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PubMed1988

Risk of fatality from physical trauma versus sex and age.

No large-scale epidemiologic study to investigate how sex and age affect fatal trauma risk from the same impact has been possible previously because large numbers of people are rarely subject to sufficiently similar major physical insults. This paper describes such a study, made possible by two recent developments: first, the availability of a large data file, the Fatal Accident Reporting System, which gives information on more than one third of a million people fatally injured in traffic crashes; second, a new technique, the double-pair comparison method, which, by focusing on vehicles containing two occupants, at least one of whom is killed, allows appropriate inferences to be made from such data. Fatality risk versus sex and age was determined for ten categories of vehicle occupants (unbelted car drivers, helmeted motorcycle passengers, etc.). Similar effects were found for different occupants, indicating that basic physiologic response (not confined to traffic fatalities) is being measured. It is found that fatality risk is about 25% greater for females than for similar aged males from about age 15 to 45 years. At younger and older ages males are more at risk. For both sexes, fatality risk is least at age 20 years. At age 70 it is about three times what it is at age 20.

Accidents, Traffic↗

PubMed2002

Vehicle weight and fatality risk for sport utility vehicle-versus-passenger car crashes.

BACKGROUND: This study examines whether mortality is greater in sport utility vehicles (SUVs) or passenger cars when these vehicles collide in a head-on crash. METHODS: This study analyzed the effect of vehicle weight in head-on crashes between passenger cars and SUVs between 1994 and 1999. Variables such as location of impact, safety belt use, vehicle weight, vehicle type, number of occupants, and number of fatalities were extracted from the Fatality Analysis Reporting System. RESULTS: Belted occupants of passenger cars involved in a fatal head-on collision with an SUV had a higher fatality rate (total deaths per vehicle type/total occupants per vehicle type) than belted occupants of the SUV (56.3% of passenger car occupants vs. 17.6% of SUV occupants). The difference in fatality rates is reduced when the weight of the passenger car is equivalent to the weight of the SUV but is still significant (45.6% of passenger car occupants vs. 26.5% of SUV occupants). In the 57 crashes where the passenger cars outweighed the SUVs by an average of 234 lb, the occupants of the cars still had a higher fatality rate than occupants of the SUVs (40.1% of passenger car occupants vs. 24.4% of SUV occupants). CONCLUSION: Occupants of passenger cars have a higher risk of fatality than occupants of SUVs in car-versus-SUV head-on crashes. Vehicle differential weight plays an important role in determining the safety of occupants involved in these crashes, but safety cannot be evaluated on the basis of vehicle weight alone. Other factors such as mismatches in vehicle design and structural load path must also be considered.

Accidents, Traffic↗

PubMed1995

Fatal farm injuries: a five-year study utilizing a unique surveillance approach to investigate the concordance of reporting between two data sources.

The agricultural industry has been ranked among the most hazardous. Yet, it has been alleged that occupational injuries and fatalities are seriously underreported. Access to quality agricultural injury data poses a special problem. The purpose of this study was to investigate the concordance of reporting of fatal agricultural injuries between death certificate data and the Newspaper Clipping Service data in the state of Minnesota, utilizing a surveillance system developed by the University of Minnesota. Between September 1, 1981, and August 31, 1986, a total of 350 agricultural fatalities were identified in Minnesota; 82% were identified through death certificate data and 67% through the Newspaper Clipping Service. Differences in reporting between the two data sources were noted for gender, age, injury type, anatomical site, source, mechanism of injury, and multiple versus single injury. If only death certificates had been utilized, 18% of the fatalities would have been missed. Although it is apparent that death certificate data have an advantage over the Newspaper Clipping Service data for fatality reporting of specific variables, this study revealed that death certificate surveillance alone will miss mortality data and detection of certain potential risk factors. Suggestions for improving surveillance of agricultural fatalities are identified. However, until relevant changes are made, it will be essential to use a combination of data sources that include the Newspaper Clipping Service to identify agricultural injury fatalities accurately.

