Back to Journals » Clinical Epidemiology » Volume 11

Inhospital death is a biased measure of fatal outcome from bloodstream infection

Authors Laupland KB, Pasquill K, Parfitt EC, Dagasso G, Gupta K, Steele L

Received 13 September 2018

Accepted for publication 29 November 2018

Published 4 January 2019 Volume 2019:11 Pages 47—52

DOI https://doi.org/10.2147/CLEP.S187381

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 5

Editor who approved publication: Professor Henrik Toft Sørensen


Kevin B Laupland,1 Kelsey Pasquill,2 Elizabeth C Parfitt,1 Gabrielle Dagasso,1 Kaveri Gupta,1 Lisa Steele2

1Department of Medicine, Royal Inland Hospital, Kamloops, BC, Canada; 2Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, BC, Canada

Purpose: Inhospital death is commonly used as an outcome measure. However, it may be a biased measure of overall fatal outcome. The objective of this study was to evaluate inhospital death as a measure of all-cause 30-day case fatality in patients with bloodstream infection (BSI).
Patients and methods: A population-based surveillance cohort study was conducted, and patients who died in hospital within 30 days (30-day inhospital death) were compared with those who died in any location by day 30 post BSI diagnosis (30-day all-cause case fatality).
Results: A total of 1,773 residents had first incident episodes of BSI. Overall, 299 patients died for a 30-day all-cause case fatality rate of 16.9%. Most (1,587; 89.5%) of the patients were admitted to hospital, and ten (5.4%) of the 186 patients not admitted to hospital died. Of the 1,587 admitted patients, 242 died for a 30-day inhospital death rate of 15.2%. A further 47 patients admitted to hospital died after discharge but within 30 days of BSI diagnosis for a 30-day case fatality rate among admitted patients of 18.2%. Patients who died following discharge within 30 days were older and more likely to have dementia.
Conclusion: The use of inhospital death is a biased measure of true case fatality.

Keywords: mortality, case fatality, bacteremia

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]