Diagnosis and mortality in prehospital emergency patients transported to hospital:a population-based and registry-based cohort study

OBJECTIVE: Knowledge about patients after calling for an ambulance is limited to subgroups, such as patients with cardiac arrest, myocardial infarction, trauma and stroke, while population-based studies including all diagnoses are few. We examined the diagnostic pattern and mortality among all patients brought to hospital by ambulance after emergency calls. DESIGN: Registry-based cohort study. SETTING AND PARTICIPANTS: We included patients brought to hospital in an ambulance dispatched after emergency calls during 2007–2014 in the North Denmark Region (580 000 inhabitants). We reported hospital diagnosis according to the chapters of the International Classification of Diseases, 10th Edition (ICD-10), and studied death on days 1 and 30 after the call. Cohort characteristics and diagnoses were described, and the Kaplan-Meier method was used to estimate mortality and 95% CIs. RESULTS: In total, 148 757 patients were included, mean age 52.9 (SD 24.3) years. The most frequent ICD-10 diagnosis chapters were: ‘injury and poisoning’ (30.0%), and the 2 non-specific diagnosis chapters: ‘symptoms and abnormal findings, not elsewhere classified’ (17.5%) and ‘factors influencing health status and contact with health services’ (14.1%), followed by ‘diseases of the circulatory system’ (10.6%) and ‘diseases of the respiratory system’ (6.7%). The overall 1-day mortality was 1.8% (CI 1.7% to 1.8%) and 30-day mortality 4.7% (CI 4.6% to 4.8%). ‘Diseases of the circulatory system’ had the highest 1-day mortality of 7.7% (CI 7.3% to 8.1%) accounting for 1209 deaths. After 30 days, the highest number of deaths were among circulatory diseases (2313), respiratory diseases (1148), ‘symptoms and abnormal findings, not elsewhere classified’ (1119) and ‘injury and poisoning’ (741), and 30 days mortality in percentage was 14.7%, 11.6%, 4.3% and 1.7%, respectively. CONCLUSIONS: Patients' diagnoses from hospital stay after calling 1-1-2 in this population-based study were distributed across all ICD-10 chapters. Mortality varied widely between diagnostic groups. Non-specific diagnoses accounted for one-third of the patients and contributed to mortality in terms of total number of deaths

Rehospitalisation and mortality after hospitalisation for orapharyngeal dysphagia and community-acquired pneumonia: A 1-year follow-up study

Research has documented a high prevalence of oropharyngeal dysphagia (OD) in older patients with community-acquired pneumonia (CAP). This study investigated OD as a risk factor for long-term re-hospitalization and mortality in patients hospitalized with CAP. A total of 36 patients (72.2% male, mean age 80.9 years) who were alive 30 days after discharge were included in the follow-up study. Demographic data, CURB65, Charlson Comorbidity Index, Modified Rankin Scale and Barthel-20 score were recorded and OD was assessed with Volume Viscosity Swallow Test. 69.5% of the patients were moderately to severely disabled, and the mean Barthel-20 score was 13.2 and 27.8% lived in nursing homes. In the period from 31 to 180 days 50% of the patients were re-hospitalized and from 181 to 360 days 60.7% were re-hospitalized. Re-hospitalized patients had a significantly higher Barthel-20 score and longer length of stay (LOS) in the hospital. During 31–180 days after discharge 22.2% of the patients died. From 181 to 360 days after discharge 46.4% of the patients died, they had a significantly higher Charlson Comorbidity Index and a significantly weaker handgrip. The one-year mortality was 71.7%. Despite the small sample size, this study confirms a high re-hospitalisation frequency and high mortality. The 1-year mortality is 71.7% for patients hospitalised with CAP and OD

Changes in Weight and Body Composition Among Women With Breast Cancer During and After Adjuvant Treatment:A Prospective Follow-up Study

Background: Antineoplastic adjuvant treatment for breast cancer can cause changes in women's weight and body composition and influence their general health and survival. Objective: The aim of this study is to investigate the extent and patterns of change in weight and body composition after current standard adjuvant antineoplastic treatment for breast cancer. Methods: Data on weight and body composition from 95 women with breast cancer Stage I to III were obtained during 18 months on a bioelectric impedance analyzer. Changes and odds ratio (OR) were calculated by a linear mixed model and logistic regression. Results: At 18 months, there was an increase in weight of 0.9 kg (95% confidence interval [CI], 0.3-1.5; P = .003) and an average positive association of 0.35 kg/cm increased waist circumference (95% CI, 0.29-0.42 kg; P < .0001). Relative weight changes ranged from -12.7% to 20.5%. Weight gains related to increased body fat were observed mainly in premenopausal women receiving chemotherapy (1.4 kg; 95% CI, 0.4-2.4; P = .007). For menopausal status, OR was 2.9 (95% CI, 1.14-7.1; P = .025), and for chemotherapy, OR was 2.6 (95% CI, 1.03-6.41; P = .043). The OR for weight loss in Stage III breast cancer was 12.5 (95% CI, 1.21-128.84; P = .034) and 4.3 (CI, 1.07-17.24; P = .40) for comorbidity. Conclusions: Results demonstrate that weight changes in a pooled sample are overestimated. However, premenopausal women receiving anthracycline-based chemotherapy show a tendency toward a body composition with increasing fat mass. Implications for Practice: A scheduled assessment of changes in weight and body composition is relevant at 18 months after treatment. To compare future studies, common measuring and cutoff points are needed.Birgith Pedersen, Charlotte Delmar, Mette Dahl Bendtsen, Ingvar Bosaeus, Andreas Carus, Ursula Falkmer, Mette Groenkjaer