Outcomes Study Surgical Risk Score. RESULTS Among 484 patients reviewed, 149 (30.8%) were women. 165 (34.1%) patients developed complications, with women experiencing more than men (40.9% versus 31.0%; P = 0.03) and longer hospital stays (median 6 days (4-9) versus 5 (4-7); P = 0.02). After controlling for Africa Surgical Outcomes Study Surgical Risk Score, odds of developing complications for women were 1.67 (95% confidence interval: 1.09-2.55; P = 0.019) times higher than men, and the odds of death were 2.38 (95% confidence interval: 1.12-5.09; P = 0.025) times greater for women than men, despite similar failure-to-rescue rates and intensive care unit utilization. Total hospital costs were increased for women by 531 international dollars purchasing power parity (117-946; P = 0.012) when compared to men, attributed to longer lengths of stay. CONCLUSIONS These findings demonstrate that a discrepancy exists between men and women undergoing emergency gastrointestinal surgery in our setting. Further exploration of the underlying causes of this inequity is necessary for quality improvement for women in rural Kenya.
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Affiliation(s)
- Kemunto Otoki
- Department of Surgery, Tenwek Hospital, Bomet, Kenya. https://twitter.com/kemuntootoki
| | - Andrea S Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya. https://twitter.com/AP_the_surgeon
| | - Heath R Many
- Department of Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
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Homma K, Liu K, Niimi Y, Fukuda S, Hirasawa Y, Baljinnyam T, Bazhanov N, Nawgiri R, Muthukumarana P, Lucas R, Prough D, Enkhbaatar P. GENDER-RELATED VARIATIONS IN PATHOPHYSIOLOGICAL RESPONSES TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS PNEUMONIA AND SEPSIS. Shock 2023; 59:810-819. [PMID: 36870071 DOI: 10.1097/shk.0000000000002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
ABSTRACT In preclinical studies, the protective effects of female sex hormones and the immunosuppressive effects of male sex hormones were demonstrated. However, gender-related differences in multiorgan failure and mortality in clinical trials have not been consistently explained. This study aims to investigate gender-related differences in the development and progression of sepsis using a clinically relevant ovine model of sepsis. Adult Merino male (n=7) and female (n=7) sheep were surgically prepared with multiple catheters before the study. To induce sepsis, bronchoscopy instilled methicillin-resistant Staphylococcus aureus into sheep's lungs. The time from the bacterial inoculation until the modified Quick Sequential Organ Failure Assessment (q-SOFA) score became positive was measured and analyzed primarily. We also compared the SOFA score between these male and female sheep over time. Survival, hemodynamic changes, the severity of pulmonary dysfunction, and microvascular hyperpermeability were also compared. The time from the onset of bacterial inoculation to the positive q-SOFA in male sheep was significantly shorter than in female sheep. Mortality was not different between these sheep (14% vs. 14%). There were no significant differences in hemodynamic changes and pulmonary function between the two groups at any time point. Similar changes in hematocrit, urine output, and fluid balance were observed between females and males. The present data indicate that the onset of multiple organ failure and progression of sepsis is faster in male sheep than in female sheep, even though the severity of cardiopulmonary function is comparable over time. Further studies are warranted to validate the above results.
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Affiliation(s)
- Kento Homma
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Keibun Liu
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Yosuke Niimi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Satoshi Fukuda
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | | | | | - Nikolay Bazhanov
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | | | - Rudolf Lucas
- Vascular Biology Center, Division of Pulmonary Critical Care Medicine, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Donald Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
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Cui L, Zha Y, Zhang C, Zhang H, Yu C, Rui H, Shao M, Liu N. Exploration of a nomogram prediction model of 30-day survival in adult ECMO patients. Front Med (Lausanne) 2023; 10:1062918. [PMID: 36926323 PMCID: PMC10011074 DOI: 10.3389/fmed.2023.1062918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Objective To investigate the factors of 30-day survival in ECMO patients, establish a nomogram model, and evaluate the predictive value of the model. Methods A total of 105 patients with extracorporeal membrane oxygenation (ECMO) were admitted to the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, from January 2018 to March 2021. Cox regression analysis screened out the risk factors. Based on the results of multivariate analysis, the nomogram model was established by using R software, and the discrimination of the model was verified by bootstrap and calibration. Results The results showed that sex, acute physiology and chronic health evaluation (APACHE) II score, disseminated intravascular coagulation (DIC) score before ECMO initiation and average daily dose of norepinephrine were independent risk factors for prognosis. Verify that the nomogram model is verified by bootstrap internally, and the corrected C-index is C-index: 0.886, showing a good degree of discrimination. The calibration curve (calibration) showed that the nomogram model had good agreement. The decision curve analysis(DCA) curve shows good clinical validity above the two extreme curves. Kaplan-Meier curves were drawn for patients in the tertile and compared with the first and second groups. The third group predicted the worst 30-day prognosis for ECMO patients. Conclusion The nomogram prediction model constructed based on the sex, APACHE II and DIC score, average daily dose of norepinephrine can effectively screen out the factors affecting the prognosis and provide a reference for individualized treatment of ECMO patients.
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Affiliation(s)
- Liangwen Cui
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yutao Zha
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng Zhang
- Department of Anhui Provincial Cancer Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Zhang
- Anhui Maternal and Child Health Hospital, Hefei, China
| | - Chao Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huang Rui
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Nian Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Brandi G, Stumpo V, Gilone M, Tosic L, Sarnthein J, Staartjes VE, Wang SSY, Van Niftrik B, Regli L, Keller E, Serra C. Sex-related differences in postoperative complications following elective craniotomy for intracranial lesions: An observational study. Medicine (Baltimore) 2022; 101:e29267. [PMID: 35801766 PMCID: PMC9259102 DOI: 10.1097/md.0000000000029267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The integration of sex-related differences in neurosurgery is crucial for new, possible sex-specific, therapeutic approaches. In neurosurgical emergencies, such as traumatic brain injury and aneurysmal subarachnoid hemorrhage, these differences have been investigated. So far, little is known concerning the impact of sex on frequency of postoperative complications after elective craniotomy. This study investigates whether sex-related differences exist in frequency of postoperative complications in patients who underwent elective craniotomy for intracranial lesion. MATERIAL AND METHODS All consecutive patients who underwent an elective intracranial procedure over a 2-year period at our center were eligible for inclusion in this retrospective study. Demographic data, comorbidities, frequency of postoperative complications at 24 hours following surgery and at discharge, and hospital length of stay were compared among females and males. RESULTS Overall, 664 patients were considered for the analysis. Of those, 339 (50.2%) were females. Demographic data were comparable among females and males. More females than males suffered from allergic, muscular, and rheumatic disorders. No differences in frequency of postoperative complications at 24 hours after surgery and at discharge were observed among females and males. Similarly, the hospital length of stay was comparable. CONCLUSIONS In the present study, no sex-related differences in frequency of early postoperative complications and at discharge following elective craniotomy for intracranial lesions were observed.
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Affiliation(s)
- Giovanna Brandi
- Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- * Correspondence: Giovanna Brandi, MD, Neurosurgical Intensive Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, CH-8006 Zurich, Switzerland. (e-mail: )
| | | | - Marco Gilone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli “Federico II,” Naples, Italy
| | - Lazar Tosic
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Victor E. Staartjes
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Bas Van Niftrik
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emanuela Keller
- Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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Howard SD, Kvint S, Borja AJ, Dimentberg R, Shultz K, Amankulor NM, McClintock SD, Malhotra NR. Matched analysis of patient gender and meningioma resection outcomes. Br J Neurosurg 2022; 36:613-619. [PMID: 35445630 DOI: 10.1080/02688697.2022.2064430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Gender is a known social determinant of health (SDOH) that has been linked to neurosurgical outcome disparities. To improve quality of care, there exists a need to investigate the impact of gender on procedure-specific outcomes. The objective of this study was to assess the role of gender on short- and long-term outcomes following resection of meningiomas - the most common benign brain neoplasm of adulthood - between exact matched patient cohorts. MATERIAL AND METHODS All consecutive patients undergoing supratentorial meningioma resection (n = 349) at a single, university-wide health system over a 6-year period were analyzed retrospectively. Coarsened exact matching was employed to match patients on numerous key characteristics related to outcomes. Primary outcomes included readmission, ED visit, reoperation, and mortality within 30 and 90 days of surgery. Mortality and reoperation were also assessed during the entire follow-up period. Outcomes were compared between matched female and male cohorts. RESULTS Between matched cohorts, no significant difference was observed in morbidity or mortality at 30 days (p = 0.42-0.75), 90-days (p = 0.23-0.69), or throughout the follow-up period (p = 0.22-0.45). Differences in short-term mortality could not be assessed due to the low number of mortality events. CONCLUSIONS After matching on characteristics known to impact outcomes and when isolated from other SDOHs, gender does not independently affect morbidity and mortality following meningioma resection. Further research on the role of other SDOHs in this population is merited to better understand underlying drivers of disparity.
