According to the findings, the mortality associated with the adverse effects of medical treatments decreased slightly in the United States from 1990 to 2016. published online January 18 in JAMA Network open now. However, the risk of death by AEMT is not evenly distributed, with some age groups and some geographic areas being more affected than others.
A published study in 2016, medical error is the third leading cause of death in the United States after heart disease and cancer. However, International Classification of Disease (ICD) codes commonly found on death certificates may not provide sufficient information to indicate whether medical treatment or its consequences have contributed to a death.
As a result, the authors of this report, Martin Makary, MD, and researcher Michael Daniel, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, called for a more granular account of the events surrounding the treatment-related deaths to better estimate the scale of the problem, which could facilitate mortality reduction strategies.
In the new study, Jacob E. Sunshine, MD, of the University of Washington School of Medicine in Seattle, and his colleagues have gone over information on death certificates to quantify stratified causes by group of patients. Age, sex and country of residence. The cohort study used data from 1990 to 2016 on mortality in the United States, due to the EATM of the Global Tool for Burden of Disease, Injury and Risk Factors (GBD). They also investigated trends in the types of injuries and associations with other diseases and injuries, which they describe as "chains of the cause of death".
Overall, researchers estimated that 123,603 deaths were attributable to the TMEA (95% uncertainty interval [UI], 100 856 – 163 814 deaths) from 1990 to 2016. In absolute terms, the number of deaths with AEMT as the underlying cause increased from 4180 (95% UI, 3087 – 4993) to 5180 (95% UI, 4469 – 7436) in 2016..
However, the death rate decreased by 21.4% (95% of unemployment insurance, 1.3% to 32.2%) by 1.46 (95% of unemployment insurance) , 1.09 to 1.76) deaths per 100,000 population in 1990 to 1.15 (95% of unemployment insurance, 1.00 to 1.60) in 2016..
In comparison, the 1999 report of the Institute of Medicine "It's a Human Fault: Building a Safer Healthcare System, "attributed between 44,000 and 98,000 annual deaths to medical errors, however," the two studies are not comparable because their methodologies are different. We use the Global Burden of Diseases methodology which is based primarily on the underlying cause of death rather than the long list that provides the causes that led to a specific cause of death, "said Sunshine Medscape Medical News.
The new analysis also revealed an obvious age effect. Mortality rates for people aged 70 and over were almost 20 times higher than those aged 15 to 49 (2016 mortality rate: 7.93 vs. 0.38 per 100,000 population). Men and women had similar mortality rates by AEMT.
The researchers found a geographical disparity. California had the lowest age standardized AEMT mortality rate with 0.84 deaths (95% unemployment insurance, 0.57 – 1.47 deaths) per 100,000 population. Mississippi recorded the highest number of deaths at 1.67 (95% unemployment insurance, 1.19 to 2.03 deaths).
The District of Columbia recorded the largest percentage decrease in the age-standardized AEMT mortality rate (39.9%), followed by New York (33%), Maryland (32.2%), New Jersey (30.5%) and California (28.5%). Mortality by AEMT decreased after the turn of the millennium in Colorado (16.6%), Oregon (14%) and Virginia (18.8%).
Perioperative events and surgical problems were the most common reason for OMEA, accounting for 63.6% of the deaths associated with the OMEA. Other reasons for AEMT were drug-related adverse events (8.9%), "medical accidents" (the legal term for bodily injury resulting from medical error or the unintentional outcome of an intentional act) ( 8.5%), and adverse events associated with medical management (14%) or medical or surgical devices (4.5%). A death might have been associated with more than one cause.
Traumatic injury was the most common indication for which the AEMT was indicated on the death certificate as the cause of death. The other most common causes were cardiac arrest and sepsis, cardiovascular diseases and gastrointestinal disorders generally requiring surgery.
"Together with other detection systems, the GBD study could provide an increasingly robust assessment of AEMT's burden across the United States," the researchers conclude.
The limitations of the study include the reliability of CIM code information on death certificates when identifying medical damage, the possibility of under-reporting deaths following an AEMT test, and the inability to recognize situations that may occur. do not match a CIM code.
The study was funded in part by the Bill and Melinda Gates Foundation and the Foundation for Anesthesia Education and research. The researchers did not reveal any relevant financial relationship.
JAMA Network open now. Posted online 18 January 2019. Full Text