This document summarizes trends in hospitalizations for septicemia or sepsis in the United States from 2000 to 2008 based on data from the National Hospital Discharge Survey. Some key findings include:
- The rate of hospitalizations with septicemia or sepsis as either a primary or secondary diagnosis more than doubled over this period, increasing from 22.1 per 10,000 people in 2000 to 37.7 per 10,000 in 2008.
- Hospitalization rates increased with age, with those aged 85 and over having a rate over 4 times higher than those aged 65-74.
- Patients hospitalized for septicemia or sepsis were sicker, with longer hospital stays, and over 8 times more likely to die
Deaths from Renal Diseases in England, 2001 to 2008
This short report focuses on the analysis of Office for National Statistics mortality data to give insight into differences in numbers, rates and place of death from selected renal diseases.
Related resources: Chronic Kidney Disease Profiles published by the East Midlands Public Health Observatory and NHS Kidney Care and the UK Renal Registry.
Deaths from Renal Diseases in England, 2001 to 2008
This short report focuses on the analysis of Office for National Statistics mortality data to give insight into differences in numbers, rates and place of death from selected renal diseases.
Related resources: Chronic Kidney Disease Profiles published by the East Midlands Public Health Observatory and NHS Kidney Care and the UK Renal Registry.
PREDICTIVE MODEL FOR LIKELIHOOD OF DETECTING CHRONIC KIDNEY FAILURE AND DISEA...ijcsitcejournal
Fuzzy logic is highly appropriate and valid basis for developing knowledge-based systems in medicine for different tasks and it has been known to produce highly accurate results. Examples of such tasks include syndrome differentiation, likelihood survival for sickle cell anaemia among paediatric patients, diagnosis and optimal selection of medical treatments and real time monitoring of patients. For this paper, a Fuzzy logic-based system is untaken used to provide a comprehensive simulation of a prediction model for determining the likelihood of detecting Chronic Kidney failure/diseases in humans. The Fuzzy-based system uses a 4-tuple record comprising of the following test taken: Blood Urea Test, Urea Clearance Test, Creatinine Clearance test and Estimated Glomerular Filtrate
ate(eGFR).Understanding of the test was elicited from a private hospital in Ibadan through the help of an experienced and qualified nurse which also follows same test according to National Kidney Foundation. This knowledge was then used in the developing the simulated and rule-base prediction model using MATLAB software. The paper also follows the 3 major stages of Fuzzy logic. The results of fuzzification of variables, inference, model testing and defuzzification of variables was also presented. This in turn simplifies the complication involved in detecting Chronic Kidney failure/disease using Fuzzy logic based model.
Presented November, 3 2017.
Peter McCullough, MD, MPH, FACC, FACP, FCCP, FAHA, FNKF
Baylor University Medical Center
EMERGING PRESCRIPTION PROTOCOL FOR MORE FREQUENT HEMODIALYSIS
Ultrafiltration controlled prescription guide that improves treatment tolerability, reduces dialysis-induced cardiomyopathy, addresses chronic fluid overload while meeting clinical targets.
Discussion lead:
Allan Collins, MD, FACP
University of Minnesota School of Medicine
Chief Medical Officer, NxStage Medical, Inc.
CURBSIDE CONSULTATION: HOME DIALYSIS PATIENT CONSIDERATIONS
Biochemical, health-related quality of life, and economic factors when transitioning patients home.
Discussion lead:
Paul Komenda, MD, MHA, FRCPC
Seven Oaks General Hospital
REAL LIFE EXPERIENCE: PHYSICIAN AND PATIENT LEARNINGS
Dr. Kraus will discuss the prescribed regimen while Mr. Davis shares his clinical and lifestyle experiences as a more frequent hemodialysis patient.
Discussion leads:
Michael Kraus, MD, FACP
Indiana University School of Medicine
Evernard Davis III
Current Dialysis Patient, Retired Energy Consultant:
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Advancing dialysis multinational guidelines for increased time and frequency ...AdvancingDialysis.org
Clinical practice guidelines and appropriate indications from 5 medical societies in North America, Europe and Asia for increased hemodialysis frequency and time.
