Injury death certificates without specification of the circumstances leading to the fatal injury - the Norwegian Cause of Death Registry 2005-2014.

BACKGROUND: For injury deaths, the underlying cause of death is defined as the circumstances leading to the injury. When this information is missing, the ICD-10 code X59 (Exposure to unspecified factor) is used. Lack of knowledge of factors causing injuries reduces the value of the cause of death statistics. The aim of this study was to identify predictors of X59-coded deaths in Norway, and to assess methods to identify the true underlying cause of injury deaths. METHODS: We used data from the Norwegian Cause of Death Registry from 2005 to 2014. We used logistic regression to identify determinants of X59-coded deaths. For redistribution of the X59 deaths, we used a multinomial logistic regression model based on the cases where injury circumstances were known. The data were divided into training and test sets. The model was developed on the training set and assessed on the test set before it was applied to the X59 deaths. The models used death certificate information on the nature of injury and demographic characteristics as predictor variables. Furthermore, we mailed a query to the certifying physicians of X59 deaths reported in the year 2015, where we asked for additional information on the circumstances leading to the fatal injury. RESULTS: There were 24,963 injury deaths reported to the Cause of Death Registry of Norway 2005-2014. Of these, 6440 (25.8%) lacked information on the circumstances leading to the death. The strongest predictor for a X59 death was the nature of injury (hip fracture), followed by lack of information on the scene of injury. Applying our redistribution algorithm, we estimated that 97% of the X59-coded deaths were accidental falls. The strongest covariate was the nature of injury, followed by place of death and age at death. In 2015, there were 591 X59-coded deaths. Queries were sent to the certifying doctors in 559 cases. Among the informative replies to the query, 88% of the deaths were reclassified to accidental falls. CONCLUSIONS: A large proportion of injury deaths in Norway lack information on the circumstances leading to the fatal injury. Typically, these deaths represent accidental falls causing hip fracture in elderly individuals.

Are there any risk factors for developing complications with the use of retrievable vena cava filters in orthopaedic surgery?

BACKGROUND: In high-risk patients, common prophylaxis may be insufficient to prevent thromboembolic events after orthopaedic procedures. In this scenario, a retrievable vena cava filter (VCF) could be considered as an alternative, although it's use remains controversial. Therefore, we asked: (1) what is the overall mechanical complication rate associated with the use of retrievable VCFs in orthopaedic surgery?, (2) what is the association with thromboembolic disease (TED) recurrence, post-thrombotic syndrome and/or major bleeding according to different surgical characteristics?, (3) What is the overall mortality rate attributed to VCF use? METHODS: We retrospectively analyzed a cohort of 68 patients who underwent orthopaedic surgery with a previous diagnosis of TED, in whom a retrievable VCF was placed. Permanent filters were excluded. We studied the filter's mechanical complications and considered as possible outcomes death and 3 hematologic complications: TED recurrence, post-thrombotic syndrome and major bleeding. To estimate association with risk factors, we subclassified surgeries into 5 groups: 1, arthroplasty/non-arthroplasty; 2, primary/revision; 3, elective/urgent; 4, oncologic/non-oncologic; 5, preoperative/postoperative filter. RESULTS: Mechanical complications were 16% and required a filter revision. Sixty-four percent of the revised VCFs developed a mechanical failure and could not be retrieved. Overall prevalence of TED recurrence, post-thrombotic syndrome and hemorrhage was 33%, 15% and 4.5%, respectively. Spinal surgeries were a risk factor for developing TED recurrences.  Only 4% of patients died of a TED recurrence. CONCLUSIONS: Orthopaedic procedures had a high risk of mechanical and hematologic complications after using a retrievable VCF. However, mortality was low due to these complications.

Features of fatal injuries in older cyclists in vehicle-bicycle accidents in Japan.

OBJECTIVE: The purpose of this study was to identify and better understand the features of fatal injuries in cyclists aged 75 years and over involved in collisions with either hood- or van-type vehicles. METHODS: This study investigated the fatal injuries of cyclists aged 75 years old and over by analyzing accident data. We focused on the body regions to which the fatal injury occurred using vehicle-bicycle accident data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) in Japan. Using data from 2009 to 2013, we examined the frequency of fatally injured body region by gender, age, and actual vehicle travel speed. We investigated any significant differences in distributions of fatal injuries by body region for cyclists aged 75 years and over using chi-square tests to compare with cyclists in other age groups. We also investigated the cause of fatal head injuries, such as impact with a road surface or vehicle. RESULTS: The results indicated that head injuries were the most common cause of fatalities among the study group. At low vehicle travel speeds for both hood- and van-type vehicles, fatalities were most likely to be the result of head impacts against the road surface. The percentage of fatalities following hip injuries was significantly higher for cyclists aged 75 years and over than for those aged 65-74 or 13-59 in impacts with hood-type vehicles. It was also higher for women than men in the over-75 age group in impacts with these vehicles. CONCLUSIONS: For cyclists aged 75 years and over, wearing a helmet may be helpful to prevent head injuries in vehicle-to-cyclist accidents. It may also be helpful to introduce some safety measures to prevent hip injuries, given the higher level of fatalities following hip injury among all cyclists aged 75 and over, particularly women.

