Kaewjai Thepsuthammarat

Mortality, Length of Stay, and Cost Associated with Hospitalized Adult Cancer Patients with Febrile Neutropenia

BACKGROUND Febrile neutropenia (FN) is a serious complication following chemotherapy and is associated with significant mortality and financial expenditure. The aim of this study was to evaluate risk factors for longer length of stay (LOS) and mortality and cost of treatment among hospitalized adults with cancer who developed febrile neutropenia in Thailand. MATERIALS AND METHODS Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data covered 96% of the population and were analyzed by age groups, hospital level, and insurance year schemes in patients with febrile neutropenia. RESULTS A total of 5,809 patients were identified in the study. The mortality rate was 14%. The median LOS was 8.67 days and 69% of patients stayed for longer than 5 days. On bivariate analysis, age, cancer type, and infectious complications (bacteremia/sepsis, hypotension, fungal infections, and pneumonia) were significantly associated with longer LOS and death. On multivariate analysis, acute leukemia and infectious complications were linked with longer LOS and death significantly. The median cost of hospitalized FN was THB 33,686 (USD 1,122) with the highest cost observed in acute leukemia patients. CONCLUSIONS FN in adult patients results in significant mortality in hospitalized Thai patients. Factors associated with increased mortality include older age (>70), acute leukemia, comorbidity, and infectious complications.

A national database of incidence and treatment outcomes of status epilepticus in Thailand

Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion, the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population.

National data on stroke outcomes in Thailand

Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼

Rheumatic and congenital heart diseases among school children of Khon Kaen, Thailand: declining prevalence of rheumatic heart disease

USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand.

Status epilepticus in the elderly patients: A national data study in Thailand

Abstract Background: Rheumatic fever (RF), rheumatic heart disease (RHD), and congenital heart disease (CHD) are still major problems among Thai school children. Objective: To examine trends in the prevalence of RF/RHD and CHD along with the socioeconomic status of school children in urban Khon Kaen, northeastern Thailand. Methods: We conducted cross-sectional survey of 8,555 school children aged 5-15 years from 4 schools in urban Khon Kaen from January to March 2006. Pediatric cardiologists examined the school children and all cardiac diagnoses were confirmed by echocardiography. Socioeconomic data were also collected. Schools were divided into high and low socioeconomic status (SES) schools, based on the prevailing levels of parental education and household income. All positive cases of heart disease were followed and reviewed at a university hospital up to December 2013. Results: Of 8,555 children examined, 2 had RF/RHD, and 10 had CHD. The prevalence of RF/RHD was 0.23 per 1,000 (95% CI 0.03-0.84), and the prevalence of CHD was 1.2 per 1,000 (95% CI 0.56-2.15). Prevalence of RF/RHD among urban school children in the center of northeastern Thailand had declined from 1.13 to 0.23 per 1,000 since 1986. The indices of socioeconomic development revealed marked improvement during this 20 year interim. The prevalence of RF/RHD was higher among low SES schools (4.6 per 1,000) compared with high SES schools (0 per 1,000). Conclusion: There is a low prevalence of RHD in school children in this region compared with the period before 1986.

Mortality and treatment costs of hospitalized chronic kidney disease patients between the three major health insurance schemes in Thailand

There are limited data in terms of incidence, clinical features, and outcomes in elderly patients with status epilepticus (SE) in national level. We retrospectively explored national data in Thailand for reimbursement of all SE in elderly patients admitted in the fiscal year 2004-2012. SE in elderly patients (age>60years old) were diagnosed and searched based on ICD 10 (G41) from the national database of from the National Health and Security Office. There were 3326 SE in elderly patients. The national incidence of SE was highest at 8.78patients/100,000/year in 2012. The average age was 72.02years and most were males (1379 patients; 58.8%). At discharge, 66% of patients had improved and in-hospital mortality rate was 14.5%. Predictors of poor outcomes were older age≥80years, being female, hospital levels, chronic renal failure, central nervous system infection, respiratory failure, pneumonia, septicemia, shock, acute renal failure, and hyperkalemia. In conclusion, the number of cases of SE in elderly patients in Thailand has been increasing annually. Increasing age was associated with poor outcome in admitted elderly SE patients.

Hospital mortality from atrial fibrillation associated with ischemic stroke: a national data report.

