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PubMed2001

Declining trend in the in-hospital case-fatality rate from acute myocardial infarction in Miyagi Prefecture from 1980 to 1999.

The case-fatality rate from acute myocardial infarction (AMI) appears to have been declining in recent decades, so the present study reviewed the trend in in-hospital case-fatalities from AMI in Miyagi Prefecture, Japan, 1980-1999. The causes of death and the effects of gender and age on the trend were also analyzed. From the AMI registration database of the Miyagi Study Group for AMI, 12,961 cases of AMI were analyzed. The 30-day in-hospital case-fatality was calculated from the data for 1980-1999: data for causes of death were available for 1980-1997, and the data concerning primary percutaneous transluminal coronary angioplasty (PTCA) for AMI were available for 1997-1999. The in-hospital case-fatality rate declined from 17.0% in the early 80s to 7.3% in the late 90s (approximately 57% reduction). The in-hospital case-fatality rate was higher in female patients. Rhythm failure substantially decreased in the late 1980s. Pump failure is decreasing, but is still the biggest problem. The in-hospital case-fatality rate was significantly lower in patients received PTCA. The declining trend in the in-hospital case-fatality rate suggests the benefits of current therapeutic procedures, including primary PTCA, for AMI. Pump failure is an important target for further decreasing the trend.

Adult↗

PubMed2001

Importance of fatalism in understanding mammography screening in rural elderly women.

This study examined the relationship between demographic factors and other correlates of fatalism, and assessed the impact of fatalistic beliefs on the participation in breast cancer screening in rural women. The subjects were 220 women aged 50 and over recruited from 6 large rural counties in South Carolina. Data were collected using a demographic questionnaire and the revised Powe Fatalism Inventory. Results show significant associations between fatalism and increased age (p = 0.005), race (p = 0.0001), doctor recommendation (p = .0034) and decreased educational level (p = 0.001). Fatalism was associated with noncompliance with mammography screening in univariate analysis among African-American women (OR = .362; 95% CI: 1.11, 11.8). After adjusting for possible confounders (age, education, and doctor recommendation), fatalism was not significantly associated with noncompliance with screening. These results illustrate age, race, and education may be important predictors of fatalism and that fatalism may be one barrier that has previously gone unmeasured and unchallenged in understanding screening behavior in older women.

Aged↗

PubMed2001

Fatal on-farm injuries among youth 16 to 19 years of age: 1982-1994.

Data from the Vital Statistics Mortality (VSM) public use file and the National Traumatic Occupational Fatalities (NTOF) surveillance systems were used to describe fatal injuries among youth 16-19 years of age in the United States that occurred on farms for the years 1982 through 1994. The VSM captures all deaths in the United States, while the NTOF only captures occupational injury deaths. There were 550 total on-farm fatalities to youth 16-19 years of age in the VSM, and 221 occupational on-farm deaths from the NTOF for the same age group. These numbers suggest that 40% of the on-farm deaths were occupational. It was found that the proportions of deaths attributable to work increased with age. Fatality rates for on-farm nonoccupational deaths decreased slightly during the time period (from 8.4 deaths/100,000 for 1982-1985 to 6.8 deaths/100,000 for 1991-1994), while on-farm occupational fatality rates dropped dramatically (12.0 deaths/100,000 for 1982-1985 down to 4.9 deaths/100,000 for 1991-1994). The leading causes of death for on-farm occupational fatalities were machinery (54%) and electrical current (20%). The most common causes of on-farm fatalities that were nonoccupational were drowning (38.9%) and firearms (28.6%). For the years 1991 through 1994, drowning and firearms accounted for approximately the same number of on-farm deaths as machinery. Nonoccupational risks are a concern for youth 16-19 years of age on the farm.

Accidents↗

PubMed2005

Animal-related fatalities in the United States-an update.

OBJECTIVE: To evaluate the causes of human fatalities in the United States from 1991 to 2001 that were caused by venomous and nonvenomous animal encounters exclusive of zoonotic infections or animal-vehicle collisions. METHODS: An inquiry of CDC Wonder, a database for epidemiologic research, was used to provide information on animal-related fatalities on the basis of ICD-9 and ICD-10 codes. RESULTS: From 1991 to 2001, 1943 persons died in the United States after venomous and non-venomous animal encounters. An average of 177 fatalities per year were recorded. Venomous animal encounters were responsible for 39% of the fatalities. White males appear to be the group most likely to die from an encounter. Most fatalities occurred in the southern United States. CONCLUSIONS: Although the average number of fatalities from animal encounters has increased compared with the previous decade, the death rate has remained essentially unchanged. The medical and financial costs from both fatal and nonfatal animal encounters have a significant impact on public health.