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Affiliation(s)
- Susanna D Howard
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Svetlana Kvint
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Dimentberg
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kaitlyn Shultz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Nduka M Amankulor
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA
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Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis. Crit Care Med 2022; 50:913-923. [PMID: 35148525 DOI: 10.1097/ccm.0000000000005469] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate and synthesize the available literature on sex differences in the treatment of adult ICU patients. DATA SOURCES MEDLINE and EMBASE. STUDY SELECTION Two reviewers independently screened publications to identify observational studies of adult ICU patients that explicitly examined the association between sex and ICU treatment-specifically, mechanical ventilation, renal replacement therapy, and length of stay. DATA EXTRACTION We extracted data independently and in duplicate: mean age, illness severity, use of mechanical ventilation and renal replacement therapy, and length of stay in ICU and hospital. We assessed risk of bias using the Newcastle-Ottawa Scale. We used a DerSimonian-Laird random-effects model to calculate pooled odds ratios (ORs) and mean differences between women and men. DATA SYNTHESIS We screened 4,098 publications, identifying 21 eligible studies with 545,538 participants (42.7% women). The study populations ranged from 246 to 261,255 participants (median 4,420). Most studies (76.2%) were at high risk of bias in at least one domain, most commonly representativeness or comparability. Women were less likely than men to receive invasive mechanical ventilation (OR, 0.83; 95% CI, 0.77-0.89; I2 = 90.4%) or renal replacement therapy (OR, 0.79; 95% CI, 0.70-0.90; I2 = 76.2%). ICU length of stay was shorter in women than men (mean difference, -0.24 d; 95% CI, -0.37 to -0.12; I2 = 89.9%). These findings persisted in meta-analysis of data adjusted for illness severity and other confounders and also in sensitivity analysis excluding studies at high risk of bias. There was no significant sex difference in duration of mechanical ventilation or hospital length of stay. CONCLUSIONS Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses.
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Bögli SY, Utebay D, Smits N, Westphal LP, Hirsbrunner L, Unseld S, Keller E, Brandi G. Sex-related differences of invasive therapy in patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2022; 164:2899-2908. [PMID: 35986220 PMCID: PMC9613555 DOI: 10.1007/s00701-022-05345-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sex-related differences in patients with aneurysmal subarachnoid hemorrhage (aSAH) exist. More females than males are affected. Aneurysm location is associated to sex. The relationship between sex and outcome, however, is unclear. Possible differences in management might influence the occurrence of primary and secondary brain injury and thus outcome. The study compares demographics, intensity of treatment, complications, and outcome among females and males with aSAH. METHODS All consecutive patients with aSAH admitted to the neurocritical care unit, University Hospital Zurich over a 5-year period were eligible in this retrospective study. Patients' characteristics, comorbidities, aSAH severity, frequency of vasospasm/delayed cerebral ischemia, frequency of invasive interventions, and 3-month outcome were compared by sex. Univariate analysis was performed with the data dichotomized by sex, and outcome. Multivariate analysis for prediction of outcomes was performed. RESULTS Three hundred forty-eight patients were enrolled (64% females). Women were older than men. Comorbidities, scores at admission, and treatment modality were comparable among males and females. Vasospasm and DCI occurred similarly among females and males. Interventions and frequency of intraarterial spasmolysis were comparable between sexes. In the multivariate analysis, increasing age, female sex, increasing comorbidities, WFNS and Fisher grade, and presence of delayed cerebral ischemia were predictors of unfavorable outcome when considering all patients. However, after excluding death as a possible outcome, sex did not remain a predictor of unfavorable outcome. CONCLUSIONS In the study population, women with aSAH might have present a worse outcome at 3 months. However, no differences by sex that might explain this difference were found in intensity of treatment and management.
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Affiliation(s)
- S. Y. Bögli
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - D. Utebay
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - N. Smits
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - L. P. Westphal
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - L. Hirsbrunner
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - S. Unseld
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - E. Keller
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - G. Brandi
- grid.412004.30000 0004 0478 9977Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Joundi RA, Smith EE, Yu AYX, Rashid M, Fang J, Kapral MK. Age-Specific and Sex-Specific Trends in Life-Sustaining Care After Acute Stroke. J Am Heart Assoc 2021; 10:e021499. [PMID: 34514807 PMCID: PMC8649550 DOI: 10.1161/jaha.121.021499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Temporal trends in life‐sustaining care after acute stroke are not well characterized. We sought to determine contemporary trends by age and sex in the use of life‐sustaining care after acute ischemic stroke and intracerebral hemorrhage in a large, population‐based cohort. Methods and Results We used linked administrative data to identify all hospitalizations for acute ischemic stroke or intracerebral hemorrhage in the province of Ontario, Canada, from 2003 to 2017. We calculated yearly proportions of intensive care unit admission, mechanical ventilation, percutaneous feeding tube placement, craniotomy/craniectomy, and tracheostomy. We used logistic regression models to evaluate the association of age and sex with life‐sustaining care and determined whether trends persisted after adjustment for baseline factors and estimated stroke severity. There were 137 358 people with acute ischemic stroke or intracerebral hemorrhage hospitalized during the study period. Between 2003 and 2017, there was an increase in the proportion receiving care in the intensive care unit (12.4% to 17.7%) and mechanical ventilation (4.4% to 6.6%). There was a small increase in craniotomy/craniectomy, a decrease in percutaneous feeding tube use, and no change in tracheostomy. Trends were generally consistent across stroke types and persisted after adjustment for comorbid conditions, stroke‐center type, and estimated stroke severity. After adjustment, women and those aged ≥80 years had lower odds of all life‐sustaining care, although the disparities in intensive care unit admission narrowed over time. Conclusions Use of life‐sustaining care after acute stroke increased between 2003 and 2017. Women and those at older ages had lower odds of intensive care, although the differences narrowed over time. Further research is needed to determine the reasons for these findings.
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Affiliation(s)
- Raed A Joundi
- ICES Toronto Canada.,Department of Clinical Neurosciences Cumming School of MedicineUniversity of Calgary Calgary Canada.,Division of Neurology Hamilton Health Sciences McMaster University & Population Health Research Institute Hamilton Canada
| | - Eric E Smith
- ICES Toronto Canada.,Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary Calgary Canada
| | - Amy Y X Yu
- ICES Toronto Canada.,Department of Medicine (Neurology) Sunnybrook Health Sciences Centre University of Toronto Toronto Canada
| | | | | | - Moira K Kapral
- ICES Toronto Canada.,Department of Medicine Division of General Internal Medicine University of Toronto Toronto Canada.,Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Canada
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Modra L, Higgins A, Vithanage R, Abeygunawardana V, Bailey M, Bellomo R. Sex differences in illness severity and mortality among adult intensive care patients: A systematic review and meta-analysis. J Crit Care 2021; 65:116-123. [PMID: 34118502 DOI: 10.1016/j.jcrc.2021.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the association between sex and illness severity and mortality of ICU patients. METHODS We performed systematic searches of MEDLINE and EMBASE for observational studies of adult ICU patients that explicitly examined the association between sex and illness severity or mortality. We used a random effects model to calculate standardised mean differences in illness severity scores and pooled odds ratios for mortality of women compared to men. RESULTS We identified 21 studies with 505,138 participants in total (43.1% women). There was substantial heterogeneity among studies. Only two studies were at low risk of bias overall. At ICU admission, there was a pattern of higher illness severity scores among women (standardised mean difference 0.04, 95% CI -0.01-0.09). Women had higher risk-adjusted mortality than men at ICU discharge (OR 1.25 95% CI 1.03-1.50) and 1 year (OR 1.08, 95% CI 1.02-1.13), however this finding was not robust to sensitivity analysis. CONCLUSIONS Women tend to have higher illness severity scores at ICU admission. Women also appear to have higher risk-adjusted mortality than men at ICU discharge and at 1 year. Given the heterogeneity and risk of bias in the existing literature, additional studies are needed to confirm or refute these findings.