BackgroundThailand has reformed its healthcare to ensure fairness and universality. Previous reports comparing the fairness among the 3 main healthcare schemes, including the Universal Coverage Scheme (UCS), the Civil Servant Medical Benefit Scheme (CSMBS) and the Social Health Insurance (SHI) have been published. They focused mainly on provision of medication for cancers and human immunodeficiency virus infection. Since chronic kidney disease (CKD) patients have a high rate of hospitalization and high risk of death, they also require special care and need more than access to medicine. We, therefore, performed a 1-year, nationwide, evaluation on the clinical outcomes (i.e., mortality rates and complication rates) and treatment costs for hospitalized CKD patients across the 3 main health insurance schemes.MethodsAll adult in-patient CKD medical expense forms in fiscal 2010 were analyzed. The outcomes focused on were clinical outcomes, access to special care and equipment (especially dialysis), and expenses on CKD patients. Factors influencing mortality rates were evaluated by multiple logistic regression.ResultsThere were 128,338 CKD patients, accounting for 236,439 admissions. The CSMBS group was older on average, had the most severe co-morbidities, and had the highest hospital charges, while the UCS group had the highest rate of complications. The mortality rates differed among the 3 insurance schemes; the crude odds ratio (OR) for mortality was highest in the CSMBS scheme. After adjustment for biological, economic, and geographic variables, the UCS group had the highest risk of in-hospital death (OR 1.13;95% confidence interval (CI) 1.07–1.20; p < 0.001) while the SHI group had lowest mortality (OR 0.87; 95% CI 0.76–0.99; p = 0.038). The circumscribed healthcare benefits and limited access to specialists and dialysis care in the UCS may account for less favorable comparison with the CSMBS and SHI groups.ConclusionsSignificant differences are observed in mortality rates among CKD patients from among the 3 main healthcare schemes. Improvements in equity of care might minimize the differences.

Factors predicting the outcomes of elderly hospitalized myasthenia gravis patients: a national database study

Purpose: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database. Materials and Methods: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004–2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied. Results: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p < 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16). Conclusions: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF.

Original article. Childhood infective endocarditis in Khon Kaen University Hospital from 1992 to 2011

Background Myasthenia gravis (MG) in elderly populations is increasing. This study aimed to evaluate predictors for treatment outcomes in elderly hospitalized MG patients using the national database. Methods We collected data of elderly hospitalized MG patients from the National Health Security Office from October 2009 to September 2010. Predictors for treatment outcomes were examined. Results During the study period, 1,948 identified MG patients were admitted to hospitals throughout Thailand. Of those, 441 patients (22.64%) were aged ≥ 60 years. There were 66 patients (14.97%) who had poor outcomes. There were only three significant factors in the final model. Presence of pneumonia, use of mechanical ventilators, and septicemia had adjusted odds ratios (95% confidence interval) of 2.83 (1.03, 7.75), 5.33 (2.24, 12.72), and 4.47 (1.86, 10.75), respectively. Conclusion Pneumonia, being on a mechanical ventilator, and septicemia were independent factors associated with poor treatment outcomes in elderly hospitalized MG patients according to national data.

Prediction of Percentage Body Fat in Rural Thai Population Using Simple Anthropometric Measurements

Abstract Background: Infective endocarditis (IE) is an important cause of child morbidity and mortality, but the current burden of the disease in Thai children is unknown. Objectives: To determine the current burden of IE in Thai children. Patients and Methods: The records of all children aged <15 years admitted to Khon Kaen University Hospital from 1992 to 2011 were reviewed. Results: Of 69,822 admissions, 56 patients fulfilled the modified Duke criteria for definite IE giving a rate of 0.8 cases per 1,000 admissions. Age at diagnosis was 7.9 ± 3.8 years (range, 8 days to 14.8 years). There was congenital heart disease in 38 (68%) patients, rheumatic heart disease (RHD) in 10 (18%), and no previous heart disease in 8 (14%). RHD was a less frequent underlying disease during the latter half (2002-2011) of the period studied (1/34 vs. 9/22, P < 0.001). Blood cultures were positive for pathogens in 34 (61%) patients with 11 cases of Streptococcus viridians and 8 cases of Staphylococcus aureus infections. Vegetations on echocardiography were present in 46 (82%) patients. For 8 embolic events, patients with large vegetations had a higher rate (4/6) than patients with small and no vegetations (4/50) (P < 0.003). In-hospital mortality was 11%. Eight patients with S. aureus infection had a higher mortality (5/8) than 26 patients (1/26) infected with other pathogens (P < 0.001). Conclusion: The changing epidemiology of pediatric IE was toward fewer children with RHD. Mortality among children with IE was higher in those with S. aureus infection.