The Impact of BMI on Adult Blunt Trauma Outcomes

2019 ◽  
Vol 85 (12) ◽  
pp. 1354-1362
Author(s):  
Rahman Barry ◽  
Milad Modarresi ◽  
Rodrigo Aguilar ◽  
Jacqueline Sanabria ◽  
Thao Wolbert ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

scholarly journals The Impact of Winter Months on Patients with Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), a Retrospective Analysis of Hospital Outcomes in the United States (US) from 1998-2011

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4451-4451
Author(s):  
Danielle Krol ◽  
Parshva Patel ◽  
Konstantine Halkidis ◽  
Gaurav Varma ◽  
Ravindra Sangitha ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
The United States ◽  
Mortality Rates ◽  
Teaching Hospitals ◽  
Hospital Outcomes ◽  
North Central ◽  
Increased Risk ◽  
The Us ◽  
The Impact

Abstract Background: DVT and PE are common complications in hospitalized patients. Many hospitals have implemented EMR-based protocols to identify patients who could benefit from prophylactic anticoagulation, because of the increased morbidity, mortality, and cost associated with thrombotic disease. Several groups have sought to characterize the potential seasonal and winter variation in the incidence of DVT and PE, with several international studies supporting a so called "Winter effect" (Damnjanović et al., Hippokratia 2013); however, no study has demonstrated a "Winter effect" on patients within the US (Stein et al., Am J Cardiol 2004). Objective: (1) To compare mortality rates and length of stay (LOS) in hospitals by month to identify a "Winter effect" in patients diagnosed with either DVT or PE; and (2) characterize other factors that might influence mortality and LOS, using the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Methods: The NIS was queried from 1998-2011. Inclusion criteria were a diagnosis of DVT (ICD-9 453.4X, 453.8X) and/or PE (ICD-9 415.1X) in patients aged 18 years or more. The sample was weighted to approximate the full inpatient population of the United States over the period of interest. Admission data was then analyzed to compare mortality rates over those years by month. Demographics, Charlson Comorbidity Index (CCI), length of stay, hospital region, and admission type (emergent/urgent versus elective admissions) were assessed. Linear and logistic models were generated for complex survey design to assess predictors of mortality and LOS. Results: A total of 1,449,113 DVT/PE cases were identified in the NIS (weighted n = 7,150,613). 54.7% of admission were for females, 56.4% were white, and 49% of admissions were at a teaching facility. Mortality over the 12 months was 6.4% and was noted to be higher in four months: November (6.52%), December (6.9%), January (6.94%), and February (6.93%), as indicated in the graph below. A similar trend was noted on a regional basis with higher mortality noted in winter months for all hospital regions (Northeast, Midwest or North Central, South, and West). No significant trend was noted in DVT/PE hospitalization rates between regions over 12 months (p=0.7674). Mortality in the total cohort was found to be significantly higher in December, OR 1.10 (95% CI: 1.06-1.14), p<0.0001; January, OR 1.11 (95% CI: 1.08-1.15), p<0.0001; and February, OR 1.11 (95% CI: 1.07-1.15), p<0.0001 compared to June (Table 1). Mortality was significantly lower in the Midwest or North Central, OR 0.78 (95% CI: 0.72-0.83), p<0.0001; and West, OR 0.80 (95% CI: 0.73-0.87), p<0.0001 compared to the Northeast. Mortality was also significantly higher in teaching hospitals than in nonteaching hospitals (OR 1.16 [95% CI: 1.10-1.22], p<0.0001), with mortality higher in teaching hospitals in all months. Length of stay was also significantly increased in the winter months. Similar results were noted in the subgroups of patients greater than age 80 or with a CCI score of 2 or more. Conclusion: This national study identified an increased risk of mortality and increased LOS associated with hospitalizations for DVT/PE during the winter months (December, January, and February), supporting the existence of a "Winter effect" on hospital outcomes. Our data differs from previous reports on seasonal variation in DVT/PE in the US because of the database used (Bekkers et al., Clin Orthop Relat Res 2014). Since no regional variation was shown, decreased activity or cold temperature is unlikely to be the cause of this phenomenon. Alternative explanations should be sought. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