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Affiliation(s)
- Lucy Modra
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Alisa Higgins
- Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | - Michael Bailey
- Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia; Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Dwyer R, Kalin M. Significance of the physician's and the patient's sex in hospitalized patients with community-acquired pneumonia. Infect Dis (Lond) 2021; 53:538-545. [PMID: 33750259 DOI: 10.1080/23744235.2021.1900906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Numerous studies have revealed that the sex of the patient or of the attending physician have impact on patient care, treatment, morbidity and mortality. Community-acquired pneumonia (CAP) is a common cause of hospitalization, antibiotic treatment and intensive care unit (ICU) admission. The purpose of this study was to examine if the patient's or the attending physicians' sex may influence the management of hospitalized patients with CAP. METHODS Our study included 826 consecutive inpatients with CAP (404 females, and 422 male patients, 429 patients initially treated by a female physician and 397 patients initially treated by a male physician). We examined if the patient's, or the initial attending physician's sex, affected treatment and outcome in patients with CAP. RESULTS Patients mean age was 69 years, 30-day mortality 9%. By use of the pneumonia severity index, male patients were found to be more severely ill at admission (p = .0008). Fewer female physicians' patients were admitted from the emergency department (ED) to the ICU when compared to male physicians' patients, 5% versus 10% (p = .006), and female physicians' patients received their first intravenous (IV) antibiotic dose later than male physicians' patients in the ED (p = .003). CONCLUSION Our study indicates that the sex of the attending physician may affect the chosen level of care and antibiotic treatment, and that admitted male patients with CAP were more seriously ill than admitted female patients with CAP.
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Affiliation(s)
- Richard Dwyer
- Department of Infectious Diseases/Venhälsan, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mats Kalin
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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12
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IJsbrandy C, Ottevanger PB, Gerritsen WR, van Harten WH, Hermens RPMG. Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study. J Cancer Surviv 2020; 15:163-177. [PMID: 32986232 PMCID: PMC7822788 DOI: 10.1007/s11764-020-00921-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands. .,Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. .,Department of Radiation Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, MB-HTSR, University of Twente, Enschede, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
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13
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Barbagelata E, Cillóniz C, Dominedò C, Torres A, Nicolini A, Solidoro P. Gender differences in community-acquired pneumonia. Minerva Med 2020; 111:153-165. [PMID: 32166931 DOI: 10.23736/s0026-4806.20.06448-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is the most common type of lower respiratory tract infection and a major cause of morbidity and mortality in adults worldwide. Sex and gender play an active role in the incidence and outcomes of major infectious diseases, including CAP. EVIDENCE ACQUISITION We searched the following electronic databases from January 2001 to December 2018: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), Cochrane Database of Systematic Reviews and ACP Journal Club database. EVIDENCE SYNTHESIS Several studies have reported higher male susceptibility to pulmonary infections and higher risk of death due to sepsis. Biological differences (e.g. hormonal cycles and cellular immune-mediated responses) together with cultural, behavioral and socio-economic differences are important determinants of the course and outcome of CAP. However, gender-related bias in the provision of care and use of hospital resources has been reported among women, resulting in delayed hospital admission and consequently necessary care. CONCLUSIONS CAP is more severe in males than in females, leading to higher mortality in males, especially in older age. To identify gender differences in CAP can guide patient's prognostication and management.
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Affiliation(s)
- Elena Barbagelata
- Department of Internal Medicine, General Hospital, Sestri Levante, Genoa, Italy
| | - Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Antonello Nicolini
- Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy -
| | - Paolo Solidoro
- Unit of Pneumology U, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
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14
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Rucker D, Warkentin LM, Huynh H, Khadaroo RG. Sex differences in the treatment and outcome of emergency general surgery. PLoS One 2019; 14:e0224278. [PMID: 31682610 PMCID: PMC6827895 DOI: 10.1371/journal.pone.0224278] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/09/2019] [Indexed: 01/01/2023] Open
Abstract
Background Sociodemographic characteristics, such as sex, have been shown to influence health care delivery. Acute care surgery models are effective in decreasing mortality and morbidity after emergency surgeries, but sex-based differences in delivery and outcomes have not been explored. Our objective was to explore sex associated differences in the patient characteristics and clinical outcomes of those admitted to emergency general surgery. Methods A post-hoc analysis of 512 emergency general surgical patients admitted consecutively to two tertiary care hospitals in Alberta Canada, between April 1, 2014 and July 31, 2015. We measured associations between sex and patient demographics, pre-, intra- and post-operative delivery of care, as well as post-operative outcomes. Findings Of those excluded from the analysis, older females were more likely to undergo conservative management compared to older men (41% vs 34%, p = 0.03). Overall, there were no differences between sexes for time from admission to surgery, time spent in surgery, overall complication rate, mortality, hospital length of stay, or discharge disposition. Women were more likely to have a cancer diagnosis [OR 4.12 (95% CI: 1.61–10.5), p = 0.003, adjusted for age], while men were more likely to receive hernia surgery [OR 2.33 (95% CI 1.35–4.02), p = 0.002, adjusted for age and Charlson Comorbidity Index]. Finally, men were more likely to have a major respiratory complication [OR 2.73 (95% CI: 1.19–6.24), p = 0.02, adjusted for age]. Conclusions Only two differences in peri and post-operative complications between sexes were noted, which suggests sex-based disparity in quality of care is limited once a decision has been made to operate. Future studies with larger databases are needed to corroborate our findings and investigate potential sex biases in surgical versus conservative management.
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Affiliation(s)
- Diana Rucker
- Department of Medicine, Division of Geriatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Hanhmi Huynh
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rachel G. Khadaroo
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- * E-mail:
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15
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Bassford C, Griffiths F, Svantesson M, Ryan M, Krucien N, Dale J, Rees S, Rees K, Ignatowicz A, Parsons H, Flowers N, Fritz Z, Perkins G, Quinton S, Symons S, White C, Huang H, Turner J, Brooke M, McCreedy A, Blake C, Slowther A. Developing an intervention around referral and admissions to intensive care: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BackgroundIntensive care treatment can be life-saving, but it is invasive and distressing for patients receiving it and it is not always successful. Deciding whether or not a patient will benefit from intensive care is a difficult clinical and ethical challenge.ObjectivesTo explore the decision-making process for referral and admission to the intensive care unit and to develop and test an intervention to improve it.MethodsA mixed-methods study comprising (1) two systematic reviews investigating the factors associated with decisions to admit patients to the intensive care unit and the experiences of clinicians, patients and families; (2) observation of decisions and interviews with intensive care unit doctors, referring doctors, and patients and families in six NHS trusts in the Midlands, UK; (3) a choice experiment survey distributed to UK intensive care unit consultants and critical care outreach nurses, eliciting their preferences for factors used in decision-making for intensive care unit admission; (4) development of a decision-support intervention informed by the previous work streams, including an ethical framework for decision-making and supporting referral and decision-support forms and patient and family information leaflets. Implementation feasibility was tested in three NHS trusts; (5) development and testing of a tool to evaluate the ethical quality of decision-making related to intensive care unit admission, based on the assessment of patient records. The tool was tested for inter-rater and intersite reliability in 120 patient records.ResultsInfluences on decision-making identified in the systematic review and ethnographic study included age, presence of chronic illness, functional status, presence of a do not attempt cardiopulmonary resuscitation order, referring specialty, referrer seniority and intensive care unit bed availability. Intensive care unit doctors used a gestalt assessment of the patient when making decisions. The choice experiment showed that age was the most important factor in consultants’ and critical care outreach nurses’ preferences for admission. The ethnographic study illuminated the complexity of the decision-making process, and the importance of interprofessional relationships and good communication between teams and with patients and families. Doctors found it difficult to articulate and balance the benefits and burdens of intensive care unit treatment for a patient. There was low uptake of the decision-support intervention, although doctors who used it noted that it improved articulation of reasons for decisions and communication with patients.LimitationsLimitations existed in each of the component studies; for example, we had difficulty recruiting patients and families in our qualitative work. However, the project benefited from a mixed-method approach that mitigated the potential limitations of the component studies.ConclusionsDecision-making surrounding referral and admission to the intensive care unit is complex. This study has provided evidence and resources to help clinicians and organisations aiming to improve the decision-making for and, ultimately, the care of critically ill patients.Future workFurther research is needed into decision-making practices, particularly in how best to engage with patients and families during the decision process. The development and evaluation of training for clinicians involved in these decisions should be a priority for future work.Study registrationThe systematic reviews of this study are registered as PROSPERO CRD42016039054, CRD42015019711 and CRD42015019714.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The University of Aberdeen and the Chief Scientist Office of the Scottish Government Health and Social Care Directorates fund the Health Economics Research Unit.