Adolescent↗

PubMed1988

Seating position in cars and fatality risk.

Fatality risk in passenger cars according to seating position (front versus rear; left versus center or right) was examined using Fatal Accident Reporting System (FARS) data for 1975 through 1985. Comparing the fatality risk of unrestrained occupants matched in sex and age (within three years) revealed effects attributable to seating position, and not to occupant characteristics correlated with use of different seats. Fatality risk to drivers was the same as fatality risk to right front passengers to within 1 per cent; this was so for crashes in all directions and for frontal crashes. Fatality risk in rear seats was (26 +/- 2) per cent lower than in front seats, and lower in center compared to outboard seats by (22 +/- 4) per cent for front seats and (15 +/- 4) per cent for rear seats. The center rear seat was associated with the lowest fatality risk.

Accidents, Traffic↗

PubMed2003

Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities.

OBJECTIVES: We sought to determine the association between urban sprawl and traffic fatalities. METHODS: We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities. RESULTS: For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P <.001) and pedestrian fatality rates fell by 1.47% to 3.56%, after adjustment for pedestrian exposure (P <.001). CONCLUSIONS: Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates.

Accidents, Traffic↗

PubMedDate not supplied

The diagnosis of potentially fatal asthma.

The concept of life-threatening asthma is not new. Reviews of fatal asthma often describe retrospectively identified factors that were associated with or contributed to the patient's demise. We report 55 patients considered to have the diagnosis of potentially fatal asthma who were managed for 4.8 +/- 4.3 years per patient. The diagnostic criteria of potentially fatal asthma included at least one of the following four potentially fatal asthma events: 1) mechanical ventilation for respiratory arrest or failure, 2) acute respiratory acidosis that did not necessitate mechanical ventilation, 3) two episodes of acute pneumomediastinum or pneumothorax associated with status asthmaticus, 4) two or more hospitalizations for status asthmaticus in spite of long term oral corticosteroids. The mean age of patients with potentially fatal asthma was 39.6 +/- 19.1 (range 8.5-79.5 years). During 262 patient-years of management, one 79 year old demented patient died from disseminated cryptococcal infection. Two patients died from asthma after leaving our service, one patient having left the hospital against medical advice with arterial blood gases demonstrating acute respiratory acidosis during status asthmaticus. Fifty-two patients are alive and ambulatory. Long-term corticosteroids have been essential in 43 of 45 patients in this series currently managed by full-time faculty of the Northwestern University Allergy Service. Complicating psychosocial factors of some patients with potentially fatal asthma include schizophrenia, bipolar disorders, denial of disease, adolescent non-compliance, and parental interference with essential medications for children. We believe that the diagnosis of potentially fatal asthma should be made following occurrence of major asthma events that place the patient at high risk for a death from asthma.

Acidosis, Respiratory↗

PubMed2004

Race- and course-level risk factors for fatal distal limb fracture in racing Thoroughbreds.

REASONS FOR PERFORMING STUDY: Considerable variation in the rates of equine fatality at different racecourses draws attention to probable risk factors at the level of course or race that might be partly responsible. Distal limb fractures are the most common cause of equine fatality on UK racecourses and identification of risk factors for such injuries and subsequent implementation of intervention strategies could significantly reduce the total number of racecourse fatalities. OBJECTIVES: To identify race- and course-level risk factors for fatal distal limb fracture in Thoroughbreds on UK racecourses. METHODS: A case-control study design was used. Case races were defined as those in which one or more horses sustained fatal fracture of the distal limb. Controls were selected in 2 different ways. Firstly, 3 races in which no fracture occurred were selected from all races of the same type held within 5 days of the case race (Analysis 1). Secondly, 3 control races were selected for each case race from all races of the same type held in the same year (Analysis 2). One hundred and nine cases were included in the study. Information about the race and the racecourses was collected from Computer Raceform. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture in a race. RESULTS: Longer races with a larger number of runners were more likely to contain a fracture. Firmer going and fewer days since the last race on the same course were associated with an increased risk of fracture. The going at the course at the previous race meeting was also associated with the likelihood of fracture. CONCLUSIONS: Modifications to the going on the day of a race and greater emphasis on ground maintenance between race meetings may have an impact on the risk of fatal distal limb fracture during racing. POTENTIAL RELEVANCE: Modification of risk factors such as the going and number of days since the last race meeting could reduce the number of equine fatalities on UK racecourses. The condition of the racecourse may be an important risk factor and future research should focus on the identification of course maintenance techniques that produce the safest possible racing surfaces.

