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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Dyson, Kylie, et al.
(författare)
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International variation in survival after out-of-hospital cardiac arrest : A validation study of the Utstein template.
- 2019
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 138, s. 168-181
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival.METHODS: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232).RESULTS: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival.CONCLUSIONS: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.
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| 3. |
- Isasi, Iraia, et al.
(författare)
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Restoration of the electrocardiogram during mechanical cardiopulmonary resuscitation
- 2020
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Ingår i: Physiological Measurement. - : IOP Publishing. - 0967-3334 .- 1361-6579. ; 41:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective: An artefact-free electrocardiogram (ECG) is essential during cardiac arrest to decide therapy such as defibrillation. Mechanical cardiopulmonary resuscitation (CPR) devices cause movement artefacts that alter the ECG. This study analyzes the effectiveness of mechanical CPR artefact suppression filters to restore clinically relevant ECG information. Approach: In total, 495 10 s ECGs were used, of which 165 were in ventricular fibrillation (VF), 165 in organized rhythms (OR) and 165 contained mechanical CPR artefacts recorded during asystole. CPR artefacts and rhythms were mixed at controlled signal-to-noise ratios (SNRs), ranging from –20 dB to 10 dB. Mechanical artefacts were removed using least mean squares (LMS), recursive least squares (RLS) and Kalman filters. Performance was evaluated by comparing the clean and the restored ECGs in terms of restored SNR, correlation-based similarity measures, and clinically relevant features: QRS detection performance for OR, and dominant frequency, mean amplitude and waveform irregularity for VF. For each filter, a shock/no-shock support vector machine algorithm based on multiresolution analysis of the restored ECG was designed, and evaluated in terms of sensitivity (Se) and specificity (Sp). Main results: The RLS filter produced the largest correlation coefficient (0.80), the largest average increase in SNR (9.5 dB), and the best QRS detection performance. The LMS filter best restored VF with errors of 10.3% in dominant frequency, 18.1% in amplitude and 11.8% in waveform irregularity. The Se/Sp of the diagnosis of the restored ECG were 95.1/94.5% using the RLS filter and 97.0/91.4% using the LMS filter. Significance: Suitable filter configurations to restore ECG waveforms during mechanical CPR have been determined, allowing reliable clinical decisions without interrupting mechanical CPR therapy.
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