Accidents, Occupational↗

PubMed1997

Incidence of non-fatal workplace assault injuries determined from employer's reports in California.

Although fatal work-related assault assault injury rates are routinely reported in the United States, reports of non-fatal injuries are not routinely examined. Non-fatal workplace assault injuries can be reported through many agencies. One of the most common reporting mechanisms in California is the Employer's Report of Occupational Illness and Injury. Employer's Reports filed from October 1, 1994 through January 31, 1995 in the state of California were the source of workplace assault information for this study. All reports indicating an assault-related injury were identified and characterized by gender and occupation of the victim, type of assault and weapon used, and industry. Annual rates were determined based on the number of estimated annual reports and the civilian working population. The estimated annual rate of workplace assault injuries for California based on Employer's Reports is 72.9 per 100,000 workers, which is approximately 50 times the fatal rate. Rates differed by industry, with retail, hospital, transportation and police workers exhibiting the highest rates. Assaults were predominantly Type I, which involve criminal activity, and Type II, which involve an assault by a client, patient, or inmate. The rates of non-fatal work-related assault injury are much greater and have different characteristics than fatal injuries. These non-fatal injury patterns need to be considered when estimating the burden of assault injuries on businesses, and can help identify the most effective prevention strategies.

Absenteeism↗

PubMed2000

Fire- and flame-related occupational fatalities in the United States, 1980-1994.

The National Traumatic Occupational Fatalities surveillance system recorded 1518 fire- and flame-related occupational fatalities among the civilian workforce in the United States between 1980 and 1994. The fatalities resulted from 1221 separate incidents, of which 122 involved more than one victim and accounted for 419 of 1518 deaths. Nearly 4 of 10 fatalities resulting from a multiple-victim fire were workers in the manufacturing industry. Similarly, the highest frequency of fatalities in single-victim events, over one fourth, were in manufacturing. For one fourth of the fatalities within each event category, the usual occupation of the deceased was a precision production, craft, and repair worker. Although this study sheds light on selected characteristics of these fatalities, additional research on the causal factors associated with single- and multiple-victim events is needed to present specific recommendations for prevention efforts.

Accidents, Occupational↗

PubMed2005

Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations.

OBJECTIVE: To determine recent trends in severe sepsis-related rates of hospitalization, mortality, and hospital case fatality in a large geographic area and to determine the impact of age, race, and gender on these outcomes. DESIGN: Trend analysis for the period of 1995 to 2002. SETTING: Acute care hospitals in New Jersey. PATIENTS: Subjects > or = 18 yrs of age with severe sepsis who were hospitalized in New Jersey during the period of 1995 to 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed data from the 1995-2002 New Jersey State Inpatient Databases (SID) developed as part of the Healthcare Cost and Utilization Project (HCUP), covering all acute care hospitals in the state. On the basis of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for septicemia and organ dysfunction, we identified 87,675 patients with severe sepsis. The percentage of patients with severe sepsis among all hospitalized patients with sepsis grew steadily, from 32.7% to 44.7% (p < .0001), during these years. The crude rate of hospitalization with severe sepsis increased 54.2%, from 135.0/100,000 population in 1995 to 208.2/100,000 population in 2002 (p < .0001). Over time, the crude mortality rate rose by 35.8% (p < .0001), whereas the crude case fatality rate (number of deaths/number of cases) fell from 51.0% to 45.0% (p < .0001). For any given year, the rates of hospitalization and mortality were greater among older patients. After adjustment by age, the rates among blacks were greater than among whites, and they were greater among males than females. At the same time, there was no significant difference in the age-adjusted hospital case fatality rates with regard to gender and race. There was a significant increase in age-adjusted gender- and race-specific rates for hospitalization and mortality from 1995 to 2002. Blacks were more likely than whites to be admitted to the intensive care unit: for males, odds ratio = 1.19 (95% confidence interval, 1.13-1.26), and for females, odds ratio = 1.35 (95% confidence interval, 1.29-1.42). However, although case fatality rate was increased among patients admitted to the intensive care unit, this was not reflected in an increased case fatality among blacks. In addition, age-adjusted gender- and race-specific case fatality rates declined during 1995-2002. CONCLUSIONS: In spite of increasing rates of hospitalization and mortality, there is a decreasing case fatality rate for severe sepsis. These data suggest that advances in critical care practice before and during the study period have resulted in improved outcomes for this population.