Animals↗

PubMed1997

Characterization of fatal beta blocker ingestion: a review of the American Association of Poison Control Centers data from 1985 to 1995.

OBJECTIVE: To characterize beta blocker-related deaths. METHODS: This is a retrospective review of beta blocker-related exposure data and fatality case abstracts reported to the American Association of Poison Control Centers Toxic Exposure Surveillance System during the 11 year period, 1985 to 1995. Historical and laboratory data were used to determine those fatalities which resulted primarily from beta blocker intoxication. RESULTS: Of 52,156 reported beta blocker exposures, 164 were fatal. In 38 cases, beta blockers were implicated as the primary cause of death. Propranolol was responsible for the greatest number of exposures (44%) and implicated as the cause of death in a disproportionately high percentage of fatalities (71%). Patients were generally young women; 63% were female and 92% were less than 50 years old. The dysrhythmias most often noted in fatal cases were bradycardia and asystole. Cardiopulmonary arrest did not develop until patients were in the care of health care personnel in 59% of cases. Though glucagon was initiated more often than any other intervention in fatal intoxications (83%), optimal dosing and maintenance infusions appear to have been underutilized. CONCLUSIONS: The predominance of fatalities associated with propranolol compared to other beta blockers reflects both its greater frequency of use over the time period studied and its greater toxicity. Since 59% developed. cardiac arrest after reaching health care personnel, further study should focus on identifying medical intervention that can reduce mortality in this group.

Administration, Oral↗

PubMed1985

Acute brain edema in fatal head injury: analysis by dynamic CT scanning.

Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p less than 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.

Acute Disease↗

PubMed2006

Risk factors for immediate post-operative fatal recurrence after curative resection of hepatocellular carcinoma.

AIM: To investigate the clinicopathological risk factors for immediate post-operative fatal recurrence of hepatocellular carcinoma (HCC), which may have practical implication and contribute to establishing high risk patients for pre- or post-operative preventive measures against HCC recurrence. METHODS: From June 1994 to May 2004, 269 patients who received curative resection for HCC were reviewed. Of these patients, those who demonstrated diffuse intra-hepatic or multiple systemic recurrent lesions within 6 mo after surgery were investigated (fatal recurrence group). The remaining patients were designated as the control group, and the two groups were compared for clinicopathologic risk factors. RESULTS: Among the 269 patients reviewed, 30 patients were enrolled in the fatal recurrence group. Among the latter, 20 patients showed diffuse intra-hepatic recurrence type and 10 showed multiple systemic recurrence type. Multivariate analysis between the fatal recurrence group and control group showed that pre-operative serum alpha-fetoprotein (AFP) level was greater than 1,000 microg/L (P = 0.02; odds ratio = 2.98), tumor size greater than 6.5 cm (P = 0.03; OR = 2.98), and presence of microvascular invasion (P = 0.01; OR = 4.89) were the risk factors in the fatal recurrence group. The 48.1% of the patients who had all the three risk factors and the 22% of those who had two risk factors experienced fatal recurrence within 6 mo after surgery. CONCLUSION: Three distinct risk factors for immediate post-operative fatal recurrence of HCC after curative resection are pre-operative serum AFP level > 1,000 microg/L, tumor size > 6.5 cm, and microvascular invasion. The high risk patients with two or more risk factors should be the candidates for various adjuvant clinical trials.

Adult↗

PubMed2002

Involvement by young drivers in fatal alcohol-related motor-vehicle crashes--United States, 1982-2001.

Motor-vehicle crashes are the leading cause of death in the United States for persons aged 16-24 years, and a substantial proportion of these crashes are alcohol-related. Alcohol-impaired driving is highest among persons aged 21-24 years, and the percentage of fatal crashes that are alcohol-related is highest for this age group. However, alcohol-related crashes are a serious problem even for the youngest drivers. Not only are drivers aged <21 years more likely than older drivers to be involved in fatal crashes, but their added risk for fatal crash involvement increases more sharply at all levels of alcohol use. To characterize the rate of alcohol-related fatal crashes among young drivers, CDC analyzed unpublished data from the Fatality Analysis Reporting System (FARS), a national database of information on fatal crashes. The findings indicate that the largest decrease in alcohol-related fatal crashes during 1982-2001 was among drivers aged <21 years, who have been the target of several interventions to reduce alcohol-impaired driving. Public health and traffic safety professionals should ensure that communities implement comprehensive and effective strategies to reduce alcohol-impaired driving.

Accidents, Traffic↗

PubMed2003

Selective serotonin reuptake inhibitors in pilot fatalities of civil aviation accidents, 1990-2001.

