Incidence and Aetiology of Sudden Pre-Hospital Deaths.

Dr. Srihari CattamanchiPostgraduate in Accident & Emergency

Medicine.

Aims and Objectives

1. To study the incidence of sudden pre-hospital deaths registered in emergency department.

2. To enumerate the various possible aetiological factors which have resulted in pre-hospital deaths registered in emergency department.

3. To estimate the association between sudden pre-hospital deaths and possible aetiological factors.

Materials and methods

Study type: prospective analytical study.

Study population: 80 brought dead subjects.

Study location: Accident and emergency department, tertiary care university hospital, south India.

Study period: 1st August 2007 to 31st July 2008 (1 year).

Study Tool : Verbal autopsy

A pre-formatted questionnaire asked to the close relatives of the subject, who knows the patients medical condition prior to death and who were with the patient during his death.

NAMEAGESEX ADDRESSPREVIOUS DISEASE CONDITION1. 2. 3. 4. 5. 6. COMPLAINTS PRECIDING THE DEATH

Symptoms: Duration1. Altered Sensorium & Fever2. Breathing Difficulty3. Chest pain4. Giddiness5. Seizure6. Sudden Collapse7. Profuse sweating 8. Others

Verbal autopsy questionnaire

Inclusion criteriaAll Brought - dead subjects registered in

accident and emergency department.

Cardiac - related death

Any brought - dead who had chest pain associated with profuse sweating preceding the death.

Subjects who had fever, altered sensorium, breathing difficulty, sudden collapse, seizures and other complaints preceding the death were excluded from this group.

Respiratory disease - related death

Subjects who had a breathing difficulty for a variable period of time prior to death.

Other disease resulted in sudden pre-hospital deaths

Altered sensorium with fever (probably sepsis).

Giddiness and sudden collapse.

Seizure, etc.

Exclusion Criteria

Subjects relative who did not know about the pre-morbid condition of the subject were excluded.

Study Analysis

95% confidence interval.

Chi square .

p - Value

Results

Aetiological factors resulting in sudden pre-hospital deaths.

2%8%19%

33%

38%

Cardiac- relateddeaths 38%

Respiratorydisease - relateddeaths 33%Altered sensorium& Fever 19%

Sudden collapse8%

Seizure 2%

Aetiological factors resulting in sudden pre-hospital deaths in different Sexes.

21

20

13

10

8

3

0 5 10 15 20 25

Cardiac - related deaths 31

Respiratory disease -related deaths 28

Altered sensorium & fever -related deaths 16

FemaleMale

02468

1012

Cardiac -related deaths31

Respiratorydisease -related deaths28AlteredSensorium &Fever - relateddeaths 16

Aetiological factors resulting in sudden pre-hospital deaths in different age groups.

Cardiac - related deaths Vs

Respiratory diseases - related deaths

31

28

26.5

27

27.5

28

28.5

29

29.5

30

30.5

31

Cardiac - relateddeaths

Respiratory disease -related deaths

p value - 0.5159

Analysis of cardiac and respiratory related deaths

95% confidence interval 1.6959

Chi square 0.4219

P value 0.5159

Cardiac - related deaths Vs

Altered Sensorium with fever – related deaths

31

16

0

5

10

15

20

25

30

35

Cardiac - related deaths Altered Sensorium withFever - related death

p value - 0.0070

Analysis of cardiac & altered sensorium with fever - related deaths

95% Confidence Interval 0.6066

Chi square 7.2712

p value 0.0070

Respiratory diseases - related deathsVs

Altered Sensorium with fever – related deaths

28

16

0

5

10

15

20

25

30

Respiratory disease -related deaths

Altered sensorium &Fever - related deaths

p value - 0.2184

Analysis of Respiratory related deaths & Altered sensorium with fever

95% Confidence Interval 1.3916

Chi square 1.5144

p value 0.2184

Cardiac - related Deaths Vs

Premorbid Conditions.

6

3

13

Diabetes Mellitus 3

Hypertension 6

DM + HTN 13

Limitations

Probable etiological factors is not confirmed by autopsy

The exact duration of symptoms preceding the death cannot be elicited in majority of the subjects

ConclusionIn this study the major cause of the Pre-

hospital death is found out to be cardiac - related (38.8%) and followed by respiratory diseases - related (35%).

Out of 31 cardiac - related deaths 21 found to have pre-morbid condition like diabetes mellitus and hypertension.

Thanking you…