Neurologic disorders, in-hospital deaths, and years of potential life lost in the USA, 1988–2011

Rosenbaum, Benjamin P.; Kelly, Michael L.; Kshettry, Varun R.; Weil, Robert J.

doi:10.1016/j.jocn.2014.05.006

Cited by 18 publications

(10 citation statements)

References 36 publications

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“…Our study revealed a significant difference in the total number of the most common NDs reported at administrative discharge: 555 (46%) as primary diagnoses compared with the total (1190) obtained after careful scrutiny of the medical records. This “neurological multimorbidity” is important as it is frequently neglected in medical statistics, which usually only register primary diseases listed in discharge summaries [9, 13]. In our study, older adult neurological inpatients accounted for a large number of critical patients admitted with cerebrovascular disorders, seizures, status epilepticus, severe infections complicating chronic nervous system disorders, and patients with multimorbidity.…”

Section: Discussionmentioning

confidence: 97%

“…Traumatic brain injury, intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain injury are neurological and neurosurgical disorders associated with in-hospital mortality. These disorders account for the highest premature mortality, a public health concern that can be quantified as years of potential life lost [9]. Moreover, nervous system diseases are among the leading contributors of disability-adjusted life years [10, 11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Bacellar

Pedreira

Costa

et al. 2017

BMC Health Serv Res

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BackgroundThe burden of neurological disorders (NDs) in older adult inpatients is often underestimated. We studied diagnostic frequency and comorbidity of NDs among inpatients aged ≥60 years. We compared rates of hospital mortality, length of stay (LOS), and readmission with younger patient counterparts (aged 18–59 years) and older adult non-neurological patients.MethodsThis was a retrospective cross-sectional study of inpatients in a tertiary care center in Brazil. We compiled data for all patients admitted between 1 January 2009 and 31 December 2010, and selected those aged ≥18 years for inclusion in the study. We collected data for inpatients under care of a clinical neurologist who were discharged with primary diagnoses of NDs or underlying acute clinical disorders, and data for complications in clinical or surgical inpatients. Patients who remained hospitalized for more than 9 days were categorized as having long LOS.ResultsOlder adult inpatients with NDs (n = 798) represented 56% of all neurological inpatients aged ≥18 years (n = 1430), and 14% of all geriatric inpatients (n = 5587). The mean age of older adult inpatients was 75 ± 9.1 years. Women represented 55% of participants. The most common NDs were cerebrovascular diseases (51%), although multimorbidity was observed. Hospital mortality rate was 18% (95% confidence interval [CI], 15–21) and readmission rate was 31% (95% CI, 28–35), with 40% of patients readmitted 1.8 ± 1.5 times. The long LOS rate was 51% and the median LOS was 9 days (interquartile interval, 1–20 days). In younger inpatients mortality rate was 1.4%, readmission rate was 34%, and long LOS rate was 14%. In older adult non-neurological inpatients, mortality rate was 22%, readmission rate was 49%, and long LOS rate was 30%.ConclusionsOlder adult neurological inpatients had the highest long LOS rate of all patient groups, and a higher mortality rate than neurological patients aged 18–59 years. Readmissions were high in all groups studied, particularly among older adult non-neurological inpatients. Improved structures and concerted efforts are required in hospitals in Brazil to reduce burden of NDs in older adult patients.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Bacellar

Pedreira

Costa

et al. 2017

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Our results implied that all elderly inpatients with NDs were seriously ill, whatever their neurological diagnosis or comorbidity, as all NDs had a similar high rate of hospital mortality. This was surprising, because at first we expected that cerebrovascular diseases, delirium, and epilepsy as well as comorbidities in the top rank of hospital mortality, such as infections and respiratory and cardiovascular disorders would be predictors of death in this population [ 12 , 13 , 36 , 37 ]. Therefore, although revealing a high hospital mortality rate in this population, this study was unable to identify predictors of hospital mortality among NDs or among comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