Adult↗

PubMed1994

A comparison of the drugs taken in fatal and nonfatal self-poisoning.

The objective of this study was a) to compare patterns of drug use in fatal and nonfatal overdoses and b) to find out if toxic drugs are overrepresented in overdoses with fatal outcome. A total of 179 cases of fatal overdoses in Switzerland (population 6.6 million) were compared with 269 medically treated self-poisoners from the agglomeration of Berne (population 301,630). Because of frequent multiple drug use, all the different compounds taken singly or in combination with other drugs were recorded and grouped according to drug types. The patterns of the frequencies of drugs used were remarkably similar in both groups. The majority of the drugs were psychotropics (81% in fatal and 68% in nonfatal overdose). Twenty-nine completed suicides were the result of drug combinations specifically recommended by EXIT. In the remaining cases benzodiazepines were used most frequently in both attempted and completed suicide, often in combination with other drugs or alcohol. Barbiturates were the only drugs recorded significantly more often in fatal overdoses (9% vs 3%). No significant difference was found for tricyclic antidepressants (13% vs 10%), or other types of drugs. The results are consistent with our assumption that drugs with higher toxicity would be overrepresented in overdoses with fatal outcome. Barbiturates, which are well known to be dangerous in overdose, were clearly associated with fatal overdoses, but not tricyclic antidepressants. This, in our view, suggests that the risk of prescribing tricyclic antidepressants should not be overestimated. The frequent use of benzodiazepines in completed suicide, however, indicates that there are no truly safe drugs in overdose.

Adult↗

PubMed2001

Psychological characteristics and fatal ischaemic heart disease.

OBJECTIVE: To determine the relation between psychological characteristics and subsequent fatal ischaemic heart disease (IHD) events. DESIGN: Prospective study of participants in the Northwick Park heart study (NPHS) recruited between 1972 and 1978 and followed up for fatal events until 1997. SETTING: Three occupational groups in north west London. SUBJECTS: 1408 white men without a history of myocardial infarction aged 40-64 years at entry who completed a Crown-Crisp experiential index form (CCEI). MAIN OUTCOME MEASURE: Fatal IHD during follow up. RESULTS: A one point increase in the score on the obsessionality/obsessional neurosis subscale was associated with a relative risk of fatal IHD of 1.08 (95% confidence interval (CI) 1.02 to 1.15). For the functional somatic complaint subscale the relative risk was also 1.08 (95% CI 1.02 to 1.15). In the case of the total score the relative risk of fatal IHD was 1.28 (95% CI 1.09 to 1.50) for a 10 point increase. The associations were independent of age, social class, and known cardiovascular risk factors. In the case of phobic anxiety, which had previously been found to be associated with fatal IHD in NPHS, the association was evident in the first 10 years of follow up but overall the relative risk was only 1.07 (95% CI 0.99 to 1.15) for a one point increase in the score. CONCLUSION: Scores on two of the subscales of the CCEI and the total score are significantly associated with fatal IHD on long term follow up independently of other known risk factors.

Adult↗

PubMed1995

Factors determining case fatality in myocardial infarction "who dies in a heart attack"?