Strict Glycemic Control in Critically ill patients: The Demise of another ver...Prof. Mridul Panditrao
Prof. Mridul M. Panditrao tries to explain the pros and cons about the good strategy, whcih became controversial and almost obsolete. He also tries to tract the whole aspect of the phenomenon and reviews/ RCTs/
Strict (Tight) Glycemic control (SGC/TGC), as it is called, was and still is a good strategy. It can be defined as maintenance of the blood glucose level in the range of 80-110 mg /dl. with help of dose variable and intensive insulin therapy (IIT). Since its introduction, there have been conflicting reports of its efficacy and complications. This resulted in slow but steady neglect of this very good idea leading to its almost complete demise.
An effort has been made in this review, to impartially analyze all the available evidence and try to find the reasons for the negative publicity which led to the neglect or worse still, the wrong use of this protocol. Some suggestions for fair and proper implementation of the strategy are put forward.
etc/
PREDICTIVE MODEL FOR LIKELIHOOD OF DETECTING CHRONIC KIDNEY FAILURE AND DISEA...ijcsitcejournal
Fuzzy logic is highly appropriate and valid basis for developing knowledge-based systems in medicine for different tasks and it has been known to produce highly accurate results. Examples of such tasks include syndrome differentiation, likelihood survival for sickle cell anaemia among paediatric patients, diagnosis and optimal selection of medical treatments and real time monitoring of patients. For this paper, a Fuzzy logic-based system is untaken used to provide a comprehensive simulation of a prediction model for determining the likelihood of detecting Chronic Kidney failure/diseases in humans. The Fuzzy-based system uses a 4-tuple record comprising of the following test taken: Blood Urea Test, Urea Clearance Test, Creatinine Clearance test and Estimated Glomerular Filtrate
ate(eGFR).Understanding of the test was elicited from a private hospital in Ibadan through the help of an experienced and qualified nurse which also follows same test according to National Kidney Foundation. This knowledge was then used in the developing the simulated and rule-base prediction model using MATLAB software. The paper also follows the 3 major stages of Fuzzy logic. The results of fuzzification of variables, inference, model testing and defuzzification of variables was also presented. This in turn simplifies the complication involved in detecting Chronic Kidney failure/disease using Fuzzy logic based model.
Presented November, 3 2017.
Peter McCullough, MD, MPH, FACC, FACP, FCCP, FAHA, FNKF
Baylor University Medical Center
EMERGING PRESCRIPTION PROTOCOL FOR MORE FREQUENT HEMODIALYSIS
Ultrafiltration controlled prescription guide that improves treatment tolerability, reduces dialysis-induced cardiomyopathy, addresses chronic fluid overload while meeting clinical targets.
Discussion lead:
Allan Collins, MD, FACP
University of Minnesota School of Medicine
Chief Medical Officer, NxStage Medical, Inc.
CURBSIDE CONSULTATION: HOME DIALYSIS PATIENT CONSIDERATIONS
Biochemical, health-related quality of life, and economic factors when transitioning patients home.
Discussion lead:
Paul Komenda, MD, MHA, FRCPC
Seven Oaks General Hospital
REAL LIFE EXPERIENCE: PHYSICIAN AND PATIENT LEARNINGS
Dr. Kraus will discuss the prescribed regimen while Mr. Davis shares his clinical and lifestyle experiences as a more frequent hemodialysis patient.
Discussion leads:
Michael Kraus, MD, FACP
Indiana University School of Medicine
Evernard Davis III
Current Dialysis Patient, Retired Energy Consultant:
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Advancing dialysis multinational guidelines for increased time and frequency ...AdvancingDialysis.org
Clinical practice guidelines and appropriate indications from 5 medical societies in North America, Europe and Asia for increased hemodialysis frequency and time.