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Affiliation(s)
- Chris Bassford
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Anaesthesia, Critical Care and Pain, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Mia Svantesson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mandy Ryan
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicolas Krucien
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Rees
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Agnieszka Ignatowicz
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nadine Flowers
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Zoe Fritz
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Acute Medicine, Cambridge University Hospitals NHS Trust, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Gavin Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Sarah Quinton
- Warwick Medical School, University of Warwick, Coventry, UK
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | - Huayi Huang
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jake Turner
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mike Brooke
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Aimee McCreedy
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Caroline Blake
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Anne Slowther
- Warwick Medical School, University of Warwick, Coventry, UK
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16
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Block L, Petzold M, Syrous AN, Lindqvist B, Odenstedt Hergès H, Naredi S. Age, SAPS 3 and female sex are associated with decisions to withdraw or withhold intensive care. Acta Anaesthesiol Scand 2019; 63:1210-1215. [PMID: 31190331 DOI: 10.1111/aas.13411] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/05/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care. METHODS Registry study using data from the Swedish Intensive Care Registry (SIR) 2014-2016. Age, condition at admission, including co-morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group. RESULTS Of all 97 095 cases, 47.1% were 61-80 years old, 41.9% were women and 58.1% men. 14 996 (15.4%) were allocated to the WW group and 82 149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P < 0.001), had higher SAPS 3 (P < 0.001) and were predominantly female (P < 0.001). Compared to patients 16-20 years old, patients >81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084-1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13- 1.23). CONCLUSION Older age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care.
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Affiliation(s)
- Linda Block
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Max Petzold
- Department of Public Health and Community Medicine, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Alma Nordenskjöld Syrous
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Birgitta Lindqvist
- Department of Anesthesiology and Intensive Care Northern Älvsborgs Hospital, Region Västra Götaland Trollhättan Sweden
| | - Helena Odenstedt Hergès
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Silvana Naredi
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
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17
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Healthcare utilisation and cost expenditures for pneumonia in individuals with diabetes mellitus in the USA. Epidemiol Infect 2019; 147:e212. [PMID: 31364575 PMCID: PMC6624864 DOI: 10.1017/s0950268819000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pneumonia is one of the leading causes of hospitalisations among adults in the USA. Individuals with diabetes mellitus (DM) have been associated with increased risk for pneumonia and complications including death. The objectives of this study were to (1) compare the prevalence and healthcare utilisation patterns for pneumonia in individuals with and without DM, and (2) identify risk factors for pneumonia in those with DM. We performed a retrospective, cross-sectional analysis of the US adult population using Medical Expenditure Panel Surveys (MEPS) data from 2014. Overall, the data represented 24 million individuals with DM and 218 million without DM in the USA. The population-based rate for a pneumonia event was 34 per 1000 persons for individuals with DM and 19 per 1000 persons without DM. Compared to the non-DM group, individuals with DM were treated 1.8x, 2.6x and 1.4x more in the ED, hospital and outpatient, respectively. Furthermore, the average cost per pneumonia event was significantly higher among individuals with DM compared to non-DM in the inpatient setting ($11 931 vs. $7751; P < 0.001). Among individuals with DM, female sex, DM complications, smokers and administration of pneumococcal vaccines were significant factors associated with a pneumonia event.
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18
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Hollinger A, Gayat E, Féliot E, Paugam-Burtz C, Fournier MC, Duranteau J, Lefrant JY, Leone M, Jaber S, Mebazaa A, Arrigo M. Gender and survival of critically ill patients: results from the FROG-ICU study. Ann Intensive Care 2019; 9:43. [PMID: 30927096 PMCID: PMC6441070 DOI: 10.1186/s13613-019-0514-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Few studies analyzed gender-related outcome differences of critically ill patients and found inconsistent results. This study aimed to test the independent association of gender and long-term survival of ICU patients.
Materials and methods FROG-ICU was a prospective, observational, multi-center cohort designed to investigate the long-term mortality of critically ill adult patients. The primary endpoint of this study was 1-year mortality after ICU admission of women compared to men. Results The study included 2087 patients, 726 women and 1361 men. Women and men had similar baseline characteristics, clinical presentation, and disease severity. No significant difference in 1-year mortality was found between women and men (34.9% vs. 37.9%, P = 0.18). After multivariable adjustment, no difference in the hazard of death was observed [HR 0.99 (95% CI 0.77–1.28)]. Similar 1-year survival between women and men was found in a propensity score-matched patient cohort of 506 patients [HR 0.79 (95% CI 0.54–1.14)].
Conclusion Women constituted one-third of the population of critically ill patients and were unexpectedly similar to men regarding demographic characteristics, clinical presentation, and disease severity and had similar risk of death at 1 year after ICU admission. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011. Electronic supplementary material The online version of this article (10.1186/s13613-019-0514-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexa Hollinger
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France.,Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Elodie Féliot
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Catherine Paugam-Burtz
- Anesthesiology and Perioperative Care Medicine Department, APHP Hopital Beaujon and University, Paris 7, France
| | - Marie-Céline Fournier
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Jacques Duranteau
- Département d'Anesthésie-Réanimation, UMR 942, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Yves Lefrant
- Service des Réanimations, CHU Nîmes, Place du Pr Robert Debré, 30029, Nîmes Cedex, France
| | - Marc Leone
- Department of Anaesthesiology and Critical Care Medicine, AP-HM, Hôpital Nord, Marseille, France
| | - Samir Jaber
- Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France.,PhyMedExp, INSERM U-1046, CNRS, Montpellier University, Montpellier, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France. .,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France. .,Department of Anesthesiology and Intensive Care, Saint Louis - Lariboisière University Hospitals, 2 rue Ambroise Paré, 75010, Paris, France.
| | - Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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19
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Relationship between height and outcomes among critically ill adults: a cohort study. Intensive Care Med 2018; 44:2122-2133. [PMID: 30421257 DOI: 10.1007/s00134-018-5441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Many diagnostic and therapeutic interventions for critically ill adult patients are not performed according to patient size, but are standardized for an idealized 174-cm man (ideal body weight 70 kg). This study aims to determine whether critically ill patients with heights significantly different from a standardized patient have higher hospital mortality or greater resource utilization. METHODS Retrospective cohort study of consecutive patients admitted to 210 intensive care units (ICUs) in the United Kingdom participating in the Intensive Care National Audit and Research Centre's Case Mix Programme Database from April 1, 2009, to March 31, 2015. Primary outcome was hospital mortality, adjusted for age, comorbid disease, severity of illness, socioeconomic status and body mass index, using hierarchical modeling to account for clustering by ICU. Data were stratified by sex, and the effect of height was modeled continuously using restricted cubic splines. RESULTS The cohort included 233,308 men and 184,070 women, with overall hospital mortality of 22.5% and 20.6%, respectively. After adjustment for potential confounders, hospital mortality decreased with increasing height; predicted mortality (holding all other covariates at their mean value) decreased from 24.1 to 17.1% for women and from 29.2 to 21.0% for men across the range of heights. Similar patterns were observed for ICU mortality and several additional secondary outcomes. CONCLUSIONS Short stature may be a risk factor for mortality in critically ill patients. Further work is needed to determine which unmeasured patient characteristics and processes of care may contribute to the increased risk observed.