The Fifty-Year Decline of Cancer in America

2001 ◽  
Vol 19 (1) ◽  
pp. 239-241 ◽  
Author(s):  
Brad Rodu ◽  
Philip Cole
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Mortality Rate ◽  
Cancer Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Health Statistics ◽  
The Past ◽  
The Impact

PURPOSE: From 1950 to 1990, the overall cancer mortality rate increased steadily in the United States, a trend which ran counter to declining mortality from other major diseases. The purpose of this study was to assess the impact of lung cancer on all-cancer mortality over the past 50 years. METHODS: Data from the National Centers for Health Statistics were used to develop mortality rates for all forms of cancer combined, lung cancer, and other-cancer (all-cancer minus lung cancer) from 1950 to 1998. RESULTS: When lung cancer is excluded, mortality from all other forms of cancer combined declined continuously from 1950 to 1998, dropping 25% during this period. The decline in other-cancer mortality was approximately 0.4% annually from 1950 to 1990 but accelerated to 0.9% per year from 1990 to 1996 and to 2.2% per year from 1996 to 1998. CONCLUSION: The long-term decline is likely due primarily to improvements in medical care, including screening, diagnosis, and treatment.

Abstract 118: Factors and Hospital Charges Associated With Prolonged Length of Hospitalization in Patients Admitted With Ischemic Stroke in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Iqra N Akhtar ◽  
Mohsain Gill ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Hospital Charges ◽  
Median Length ◽  
The Impact ◽  
Length Of Hospitalization

Background and Purpose: The duration of hospitalization and associated factors are not well studied in national cohorts. We identified the proportion and determinants of prolonged hospitalization and determined the impact on hospital charges using nationally representative data. Methods: National estimates of length of stay, mortality, and hospital charges incurred in patients admitted with primary diagnosis of ischemic stroke (ICD-9 CM diagnosis-related code 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436) using Nationwide Inpatient Sample data from 2010 to 2015. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States. Patient who were transferred from another acute hospital or had mortality within 2 days of admission were excluded from the analysis. All the variables pertaining to hospitalization were compared in four quartiles based on distribution data for length of hospital stay (≤2, 3 to 4, 5 to 6 and ≥7 days). Results: A total of 2,490,136 patients were admitted with the diagnosis of ischemic attack during the study period. The median length of stay for hospitalization was 4 days. The length of hospitalization was ≤2, 3 to 4, 5 to 6 and ≥7 days in 706,550 (28.4%), 842,872 (33.8%), 417,592 (16.8%) and 523,122 (21.0%) patients, respectively. The mean hospitalization charges were $22,819, $32,593, $ 45,486 and $97,868 for patients hospitalized in four quartiles, respectively. In the multivariate analysis, the following patient factors and in hospital complications were associated with above median length of hospitalization of ≥4 days: age >65 years (odds ratio [OR], 1.06), women (OR, 1.07), history of alcohol use (OR, 1.29), deep venous thrombosis (OR, 2.67), urinary tract infection (OR, 1.68), pneumonia (OR, 1.53), sepsis (OR, 1.85), pulmonary embolism (OR, 1.48), admission to urban teaching hospitals (OR, 1.07), Medicaid insurance (OR, 1.53), and hospital location in Northeast US region (OR, 1.86; all P values <0.0001). Conclusions: The hospital stay in more than half of patients admitted with ischemic stroke is 4 days or greater. Strategies that focus on modifiable factors associated with prolonged hospital stay may reduce the hospitalization charges in United States.

scholarly journals Outcomes for Children and Adolescents With Cancer: Challenges for the Twenty-First Century

2010 ◽  
Vol 28 (15) ◽  
pp. 2625-2634 ◽  
Author(s):  
Malcolm A. Smith ◽  
Nita L. Seibel ◽  
Sean F. Altekruse ◽  
Lynn A.G. Ries ◽  
Danielle L. Melbert ◽  
...  
Keyword(s):  
United States ◽  
Childhood Cancer ◽  
Cancer Mortality ◽  
Lymphoblastic Leukemia ◽  
The United States ◽  
Mortality Rates ◽  
Mortality Data ◽  
Childhood Cancers ◽  
Essential Information ◽  
The Impact

