Inhospital death is a biased measure of fatal outcome from bloodstream infection
Received 13 September 2018
Accepted for publication 29 November 2018
Published 4 January 2019 Volume 2019:11 Pages 47—52
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
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