Case Fatality Rate and Length of Hospital Stay among Patients with Typhoid Intestinal Perforation in Developing Countries: A Systematic Literature Review

<div><p>Background</p><p>Typhoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies.</p><p>Objectives</p><p>To estimate the case fatality rate (CFR) and length of hospital stay among patients with typhoid intestinal perforation in developing countries.</p><p>Data Sources</p><p>Peer-reviewed publications listed in PubMed and Google Scholar.</p><p>Study Eligibility</p><p>The publications containing data on CFR or length of hospitalization for typhoid fever from low, lower middle and upper middle income countries based on World Bank classification. Limits are English language, human research and publication date from 1st January 1991 to 31st December 2011.</p><p>Participants</p><p>Subjects with reported typhoid intestinal perforation.</p><p>Interventions</p><p>None, standard practice as reported in the publication.</p><p>Study Appraisal and Synthesis Methods</p><p>Systematic literature review followed by meta-analysis after regional classification on primary data. Descriptive methods were applied on secondary data.</p><p>Results</p><p>From 42 published reports, a total of 4,626 hospitalized typhoid intestinal perforation cases and 706 deaths were recorded (CFR = 15·4%; 95% CI; 13·0%–17·8%) with a significant regional differences. The overall mean length of hospitalization for intestinal perforation from 23 studies was 18.4 days (N = 2,542; 95% CI; 15.6–21.1).</p><p>Limitations</p><p>Most typhoid intestinal perforation studies featured in this review were from a limited number of countries.</p><p>Conclusions</p><p>The CFR estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990. Aggressive resuscitation, appropriate antimicrobial coverage, and prompt surgical intervention may have contributed to decrease mortality.</p><p>Implications</p><p>The quantification of intestinal perforation outcomes and its regional disparities as presented here is valuable in prioritizing and targeting typhoid-preventive interventions to the most affected areas.</p></div

Additional file 3 of Efficacy of a bivalent killed whole-cell cholera vaccine over five years: a re-analysis of a cluster-randomized trial

Supplementary Text (Model equations). (PDF 45.5 kb

Case fatality rate (CFR) in hospitalized typhoid intestinal perforation cases by study (1991–2011).

<p>Note: Studies are listed in the table by descending order of publication year.</p

Additional file 2 of Efficacy of a bivalent killed whole-cell cholera vaccine over five years: a re-analysis of a cluster-randomized trial

Figure S1. (PDF 27.4 kb

Mean values for weighted case fatality rate, male to female ratio, age and length of hospital stay by region in studies published from 1991 to 2011.

<p>N = sample size, NA = not applicable,</p><p>* weighted mean,</p>§<p>region comparison by Kruskal-Wallis test.</p

Forest plot showing mean case fatality rate for intestinal perforation along with 95% confidence interval based on studies published from 1991 to 2011.

<p>Forest plot showing mean case fatality rate for intestinal perforation along with 95% confidence interval based on studies published from 1991 to 2011.</p

Study selection flow diagram. CFR = case fatality rate.

<p>Study selection flow diagram. CFR = case fatality rate.</p

Length of hospital stay among typhoid intestinal perforation cases by study (1991–2011).

<p>SD = standard deviation, NA = not available. Note: Studies are listed in the table by descending order of publication year.</p

Box plot showing multiple comparisons between regions for case fatality rate, male to female ratio, mean age and mean length of hospital stay based on studies published from 1991 to 2011.

<p>Box plot showing multiple comparisons between regions for case fatality rate, male to female ratio, mean age and mean length of hospital stay based on studies published from 1991 to 2011.</p

Spatial risk for gender-specific adult mortality in an area of southern China-1

<p><b>Copyright information:</b></p><p>Taken from "Spatial risk for gender-specific adult mortality in an area of southern China"</p><p>http://www.ij-healthgeographics.com/content/6/1/31</p><p>International Journal of Health Geographics 2007;6():31-31.</p><p>Published online 24 Jul 2007</p><p>PMCID:PMC1950492.</p><p></p>erging color scheme (blue to red) in ColorBrewer