Articles: mortality.
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Critical care medicine · Oct 1990
Outcome prediction models on admission in a medical intensive care unit: do they predict individual outcome?
Prospectively acquired data from 941 patients staying greater than 24 h in a medical ICU were analyzed to determine the relevance of scoring on ICU admission by the following methods of outcome prediction: Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS), and Mortality Prediction Model (MPM). Analysis was performed separately for all patients (group A) and for a subsample (group B), obtained by excluding coronary care patients. Calculation of risk and classification of patients were carried out as recommended in the literature for MPM, APACHE II, and SAPS. ⋯ Application of APACHE II to diagnostic subgroups, using disease-adapted risk calculations, revealed marked inconsistencies between the estimated risk and the observed mortality. We conclude that the estimation of risk on admission by the three methods investigated might be helpful for global comparisons of ICU populations, although the lack of disease specificity reduces their applicability for severity grading of a given illness. The inaccuracy of these methods makes them ineffective for predicting individual outcome; thus, they provide little advantage in clinical decision-making.
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The authors studied the hospital mortality among 0-15 years old children hospitalized in a department of pediatrics in Tunis from 1983 to 1987. A significant decrease in the mortality rate was observed (from 12.21 to 8.23%). ⋯ The maximum of deaths were observed during the Summer-Autumn period and especially in the evenings. The decrease in the mortality rate was correlated with the time when mothers began to be hospitalized with their children.
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The maternal mortality ratio in New York City during the 3-year period of 1981-1983 was 36.1 deaths per 100,000 live births. Eight (7%) of 120 deaths occurred more than 42 days after termination of the pregnancy. Eighteen (15%) of the cases involved white, non-Hispanic women, 66 (55%) were black, and 32 (27%) were Hispanic. ⋯ Increasing age and parity were associated with greater maternal mortality ratios. The leading causes of pregnancy-associated mortality were found to be ectopic pregnancy, pulmonary embolism, anesthetic complications, amniotic fluid embolism, intracranial hemorrhage, hypertensive diseases of pregnancy, infection, and cardiac disease. Abortion-related mortality was about nine times less than the maternal mortality ratio, and the cesarean death-to-case rates could be considered roughly comparable to overall maternal mortality.