Mortality at the Clinic of Internal Medicine of University Clinical Center in Tuzla During 2008

Abstract

Introduction: Accurate information about the cause of death is given byexpert teams based on pathological or forensic expertise. Reliable informationcan be obtained from doctors from clinical-hospital institutionsif the deceased person was treated in such an institution and with previouslydiagnosed disease (hospital mortality). Analysis of hospital mortality providesa lot of data that can be used in planning the hospital beds capacities,the amount of drug procurement, purchasing equipment, organization andcreation of highly specialized medical teams (medical team for resuscitation),the number of reanimation techniques, the number of pathologists who arerequired for autopsy procedures, etc. Goal was to determine the total numberof deaths, the most common causes of death and the 10 leading diagnosesof deceased patients at the Clinic for Internal Medicine of Clinical Centerin Tuzla during 2008. Material and methods: We used the material fromthe archive (medical records and reports on deceased patients, delivered byphysicians working at the Clinic for Internal Medicine of Clinical Center inTuzla). Results: During 2008 at the Clinic for Internal Medicine 368 patientsdied. According to the analyzed data leading cause of death and leadingdiagnosis as cause of death at the Clinic for Internal Medicine in 2008 wereas follows: cardiogenic shock in 73 (19.84%), cerebrovascular stroke in 46(12.50%), coma due to stroke in 32 (8.70%), coma not classified as cerebralin 25 (6.79 %) (metabolic 13 (3.53%) and hepatic 12 (3.26%), cardiomyopathyin 22 (5.98%), malignant neoplasm of the abdomen in 17 (4.62%), respiratoryinsufficiency in 17 (4.62%), acute myocardial infarction and myocardialinfarction with rupture in 17 (4.62%), pulmonary edema in 16 (4.35%), andcardiorespiratory arrest in 13 (3.53%) deaths. Conclusion: During 2008 atthe Clinic for Internal Medicine of Clinical Center in Tuzla died a total of368 patients. The most common cause of death of patients at the Clinic forInternal Medicine of Clinical Center in Tuzla are cardiovascular disease(n=175; 47.55% of deaths), in second place was cerebrovascular disease (n=76;20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascularand cerebrovascular disease.

Mortality at the Clinic of Internal Medicine of University Clinical Center in Tuzla During 2008

PROFESSIONAL PAPER

Mortality at the Clinic of Internal Medicine of University Clinical Center in Tuzla During 2008

Fahir Barakovic, Mithat Tabakovic, Zumreta Kusljugic, Denis Mrsic, Suada Mulic, Elnur Smajic, Esad Brkic, Denijal Tulumovic, Jasna Sehic-Meric, Nada Pavlovic, Mario Krizic.

Clinic of Internal Medicine Public Health Institution, Clinical Center Tuzla

Introduction: Accurate information about the cause of death is given by expert teams based on pathological or forensic expertise. Reliable information can be obtained from doctors from clinical-hospital institutions

if the deceased person was treated in such an institution and with previously diagnosed disease (hospital mortality). Analysis of hospital mortality provides a lot of data that can be used in planning the hospital beds capacities, the amount of drug procurement, purchasing equipment, organization and creation of highly specialized medical teams (medical team for resuscitation), the number of reanimation techniques, the number of pathologists who are required for autopsy procedures, etc. Goal was to determine the total number of deaths, the most common causes of death and the 10 leading diagnoses of deceased patients at the Clinic for Internal Medicine of Clinical Center in Tuzla during 2008. Material and methods: We used the material from the archive (medical records and reports on deceased patients, delivered by physicians working at the Clinic for Internal Medicine of Clinical Center in Tuzla). Results: During 2008 at the Clinic for Internal Medicine 368 patients died. According to the analyzed data leading cause of death and leading diagnosis as cause of death at the Clinic for Internal Medicine in 2008 were as follows: cardiogenic shock in 73 (19.84%), cerebrovascular stroke in 46 (12.50%), coma due to stroke in 32 (8.70%), coma not classied as cerebral in 25 (6.79 %) (metabolic 13 (3.53%) and hepatic 12 (3.26%), cardiomyopathy in 22 (5.98%), malignant neoplasm of the abdomen in 17 (4.62%), respiratory insufficiency in 17 (4.62%), acute myocardial infarction and myocardial infarction with rupture in 17 (4.62%), pulmonary edema in 16 (4.35%), and cardiorespiratory arrest in 13 (3.53%) deaths. Conclusion: During 2008 at the Clinic for Internal Medicine of Clinical Center in Tuzla died a total of 368 patients. The most common cause of death of patients at the Clinic for Internal Medicine of Clinical Center in Tuzla are cardiovascular disease (n=175; 47.55% of deaths), in second place was cerebrovascular disease (n=76; 20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascular and cerebrovascular disease. Key words: overall mortality, cardiovascular disease, cerebrovascular diseases, mortality rate.