Strict Glycemic Control in Critically ill patients: The Demise of another ver...Prof. Mridul Panditrao
Prof. Mridul M. Panditrao tries to explain the pros and cons about the good strategy, whcih became controversial and almost obsolete. He also tries to tract the whole aspect of the phenomenon and reviews/ RCTs/
Strict (Tight) Glycemic control (SGC/TGC), as it is called, was and still is a good strategy. It can be defined as maintenance of the blood glucose level in the range of 80-110 mg /dl. with help of dose variable and intensive insulin therapy (IIT). Since its introduction, there have been conflicting reports of its efficacy and complications. This resulted in slow but steady neglect of this very good idea leading to its almost complete demise.
An effort has been made in this review, to impartially analyze all the available evidence and try to find the reasons for the negative publicity which led to the neglect or worse still, the wrong use of this protocol. Some suggestions for fair and proper implementation of the strategy are put forward.
etc/
Morbidity and Mortality are Not Improved by Preemptive ICU Transfer of Acute ...semualkaira
Acute myeloid leukemia (AML) is associated
with a high rate of life-threatening early complications. Patients
presenting with hyperleukocytosis >50x10⁹/L and/or promyelocytic leukemia at the time of AML diagnosis can be considered at
high risk of early complications (HReC) and thus at high risk of
mortality. At our institution, we propose preemptive ICU admission to HReC patients. In so doing, our goal is to prevent complication occurrence, or, failing that, to provide rapid life-sustaining
treatment (LST). In the present retrospective study, we sought to
determine whether preemptive ICU admission improves survival
for patients newly diagnosed with AML.
Comorbidities and Other Predictors for Severity of Colonic Diverticulitis?semualkaira
Predicting severity of acute colonic diverticulitis (ACD) is important for management, morbidity and mortality. The aim of this study is evaluating the Charlson’s Comorbidity Index (CCI) as severity predictor of ACD.
Contributors, complications, and causative factors for central venous cathete...Texas Children's Hospital
Central venous catheter (CVC) use is common in the management of critically ill children, especially those with congenital or acquired heart disease (CHD).
Prior studies suggest that the presence of a CVC augments the risk of deep vein thrombosis (DVT) in adults and children.
In recent years, the reported incidence of VTE in children has increased dramatically.
How CVC-associated DVTs contribute to morbidity and mortality in this high risk patient population is unknown
The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study
Aridhia recently presented a keynote session on the big data phenomenon and the implications for healthcare at the 4th Big Data Insight Group Forum in London, November 2012.
Comparison of Infection Episodes in CKD Patients with or without Hemodialysis...ijtsrd
Chronic kidney diseases CKD is a progressive and irreversible deterioration of renal function. Patients with CKD are prone to a variety of infections. Further chronic hemodialysis increases the infections and related morbidity and mortality. The present study was conducted to assess the probability of infection episode in CKD patients in patients with or without haemodialysis. A Cross sectional observational study was conducted with a total 56 patients with CKD. Clinical and biochemical data related to infections were collected from the individual patient records. The results showed that the chills and rigors, increased TLC, and elevated ESR were found to more in CKD patients on chronic haemodialysis. Further, our results suggested that CKD patient population showed increased-risk for the development of lethal sepsis. Hence, identification of the causes of infection and the appropriate treatment based on the severity of symptoms are essential for CKD patients who are on dialysis. Punit Gupta | Swati Sharma | Ashish Deo "Comparison of Infection Episodes in CKD Patients with or without Hemodialysis from Tribal Population" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-1 , December 2018, URL: http://www.ijtsrd.com/papers/ijtsrd19000.pdf
http://www.ijtsrd.com/medicine/other/19000/comparison-of-infection-episodes-in-ckd-patients-with-or-without-hemodialysis-from-tribal-population/punit-gupta
Mucormycosis in Patients without Cancer: A Case Series from A Tertiary Care H...Apollo Hospitals
mucormycosis (Zygomycosis) is a life-threatening infection. We attempted to analyse clinical
features and risk factors of mucormycosis cases in a tertiary care referral institution in India, in patients without underlying malignancy.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
CDC Sepsis Brief 2011
1. NCHS Data Brief ■ No. 62 ■ June 2011
Inpatient Care for Septicemia or Sepsis: A Challenge
for Patients and Hospitals
Margaret Jean Hall, Ph.D.; Sonja N. Williams, M.P.H.;
Carol J. DeFrances, Ph.D.; and Aleksandr Golosinskiy, M.S.
