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In This Issue of Archives of Internal Medicine
November 08, 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2010;170(20):1789. doi:10.1001/archinternmed.2010.388
The Effect of Hospital-Acquired Clostridium difficile Infection on In-Hospital Mortality

This study determined the independent impact of hospital-acquired Clostridium difficile infection (CDI) on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission. In a cohort of 136 877 admissions, hospital-acquired CDI was identified in 1393 (overall risk per admission, 1.02%). Cox regression analysis revealed an average 3-fold increase in the hazard of death associated with hospital-acquired CDI; this hazard ratio decreased with increasing baseline mortality risk. Across all baseline risk strata, for every 10 patients acquiring the infection, 1 person died.

Article
Delay From Symptom Onset to Hospital Presentation for Patients With Non–ST-Elevation Myocardial Infarction

Ting et al studied 104 622 patients with non–ST-segment elevation myocardial infarction enrolled at 568 hospitals participating in the CRUSADE National Quality Improvement Initiative from January 1, 2001, to December 31, 2006. Median delay time from symptom onset to hospital presentation was 2.6 hours (interquartile range, 1.3-6.0 hours) and has not changed significantly from 2001 to 2006 (P value for trend, .16). After multivariable adjustment, factors associated with longer delay time included older age, female sex, nonwhite race, diabetes, and current smoking. Time of day had the largest impact on delay time, as patients who presented to the hospital during weekday or weekend nights (>12 AM to 8 AM) have 25% shorter delay times compared with those presenting during weekday daytime (>8 AM to 4 PM) (P<.001).

Article
Prevalence of Fracture and Fragment Embolization of Bard Retrievable Vena Cava Filters and Clinical Implications Including Cardiac Perforation and Tamponade

Fracturing of a vena cava filter strut with subsequent end-organ embolization is a rarely reported potentially life-threatening occurrence. A retrospective, single-center, cross-sectional study to evaluate patients having received either a first-generation Bard Recovery filter or a second-generation Bard G2 filter was performed. Of all patients, 16% had at least 1 strut fracture; 25% of the Bard Recovery filters and 11.5% of Bard G2 filters had fractured. Five patients had at least 1 fragment embolize to the heart, with 3 patients having experienced life-threatening symptoms of ventricular tachycardia and/or tamponade, including 1 patient who experienced sudden death at home. Both the Bard Recovery Filter and Bard G2 filters had high prevalences of fracture and embolization with potentially life-threatening sequelae.

Article
Trends in Door-to-Balloon Time and Mortality in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

This retrospective analysis assessed the temporal trend in door-to-balloon (DTB) time for 8771 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI from 2003 to 2008 to determine if a reduction in DTB time corresponded to a reduction in mortality. Median DTB time decreased each year from 113 minutes in 2003 to 76 minutes in 2008 (P < .001), and the percentage of patients revascularized with DTB time less than 90 minutes increased from 28.5% in 2003 to 67.2% in 2008 (P < .001). In-hospital mortality remained unchanged at 4.10% in 2003, 4.02% in 2004, 4.40% in 2005, 4.42% in 2006, 4.73% in 2007, and 3.62% in 2008 (P = .69). These data suggest that successful reduction of DTB time has not resulted in a reduction in early mortality in patients undergoing primary PCI and other strategies need to be explored to improve the outcome of patients with STEMI.

Article
The Evolving Epidemiology of Hepatitis A in the United States

Klevens et al characterize cases of hepatitis A disease reported from 2005 through 2007 to determine who remains at risk in the United States. Their findings suggest that, in addition to continued childhood vaccination, vaccinating susceptible travelers is likely to reduce the rate of hepatitis A disease further. The authors found an overall annual incidence rate of 1.3 per 100 000 population (range by site, 0.7-2.3). Of the reported cases, 53.4% were male, 42.4% were white, 44.7% were aged 15 to 39 years, and 91.4% resided in urban areas. Reported risk factors were international travel (45.8%), contact with a case (14.8%), employee or child in a daycare center (7.6%), exposure during a food or waterborne common-source outbreak (7.2%), illicit drug use (4.3%), and men who had sex with men (MSM) (3.9%).

Potential source of infection or risk factor for hepatitis A.

Potential source of infection or risk factor for hepatitis A.

Article
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