A Study of Mortality among 6130 hospitalizations in General Medicine wards in Atertiary Care Hospital

INTRODUCTION : Today’s health-care delivery is highly complex. Care is often delivered in a pressurized and fast-moving environment, involving a vast array of technology and several individual decisions and judgements by health-care professionals. In such circumstances things can, and do go wrong. Sometimes unintentional harm comes to a patient during a clinical procedure or as a result of a clinical decision. Errors in the process of care can result in injury. Sometimes the harm caused is serious and can even be fatal. This problem of adverse events in health care is not new. There were studies done as early as the 1950s and 1960s on adverse events, but the subject remained largely neglected. A body of evidence started to emerge in the early 1990s with the publication of the results of the Harvard Medical Practice Study in 1991. Subsequent research in Australia, the United Kingdom of Great Britain and Northern Ireland (UK)4 and the United States of America (USA) and in particular the 1999 publication “To err is human: building a safer health system by the Institute of Medicine (IOM)”, provided further data and brought the subject to the top of the policy agenda and the forefront of public debate worldwide. Today more countries, including Canada, Denmark, the Netherlands, and Sweden are taking a serious look at this problem. New Zealand and Canada8 have recently published research into adverse events in public Hospitals. AIMS : To study the profile of causes of deaths among hospitalizations in General Medical wards. To perform a systematic analysis of the recorded causes and classify possible medical error related deaths. OBJECTIVES : The main objectives of the study are; 1. To study the profile of causes of deaths among hospitalizations by the general medicine units. 2. To determine frequency of occurrence of medical error related deaths and factors contributing to it. METHODS : Study design: A one-year cross-sectional study. Study setting : The study was conducted during 1st January 2005 through 31st December 2005 in The Christian Medical College Vellore. In that year there were 68,872 hospitalizations and 1,758 deaths were recorded. In the wards under general medicine units there were 6130 hospitalizations and among them 496 deaths. Study subjects : All 496 deaths occurring in the medical wards and the medical ICU were included. Study materials : Data on all in-hospital deaths such as diagnosis, elective or emergency hospitalization, duration of stay in hospital prior to death and details as mentioned in annexure 1(enclosed) were collected. The cause of death as recorded by the treating senior house officer/post graduate physician/intensivist trainee and verified by the supervising physician was noted. The cause of death is as defined by the International WHO death certificate form as the “underlying disease eventually leading to death”. The immediate cause of death is the “disorder precipitating death”. The diagnosis was coded based on system involved using the International Classification of Diseases-10 (ICD-10 WHO 2000). DISCUSSION : There were 6130 admissions in the year 2005 with a median age of 47 years and a mode of 65 years. The age distribution suggests that the majority of the admissions are in the young (12yrs - 40 yrs) and the elderly (>60yrs) populations with male predominance. Infectious diseases admissions account for majority of the admissions and among this group tuberculosis is the leading cause followed by HIV and AIDS related diseases (non tuberculous) and diarrhoeal diseases. This profile reflects the burden of infectious diseases in our country.28The second group involves the circulatory system disorders inclusive of cerebrovascular accidents. This is on par with the cause of death in the developed nations. Neoplasm or malignancy relates are only 5 % in this study while in the West it is the leading cause. The elderly28 (>60yrs) presented with mostly non-communicable diseases like complications of hypertension, diabetes, malignancies. The younger (12yrs - 40 yrs) population28 presented with tuberculosis, AIDS ands its opportunistic infections, suicidal attempts mostly with organophosphorus (OP) compounds. This disease profile also gives us an insight into the lifestyle changes that are happening with increasing incidence of non-communicable diseases and its complications. CONCLUSION : The summary of the results of this study are I. Disease burden in general medical wards in our hospital in 2005 were similar to our country’s profile with infectious disease being the leading cause. The death rate in general medical wards was 8.1%. II. a. The likely medical error related deaths occurred in 11% of all deaths in the general medical wards. b. 75% of the medical error related occurred due to system faults. Nosocomial infections(42%) are the predominant cause. c. The occurrence of a likely medical error related deaths increases as the duration of stay in hospital becomes longer than seven days

Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial

International audienceBackgroundHip fractures carry a substantial risk of complications and death. This study aimed to report the 90-day incidence of mortality, major perioperative complications and in-hospital timelines after a hip fracture in the Spanish HIP ATTACK-1 trial cohort, comparing with the non-Spanish cohort.MethodsProspective cohort study of Spanish patients nested in the HIP ATTACK-1 trial. The HIP ATTACK-1 was an international, randomized, controlled trial (17 countries, 69 hospitals, 7 in Spain, highest recruiting country). Patients were randomized to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. Participants were ≥45 years of age who presented with a low-energy hip fracture requiring surgery.ResultsAmong 534 patients in the Spanish cohort, 69 (12.9 %) patients died at 90 days follow-up, compared to 225 (9.2 %) in the non-Spanish cohort (p = 0.009), mostly due to higher nonvascular related mortality. A composite of major postoperative complication occurred in 126 patients (23.6 %). The most common perioperative complications were myocardial injury (189 patients, 35.4 %), infection with no sepsis (86 patients, 16.1 %) and perioperative delirium (84 patients, 15.7 %); all these complication rates in Spain were significantly higher than the non-Spanish patients (29.2 % p = 0.005; 11.9 % p = 0.008 and 9.2 % p < 0.0001, respectively). Spanish cohort patients were older and had more comorbidities than the non-Spanish cohort, evidencing their greater frailty at baseline. Among Spanish patients, the median time from hip fracture diagnosis to surgery was 30.0 h (IQR 21.1–53.9) in the standard-care group, with 68.8 % of patients receiving surgery within 48 h of diagnosis. This median time was lower in the non-Spanish cohort (22.8 h, IQR 9.5–37.0), where 82.1 % of patients were operated within 48 h.ConclusionsIn the HIP ATTACK-1 trial, 1 in 8 patients died 90 days after a hip fracture in Spain. The most common complication after a hip fracture was myocardial injury, followed by infection and delirium. Spanish patients had worse outcomes than non-Spanish patients. Research needs to focus on new interventions such as accelerated surgery and perioperative troponin measurement with the appropriate investment of resources, to prevent and identify early these complications with a goal of improving mortality for this high-risk population.Level of evidence I

Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study

Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated.Methods: This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy.Results: Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P1/40.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P&lt;0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05-1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95-1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60-1.02).Conclusions: In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events