Septicemia and sepsis are serious bloodstream infections that can rapidly
Key findings become life-threatening. They arise from various infections, including those of
Data from the National the skin, lungs, abdomen, and urinary tract (1,2). Patients with these conditions
Hospital Discharge are often treated in a hospital’s intensive care unit (3). Early aggressive
Survey, 2008 treatment increases the chance of survival (4). In 2008, an estimated $14.6
billion was spent on hospitalizations for septicemia, and from 1997 through
• The number and rate
2008, the inflation-adjusted aggregate costs for treating patients hospitalized
per 10,000 population of
hospitalizations for septicemia for this condition increased on average annually by 11.9% (5).
or sepsis more than doubled Despite high treatment expenditures, septicemia and sepsis are often fatal (6).
from 2000 through 2008.
Those who survive severe sepsis are more likely to have permanent organ
• The hospitalization rates for damage (7), cognitive impairment, and physical disability (8). Septicemia is a
septicemia or sepsis in 2008 leading cause of death (9). The purpose of this report is to describe the most
were similar for males and recent trends in care for hospital inpatients with these diagnoses.
females and increased with age.
Keywords: National Hospital Discharge Survey • hospitalization • health care
• Patients under age 65 and utilization
aged 65 and over who were
hospitalized for septicemia
or sepsis in 2008 were sicker Hospitalization rates for septicemia or sepsis more than
and stayed longer than doubled from 2000 through 2008.
those hospitalized for other
conditions. Figure 1. Hospitalizations for and with septicemia or sepsis
• In 2008, the proportion of 50
hospitalized patients who were
Rate per 10,000 population
discharged to other short-stay 40 37.7
hospitals or long-term care Hospitalizations with septicemia or sepsis
institutions was higher for 30
those with septicemia or sepsis 22.1
Hospitalizations for septicemia or sepsis 24.0
(36%) than for those with other 20
conditions (14%). Seventeen
percent of septicemia or sepsis 10 11.6
hospitalizations ended in death,
0
whereas only 2% of other 2000 2001 2002 2003 2004 2005 2006 2007 2008
hospitalizations did. Year
NOTE: Significant linear trend from 2000 through 2008 for both categories.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2008.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
2. NCHS Data Brief ■ No. 62 ■ June 2011
• Hospitalizations for septicemia or sepsis (as a first-listed or principal diagnosis) increased
from 326,000 in 2000 to 727,000 in 2008, and the rate of these hospitalizations more than
doubled from 11.6 per 10,000 population in 2000 to 24.0 per 10,000 population in 2008
(Figure 1). Overall hospitalizations did not increase during this period (10,11).
• Hospitalizations with septicemia or sepsis—as the first-listed, principal, or a secondary
diagnosis—increased from 621,000 in 2000 to 1,141,000 in 2008, and the rate of these
hospitalizations increased by 70% from 22.1 per 10,000 in 2000 to 37.7 per 10,000 in
2008 (Figure 1). This rate includes patients (a) hospitalized for septicemia or sepsis, (b)
hospitalized for another diagnosis but who had septicemia or sepsis at the time they were
admitted, and (c) who acquired septicemia or sepsis during their hospital stay.
Hospitalization rates for sepsis or septicemia were similar for males and
females and increased with age.
• The rate of hospitalizations for septicemia or sepsis was much higher for those aged 65 and
over (122.2 per 10,000 population) than for those under age 65 (9.5 per 10,000 population).
• About two-thirds of patients hospitalized for septicemia or sepsis in 2008 were aged 65
and over and had Medicare as their expected source of payment (data not shown). This
proportion has been stable over the past decade.
• The septicemia or sepsis hospitalization rate for those aged 85 and over (271.2 per 10,000
population) was about 30 times the rate for those under age 65, and was more than four
times higher than the rate of 65.7 per 10,000 for the 65–74 age group (Figure 2).
■ 2 ■
3. NCHS Data Brief ■ No. 62 ■ June 2011
Patients hospitalized for septicemia or sepsis were more severely ill than
patients hospitalized for another diagnosis.