1. INTRODUCTION

Natural death is the result of disease or health impairment which may be caused by natural internal or external factors that determine the pathological state resulting in death. Most accurate data on causes of death provide expert teams on the basis of pathological or forensic expertise. Accurate data can be obtained from doctors from clinical-hospital institutions if the deceased person was treated in such an institution and if it was previously diagnosed (hospital mortality).

Based on the data are being made the analysis of causes of death and usually are grouped into 10 most common causes which are then structurally analyzed. The most common causes of mortality are from cardiovascular and cerebrovascular diseases. International studies indicate a decline in mortality rates from coronary heart disease. Hospital mortality from this disease varies from 4-7% depending on the study (1,2,3). The presence of obesity, diabetes mellitus and vascular disease of non-cardiac origin increases hospital mortality (3,4).

Annual hospital mortality from acute myocardial infarction often exceeds 10% (4,5). Hospital mortality after cerebrovascular stroke in dierent studies varies from hospital to hospital and from country to country, and amounts to 8-56% (6,7,8).

Corresponding author: Fahir Barakovic, MD, PhD. Department of Internal medicine. University Clinical Center of Tuzla, Tuzla, Trnovac 1, Bosnia and Herzegovina. E-mail: [email protected]

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Mortality at the Clinic of Internal Medicine of University Clinical Center in Tuzla During 2008

No. Cause of death No. of deaths Percentage[%] 1 Cardiogenic shock 73 19.842 Cerebrovascular stroke 46 12.503 Coma due to stroke 32 8.704 Coma that is not classified as cerebral 25 6.795 Cardiomyopathy 22 5.986 Malignant neoplasms of the abdomen 17 4.627 Respiratory insufficiency 17 4.62

8 Acute myocardial infarction and myocardial

infarction with rupture 17 4.629 Pulmonary edema 16 4.3510 Cardiorespiratory arrest 13 3.53

Table 1. Most often diagnoses as cause of death in the total mortality sample

No. Cause of death No. of deaths Percentage[%] 1 Cardiovascular diseases 175 47.552 Cerebrovascular diseases 76 20.653 Gastrointestinal diseases 54 14.674 Respiratory diseases 17 4.625 Endocrinology diseases 14 3.806 Hematology diseases 12 3.267 Nephrology diseases 5 1.368 Rheumatoid diseases 1 0.279 Other diseases 14 3.80Total: 368 100.00

Table 2. Causes of death by disease of specific systems

According to analyzed data most often diagnosed cause of death at the Clinic for Internal Medicine in 2008 in the total number of deaths (n=368) were: cardiogenic shock in 73 (19.84%) deaths,

cerebrovascular stroke in 46 (12.50%) deaths, coma due to stroke in 32 (8.70%) deaths,

coma that is not classied as cerebral in 25 (6.79%) deaths (metabolic 13 (3.53%) and hepatic 12 (3.26%)), cardiomyopathy in 22 (5.98%) deaths,

malignant neoplasms of the abdomen in 17 (4.62%) deaths,

respiratory insufficiency in 17 (4.62%) deaths, acute myocardial infarction and myocardial infarction with rupture in 17 (4.62%) deaths,

pulmonary edema in 16 (4.35%) deaths,

cardiorespiratory arrest in 13 (3.53%) deaths (Table 1).

Other diagnoses as causes of death listed by the number of occurrences. hemorrhagic shock in 11 (2.99%) deaths,

leucosis in 9 (2.45%) deaths, sepsis in 8 (2.18%) deaths, pulmonary embolism in 8 (2.18%) deaths,

sudden cardiac death in 7 (1.91%) deaths,

multiple organ failure in 6 (1.64%) deaths,

unknown cause of death (mors subito) 4 (1.10%) deaths,

renal failure in 4 (1.10) death, esophageal varices in 3 (0.81%) deaths,

Analysis of hospital mortality provides a lot of data that can be used in planning the hospital beds capacities, the amount of drug procurement, purchasing equipment, organization and creation of highly specialized medical teams (medical team for resuscitation), the number of reanimation techniques, the number of pathologists who are required for autopsy procedures, etc. Hospital mortality has not been analyzed at the Clinic of Internal Medicine in Tuzla.

2. GOAL

The goal was to determine the total number of deaths, the most common causes of death and the 10 leading diagnoses of deceased patients at the Clinic for Internal Medicine of Clinical Center in Tuzla during 2008.

3. MATERIAL AND METHODOLOGY

We used the material from the archive (medical records and reports on deceased patients, delivered by physicians working at the Clinic for Internal Medicine of Clinical Center in Tuzla). Data were statistically analyzed for all patients who died in 2008 at the Clinic

for Internal Medicine.

