Browsing by Author "Hadžibegović, Adi (57191339256)"

Advances in modern medicine and more accurate and precise diagnostic procedures have been considered to be the main reason for the reduction in autopsy rates. However, there is still a discrepancy between clinical and autopsy diagnoses. This retrospective study, designed as a cross-sectional study, included a sample of 931 patients who died at the Clinical Hospital Centre ‘Zemun’. We analysed sex, age, length of hospitalisation and clinical and post-mortem diagnoses, including the discrepancies between them. In 314 (34%) cases, there was complete agreement between the clinical and autopsy diagnoses, complete disagreement in the same percentage and incomplete agreement in 303 (32%) cases. In people aged >60 years, the risk of misdiagnosis was 2.5-fold higher than in the those aged <60 years (odds ratio (OR)=2.522, p<0.001), while the influence of sex on the risk of misdiagnosis was not statistically significant (OR=0.981, p>0.05). An increase in the number of autopsies would be one of the best methods to make discrepancies between clinical and post-mortem diagnoses visible, and a good method for continuous evaluation of diagnostic tests, as well as for providing a wider perspective on presentations of different clinical conditions. © The Author(s) 2019.

Advances in modern medicine and more accurate and precise diagnostic procedures have been considered to be the main reason for the reduction in autopsy rates. However, there is still a discrepancy between clinical and autopsy diagnoses. This retrospective study, designed as a cross-sectional study, included a sample of 931 patients who died at the Clinical Hospital Centre ‘Zemun’. We analysed sex, age, length of hospitalisation and clinical and post-mortem diagnoses, including the discrepancies between them. In 314 (34%) cases, there was complete agreement between the clinical and autopsy diagnoses, complete disagreement in the same percentage and incomplete agreement in 303 (32%) cases. In people aged >60 years, the risk of misdiagnosis was 2.5-fold higher than in the those aged <60 years (odds ratio (OR)=2.522, p<0.001), while the influence of sex on the risk of misdiagnosis was not statistically significant (OR=0.981, p>0.05). An increase in the number of autopsies would be one of the best methods to make discrepancies between clinical and post-mortem diagnoses visible, and a good method for continuous evaluation of diagnostic tests, as well as for providing a wider perspective on presentations of different clinical conditions. © The Author(s) 2019.

Introduction/Objective The aim of this study was to determine independent predictors and the best trauma scoring system (REMS, RTS, GSC, SOFA, APPACHE II) of in-hospital mortality in patients with severe trauma at the Department of Emergency, Emergency Center, Clinical Center of Serbia, Belgrade. Methods Longitudinal study included 208 consecutive patients with severe trauma. In order to determine independent survival contributors, univariate and multivariate Cox regression analyses were performed. The power of above-mentioned scoring systems (measured at admission to the Emergency center) to predict mortality was compared using the area under the curve (AUC). Results There were 208 patients (159 male, 49 female), with the average age of 47.3 ± 20.7 years. Majority of patients were initially intubated (86.1%) on admission to the emergency department, and 59.6% patients were sedated before intubation. After finishing of diagnostic procedures, 17 patients were additionally intubated, and, at that time, 94.2% patients were on mechanic ventilation. The majority of patients was traumatized in a car crash (33.2%), followed by falls from height (26.4%) and as pedestrians (22.6%). Patients had an average of 24.7 ± 21.2 days spent in intensive care unit. The overall case-fatality ratio was 17/208 (8.2%). In Cox regression analysis only elevated heart rate (HR = 1.03, p = 0.012) and decreased arterial oxygen saturation (SpO2) (HR = 0.91, p = 0.033) singled out as independent contributors to in-hospital mortality of patients with severe trauma. REMS (AUC 0.72 ± 0.64) and SOFA (AUC 0.716 ± 0.067) scores were found fair and similar predictor of in-hospital mortality, while APACHE II (AUC 0.614 ± 0.062) and RTS (0.396 ± 0.068) were poor predictors. Conclusion Results of this study showed an important role of REMS, which appears to provide balance between the predictive ability and the practical application, and components of REMS in prediction of outcome in patients with severe trauma and that HR and SpO2 are independent predictors of in-hospital mortality. © 2019, Serbia Medical Society. All rights reserved.

Sepsis is a medical emergency and therefore requires early identification and immediate management, which is not a matter of hours, but minutes. Since the first definition in 1991, sepsis remains a major challenge for clinicians and scientists. Despite significant advances in technology and therapy, mortality and cost of treatment are unacceptably high. Septic shock is the leading cause of mortality in critically ill patients. Cognitive impairment and functional disability were observed after survivors’ long term follow-up. Since its foundation in 2002, Surviving Sepsis Campaign aims to implement global strategies and to raise awareness of the challenges associated with sepsis. The implementation of guidelines and sepsis care bundles resulted in significant decrease in mortality. Hospital mortality is lower in hospitals with high versus low bundle compliance. Still, epidemiological data for sepsis are missing for low-and middle-income countries. © 2020, Serbia Medical Society. All rights reserved.