Purpose This report provides an overview of current childhood cancer statistics to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions. Methods Incidence and survival data for childhood cancers came from the Surveillance, Epidemiology, and End Results 9 (SEER 9) registries, and mortality data were based on deaths in the United States that were reported by states to the Centers for Disease Control and Prevention by underlying cause. Results Childhood cancer incidence rates increased significantly from 1975 through 2006, with increasing rates for acute lymphoblastic leukemia being most notable. Childhood cancer mortality rates declined by more than 50% between 1975 and 2006. For leukemias and lymphomas, significantly decreasing mortality rates were observed throughout the 32-year period, though the rate of decline slowed somewhat after 1998. For remaining childhood cancers, significantly decreasing mortality rates were observed from 1975 to 1996, with stable rates from 1996 through 2006. Increased survival rates were observed for all categories of childhood cancers studied, with the extent and temporal pace of the increases varying by diagnosis. Conclusion When 1975 age-specific death rates for children are used as a baseline, approximately 38,000 childhood malignant cancer deaths were averted in the United States from 1975 through 2006 as a result of more effective treatments identified and applied during this period. Continued success in reducing childhood cancer mortality will require new treatment paradigms building on an increased understanding of the molecular processes that promote growth and survival of specific childhood cancers.

scholarly journals Adult sports-related traumatic brain injury in United States trauma centers

2016 ◽  
Vol 40 (4) ◽  
pp. E4 ◽  
Author(s):  
Ethan A. Winkler ◽  
John K. Yue ◽  
John F. Burke ◽  
Andrew K. Chan ◽  
Sanjay S. Dhall ◽  
...  
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Health Concern ◽  
Medical Complications ◽  
Equestrian Sports ◽  
Prolonged Hospital

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories—fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use—particularly in equestrian and roller sports—are critical elements for decreasing sports-related TBI events in adults.

scholarly journals Epidemiology and Factors Affecting Mortality of Hospitalized Patients with Disseminated Intravascular Coagulation in the United States

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2404-2404
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Appalanaidu Sasapu
Keyword(s):  
United States ◽  
African Americans ◽  
Native Americans ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Disseminated Intravascular Coagulation ◽  
The United States ◽  
Hospitalized Patients ◽  
Northeast Region ◽  
Intravascular Coagulation

Introduction Disseminated Intravascular Coagulation (DIC) is a systemic coagulopathy which leads to widespread thrombosis and hemorrhage and ultimately results in multiorgan dysfunction. DIC usually occurs as a complication of illnesses like severe sepsis, malignancies, trauma, acute pancreatitis, burns, and obstetrical complications. The prognosis and mortality of DIC depend on the etiology, however, the mortality of DIC is known to be on the higher side. The aim of the study is to analyze if gender, race, regional differences have any association with the mortality of hospitalized patients with DIC. Method The National Inpatient Sample database from the Healthcare Cost and Utilization Project (HCUP) for the year 2016 was queried for data. We identified hospital admissions for DIC with the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code D65. The data was analyzed with STATA 16.0 version and univariate and multivariate analysis were performed. We studied the characteristics of all such hospitalizations for the year 2016 and the factors associated with the in-hospital mortality rate (MR) of DIC. We used length of stay, cost of stay as an outcome to determine if gender, race, and location play a role in the mortality. Results A total of 8704 admissions were identified with a diagnosis of DIC during the year 2016. The mean age for admission was found to be 56.48± 0.22. The percentage of admissions in females and males did not have a notable difference (50.57% vs 49.43%). The disease specific MR for DIC was 47.7%. Admission during weekend vs weekdays did not carry a statistically significant difference in terms of MR. Females with DIC were less likely to die in the hospital when compared to males with DIC (OR= 0.906, CI 0.82 - 0.99, p= 0.031). Interestingly, African Americans (AA) with DIC admissions were found to have 24% more risk of dying when compared to Caucasians admitted with DIC (OR= 1.24, CI 1.10 - 1.39, P= 0.00), Native Americans (NA) has 67% more risk of dying when compared to Caucasians (OR= 1.67, CI 1.03 - 2.69, p= 0.035). The mortality rate of NA, AA, Caucasians with DIC was found to be 57%, 52%, 47% respectively. The MR was found to be highest in hospitals of the northeast region (52%), then hospitals in the south (47%), followed by west and mid-west (46%), p= 0.000. Patients admitted to west and mid-west were 24% less likely to die when compared to patients admitted to northeast region hospitals (OR= 0.76, p= 0.001). The average length of stay and cost of stay were also less in west and mid-west regions when compared to north east. The difference in outcomes persisted after adjusting for age, gender, race, hospital division, co-morbid conditions. Conclusion Our study demonstrated that African Americans and Native Americans with DIC have high risk of dying in the hospital. Also, there exists a difference between the mortality rate, length and cost of stay among different regions in the United States. More research is needed to elucidate the factors that might be impacting the location-based variation in mortality. Disclosures No relevant conflicts of interest to declare.

