Status and perspectives of hospital mortality in a public urban Hellenic hospital, based on a five-year review

Medical Admissions in a Rural Teaching Hospital in Southern Nigeria: A Retrospective Review

Background

Hospital-based morbidity and mortality records reflect the health status of host communities. This helps policymakers and industry actors plan and allocate resources for health services, research, training, and development. This study aimed to determine the pattern and outcome of medical admissions in a Nigerian teaching hospital.

Methodology

This was a three-year retrospective review from 2019 to 2021.Data on morbidity and mortality were extracted from ward registers. The relevant data was analysed using the IBM SPSS software. Tests were considered significant at p values of less than 0.05.

Results

A total of 2544 patients were admitted during the study period. There were 1420 females (55.8%) and 1124 males (44.2%), and the majority (36.9%) of patients were middle-aged. The mean age was 53.81 ± 18.81 years, and the mean duration of hospital stay was 9.07 ± 8.41 days, with 97.2% of the patients spending less than 30 days on admission. Non-communicable diseases (70.6%) were the most common causes of admissions. The top disease-specific causes of admissions were diabetes mellitus with its complications (14.9%), renal failure (11.8%), heart failure (9.2%), hypertension and its emergencies (9.2%), stroke (7.8%) and tuberculosis (7.0%). Cardiology (15.5%), endocrinology (15.1%), nephrology (15.0%), pulmonology (14.8%), and neurology (13.3%) accounted for the majority (86.4%) of the admissions. The major causes of death were renal failure (16.2%), stroke (15.8%), diabetes mellitus and its complications (12.5%) and HIV/AIDS (8.7%). The majority (86.7%) of patients were discharged, 10.4% died, 2.2% were discharged against medical advice, and 0.7% were referred.

Conclusion

The study found an increased burden of non-communicable diseases relative to communicable diseases. Effective health education and promotion initiatives must be implemented to combat the impact of the increasing prevalence of these diseases.

Preventing suicide among inpatients

OBJECTIVE

Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide.

METHOD

A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data).

RESULTS

A qualitative discussion is presented, based on the findings of the literature searched.

CONCLUSIONS

The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment.

Retrospective analysis of mortalities in a tertiary care hospital in Northeast Ethiopia

Background

Mortalities in the health care set up are prevalent, and causes are multifactorial with variations from area to area and also from ward to ward in the same health care set up. Analysis of mortalities and its causes in Ethiopian hospitals including Dessie Referral Hospital is not adequately known. Thus, the aim of this study is to determine the prevalence of mortalities and its causes in the Dessie Referral Hospital, Northeast Ethiopia.

Methods

A retrospective analysis of mortalities during a three year period (September 2010–2012) was conducted in the Dessie Referral Hospital from August-September, 2012. All in hospital mortalities in the hospital during the last three years were included in the study. Data were collected from patient discharge recording books. Finally, data were entered into SPSS windows version 16.0 and descriptive statistics were generated to meet the study objective.

Results

During the last 3 years there were 1,481 (4.8%) mortalities in the hospital. Around 60.0% of the mortalities were among male patients, and two third of the mortalities were among patients aged 15 years or older. The majority of the mortalities (38.9%) were in the medical ward followed by pediatric (34.6%) and surgical (18.2%) wards. Most of the mortalities (34.8%) occurred during 2011 while least was in 2012 (31.8%). HIV/AIDS (14.8%), pneumonia (9.9%), and sepsis/shock (7.6%) were the three most common causes of mortality in the hospital during the three year period. On average, patients stayed for 2.86 (±2. 99) days in the wards before mortality.

Conclusion

Mortalities in the wards of the Dessie Referral Hospital were high and the causes were mainly of infectious origin, HIV/AIDS and its complications being the most common causes. This calls for an integrated effort to reduce in hospital mortalities by equipping the hospital and its health care providers with the skills and medical supplies required for proper management of the most common causes of in hospital mortality reported in this study.

Causes of death certification of adults: an exploratory cross-sectional study at a university hospital in Riyadh, Saudi Arabia

BACKGROUND AND AIMS

Saudi Arabia has no precise data on causes of death. We sought to ascertain the commonest causes of death as stated in death certificates of adults and evaluate the completeness of death certificates at a teaching hospital in Riyadh.

DESIGN AND SETTINGS

A cross-sectional study carried out at King Khalid University Hospital in Riyadh, Saudi Arabia, during the year 2008.

METHODS

All death certificates that were issued in 2008 were reviewed and data were checked by two reviewers. Causes of death were coded according to specially-designed codes.

RESULTS

The mean (SD) age of death was 63.9 (20.7) years. More than 80% arrived alive at the hospital. Among the 410 certificates, 62.2% had the first reported cause of death being classified as "inappropriate" and this tended to be slightly, but significantly more frequent among women. The first most common appropriately reported cause of death was malignancy of any type (7.3%) followed by ischemic heart diseases (4.9%). Accidents and fractures were more common in the younger age groups and among men.