Unintentional fall-related mortality in the elderly: comparing patterns in two countries with different demographic structure.

OBJECTIVES: Falls are among the major external causes of unintentional injury and injury-related mortality in the elderly. The aim of this study was to compare the patterns of unintentional fall-related mortalities in two countries with different demographic structure: Slovakia and Austria in 2003-2010. METHODS: A study was conducted using death certificate data, trends of fall-related mortality in the elderly (over 65 years) in Austria and Slovakia were compared. Crude and age-standardised mortality rates were calculated. Rate ratios were used to quantify differences based on age, sex and country. The role of demographic structure and population ageing was considered. RESULTS: The annual average crude mortality for Slovakia was 28.82, for Austria 54.19 per 100,000 person-years. Increasing rates were observed towards higher age in both countries. Males had higher mortality than females (1.18 times higher in Austria, 2.4 higher in Slovakia). In ages over 75 years rates were significantly higher in Austria, compared to Slovakia. Injuries to head (in males) and hip (in females) were most commonly the underlying cause of death. The proportion of populations over 65 and over 80 and rate of their increase were higher in Austria than in Slovakia. CONCLUSIONS: We conclude that higher proportions of the elderly population of Austria could have contributed to the higher fall-related mortality rates compared to Slovakia, especially in females over 80 years. Our study quantified the differences between two countries with different structure of the elderly population and these findings could be used in planning future needs of health and social services and to plan prevention in countries where a rapid increase in age of the population can be foreseen.

Mortality following hip arthroplasty--inappropriate use of National Joint Registry (NJR) data.

Mortality following hip arthroplasty is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. Relevant variables available from the 2011 NJR data set were included in the Cox model. Mortality rates in hip arthroplasty patients were lower than in the age-matched population across all hip types. Age at surgery, ASA grade, diagnosis, gender, provider type, hip type and lead surgeon grade all had a significant effect on mortality. Schemper's statistic showed that only 18.98% of the variation in mortality was explained by the variables available in the NJR data set. It is inappropriate to use NJR data to study an outcome affected by a multitude of confounding variables when these cannot be adequately accounted for in the available data set.

Avaliação da taxa de mortalidade em um ano após fratura do quadril e fatores relacionados à diminuição de sobrevida no idoso / Evaluation of the mortality rate one year after hip fracture and factors relating to diminished survival among elderly people

OBJETIVO: Avaliar a taxa de mortalidade em um ano e fatores pré-operatórios correlacionados em pacientes com fratura do quadril. MÉTODOS: Os autores estudaram, prospectivamente, 202 de um total de 376 pacientes com diagnóstico de fratura do quadril, que foram admitidos no Hospital Cristo Redentor entre outubro de 2007 e março de 2009. A montagem do banco de dados com análise do perfil epidemiológico foi realizada durante a internação e os dados de seguimento preferencialmente por telefone. RESULTADOS: A taxa de mortalidade total após um ano de seguimento foi de 28,7% ou 58 óbitos, dentre os quais 11 (5,45%) ocorreram na internação. As fraturas foram mais prevalentes em mulheres (71,3%) e pouco comuns em negros (5%). Dentre as comorbidades, demência e depressão apresentaram uma redução estatisticamente significante da sobrevida, (p de 0,018 e de 0,007, respectivamente). CONCLUSÃO: A taxa de mortalidade após um ano de seguimento foi de 28,7%. A demência e a depressão aumentaram esta taxa.

OBJECTIVE: To evaluate the mortality rate at one year and preoperative correlated factors in patients with hip fractures. METHODS: We studied prospectively, 202 of a total of 376 patients with hip fracture who were admitted to the Hospital Cristo Redentor, between October 2007 and March 2009. The assembly of the database with the epidemiological analysis was performed during hospitalization and follow up data preferably by phone. RESULTS: The overall mortality rate after one year of follow-up was 28.7% or 58 deaths, among which 11 (5.45%) occurred during hospitalization. The fractures were more prevalent among women (71.3%) and less common in blacks (5%). Among the comorbidities, dementia and depression showed a statistically significant reduction in survival (p of 0,018 and 0,007, respectively). CONCLUSION: Mortality rate after one year of follow-up was 28,7%. Dementia and depression increased this rate.