OBJECTIVE: To examine the determinants of case fatality in the first major ischaemic heart disease event (heart attack) after screening. METHODS: Prospective study of 7735 middle aged men drawn from general practices in 24 British towns. RESULTS: During 11.5 years follow up there were 743 major ischaemic heart disease events of which 302 (40.6%) were fatal within 28 days of onset. Previous definite myocardial infarction or stroke and age at time of event were most strongly associated with case fatality. In men with no previous myocardial infarction or stroke, after adjustment for a range of risk factors, antihypertensive treatment (odds ratio (OR) = 1.97, P < 0.05), arrhythmia (OR = 1.93, P = 0.06), increased heart rate (OR = 2.03, P = 0.06), and diabetes (OR = 2.61, P = 0.07) were associated with increased case fatality. High levels of physical activity (OR = 0.53, P < 0.05) and moderate drinking (16-42 units/week) (OR = 0.61, P < 0.05) were associated with lower case fatality, although moderate drinking was not associated with a lower incidence of major ischaemic heart disease events. Current smoking, serum total cholesterol, and systolic blood pressure were not significantly associated with case fatality. In men with previous myocardial infarction or stroke, arrhythmia and to a lesser degree antihypertensive treatment, moderate or heavy drinking, and diabetes were associated with higher case fatality. CONCLUSION: These findings suggest that physical activity may be an important modifiable factor influencing the incidence of ischaemic heart disease and the chance of survival in men without a previous heart attack or stroke. Arrhythmia, increased heart rate, diabetes, and treatment for hypertension are also areas of concern.

Adult↗

PubMed2004

A study of logger fatalities from 1992-2000.

OBJECTIVES: To determine if certain loggers are at increased risk of death during logging operations. METHODS: Statistical analysis of 780 logger fatalities for a nine year period (1992-2000). RESULTS: The major findings are: (1) treefallers suffer nearly 63% of all fatalities, (2) the region where the fatality occurred and the size of the employer were not significant factors that contributed to a high percentage of treefaller fatalities, and (3) the Northeast and Midwest regions showed a higher percentage of fatalities compared with the South and West regions. CONCLUSIONS: Overall, the logger fatality rate for 1992-2000, compared with 1980-88 has decreased slightly; however, treefallers continue to be the group of loggers who suffer the highest fatality rate.

Accidents, Occupational↗

PubMed2005

Comparison of injury case fatality rates in the United States and New Zealand.

OBJECTIVE: To compare injury case fatality rates in the United States (US) with New Zealand (NZ) to guide future information collection, research, and evaluation. DESIGN: Using NZ (1992-96) and US (1996-98) mortality censuses, NZ national 1992-96 hospital discharge censuses, and US 1996-98 National Hospital Discharge Survey data, the authors compared case fatality rates by mechanism and intent of injury and age group. The analysis was restricted to severe injuries (AIS> or =3). SUBJECTS: NZ (1992-96) and US (1996-98) populations. MAIN OUTCOME MEASURES: Ratio of case fatality rates in NZ versus the US (RCFR(NZ:US)). RESULTS: Overall, among cases meeting the study criteria, unintentional injuries were 1.57 times more likely fatal in NZ and intentional assault injuries were 1.14 times more likely to be fatal in the US. Firearms were involved in 50% of US assaults versus 8% of NZ assaults. By mechanism, cutting/piercing injuries were 1.86, firearm injuries were 1.41, and motor vehicle injuries were 1.44 times more to be likely fatal in NZ. Natural/environmental injuries (RCFR(NZ:US) = 0.57), unintentional poisonings (RCFR(NZ:US) = 0.26), and unintentional suffocations (RCFR(NZ:US) = 0.67) were significantly more likely to be fatal in the US. CONCLUSIONS: Possible reasons for the observed results include: differences in geography and proportion of population in rural areas, trauma system differences, road design and vehicle types, seat belt use, larger role of firearms in US assaults, coding practices, policies, and environmental factors. Disparities evoke hypotheses to test in future research that will guide priority setting and intervention.

Accidents, Traffic↗

PubMed1998

Trends in rates of occupational fatal injuries in the United States (1983-92).