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression. With a few exceptions, these psychotropic medications are not approved by aeromedical regulatory authorities for use by aviators. Since SSRIs have the potential for impairing performance and causing drug-drug interactions, the prevalence of SSRIs in pilot fatalities of civil aviation accidents was evaluated. METHODS: Postmortem samples from pilots involved in fatal civil aircraft accidents are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological evaluation. Findings from such evaluations are maintained in the CAMI Toxicology Database. This database was examined for the presence of SSRIs in pilot fatalities of the accidents that occurred during 1990-2001. RESULTS: Out of 4,184 fatal civil aviation accidents from which CAMI received samples, there were 61 accidents in which pilot fatalities had SSRIs. Of these accidents, 56 were of the general aviation category, 2 were of the air taxi and commuter category, 2 were of the agricultural category, and 1 was of the ultralight category. Blood concentrations of SSRIs in the fatalities were 11-1121 ng x ml(-1) for fluoxetine; 47-13102 ng x ml(-1) for sertraline; 68-1441 ng x ml(-1) for paroxetine; and 314-462 ng x ml(-1) for citalopram. In 39 of the 61 pilots, other drugs--for example, analgesics, antihistaminics, benzodiazepines, narcotic analgesics, and/or sympathomimetics--and/or ethanol were also present. As determined by the National Transportation Safety Board, the use of an SSRI [with or without other drug(s) and/or ethanol] has been a contributory factor in at least 9 of the 61 accidents. CONCLUSIONS: Numbers of SSRI-involved accidents were low, and blood SSRI concentrations in the associated pilot fatalities ranged from subtherapeutic to toxic levels. However, the interactive effects of other drug(s), ethanol, and/or even altitude hypoxia in producing adverse effects in the pilots cannot be ruled out. Findings from this study should be useful in investigating SSRI and other substance-involved accidents and in making decisions concerning the use of SSRIs in aviation.

Accidents, Aviation↗

PubMed2004

The New Zealand child work-related fatal injury study: 1985-1998.

AIMS: To estimate the numbers and rates of work-related fatal injury for children under the age of 15 years. METHODS: Potential cases of work-related injury deaths of persons aged <15 years of age were identified from the national electronic mortality data-files for the period 1985-1998 inclusive. The circumstances of the death in each fatality incident were reviewed directly from coronial files to determine work-relatedness. RESULTS: A total of 87 workplace work-related fatalities were identified. The vast majority of children identified were fatally injured while a bystander to another person's work. Workplace bystander involvement was found to vary by age, with the majority of workers identified aged 10-14 years old. With a third of all fatalities, the agricultural industry was the most common industry for workplace work-related fatalities in children. In the period 1985-94, children <15 years of age were found to account for 46% of New Zealand's total workplace bystander deaths. CONCLUSIONS: Children contribute significantly to the overall burden of work-related fatal injury in New Zealand, especially as bystanders to other people's work. The high contribution to bystander deaths by children aged <15 years suggests that hazard control in certain work settings is lacking.

Accidents, Occupational↗

PubMed2005

Geographic analysis of traffic injury in Wisconsin: impact on case fatality of distance to level I/II trauma care.

PURPOSE: Traffic injuries are an important public health problem in Wisconsin. This paper examines geographic variations in the incidence and case fatality of traffic injuries, and evaluates proximity to Level I/II trauma care as a predictor of case fatality. METHODS: Data on all persons injured in motor vehicle crashes on Wisconsin roadways during a 10-year period (1992-2001) were obtained from the Wisconsin Crash Outcome Data Evaluation System. Injury rates per 100 million vehicle miles traveled (VMT) and case fatality were visually displayed by county. Multiple logistic regression models were used to evaluate distance between crash site and Level I/II trauma care as a risk factor for fatality, controlling for other factors. RESULTS: During the 10-year period, 50,300 people were severely injured in motor vehicle crashes and 7450 (15%) died. Injury rates per VMT were highest in the southeast counties. In contrast, case-fatality for all injuries and for severe injuries was highest in northern and western counties and significantly associated with distance from Level I/II trauma care after controlling for other predictors of case fatality. CONCLUSIONS: Strategies are needed to reduce the disparity in traffic injury case fatality across the state and to improve outcomes for persons injured in counties distant from Level I/II trauma care.

Accidents, Traffic↗

PubMed2005

Vector analysis correlating bullet trajectory to outcome after civilian through-and-through gunshot wound to the head: using imaging cues to predict fatal outcome.