• For patients under age 65, those hospitalized for septicemia or sepsis were more than twice
as likely to have seven or more diagnoses than those hospitalized for other conditions
(Figure 3).
• For those aged 65 and over, those hospitalized for septicemia or sepsis were 26% more
likely to have seven or more diagnoses than those hospitalized for other conditions.
Patients hospitalized for septicemia or sepsis stayed longer than other
inpatients.
• Those hospitalized for septicemia or sepsis had an average length of stay that was 75%
longer than those hospitalized for other conditions (Figure 4).
• Those under age 65 hospitalized for septicemia or sepsis had an average length of stay that
was more than double that of other hospitalizations.
• Those aged 65 and over hospitalized for septicemia or sepsis had an average length of stay
that was 43% higher than that of other patients.
■ 3 ■
4. NCHS Data Brief ■ No. 62 ■ June 2011
Patients hospitalized for septicemia or sepsis were more than eight times
as likely to die during their hospitalization.
Table. Hospitalizations for septicemia or sepsis compared with hospitalizations for other diagnoses, by discharge
disposition, 2008
Characteristic Septicemia or sepsis Other diagnoses
Disposition Percent
Routine1 39 79
Transfer to other short-term care facility1 6 3
Transfer to long-term care institution 1
30 10
Died during the hospitalization1 17 2
Other or not stated 8 6
Total 100 100
Difference is statistically significant at the 0.05 level.
1
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2008.
• Only 2% of hospitalizations in 2008 were for septicemia or sepsis, yet they made up 17% of
in-hospital deaths (data not shown).
• In-hospital deaths were more than eight times as likely among patients hospitalized
for septicemia or sepsis (17%) compared with other diagnoses (2%). In addition, those
hospitalized for septicemia or sepsis were one-half as likely to be discharged home, twice
as likely to be transferred to another short-term care facility, and three times as likely to be
discharged to long-term care institutions, as those with other diagnoses (Table).
■ 4 ■
5. NCHS Data Brief ■ No. 62 ■ June 2011
• For those under age 65, 13% of those hospitalized for septicemia or sepsis died in the
hospital, compared with 1% of those hospitalized for other conditions (data not shown).
• For those aged 65 and over, 20% of septicemia or sepsis hospitalizations ended in death
compared with 3% for other hospitalizations (data not shown).
Summary
The hospitalization rate of those with a principal diagnosis of septicemia or sepsis more than
doubled from 2000 through 2008, increasing from 11.6 to 24.0 per 10,000 population. During
the same period, the hospitalization rate for those with septicemia or sepsis as a principal or as a
secondary diagnosis increased by 70% from 22.1 to 37.7 per 10,000 population. Reasons for these
increases may include an aging population with more chronic illnesses; greater use of invasive
procedures, immunosuppressive drugs, chemotherapy, and transplantation; and increasing
microbial resistance to antibiotics (3,6). Increased coding of these conditions due to greater
clinical awareness of septicemia or sepsis (12) may also have occurred during the period studied.
Septicemia or sepsis treatment involves caring for sicker patients who have longer inpatient
stays than those with other diagnoses. Total nationwide inpatient annual costs of treating those
hospitalized for septicemia have been rising and were estimated to be $14.6 billion in 2008
(5). Even with this expenditure, the death rate was high. Patients who do survive severe cases
are more likely to have negative long-term effects on health and on cognitive and physical
functioning (8).
The “Surviving Sepsis Campaign” was an international effort organized by physicians that
developed and promoted widespread adoption of practice improvement programs grounded in
evidence-based guidelines (12). The goal was to improve diagnosis and treatment of sepsis.
Included among the guidelines were sepsis screening for high-risk patients; taking bacterial
cultures soon after the patient arrived at the hospital; starting patients on broad-spectrum
intravenous antibiotic therapy before the results of the cultures are obtained; identifying
the source of infection and taking steps to control it (e.g., abscess drainage); administering
intravenous fluids to correct a loss or decrease in blood volume; and maintaining glycemic (blood
sugar) control (13). These and similar guidelines have been tested by a number of hospitals and
have shown potential for decreasing hospital mortality due to sepsis (12).