OBJECTIVES: An updated version of a national surveillance system of traumatic occupational fatalities was used to explore adjusted and unadjusted trends in rates of fatal injury. METHODS: Data from the national traumatic occupational fatalities surveillance system were combined with data on employment from the United States Bureau of Labor Statistics. Poisson regression was then used to examine trends in rates of occupational fatality injuries while controlling for demographic and workplace characteristics. RESULTS: Adjusted annual changes in rates of fatal injuries ranged from a decline of 6.2% for workers in technical and administrative support occupations--for example, health, science, and engineering technicians, pilots, computer programmers--to an increase of 1.6% in machine operators, assemblers, and inspectors. For industries, annual changes ranged from a decline of 5.3% for workers in public administration--for example, justice, public order, and safety workers--to an increase of 2.6% for workers in the wholesale trade. By comparison, the annual decline over all industries and occupations was 3.1%. In many industries and occupations, an effect modification of annual trends by the age of the worker was also found with the oldest workers experiencing either no decline or a significant increase in rates of fatal injuries. CONCLUSIONS: This general pattern of decline, adjusted for the effects of demographic characteristics of the worker population, is encouraging; however, increases in rates of fatal injuries found in particular industries and occupations, suggest appropriate targets for increased injury prevention efforts.

Accidents, Occupational↗

PubMed2004

Current smoking and the risk of non-fatal myocardial infarction in the WHO MONICA Project populations.

BACKGROUND: Cohort studies have shown that smoking has a substantial influence on coronary heart disease mortality in young people. Population based data on non-fatal events have been sparse, however. OBJECTIVE: To study the impact of smoking on the risk of non-fatal acute myocardial infarction (MI) in young middle age people. METHODS: From 1985 to 1994 all non-fatal MI events in the age group 35-64 were registered in men and women in the WHO MONICA (multinational monitoring of trends and determinants in cardiovascular disease) project populations (18,762 events in men and 4047 in women from 32 populations from 21 countries). In the same populations and age groups 65,741 men and 66,717 women participated in the surveys of risk factors (overall response rate 72%). The relative risk of non-fatal MI for current smokers was compared with non-smokers, by sex and five year age group. RESULTS: The prevalence of smoking in people aged 35-39 years who experienced non-fatal MI events was 81% in men and 77% in women. It declined with increasing age to 45% in men aged 60-64 years and 36% in women, respectively. In the 35-39 years age group the relative risk of non-fatal MI for smokers was 4.9 (95% confidence interval (CI) 3.9 to 6.1) in men and 5.3 (95% CI 3.2 to 8.7) in women, and the population attributable fractions were 65% and 55%, respectively. CONCLUSIONS: During the study period more than half of the non-fatal MIs occurring in young middle age people can be attributed to smoking.

Adult↗

PubMed1998

Case-control study of salmeterol and near-fatal attacks of asthma.

BACKGROUND: A case-control study was undertaken to investigate the hypothesis that the use of the long acting beta agonist salmeterol increases the risk of a near-fatal attack of asthma. METHODS: The cases comprised admissions to the intensive care unit (ICU) for asthma in 14 major hospitals within the Wessex region in 1992. For each of the cases four age-matched controls were selected from asthma admissions to the same hospital during the same period. Information on prescribed drug therapy for the 48 cases and 185 controls was collected from the hospital admission records. RESULTS: The patients admitted to the ICU had greater chronic asthma severity and had generally been prescribed more asthma drugs than the control admissions to hospital. The relative risk of a near-fatal attack of asthma in patients prescribed inhaled salmeterol was 2.32 (95% CI 1.05 to 5.16), p = 0.04. However, the salmeterol relative risk decreased to 1.42 (95% CI 0.49 to 4.10), p = 0.52 when the analysis was restricted to the more chronically severe patients (those in the subgroup of patients with a hospital admission for asthma in the previous 12 months). These findings suggest that the increased unadjusted relative risk with salmeterol is predominantly due to confounding by severity--that is, the increased relative risk is due to patients with more severe asthma (at greatest risk of a near-fatal asthma attack) being preferentially prescribed salmeterol. This interpretation is supported by the finding in this study that, within the control group (selected from the population of asthmatics requiring hospital admission), salmeterol was preferentially prescribed to the most severe patients (a threefold greater prescription of salmeterol to control patients if they had been admitted to hospital in the 12 months prior to the index admission). There was no increased risk of a near-fatal attack of asthma in patients prescribed a beta agonist by metered dose inhaler (OR 0.75 (95% CI 0.31 to 1.78), p = 0.51). In contrast, the relative risks for beta agonists delivered by nebulisation (OR 3.86 (95% CI 1.99 to 7.50), p < 0.001) and oral theophylline (OR 2.45 (95% CI 1.26 to 4.78), p < 0.01) were increased and did not markedly decrease when the analysis was restricted to the more severe asthmatic subjects. CONCLUSIONS: Although these findings are not conclusive, particularly because of the small numbers involved in some subgroup analyses, they suggest that the use of salmeterol by patients with chronic severe asthma is not associated with a significantly increased risk of a near-fatal attack of asthma. If a near-fatal asthma attack is considered to be an intermediate step in a process by which a severe attack of asthma may become fatal, these results would suggest that salmeterol is unlikely to be associated with an increased risk of death, at least by this mechanism.