Physician consultation, multidisciplinary care, and 1-year mortality in Medicare recipients hospitalized with hip and lower extremity injuries.

OBJECTIVE: To determine whether routine surgeon consultation with medicine specialists and multidisciplinary care conferences-potentially modifiable hospital characteristics-are associated with lower 1-year mortality in older adults with hip and lower extremity injuries. DESIGN: Retrospective cohort study. SETTING: Oregon hospitals. PARTICIPANTS: Two thousand five hundred thirty-eight Medicare recipients aged 67 and older hospitalized in Oregon hospitals in 2002 with hip or lower extremity injuries. MEASUREMENTS: Demographic, injury, comorbidity, and survival information were gathered from Medicare records for 2000 to 2003. All Oregon hospitals with a qualifying case were surveyed using a structured telephone interview to collect information about routine surgeon consultations and multidisciplinary care conferences for older adult orthopedic patients. Multivariable generalized estimating equation models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between hospital characteristics and mortality. RESULTS: After adjusting for age, injury severity, comorbid conditions, trauma center status, and hospital annual volume of patients with hip fracture, the relative odds of dying in the year after injury for inpatients treated in settings with routine surgeon consultation with medical staff was 0.69 (95% CI 0.57-0.83) compared with patients not treated in such settings. Inpatient treatment in settings with routine multidisciplinary care conferences did not significantly affect the relative odds of dying in the year after injury (OR=1.06, 95% CI=0.89-1.26). CONCLUSION: Routine consultation by attending orthopedic surgeons with medicine or primary care specialists for Medicare inpatients is associated with better survival 1 year after injury.

Evolución prospectiva de un programa de intervención geriátrica interdisciplinaria y secuencial en la recuperación funcional del anciano con fractura de cadera / A multidisciplinary and sequential program in elderly patient with hip fracture: a prospective evolution

Objetivos: el tratamiento del anciano con fractura de cadera es muy variable, así como los resultados funcionales y la mortalidad. Hemos diseñado un programa de intervención para aumentar la proporción de pacientes que recuperan el estado funcional, disminuir la mortalidad y la utilización de recursos sanitarios a medio y largo plazo. Material y métodos: Estudio «quasi-experimental» con grupo control histórico (GC) sobre los beneficios de un modelo de tratamiento combinado (GI) (ortopédico y geriátrico) y secuencial (fases aguda, rehabilitadora y de mantenimiento), del anciano con fractura de cadera. Resultados: En relación con el GC, el GI aumenta la proporción de pacientes que recuperan la capacidad de caminar a los 3 (47% - 30%) y 6 (62% - 44%) meses de la fractura. Mayor mortalidad hospitalaria en el GI que en el GC (5,1% - 0,6%), sin diferencias a 3, 6 ni 12 meses. Menor estancia hospitalaria en GI (10,1 - 17,6 días, p<0,001) y con un mayor porcentaje de pacientes derivados a centro de rehabilitación (67% - 21%, p<0,001). Conclusión: El tratamiento combinado y secuencial del anciano con fractura de cadera, aumenta la proporción de pacientes que recuperan el estado funcional previo a la fractura a medio plazo (AU)

Aim: Treatment, functional recovery and mortality of elderly patients with hip fracture are very variable. We have designed an intervention program to improve the number of patients who recover their previous functional status and to reduce mortality and resources use in medium and long term follow up. Patients and Methodology: a «quasi- experimental» study with historical control group and intervention group to demonstrate benefits of a combined (orthopedics and geriatrics) and consecutive (acute, rehabilitation and supportive periods), in elderly patients with hip fracture. Results: Being treated in the IG increases likelihood of recovering walking ability at 3 months (47 vs 30%) and at 6 months (62 vs 44%), according to that treated in the CG. There is a higher in hospital mortality rate in the IG (5,1 vs 0,6%) compared with the patients in the CG; without differences at 3, 6 and 12 months follow up. Patients in the IG stay less at hospital (10,1 vs 17,6 days, p <0,001) and are more likely to be transferred to a rehabilitation facility (67 vs 21%, p <0,001). Conclusions: Combined and consecutive treatment in elderly patients with hip fracture increase the percentage of patients who recover functional status in a medium follow up (AU)