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20
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Forsblom E, Kakriainen A, Ruotsalainen E, Järvinen A. Comparison of patient characteristics, clinical management, infectious specialist consultation, and outcome in men and women with methicillin-sensitive Staphylococcus aureus bacteremia: a propensity-score adjusted retrospective study. Infection 2018; 46:837-845. [PMID: 30194636 DOI: 10.1007/s15010-018-1216-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sex-related treatment inequalities are suggested to explain outcome differences between men and women in Staphylococcus aureus bacteremia (SAB). We compared patient characteristics, clinical management, infectious specialist consultation (ISC) and outcome in men and women with SAB. METHODS Multicenter retrospective study of methicillin-sensitive (MS-) SAB patients categorized according to sex and ISC consultation provided within 7 days of diagnosis. RESULTS Altogether 617 SAB patients were included in the analysis: 62% males and 38% females. Male sex was associated less often to nosocomial bacteremia (OR 0.69, 95% CI 0.50-0.96, p = 0.029) and more often to alcoholism (OR 2.25, 95% CI 1.31-3.87, p = 0.003). No sex-related differences were seen in basic or immunologic laboratory tests, illness severity, intensive care unit treatment or thromboembolic events. ISC was provided to most patients (94%) irrespective of sex. No differences were seen in clinical management of men or women: Transthoracic or -esophageal echocardiography (61% vs. 65%), deep infection (77% vs. 72%), infection removal (30% vs. 27%) and anti-staphylococcal antibiotics as first-line treatment (54% vs. 51%). However, male sex was connected to more frequent adjunctive rifampicin treatment (52% vs. 41%, p = 0.025). No difference in 28- or 90-day mortality (13% vs. 13% and 18% vs. 20%) or SAB relapse (0% vs. 1%) was observed between men and women. Propensity-score adjusted Cox proportional analysis gave no connection of sex to mortality within 90 days. CONCLUSION Patient characteristics, clinical management, ISC guidance, bacteremia relapse, and outcome did not differ in men and women with MS-SAB.
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Affiliation(s)
- E Forsblom
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland.
| | - A Kakriainen
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland
| | - E Ruotsalainen
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland
| | - A Järvinen
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland
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Is a stepdown unit safe for patients with mild traumatic intracranial hemorrhages? Eur J Trauma Emerg Surg 2017; 44:897-901. [PMID: 29127440 DOI: 10.1007/s00068-017-0867-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Traumatic brain injuries (TBIs) are a major source of disability in the United States. The ideal unit in the hospital for patients with mild traumatic intracranial hemorrhages (ICHs) has not been elucidated. We sought to investigate whether patients treated in the surgical stepdown area had worse outcomes than those treated in the surgical ICU. METHODS We compared patients with ICHs and a Glasgow Coma Scale (GCS) upon admission of 14 or 15 who went to the ICU to those who went to the stepdown area from April 2014 to November 2016. We compared age, gender, Injury Severity Score (ISS), admission GCS (14 or 15), operative intervention, discharge destination, hospital length of stay (HLOS), mortality, and cost between these two groups. RESULTS Patients admitted to the ICU had a significantly longer HLOS. Admission costs for patients admitted to ICU were also significantly higher than their stepdown area counterparts. This was true for both total charges (p = 0.0001) and for net revenue (p = 0.002) (Table 2). There was no statistically significant difference in mortality, operative intervention, or discharge destination. CONCLUSION A surgical stepdown unit can be a safe disposition for patients with mild traumatic ICHs and represents an effective use of hospital resources.
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Tacconelli E, Foschi F. Does gender affect the outcome of community-acquired Staphylococcus aureus bacteraemia? Clin Microbiol Infect 2016; 23:23-25. [PMID: 27665701 DOI: 10.1016/j.cmi.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- E Tacconelli
- Infectious Diseases, Internal Medicine I, DZIF Centre, University Hospital of Tübingen, Tübingen, Germany.
| | - F Foschi
- Infectious Diseases, Internal Medicine I, DZIF Centre, University Hospital of Tübingen, Tübingen, Germany
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Kokturk N, Kilic H, Baha A, Lee SD, Jones PW. Sex Difference in Chronic Obstructive Lung Disease. Does it Matter? A Concise Review. COPD 2016; 13:799-806. [PMID: 27398767 DOI: 10.1080/15412555.2016.1199666] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chronic obstructive lung disease (COPD) primarily affects men; however, its epidemiology has been changing because more women have become smokers. Recently, investigators found that although women and men were exposed to the same amount of smoke fume, women tended to have more severe disease and higher mortality rate. They also complain of more dyspnoea and may experience more severe exacerbations than men. This led to the question of whether sex has an impact on COPD course and whether women have a higher susceptibility to smoke fumes than men. That may be explained by multiple complex factors highlighting the relationship between sex, epidemiology, method of diagnostics and the clinical course of the disease. In this review, sex differences in epidemiology, clinical presentation, exacerbation, co-morbidities and treatment are covered.
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Affiliation(s)
- Nurdan Kokturk
- a Department of Pulmonary Medicine , School of Medicine, Gazi University , Ankara , Turkey
| | - Hatice Kilic
- b Clinic of Chest Diseases , Ankara Ataturk Training and Research Hospital , Ankara , Turkey
| | - Ayse Baha
- c Department of Pulmonary Medicine , School of Medicine, Ufuk University , Ankara , Turkey
| | - S D Lee
- d Department of Pulmonary and Critical Care Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | - Paul W Jones
- e Department of Pulmonology, Clinical Science Center , St George University School of Medicine , London , UK
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Larsson E, Zettersten E, Jäderling G, Ohlsson A, Bell M. The influence of gender on ICU admittance. Scand J Trauma Resusc Emerg Med 2015; 23:108. [PMID: 26702646 PMCID: PMC4690252 DOI: 10.1186/s13049-015-0191-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/12/2015] [Indexed: 12/04/2022] Open
Abstract
Background We assume that critically ill patients are admitted to an intensive care unit (ICU) based on their illness severity coupled with their co-morbidities. Patient attributes such as religion, nationality, socioeconomic class or gender are not relevant in this setting. We aimed to explore the association of patient gender with admission to the ICU amongst hospital physicians working in Sweden. Methods Primary outcome assessed was gender bias among respondents. Two different versions of an online survey, with eight patient cases, were sent to physicians in Sweden who within their field of specialty meet patients that could be eligible for intensive care. The versions of the survey were identical except that the patient gender in each case was exchanged between the two surveys. Depending on the respondent’s birthday (odd or even number) they were directed to one of the two surveys. At the end of each case the respondent was asked to answer if they thought that the patient needed ICU care, yes or no. The respondents were not told in advance about the design of the survey. The respondents were also asked to state their age, sex, field of specialty, size of hospital and title. Results Of 1426 respondents, 679 and 747 answered survey 1 and 2, respectively. Overall, there were no significant differences in willingness to admit in between cases describing a man or woman in the physician responses. Discussion Anesthesiology/intensive care physicians more often choose to admit patients to the ICU compared to all other specialties. Female physicians tended to be more willing to admit patients, regardless of patient gender, than their male counterparts. Conclusions Using a survey, with eight cases differing only with regards to the gender of the patient, we demonstrate an absence of a gender bias among Swedish hospital physicians. Electronic supplementary material The online version of this article (doi:10.1186/s13049-015-0191-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Larsson
- Department of Anaesthesia, Surgical Services and Intensive Care (ANOPIVA) F2:00, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Erik Zettersten
- Department of Anaesthesia, Surgical Services and Intensive Care (ANOPIVA) F2:00, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriella Jäderling
- Department of Anaesthesia, Surgical Services and Intensive Care (ANOPIVA) F2:00, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Ohlsson
- Department of Anaesthesia, Surgical Services and Intensive Care (ANOPIVA) F2:00, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.
| | - Max Bell
- Department of Anaesthesia, Surgical Services and Intensive Care (ANOPIVA) F2:00, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
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Kilic H, Kokturk N, Sari G, Cakır M. Do females behave differently in COPD exacerbation? Int J Chron Obstruct Pulmon Dis 2015; 10:823-30. [PMID: 25977604 PMCID: PMC4418390 DOI: 10.2147/copd.s78952] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Little is known about whether there is any sex effect on chronic obstructive lung disease (COPD) exacerbations. This study is intended to describe the possible sex-associated differences in exacerbation profile in COPD patients. METHODS A total of 384 COPD patients who were hospitalized due to exacerbation were evaluated retrospectively for their demographics and previous and current exacerbation characteristics. RESULTS The study was conducted on 109 (28%) female patients and 275 (72%) male patients. The mean age was 68.30±10.46 years. Although females had better forced expiratory volume in 1 second and near-normal forced vital capacity, they had much impaired arterial blood gas levels (partial oxygen pressure [PO2] was 36.28 mmHg vs 57.93 mmHg; partial carbon dioxide pressure [PCO2] was 45.97 mmHg vs 42.49 mmHg; P=0.001), indicating severe exacerbation with respiratory failure. More females had two exacerbations and two hospitalizations, while more men had one exacerbation and one hospitalization. Low adherence to treatment and pulmonary embolism were more frequent in females. Females had longer time from the onset of symptoms till the admission and longer hospitalization duration than males. Comorbidities were less in number and different in women (P<0.05). Women were undertreated and using more oral corticosteroids. CONCLUSION Current data showed that female COPD patients might be more prone to have severe exacerbations, a higher number of hospitalizations, and prolonged length of stay for hospitalization. They have a different comorbidity profile and might be undertreated for COPD.