Adolescent↗

PubMed2005

Fatal vascular outcomes following major orthopedic surgery.

Major orthopedic surgery is known to be associated with potentially serious arterial and venous vascular complications, although uncertainty exists about current event rates. Using electronic databases and investigator contact, we identified randomized and cohort studies reporting overall mortality and fatal vascular events. Where possible, studies reporting high autopsy rates (>60%) were examined. Pooled incidences were calculated from eligible studies. For Autopsy studies: Pooled overall mortality and fatal pulmonary embolism for patients undergoing elective hip and knee replacement without prophylaxis could not be calculated, while with prophylaxis they were 0.44% (95% confidence interval 0.02 to 0.87%) and 0.43% (0.01 to 0.85%). For patients undergoing hip fracture surgery, the corresponding rates without prophylaxis were 15.9% (14.5 to 17.3%) and 1.9% (1.4 to 2.4%). With prophylaxis, mortality and fatal pulmonary embolismrates were 8.5% (7.3 to 9.7%) and 1.0% (0.6 to 1.5%). Among Cohort studies: Pooled overall mortality and fatal pulmonary embolism for patients undergoing elective hip and knee replacement without prophylaxis were 0.93% (0.57 to 1.29%) and 0.36% (0.14 to 0.59%). For patients receiving prophylaxis (7 to 14 days), mortality and fatal pulmonary embolism were 0.57% (0.51 to 0.62%) and 0.18% (0.14 to 0.21%). Patients undergoing hip fracture surgery receiving prophylaxis hadmortality and fatal pulmonary embolismrates of 3.2% (2.8 to 3.6%) and 0.30% (0 to 0.61%). Vascular events contributed towards approximately 50% of all deaths with similar proportions due to ischemic heart disease, cardiac failure and pulmonary embolism. In conclusion, although prophylaxis results in a reduction in overall mortality and fatal pulmonary embolism, vascular events continue to be a common cause of mortality.

Autopsy↗

PubMed2003

Prehemorrhage risk factors for fatal intracranial aneurysm rupture.