Tracking data included in this report over time will enable policymakers and health care
professionals to assess the effects of efforts to decrease disease burden and death from septicemia
and sepsis in the United States.
Definitions
Septicemia or sepsis: Are referred to as bloodstream infection or blood poisoning and are so
closely related that the terms have been used interchangeably in the past (14). Until October 1,
2002, both conditions were identified by a diagnosis code of 038, based on the International
Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) (15). After that
time, new ICD–9–CM codes for sepsis (995.91) and severe sepsis (995.92) were added to this
coding system making it possible to distinguish between septicemia and sepsis. To make the
definitions comparable over the entire period studied in this report, it was necessary to use code
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6. NCHS Data Brief ■ No. 62 ■ June 2011
038 for all years, and codes 995.91 and 995.92 for the years after they were added. For National
Hospital Discharge Survey (NHDS) data, this coding change was reflected in the data in the first
full calendar year after the codes were added (2003).
Hospitalization for septicemia or sepsis: Includes those admitted with a first-listed or principal
septicemia or sepsis diagnosis. In these cases, the main cause or reason for the hospitalization is
one of the ICD–9–CM codes listed above in the first-listed diagnostic field.
Hospitalization with septicemia or sepsis: Includes those with one or more of the ICD–9–CM
codes listed above in any of the seven diagnostic fields gathered for this survey. This includes
cases in which the septicemia or sepsis is one of the following: (a) the reason for the admission
(first-listed or principal), (b) present at admission but not the reason for admission, or (c) acquired
while in the hospital.
Rate: Refers to the number of hospitalizations per unit of population (i.e., per 10,000 population).
Using rates removes the influence of different population sizes (e.g., for males and females
in one year, or of different population sizes over multiple years) so that data can be compared
across these groups. For 2000–2008, rates were calculated using U.S. Census Bureau 2000-based
postcensal civilian population estimates.
Data source and methods
Data for this report are from NHDS, a national probability sample survey of discharges from
nonfederal short-stay hospitals or general hospitals in the United States, conducted annually by
the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics
(NCHS), Division of Health Care Statistics (DHCS). NHDS uses a modified three-stage
design. Units selected at the first stage consist of either hospitals or geographic areas, such as
counties, groups of counties, or metropolitan statistical areas. Within a sampled geographic area,
hospitals are selected. At the last stage, systematic random sampling is used to select discharges
within sampled hospitals. Survey data on hospital discharges were obtained from the hospitals’
administrative data and are also used for billing purposes. These data are a very rich source of
utilization information; however, administrative data do not contain in-depth clinical information
and so are limited in their ability to address some medical care issues. Note that if an individual
is admitted to the hospital multiple times during the survey year, that individual will be counted
more than once in NHDS.
Because of the complex multistage design of NHDS, the survey data must be inflated or weighted
to produce national estimates. Estimates of inpatient care presented in this report exclude
newborns. More details about the design of NHDS have been published (10).
Trend data from the 2000–2008 NHDS were used for Figure 1. The other figures were based upon
the recently released 2008 NHDS data.
A weighted least squares regression method (16) was used to test the significance of the time
trends shown in Figure 1. Differences among the subgroups were evaluated with two-tailed t tests
using p < 0.05 as the level of significance. Terms that express differences such as higher, lower,
largest, smallest, leading, increased, or decreased, were only used when the differences were
statistically significant. When a comparison is described as similar it means that no statistically
significant difference was found. All comparisons reported in the text were statistically significant
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7. NCHS Data Brief ■ No. 62 ■ June 2011
unless otherwise indicated. Comparisons presented in figures or the Table but not mentioned
in the text may or may not be statistically significant. Data analyses were performed using the
statistical packages SAS version 9.2 (SAS Institute, Cary, N.C.) and SUDAAN version 10.0
(Research Triangle Institute, Research Triangle Park, N.C.).
About the authors
Margaret Jean Hall, Sonja N. Williams, Carol J. DeFrances, and Aleksandr Golosinskiy are with
CDC’s NCHS, DHCS.
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