4. RESULTS

During 2008 at the Clinic for Internal Medicine 368 patients died. At the intensive care unit died 164 (44.50%) patients, cardiology ward 14 (13.80%), department of nephrology 34 (9.24%), department of endocrinology 34 (9.24%), department gastroenterology 73 (19.84%), department of rheumatology 20 (5.44%), department of hematology 24 (6.52%), day hospital 2 (0.54%) and oncology department 1 (0.27%) patient. Analysis of the rst diagnosis was made, which represents a states that can be practically considered

the cause of death.

hematemesis in 3 (0.81%) deaths,

4% 3%

1%0% 4%

Kardiovaskularne bolesti Cerebrovaskularne bolesti Gastrointestinalne bolesti Respiratorne bolesti Endokrinoloke bolesti Hematoloke bolesti Nefroloke bolesti Reumatoloke bolesti Ostale bolesti

5%

15%

47%

21%

Figure 1. Graphic presentation of the causes of death by disease of specific systems

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Mortality at the Clinic of Internal Medicine of University Clinical Center in Tuzla During 2008

ventricular brillation in 2 (0.54%) deaths,

endotoxic shock in 2 (0.54%) deaths,

mega-ulcus of the stomach in 2 (0.54%) deaths, obstructive jaundice in 2 (0.54%) deaths,

morbus Hodgkin in 2 (0.54%) deaths,

diabetic ketoacidosis in 1 (0.27%) deaths,

adenocarcinoma of the larynx in 1 (0.27%) deaths,

valvular heart disease in 1 (0.27%) deaths,

asystoly of the heart in 1 (0.27%) deaths,

hypertensive and ischemic heart disease in 1 (0.27%) deaths,

politrauma in 1 (0, 27%) deaths, disseminated intravascular coagulation in 1 (0.27%) deaths,

breast cancer in 1 (0.27%) deaths, cor pulmonale in 1 (0.27%) deaths,

organic psychosyndrome in 1 (0.27%) deaths, hepatorenal syndrome in 1 (0.27%) deaths,

systemic sclerosis in 1 (0.27%) deaths,

pancreatitis in 1 (0.27%) deaths, ovarian tumor in 1 (0.27%) deaths, peritonitis in 1 (0.27%) deaths, pleuropankreatitis in 1 (0.27%) deaths,

lung cancer in 1 (0.27%) deaths, liver cirrhosis in 1 (0.27%) deaths, paraneoplastic syndrome in 1 (0.27%) deaths.

Sudden cardiac death occurs in 7 (1.91%) of primary diagnoses. According to the analysis of the most common causes of death by disease aected specic systems, the study results are shown in Figure 1 and Table 2. From the obtained results is obvious that the most common causes of death are due to cardiovascular disease (n=175; 47.55%) and at second place due to cerebrovascular disease (n=76; 20.65%) compared to the total number of deaths, which indicates that due to diseases of the cardiovascular and cerebrovascular systems died 251 (68.20%) patients.

The rst diagnosis of the remaining 14 deceased patients could not be adequately classied into diseases that af-

fect certain systems (sepsis, unknown cause of death (mors subito), endotoxic shock, etc.).

5. DISCUSSION AND CONCLUSIONS

Data from a doctor who did not know or has not cured the dead person were partially incorrect.

For accuracy of data in statistical analysis of the causes of death are only relevant data provided by the physician.

Place of death of the deceased could be anywhere. Accuracy of data grows in proportion with increasing number of deaths in health institutions. It should not happen that persons death occurs in a hospital facility and not consult a physician who is thereby required to ll out a medical report on the cause of death. The structure of causes of death used to obtain information about the leading cause of death, whether the causes of death vary according to place of living, whether they are related to gender, age, whether are changing according to the type of occupation, religious beliefs, etc. Also they are used in calculating the specic rates by gender, age, marital status, occupation, social structure of the deceased, place of death, time of death, for calculation of life duration of residents of that territory, to obtain data on morbidity and changes in the presence of certain diseases during follow-up time (months, years) or follow-up depending on season, weather changes, economic development, early childhood diseases, cardiovascular diseases, frequency of causes of death and how much of the total mortality is included in this cause, following the rate change by comparing the causes of death across time periods in this area, the dierences in the structure of causes of death in the area if they are compared with other areas.

The structure of causes of death can also be used to calculate mortality from certain diseases (specic mortality).

International studies indicate the decline in mortality rates from coronary heart disease (myocardial infarction). Hospital mortality of this disease varies from 4-7% depending on the study to study as we get in our research (1,2,3). The presence of obesity, diabetes mellitus and vascular disease

of non-cardiac origin increasing hospital mortality (3,4). Annual hospital mortality due to acute myocardial infarction often exceeds 10% (4.5).

Hospital mortality after cerebrovascular stroke in different studies varies almost from hospital to hospital and from state to state, which is 8-56% (6,7,8). At the Clinic of Internal Medicine, died a total of 368 patients in 2008. The largest number of deaths was in the intensive care ward (n=164; 44.50% of deaths).

Most common cause of death of pa

tients at the Clinic for Internal Medicine of Clinical Center in Tuzla was cardiovascular diseases (n=175; 47.55% of deaths), in second place were cerebrovascular diseases (n=76; 20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascular and cerebrovascular disease. From acute myocardial infarction died (n=17) 4.62% of patients.

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