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Affiliation(s)
- Hatice Kilic
- Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, Gazi University, Ankara, Turkey
| | - Nurdan Kokturk
- Department of Pulmonary Medicine, School of Medicine, Gazi University School of Medicine, Gazi University, Ankara, Turkey
| | - Gulcin Sari
- Department of Pulmonary Medicine, Dr. Nafiz Körez Sincan Devlet Hastanesi, Gazi University, Ankara, Turkey
| | - Mustafa Cakır
- Department of Public Health, School of Medicine, Gazi University, Ankara, Turkey
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Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:129. [PMID: 25887421 PMCID: PMC4407397 DOI: 10.1186/s13054-015-0873-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/11/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Preclinical data indicate that oestrogen appears to play a beneficial role in the pathophysiology of and recovery from critical illness. In few previous epidemiologic studies, however, have researchers analysed premenopausal women as a separate group when addressing potential gender differences in critical care outcome. Our aim was to see if women of premenopausal age have a better outcome following critical care and to investigate the association between gender and use of intensive care unit (ICU) resources. METHODS On the basis of our analysis of 127,254 consecutive Simplified Acute Physiology Score III-scored Swedish Intensive Care Registry ICU admissions from 2008 through 2012, we determined the risk-adjusted 30-day mortality, accumulated nurse workload score and ICU length of stay. To investigate associations with sex, we used logistic regression and multivariate analyses on the entire cohort as well as on two subgroups stratified by median age for menopause (up to and including 45 years and older than 45 years) and six selected diagnostic subgroups (sepsis, multiple trauma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia and cardiac arrest). RESULTS There was no sex difference in risk-adjusted mortality for the cohort as a whole, and there was no sex difference in risk-adjusted mortality in the group 45 years of age and younger. For the group of patients older than 45 years of age, we found a reduced risk-adjusted mortality in men admitted for cardiac arrest. For the cohort as a whole, and for those admitted with multiple trauma, male sex was associated with a higher nurse workload score and a longer ICU stay. CONCLUSIONS Using information derived from a large multiple ICU register database, we found that premenopausal female sex was not associated with a survival advantage following intensive care in Sweden. When the data were adjusted for age and severity of illness, we found that men used more ICU resources per admission than women did.
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Schopper M, Bäumler PI, Fleckenstein J, Irnich D. [Gender aspects in anesthesia : modified approach in research and treatment?]. Anaesthesist 2012; 61:288-98. [PMID: 22526740 DOI: 10.1007/s00101-012-2013-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gender differences can have a relevant influence on the perioperative outcome as male and female patients are affected differently by adverse events, e.g. side effects of drugs. Furthermore, differences relating to specific drug effects, comorbidities and outcome after anesthesia or intensive care have been demonstrated. There seems to be a gender bias in diagnosis and therapy. While the knowledge regarding this field is still growing certain aspects have already been integrated into clinical practice: prevention of postoperative nausea and vomiting (PONV), target controlled infusion (TCI) model and male only policy with production of blood products. There is a need to study the influence of gender, age and race in order to optimize treatment towards a more individualized therapy. This article highlights already identified differences and discusses potential underlying mechanisms.
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Affiliation(s)
- M Schopper
- Klinik für Anästhesiologie, Klinikum der Universität München, Campus Innenstadt, München, Deutschland.
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Abstract
BACKGROUND Total joint arthroplasty (TJA) is remarkably successful for treating osteoarthritis: most patients see substantial gains in function. However, there are considerable geographic, racial, and gender variations in the utilization of these procedures. The reasons for these differences are complex. QUESTIONS/PURPOSES We examined sex and gender disparities in TJA. METHODS Through Medline/PubMed searches, we identified 632 articles and from these selected 61 for our review. WHERE ARE WE NOW?: A number of factors might explain sex and gender disparities in TJA: underrepresentation in clinical trials, differences in willingness to undergo surgery, pain responses to underlying disease and treatment, patient-physician relationships, treatment preferences, provider-level factors such as physician-patient communication style, and system-level factors such as access to specialist care. Since women have a higher prevalence of arthritis and degenerative joint diseases and overall demand for these procedures will continue to grow, the need to understand why there is a gap in utilization based on gender is imperative. WHERE DO WE NEED TO GO?: Understanding what exactly is meant by "disparity" is essential because it is possible anatomic factors may have different impacts on utilization from cultural factors. Ideally, information about these factors should be integrated into the decision-making process so that patients and providers can make the most informed choice about whether or not to undergo the procedure. HOW DO WE GET THERE?: To better understand all of the potential reasons for how anatomic and cultural factors related to sex and gender might impact decision-making and overall utilization of TJA, more research focusing on these factors must be designed and carried out.
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Affiliation(s)
- Wendy M Novicoff
- Departments of Orthopaedic Surgery and Public Health Sciences, University of Virginia School of Medicine, Box 80015, HSC, Charlottesville, VA 22908, USA.
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Gender Differences in Case Mix and Outcome of Critically Ill Patients. ACTA ACUST UNITED AC 2011; 8:32-9. [DOI: 10.1016/j.genm.2010.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 11/09/2010] [Accepted: 11/14/2010] [Indexed: 12/21/2022]
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Jüni P, Low N, Reichenbach S, Villiger PM, Williams S, Dieppe PA. Gender inequity in the provision of care for hip disease: population-based cross-sectional study. Osteoarthritis Cartilage 2010; 18:640-5. [PMID: 20167302 DOI: 10.1016/j.joca.2009.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/10/2009] [Accepted: 12/21/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine gender differences along the care pathway to total hip replacement. METHODS We conducted a population-based cross-sectional study of 26,046 individuals aged 35 years and over in Avon and Somerset. Participants completed a questionnaire asking about care provision at five milestones on the pathway to total hip replacement. Those reporting hip disease were invited to a clinical examination. We estimated odds ratios (ORs) [95% confidence intervals (CI)] for provision of care to women compared with men. RESULTS 3169 people reported hip pain, 2018 were invited for clinical examination, and 1405 attended (69.6%). After adjustment for age and disease severity, women were less likely than men to have consulted their general practitioner (OR 0.78, 95%-CI 0.61-1.00), as likely as men to have received drug therapy for hip pain in the previous year (OR 0.96, 95%-CI 0.74-1.24), but less likely to have been referred to specialist care (OR 0.53, 95%-CI 0.40-0.70), to have consulted an orthopaedic surgeon (OR 0.50, 95%-CI 0.32-0.78), or to be on a waiting list for total hip replacement (OR 0.41, 95%-CI 0.20-0.87). Differences remained in the 746 people who had sought care from their general practitioner, and after adjustment for willingness and fitness for surgery. CONCLUSIONS There are gender inequalities in provision of care for hip disease in England, which are not fully accounted for by gender differences in care seeking and treatment preferences. Differences in referral to specialist care by general practitioners might unwittingly contribute to this inequity. Accurate information about availability, benefits and risks of hip replacement for providers and patients, and continuing education to ensure that clinicians interpret and correct patients' assumptions could help reduce inequalities.
