ABSTRACT
BACKGROUND: Epidemiological, clinical and pathological study of sudden death in children and young adults under 36 years old. SUBJECTS, MATERIAL AND METHOD: Sudden deaths between 1 and 35 years that occurred in Bizkaia (North of Spain) from 1991 to 1998 were analyzed. In all cases a complete forensic autopsy including histopathological, toxicological and occasionally microbiological studies were performed. Also, pathological antecedents were investigated. RESULTS: 107 sudden death cases between 1 and 35 years occurred, being the mortality rate of 2.4/100,000/year. Males were threefold at risk of sudden death than females. Mortality rate was higher in youngs than children. 4.5% of natural deaths were sudden deaths.43% were sudden cardiac deaths, and atheromatous coronary disease was the most frequent over 30 years. Myocardial diseases and conduction system abnormalities were common between 15 and 29 years. 39% were extracardiac sudden deaths. Infections were frequent in children, and epilepsy and asthma between 15 and 29 years. Intracraneal hemorrhage was also frequent. In 19 cases (18%), specially in children, the cause of death was unexplained. Cause of death was different according to gender and age. CONCLUSIONS: Sudden death is infrequent in children and youngs, and causes are numerous. This study supports the importance of complete forensic autopsies in order to encourage epidemiological and preventive studies on sudden death.
Subject(s)
Death, Sudden/epidemiology , Adolescent , Adult , Age Factors , Autopsy , Cause of Death , Child , Child, Preschool , Data Interpretation, Statistical , Death, Sudden/etiology , Death, Sudden/pathology , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/pathology , Female , Humans , Infant , Male , Sex Factors , Spain/epidemiologyABSTRACT
We tested an appropriateness of indications tool for total hip joint replacement in patients with osteoarthritis. Criteria were developed using a modified Delphi panel judgment process. Ratings were analyzed regarding level of agreement among panelists. Another panel rated the same indications; results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. Appropriateness indication judgment was applied to 84 patients and compared to health-related quality-of-life improvement before and 3 months following intervention. Main panel ratings compared to those of a second panel resulted in a kappa statistic of 0.77. Test-retest kappa for the main panel was 0.81. Patients considered appropriate candidates for surgery, based on their composite indication scores, showed more improvement in health-related quality of life after 3 months than those considered inappropriately by composite indication scores. The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this indications algorithm as a screening tool for assessing the appropriateness of hip replacement surgery in osteoarthritis.