Bacellar

Assis

Pedreira

et al. 2018

TONEUJ

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Background:Neurological disorders (NDs) are associated with high hospital mortality. We aimed to identify predictors of hospital mortality among elderly inpatients with NDs.Methods:Patients aged ≥60 years admitted to the hospital between January 1, 2009 and December 31, 2010 with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic data, NDs, and comorbidities as independent predictors of hospital mortality. Logistic regression was performed for multivariable analysis.Results:Overall, 1540 NDs and 2679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8±9.1). Of these, 54.5% were female. Diagnostic frequency of NDs ranged between 0.3% and 50.8%. Diagnostic frequency of comorbidities ranged from 5.6% to 84.5%. Comorbidities varied from 0 to 9 per patient (90% of patients had ≥2 comorbidities), mean 3.2±1.47(CI, 3.1-3.3). Patients with multimorbidities presented with a mean of 4.7±1.7 morbidities per patient. Each ND and comorbidity were associated with high hospital mortality, producing narrow ranges between the lowest and highest incidences of death (hospital mortality = 18%) (95% CI, 15%-21%). After multivariable analysis, advanced age (P<0.001) and low socioeconomic status (P=0.003) were recognized as predictors of mortality, totaling 9% of the variables associated with hospital mortality.Conclusion:Neither a particular ND nor an individual comorbidity predicted hospital mortality. Age and low socioeconomic class accounted for 9% of predictors. We suggest evaluating whether functional, cognitive, or comorbidity scores will improve the risk model of hospital mortality in elderly patients admitted with ND.

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“…The recent establishment of the clinical course score has allowed for the improved monitoring of subarachnoid hemorrhage over time (23), and follow-up CT scans are only needed if new bleeding is a concern (150). TBI has the highest average years of potential life lost for all neurological disorders partly due to traumatic subarachnoid hemorrhage (147). Subarachnoid hemorrhage can lead to increased mortality, extended hospital stays, and central diabetes insipidus (67).…”

Section: Vasospasms Subarachnoid Hemorrhage Edema and Ischemic Hypoxiamentioning

confidence: 99%

Role of Microvascular Disruption in Brain Damage from Traumatic Brain Injury

Logsdon

Lucke‐Wold

Turner

et al. 2015

Comprehensive Physiology

125

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Traumatic brain injury (TBI) is acquired from an external force, which can inflict devastating effects to the brain vasculature and neighboring neuronal cells. Disruption of vasculature is a primary effect that can lead to a host of secondary injury cascades. The primary effects of TBI are rapidly occurring while secondary effects can be activated at later time points and may be more amenable to targeting. Primary effects of TBI include diffuse axonal shearing, changes in blood brain barrier (BBB) permeability, and brain contusions. These mechanical events, especially changes to the BBB, can induce calcium perturbations within brain cells producing secondary effects, which include cellular stress, inflammation, and apoptosis. These secondary effects can be potentially targeted to preserve the tissue surviving the initial impact of TBI. In the past, TBI research had focused on neurons without any regard for glial cells and the cerebrovasculature. Now a greater emphasis is being placed on the vasculature and the neurovascular unit following TBI. A paradigm shift in the importance of the vascular response to injury has opened new avenues of drug treatment strategies for TBI. However, a connection between the vascular response to TBI and the development of chronic disease has yet to be elucidated. Long-term cognitive deficits are common amongst those sustaining severe or multiple mild TBIs. Understanding the mechanisms of cellular responses following TBI is important to prevent the development of neuropsychiatric symptoms. With appropriate intervention following TBI, the vascular network can perhaps be maintained and the cellular repair process possibly improved to aid in the recovery of cellular homeostasis.

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Neurologic disorders, in-hospital deaths, and years of potential life lost in the USA, 1988–2011

Cited by 18 publications

References 36 publications

Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

Role of Microvascular Disruption in Brain Damage from Traumatic Brain Injury

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