CONCLUSIONS

This is the first study that documents the possible gaps among healthcare professionals in Saudi Arabia in their understanding of death and its certification based on the clinical assessment of the deceased. The findings needs to be validated by similar studies from other health care sectors. It is clear, however, that proven educational, system-related and legal interventions to improve the accuracy of death certification are strongly needed if the health care priorities are to be properly identified.

Patients with pelvic fractures due to falls: A paradigm that contributed to autopsy-based audit of trauma in Greece

BACKGROUND

Evaluation of the pelvic fractures (PFx) population in auditing effective components of trauma care is the subject of this study.

METHODS

A retrospective, case-control, autopsy-based study compared a population with PFx to a control-group using a template with trauma outcome variables, which included demographics, ICD-9, intention, mechanisms, toxicology, Abbreviated Injury Scale (AIS-90), Injury Severity Score (ISS), causes of haemorrhage, comorbidity, survival time, pre-hospital response, in hospital data, location of death, and preventable deaths.

RESULTS

Of 970 consecutive patients with fatal falls, 209 (21.5%) had PFx and constituted the PFx-group while 761 (78.5%) formed the control-group.Multivariate analysis showed that gender, age, intention, and height of fall were risk factors for PFx. A 300% higher odds of a psychiatric history was found in the PFx-group compared to the control-group (p < 0.001).The median ISS was 50 (17-75) for the PFx-group and 26 (1-75) for the control-group (p < 0.0001). There were no patients with an ISS less than 16 in the PFx group.Associated injuries were significantly more common in the PFx-group than in the control-group. Potentially preventable deaths (ISS < 75) constituted 78% (n = 163) of the PFx-group. The most common AIS3-5 injuries in the potentially preventable subset of patients were the lower extremities in 133 (81.6%), thorax in 130 (79.7%), abdomen/pelvic contents in 99 (60.7%), head in 95 (58.3%) and the spine in 26 (15.9%) patients.A subset of 126 (60.3%) potentially preventable deaths in the PFx-group had at least one AIS-90 code other than the PFx, denoting major haemorrhage. Deaths directly attributed to PFx were limited to 6 (2.9%).The median survival time was 30 minutes for the PFx-group and 20 hours for the control-group (p < 0.001). For a one-group increment in the ISS-groups, the survival rates over the post-traumatic time intervals were reduced by 57% (p < 0.0001).Pre-hospital mortality was significantly higher in the PFx-group i.e. 70.3% of the PFx-group versus 42.7% of the control-group (p < 0.001).

CONCLUSIONS

The PFx-group shared common causative risk factors, high severity and multiplicity of injuries that define the PFx-group as a paradigm of injury for audit. This reduced sample of autopsies substantially contributed to the audit of functional, infrastructural, management and prevention issues requiring transformation to reduce mortality.

Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance

AIMS

The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated.

DESIGN

Retrospective case-control study based on autopsy and toxicology.

SETTINGS

Single faculty accepting referrals from Greater Athens and prefectures.

PARTICIPANTS

Consecutive pre-hospital and in hospital fatalities.

MEASUREMENTS

Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death.

FINDINGS

Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4-90) years for the PTG and 45 (3-97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS ≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS=75). The frequency of severe trauma (ISS ≥16) was comparable between PTG and NTG (P=0.87). The PTG presented with a median ISS of 43 (6-75) versus 41 (2-75) of the NTG, hence without significant difference (P=0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P<0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P <0.001).

CONCLUSIONS

In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required.

Late mortality during the first year after acute traumatic spinal cord injury: a prospective, population-based study

BACKGROUND

Little is known about the possible impact of the system of care on mortality during the first year after acute traumatic spinal cord injury (TSCI).

OBJECTIVE

To evaluate late mortality (i.e., >7 days after trauma) during the first year after acute TSCI in 2 European Union (EU) regions, Thessaloniki in Greece and Stockholm in Sweden.

METHODS

This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS), which is a prospective, population-based study. Incidence cohorts of TSCI cases were identified and followed up in both study regions through STATSCIS. Data from Thessaloniki region were collected through physical examination, medical records review, and interviews with TSCI individuals and the medical teams. Data from Stockholm were retrieved mainly from the Nordic Spinal Cord Injury Registry, as well as from direct contact with all intensive care facilities of the region.

RESULTS

The annual case mortality rate after acute TSCI was nearly 20% in Thessaloniki and 0% in Stockholm. The mean time of survival after trauma for the 12 mortality cases of Thessaloniki was 47 days (median = 24, SD +/- 67, range = 8-228). Factors associated with mortality were higher age and presence of comorbid spinal disorders but also the inefficient transfer logistics, initially missed spinal instability, and unsuccessfully treated complications.

CONCLUSIONS

The annual case mortality rate in Thessaloniki was dramatically higher than in Stockholm. The different approaches to care, one systematic and the other not, is postulated to be an important factor leading to such major discrepancies between the outcomes of these 2 EU regions.