BACKGROUND AND PURPOSE: The goal of this study was to investigate predictive preictal risk factors for fatal subarachnoid hemorrhage (SAH) in a patient population with verified intracranial aneurysms without surgical selection of patients and with complete follow-up. METHODS: A total of 142 patients with 181 unruptured aneurysms diagnosed between 1956 and 1978 were followed up for a total of 2577 person-years until death, SAH, or the years 1997 to 2000. The predictive value of several factors known before SAH was tested for case fatality. RESULTS: During follow-up, 34 first episodes of hemorrhage from a previously verified unruptured aneurysm occurred. Of these bleeding episodes, 17 were fatal. Patients who died after the bleeding had higher blood pressure values (mean+/-SD, 148+/-11/92+/-8 mm Hg; mean pressure, 111+/-9 mm Hg) before hemorrhage than did those with nonfatal bleeding (mean+/-SD, 135+/-15/83+/-11 mm Hg; mean, 101+/-12 mm Hg) (P<0.05). Patients with fatal SAH were also older (54+/-7 versus 47+/-13 years, P=0.068) and had aneurysms larger in diameter (13+/-8 versus 10+/-5 mm) than those who survived. They had a higher prevalence of definite hypertension (56% versus 12%, P<0.05), more frequently used antihypertensive medication (29% versus 6%) by the end of follow-up, and tended to have higher blood pressure at the beginning of follow-up (140+/-21/85+/-11 versus 134+/-17/80+/-9 mm Hg). After adjustment for age, aneurysm size, and sex, the only indisputable significant independent risk factor for fatal SAH compared with nonfatal SAH was systolic blood pressure before aneurysm rupture (odds ratio, 1.11 per 1 mm Hg; 95% CI, 1.01 to 1.23; P=0.032). The adjusted odds ratio of definite hypertension for fatal SAH was 12.67 (95% CI, 1.53 to 104.70; P=0.018). CONCLUSIONS: Increased systolic blood pressure values and long-term hypertension before aneurysm rupture seem to predict fatal SAH independently of aneurysm size or patient age or sex at the time of rupture.

Blood Pressure↗

PubMed1997

Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review.

BACKGROUND: During the last three decades, new management strategies have been developed for patients with aneurysmal subarachnoid hemorrhage. To assess whether the case-fatality rate has improved after the introduction of new management strategies, we studied outcome in all population-based studies from 1960 onward. SUMMARY OF REVIEW: To identify population-based studies that reported on case-fatality rate in subarachnoid hemorrhage, we performed a MEDLINE search and checked all reference lists of the studies found. Two authors (J.W.H. and G.J.E.R.) independently assessed all studies for eligibility, using predefined criteria for case finding and diagnosis, and extracted data on case-fatality rates. We used weighted linear regression analysis to quantify change in case-fatality rate over time. We found 21 studies, describing 25 study periods between 1960 and 1992. Case-fatality rates varied between 32% and 67%, with the exception of one recent study. The case-fatality rate decreased by 0.5% per year (95% confidence interval, -0.1 to 1.2); the decline was steeper after adjustment for age and sex (0.9% per year; 95% confidence interval, -0.7 to 2.6; data from 12 studies). CONCLUSIONS: The case-fatality rate after subarachnoid hemorrhage has decreased during the last three decades. A plausible explanation for this decrease is the improved management of patients with subarachnoid hemorrhage.

Australia↗

PubMed1993

Sudden-onset fatal asthma. A distinct entity with few eosinophils and relatively more neutrophils in the airway submucosa?

To determine the histologic differences in the airways of patients who died from sudden-onset asthma and the more common slow-onset asthma, we studied seven cases of fatal asthma. The numbers of eosinophils and neutrophils, as well as extracellular deposition of their respective granule contents in the airway mucosa and submucosa, were determined and statistically analyzed. Four of the seven patients had slow-onset asthma attacks in which the time interval between onset of asthma and death was more than 2.5 h. In contrast, three patients had sudden-onset asthma in which the time interval between onset of asthma attack and death was less than 1 h. The four patients with slow-onset fatal asthma had more eosinophils (34.1 +/- 6.3 in slow-onset; 9.7 +/- 3.5 in sudden-onset; p = 0.002) and fewer neutrophils (4.8 +/- 2.0 in slow-onset; 16.8 +/- 5.4 in sudden-onset; p = 0.008) in the airway submucosa than did patients with sudden-onset fatal asthma. In addition, within the slow-onset fatal asthma group, eosinophils exceeded neutrophils in the airway submucosa (eosinophils > neutrophils, p = 0.002). By contrast, within the sudden-onset fatal asthma group, neutrophils exceeded eosinophils (neutrophils > eosinophils, p = 0.04). We suggest that sudden-onset fatal asthma is immunohistologically distinct from slow-onset fatal asthma and that it is characterized by a relative paucity of eosinophils in the face of an excess of neutrophils in the airway submucosa.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