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Affiliation(s)
- P Jüni
- Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
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Differences in immune response may explain lower survival among older men with pneumonia. Crit Care Med 2009; 37:1655-62. [PMID: 19325487 DOI: 10.1097/ccm.0b013e31819da853] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lower life expectancy in men is generally attributed to higher likelihood of risky behavior and because men develop chronic conditions earlier. If sex-related differences in survival are independent of preinfection chronic health and health behavior, it would suggest that survival differences may occur because of sex differences in quality of care and biological response to infection, and these differences may contribute to sex differences in life expectancy. We assessed if sex-related survival difference following community-acquired pneumonia (CAP) is due to differences in clinical characteristics, quality of care, or immune response. DESIGN, SETTING, AND SUBJECTS Prospective observational cohort of 2183 subjects with CAP. MEASUREMENTS AND MAIN RESULTS Mean age was 64.9 years. Men were more likely to smoke and had more comorbidity compared with women. At emergency department presentation, men had different biomarker patterns, as evidenced by higher inflammation (tumor necrosis factor, interleukin [IL]-6, and IL-10) and fibrinolysis (d-dimer), and lower coagulation biomarkers (antithrombin-III and factor IX) (p < 0.05). Small differences in favor of men were seen in care quality, including antibiotic timing and compliance with American Thoracic Society guidelines. Men had lower survival at 30, 90, and 365 days. The higher 1-year mortality was not attenuated when adjusted for differences in demographics, smoking, resuscitation, insurance, and vaccination status, comorbidity, hospital characteristics, and illness severity (unadjusted hazard ratio [HR] = 1.35, p = 0.003; and adjusted HR = 1.29, p = 0.004). HR was no longer statistically significant when additionally adjusted for differences in emergency department concentrations of tumor necrosis factor, IL-6, IL-10, d-dimer, antithrombin-III, and factor IX (adjusted HR = 1.27, p = 0.17). Patterns of biomarkers observed in men were associated with worse survival for 1 year. CONCLUSIONS Lower survival among men following CAP was not explained by differences in chronic diseases, health behaviors, and quality of care. Patterns of inflammatory, coagulation, and fibrinolysis biomarkers among men may explain reduced short-term and long-term survival.
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Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, Adhikari NKJ, Sibbald WJ, Martin CM. Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ 2007; 177:1513-9. [PMID: 18003954 DOI: 10.1503/cmaj.071112] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have suggested that a patient's sex may influence the provision and outcomes of critical care. Our objective was to determine whether sex and age are associated with differences in admission practices, processes of care and clinical outcomes for critically ill patients. METHODS We used a retrospective cohort of 466,792 patients, including 24,778 critically ill patients, admitted consecutively to adult hospitals in Ontario between Jan. 1, 2001, and Dec. 31, 2002. We measured associations between sex and age and admission to the intensive care unit (ICU); use of mechanical ventilation, dialysis or pulmonary artery catheterization; length of stay in the ICU and hospital; and death in the ICU, hospital and 1 year after admission. RESULTS Of the 466,792 patients admitted to hospital, more were women than men (57.0% v. 43.0% for all admissions, p < 0.001; 50.1% v. 49.9% for nonobstetric admissions, p < 0.001). However, fewer women than men were admitted to ICUs (39.9% v. 60.1%, p < 0.001); this difference was most pronounced among older patients (age > or = 50 years). After adjustment for admission diagnoses and comorbidities, older women were less likely than older men to receive care in an ICU setting (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.66-0.71). After adjustment for illness severity, older women were also less likely than older men to receive mechanical ventilation (OR 0.91, 95% CI 0.81-0.97) or pulmonary artery catheterization (OR 0.80, 95% CI 0.73-0.88). Despite older men and women having similar severity of illness on ICU admission, women received ICU care for a slightly shorter duration yet had a longer length of stay in hospital (mean 18.3 v. 16.9 days; p = 0.006). After adjustment for differences in comorbidities, source of admission, ICU admission diagnosis and illness severity, older women had a slightly greater risk of death in the ICU (hazard ratio 1.20, 95% CI 1.10-1.31) and in hospital (hazard ratio 1.08, 95% CI 1.00-1.16) than did older men. INTERPRETATION Among patients 50 years or older, women appear less likely than men to be admitted to an ICU and to receive selected life-supporting treatments and more likely than men to die after critical illness. Differences in presentation of critical illness, decision-making or unmeasured confounding factors may contribute to these findings.
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Affiliation(s)
- Robert A Fowler
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.
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Palepu A, Khan NA, Norena M, Wong H, Chittock DR, Dodek PM. The role of HIV infection and drug and alcohol dependence in hospital mortality among critically ill patients. J Crit Care 2007; 23:275-80. [PMID: 18725029 DOI: 10.1016/j.jcrc.2007.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 03/13/2007] [Accepted: 04/03/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE Critical care outcomes among HIV-infected patients have improved because of advances in HIV therapy and general improvements in intensive care unit (ICU) management. There is a high co-occurrence of drug and alcohol dependence among HIV-infected patients, and the independent role of drug and alcohol dependence among patients with and without HIV infection in outcomes of critical illness is unclear. MATERIALS AND METHODS We analyzed a prospectively collected database of 7015 index ICU admissions at 2 teaching hospitals between January 1999 and January 2006. The ICU diagnoses were determined from prospective chart review and classified according to the dictionary of diagnoses developed by the Intensive Care National Audit and Research Council. We used logistic regression to determine the independent association of drug and alcohol dependence as well as HIV infection with in-hospital mortality. Covariates that were adjusted for included acute drug overdose, Acute Physiology and Chronic Health Evaluation II score, age, sex, hospital site, and socioeconomic variables. RESULTS Of all patients, 4.4% (309 of 7015) were HIV infected; and of these, 56% (173 of 309) had a history of drug and alcohol dependence, whereas only 7.4% (502 of 6706) of the HIV-negative group had a history of drug and alcohol dependence. Drug and alcohol dependence was not independently associated with hospital mortality in either the model including all admissions (adjusted odds ratio [AOR] 0.80; 95% confidence interval [CI] 0.62-1.03) or the model including pneumonia and sepsis admissions only (AOR 0.92; 95% CI 0.59-1.41). Infection with HIV was independently associated with hospital mortality (AOR 2.16; 95% CI 1.60-2.93). CONCLUSIONS Although HIV infection is associated with increased hospital mortality, drug and alcohol dependence is not associated with an increased hospital mortality independent of HIV infection.
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Affiliation(s)
- A Palepu
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia
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Keene J, Li X. Gender differences in older patient populations: a case linkage study of community health, mental health, and social services in the United Kingdom. Health Care Women Int 2005; 26:713-30. [PMID: 16234213 DOI: 10.1080/07399330500179382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We identify gender differences in older health and social care populations by comparing the total population of older people with the total population of women and the total population of older women, respectively. We combine anonymised data across community health (CH; N = 82,751), mental health (MH; N = 19,029), and social care service (SC; N = 19,461) populations in one UK county (N = 496,863) over 3 years. Approximately two thirds of older care populations were female. In both single- and dual-agency care populations a profile emerged of older patients, female patients and older female patients, this profile varied across different diagnostic and care groups.
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Affiliation(s)
- J Keene
- School of Health and Social Care, University of Reading, Earley, Reading, United Kingdom.
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Hutchings A, Raine R, Brady A, Wildman M, Rowan K. Socioeconomic Status and Outcome From Intensive Care in England and Wales. Med Care 2004; 42:943-51. [PMID: 15377926 DOI: 10.1097/00005650-200410000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the association between socioeconomic status (SES) and outcome for admissions to intensive care. RESEARCH DESIGN Retrospective cohort study. SUBJECTS We studied 51,572 admissions to 99 intensive-care units in England and Wales between 1995 and 2000. MEASURES The SES of admissions was measured using Carstairs deprivation scores. Outcome was hospital mortality after adjustment for case mix using the APACHE II method. RESULTS Admissions of lower SES were, on average, younger and less likely to be following surgery. There was evidence of a SES gradient for hospital mortality in admissions after elective surgery after adjusting for case mix (test for trend P <0.001), with higher SES associated with lower mortality. In the least-deprived quintile of SES, the odds ratio for hospital mortality was 0.70 (95% confidence interval, 0.58-0.84) compared with the most deprived quintile. There was no evidence of a SES gradient for hospital mortality in nonsurgical or emergency surgical admissions, and the decision to withdraw active treatment did not differ by SES. CONCLUSIONS There is a SES gradient for hospital mortality in elective surgical admissions that is not explained by differences in case mix or the withdrawal of active treatment. Further research is required to establish if this finding can be explained by unmeasured differences in health status at admission to an intensive-care unit or differences in care and to establish the potential impact these results may have on interpreting comparative surgical performance data.