OBJECTIVE: We identify radiographic imaging similarities found on head computed tomographic (CT) scans of patients with through-and-through gunshot wounds to the head with fatal outcomes. METHODS: A retrospective analysis was conducted over an 18-month period from June 2001 through December 2002. Two hundred seventeen gunshot wound patients were evaluated. Exclusion criteria included any patient with cardiopulmonary injury and instability, airway compromise, or extracranial injuries affecting prognosis. Thirty-seven patients with isolated gunshot wounds to the head were included, 10 of which were fatal. Vital signs, examination results, Glasgow coma scale (GCS) score, intracranial pressure monitoring, surgical data, days in the intensive care unit, and CT scan appearance were collected. A Cartesian xyz coordinate system was created centered on the dorsum sella. Bullet pathways on CT scans were plotted and graphed onto a standardized magnetic resonance imaging scan. RESULTS: Ten patients progressed to brain death. GCS score and pupil irregularity were associated with fatal outcome (P < 0.0001). CT scans showed that brain shift was more common in survivors. Seventy percent of nonsurvivors had minimal brain shift. A tram-track sign on CT scans correlated with fatal outcome (P = 0.005). Vector analysis of nonsurvivors showed an area of the brain approximately 4 cm above the dorsum sella that, when penetrated through the midline, led to brain death (P = 0.0006). This zone was coined the zona fatalis. CONCLUSION: We confirm that GCS score and diabetes insipidus correlated with fatal outcome. In the setting of low-velocity gunshot wounds, fatal outcome and low GCS score were associated with a tram-track sign on CT scans. Bullet passage through a particular supra-dorsum sellar transventricular zone was associated with fatal outcome.

Adolescent↗

PubMed2005

Toxicological findings from 1587 civil aviation accident pilot fatalities, 1999-2003.

INTRODUCTION: The prevalence of drug and ethanol use in aviation is monitored by the Federal Aviation Administration (FAA). Under such monitoring, toxicological studies for the 1989-1993 and 1994-1998 periods indicated lower percentages of the presence of controlled substances (illegal drugs) than that of prescription and nonprescription (over-the-counter) drugs in aviation accident pilot fatalities. In continuation, a toxicological assessment was made for an additional period of 5 yr. METHODS: Biosamples from aviation accident pilot fatalities submitted to the FAA Civil Aerospace Medical Institute (CAMI) are analyzed, and those findings are stored in a database. This database was examined for the 1999-2003 period for the presence of controlled substances (Schedules I-V), prescription/nonprescription drugs, and ethanol in the fatalities. RESULTS: Out of 1629 fatal aviation accidents from which CAMI received biosamples, pilots were fatally injured in 1587 accidents. Drugs and/or ethanol were found in 830 (52%) of the 1587 fatalities. Controlled substances from Schedules I-II (SI-II) and Schedules III-V (SIII-V) were detected in 113 and 42 pilots, respectively. Prescription drugs were present in 315 pilots, nonprescription drugs in 259, and ethanol in 101. SI-II substances were detected in 5 of 122 first-class medical certificate-holding airline transport pilots. In addition to the controlled substances, many of the prescription/nonprescription drugs found in the fatalities have the potential for impairing performance. CONCLUSIONS: Findings from this study were consistent with those of two previous toxicological studies and support the FAA's programs aimed at reducing the usage of performance-impairing substances.

Accidents, Aviation↗

PubMed2006

[Fatal cases of poisoning in eastern Denmark during a five-year period (1998-2002)].

INTRODUCTION: The goal of this investigation was to determine the pattern of fatal poisonings in eastern Denmark from 1998 to 2002 and compare it with similar investigations from 1979 to 1996. MATERIALS AND METHODS: The material included 2,996 autopsies from eastern Denmark in which extensive forensic chemical investigations were performed. RESULTS: Of the 2,996 autopsies, 694 cases were drug addicts, in whom 497 fatal overdoses were detected, while in the remaining 2,302 cases of nonaddicts, 443 fatal poisonings were determined. Morphine (heroine) and methadone were the main causes of death among the fatal poisonings of the drug addicts, accounting for 90% of the cases. The fatal poisonings among the nonaddicts were due mainly to medicine (73% of the cases); 13% were due to carbon monoxide and/or cyanide poisoning, and 12% were due to acute ethanol poisoning. The medicine was a wide range of strong and weak analgesics, antidepressants and antipsychotic drugs of older and newer origins. Comparison with earlier investigations from 1979 to 1996 showed that the poisoning pattern had changed, but similarities were also seen. The most frequently occurring drugs involved in fatal poisonings in eastern Denmark from 1979 to 2002 were morphine, methadone, ethanol and carbon monoxide/cyanide, of which methadone increased in occurrence over the 23-year period. CONCLUSION: The investigation of fatal poisonings is an important element in monitoring changes in drug abuse and poisoning patterns and levels.

Adolescent↗