scholarly journals Using Satellite Images and Deep Learning to Identify Associations Between County-Level Mortality and Residential Neighborhood Features Proximal to Schools: A Cross-Sectional Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Joshua J. Levy ◽  
Rebecca M. Lebeaux ◽  
Anne G. Hoen ◽  
Brock C. Christensen ◽  
Louis J. Vaickus ◽  
...  
Keyword(s):  
United States ◽  
Deep Learning ◽  
Mortality Rate ◽  
Satellite Images ◽  
The United States ◽  
Mortality Rates ◽  
Image Features ◽  
County Level ◽  
Crude Mortality Rate ◽  
Crude Mortality

What is the relationship between mortality and satellite images as elucidated through the use of Convolutional Neural Networks?Background: Following a century of increase, life expectancy in the United States has stagnated and begun to decline in recent decades. Using satellite images and street view images, prior work has demonstrated associations of the built environment with income, education, access to care, and health factors such as obesity. However, assessment of learned image feature relationships with variation in crude mortality rate across the United States has been lacking.Objective: We sought to investigate if county-level mortality rates in the U.S. could be predicted from satellite images.Methods: Satellite images of neighborhoods surrounding schools were extracted with the Google Static Maps application programming interface for 430 counties representing ~68.9% of the US population. A convolutional neural network was trained using crude mortality rates for each county in 2015 to predict mortality. Learned image features were interpreted using Shapley Additive Feature Explanations, clustered, and compared to mortality and its associated covariate predictors.Results: Predicted mortality from satellite images in a held-out test set of counties was strongly correlated to the true crude mortality rate (Pearson r = 0.72). Direct prediction of mortality using a deep learning model across a cross-section of 430 U.S. counties identified key features in the environment (e.g., sidewalks, driveways, and hiking trails) associated with lower mortality. Learned image features were clustered, and we identified 10 clusters that were associated with education, income, geographical region, race, and age.Conclusions: The application of deep learning techniques to remotely-sensed features of the built environment can serve as a useful predictor of mortality in the United States. Although we identified features that were largely associated with demographic information, future modeling approaches that directly identify image features associated with health-related outcomes have the potential to inform targeted public health interventions.

Geographic Disparity in the United States Heart Allocation System

2019 ◽  
pp. 65-87
Author(s):  
Fatemeh Karami ◽  
Mehdi Nayebpour ◽  
Monica Gentili ◽  
Naoru Koizumi ◽  
Andrew Rivard
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Waiting Time ◽  
Average Distance ◽  
The United States ◽  
Allocation Model ◽  
Geographic Disparity ◽  
Transplant Candidates ◽  
Geographic Equity ◽  
The Impact

Organ allocation for transplantation across the United States is administered by the United Network for Organ Sharing (UNOS). UNOS recently approved a major policy change of the system used to allocate hearts for adult transplant candidates. The main objective of this study is to investigate the impact of the new policy on geographic disparity measured by four performance indicators (waiting time before a transplant, transplant rate, pre-transplant mortality rate, and average distance traveled by donated hearts). The current policy and the new policy were evaluated using the thoracic simulation allocation model. The results show that the new policy improves the median waiting time, transplant rate, and pre-transplant mortality rate. The overall predicted improvement in geographic equity is modest except in terms of waiting time. The findings highlight the need for a targeted approach for donor heart allocation to achieve equal access to heart transplantation in the US.

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