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Affiliation(s)
- Andrew Hutchings
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Gupta D, Keogh B, Chung KF, Ayres JG, Harrison DA, Goldfrad C, Brady AR, Rowan K. Characteristics and outcome for admissions to adult, general critical care units with acute severe asthma: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 2004; 8:R112-21. [PMID: 15025785 PMCID: PMC420044 DOI: 10.1186/cc2835] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Revised: 01/21/2004] [Accepted: 02/08/2004] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION This report describes the case mix, outcome and activity (duration of intensive care unit [ICU] and hospital stay, inter-hospital transfer, and readmissions to the ICU) for admissions to ICUs for acute severe asthma, and investigates the effect of case mix factors on outcome. METHODS We conducted a secondary analysis of data from a high-quality clinical database (the Intensive Care National Audit and Research Centre [ICNARC] Case Mix Programme Database) of 129,647 admissions to 128 adult, general critical care units across England, Wales and Northern Ireland over the period 1995-2001. RESULTS Asthma accounted for 2152 (1.7%) admissions, and in 57% mechanical ventilation was employed during the first 24 hours in the ICU. A total of 147 (7.1%) patients died in intensive care and 199 (9.8%) died before discharge from hospital. The mean age was 43.6 years, and the ratio of women to men was 2:1. Median length of stay was 1.5 days in the ICU and 8 days in hospital. Older age, female sex, having received cardiopulmonary resuscitation (CPR) within 24 hours before admission, having suffered a neurological insult during the first 24 hours in the ICU, higher heart rate, and hypercapnia were associated with greater risk for in-hospital death after adjusting for Acute Physiology and Chronic Health Evaluation II score. CPR before admission, neurological insult, hypoxaemia and hypercapnia were associated with receipt of mechanical ventilation after adjusting for Acute Physiology and Chronic Health Evaluation II score. CONCLUSION ICU admission for asthma is relatively uncommon but remains associated with appreciable in-hospital mortality. The greatest determinant of poor hospital survival in asthma patients was receipt of CPR within 24 hours before admission to ICU. Clinical management of these patients should be directed at preventing cardiac arrest before admission.
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Affiliation(s)
- Dheeraj Gupta
- Visiting Fellow, Department of Respiratory Medicine, Birmingham Heartlands Solihull NHS Trust, Birmingham, UK
| | - Brian Keogh
- Consultant in Anaesthesia and Intensive Care, Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Kian Fan Chung
- Professor of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Jon G Ayres
- Professor of Respiratory Medicine, Department of Respiratory Medicine, Birmingham Heartlands Solihull NHS Trust, Birmingham, UK
- Current address: Professor of Environmental and Occupational Medicine, and Head of Department, Liberty Safe Work Research Centre, Aberdeen, UK
| | - David A Harrison
- Statistician, Intensive Care National Audit and Research Centre, Tavistock House, Tavistock Square, London, UK
| | - Caroline Goldfrad
- Statistician/Data Manager, Intensive Care National Audit and Research Centre, Tavistock House, Tavistock Square, London, UK
| | - Anthony R Brady
- Senior Statistician, Intensive Care National Audit and Research Centre, Tavistock House, Tavistock Square, London, UK
| | - Kathy Rowan
- Director, Intensive Care National Audit and Research Centre, Tavistock House, Tavistock Square, London, UK
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Harrison DA, Brady AR, Rowan K. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care 2004; 8:R99-111. [PMID: 15025784 PMCID: PMC420043 DOI: 10.1186/cc2834] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Revised: 01/28/2004] [Accepted: 02/13/2004] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD). METHODS The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data, including use of a dataset specification, of initial and refresher training courses, and of local and central validation of submitted data for incomplete, illogical and inconsistent values. Criteria for evaluating clinical databases developed by the Directory of Clinical Databases were applied to the CMPD. The case mix, outcome and activity for all admissions were briefly summarised. RESULTS The mean quality level achieved by the CMPD for the 10 Directory of Clinical Databases criteria was 3.4 (on a scale of 1 = worst to 4 = best). The CMPD contained validated data on 129,647 admissions to 128 units. The median age was 63 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. Mortality was 20.3% in the CMP unit and was 30.8% at ultimate discharge from hospital. Nonsurvivors stayed longer in intensive care than did survivors (median 2.0 days versus 1.7 days in the CMP unit) but had a shorter total hospital length of stay (9 days versus 16 days). Results for the CMPD were comparable with results from other published reports of UK critical care admissions. CONCLUSIONS The CMP uses rigorous methods to ensure data are complete, valid and reliable. The CMP scores well against published criteria for high-quality clinical databases.
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Abstract
During the past decade, an overall theme has emerged, validating the exploration of gender-based differences in coronary heart disease (CHD) as a basis for clinical strategies to improve outcomes for women. Underrepresentation of women in most of CHD and lack of gender-specific reporting in many clinical trials continue to limit the available knowledge and evidence-based medicine needed to devise optimal managements for women with CHD. Control of conventional coronary risk factors provides comparable cardioprotection for men and women. Current evidence fails to show cardiac protection from menopausal hormone therapy. Clinical presentations of coronary heart disease (CHD) and management strategies differ between the sexes. Underutilization of proven beneficial therapies is a contributor to less-favorable outcomes in women. The contemporary increased application of appropriate diagnostic, therapeutic, and interventional managements has favorably altered the prognosis for women, particularly when the data are adjusted for baseline characteristics. Better education of women during office visits, earlier and more aggressive control of coronary risk factors, and a greater index of suspicion regarding chest pain and its appropriate evaluation may help to reverse the trend of late referral and late intervention. Research indicates that behavioral changes on the part of women and reshaping of practice patterns by their health care providers may dramatically reduce the number of women disabled and killed by CHD each year.
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Affiliation(s)
- Nanette K Wenger
- Emory School of Medicine and Grady Memorial Hospital, Emory Heart & Vascular Center, Atlanta, GA 30303, USA.
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Schatz M, Camargo CA. The relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization. Ann Allergy Asthma Immunol 2004; 91:553-8. [PMID: 14700439 DOI: 10.1016/s1081-1206(10)61533-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Age-related sex differences in asthma hospitalizations and emergency department (ED) visits have been reported, but relationships of these differences to disease prevalence and outpatient management have not been defined. OBJECTIVE To define the relationships of sex to asthma-related health care utilization and medications, accounting for age-related differences in asthma prevalence. METHODS Computerized data from Southern California Kaiser-Permanente were used to identify asthmatic patients, aged 2 to 64 years, enrolled continuously during 1999 and 2000. Age-specific asthma prevalence in 1999 was calculated to identify ages of male or female predominance. Males and females were compared with regard to asthma-related health care utilization outcomes (outpatient clinic visits, ED visits, and hospitalizations) and medication use (beta-agonists, inhaled steroids, and oral steroids). Hospitalizations, ED visits, and oral steroid use were considered markers of disease severity. RESULTS Of the 60,694 subjects, the female-male prevalence ratio was approximately 35:65 at each age between 2 and 13 years, it was inverse (65:35) between the ages of 23 and 64 years, and prevalences were relatively similar at the ages of 14 to 22 years. In patients aged 2 to 13 years, most utilization and medication variables were significantly greater in males (P < .01). Females aged 14 to 22 years had more outpatient and ED visits and used more oral steroids than males. In patients aged 23 to 64 years, all utilization variables were significantly greater in females, except beta-agonist use and mean inhaled steroid dispensings. CONCLUSIONS Asthma utilization and severity appear greater in males aged 2 to 13 years, somewhat greater in females aged 14 to 22 years, and definitely greater in females aged 23 to 64 years. The mechanisms for these striking sex differences merit further investigation.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser-Permanente Medical Care Program, San Diego, California 92111, USA.
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Black N. Secondary use of personal data for health and health services research: why identifiable data are essential. J Health Serv Res Policy 2003; 8 Suppl 1:S1:36-40. [PMID: 12869337 DOI: 10.1258/135581903766468873] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Databases provide a powerful and essential resource for health and health services research. There are seven reasons why the identification of individuals may be needed: linkage within a database; linkage between databases; ensuring comparisons are meaningful; ensuring completeness of recruitment; investigation of social factors; analysis of trends over time; and assessing the applicability of primary research findings. Examples of recent British research studies for which identifiable data were essential are described to illustrate six research applications: to understand the natural history and development of disease; to identify causes of disease; to evaluate health care interventions; to assess equity of care; to describe trends in health care utilisation; and to ensure the methodological rigour of research. Given the benefits to the public of such research activities, methods need to be found to ensure the continuation of such research while meeting legitimate concerns about individual privacy and confidentiality.
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Affiliation(s)
- Nick Black
- Department of Public Health & Policy, London School of Hygiene & Tropical Medicine London, UK
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