Upper Respiratory Infections

Medical errors now third leading cause of death in United States

Upper Respiratory Infections | Johns Hopkins Medicine

Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S.

Their figure, published May 3 in The BMJ, surpasses the U.S.

Centers for Disease Control and Prevention's (CDC's) third leading cause of death — respiratory disease, which kills close to 150,000 people per year.

The Johns Hopkins team says the CDC's way of collecting national health statistics fails to classify medical errors separately on the death certificate. The researchers are advocating for updated criteria for classifying deaths on death certificates.

“Incidence rates for deaths directly attributable to medical care gone awry haven't been recognized in any standardized method for collecting national statistics,” says Martin Makary, M.D., M.P.H.

, professor of surgery at the Johns Hopkins University School of Medicine and an authority on health reform.

“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.”

In 1949, Makary says, the U.S. adopted an international form that used International Classification of Diseases (ICD) billing codes to tally causes of death.

“At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone's death, and because of that, medical errors were unintentionally excluded from national health statistics,” says Makary.

The researchers say that since that time, national mortality statistics have been tabulated using billing codes, which don't have a built-in way to recognize incidence rates of mortality due to medical care gone wrong.

In their study, the researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S.

Department of Health and Human Services' Office of the Inspector General and the Agency for Healthcare Research and Quality.

Then, using hospital admission rates from 2013, they extrapolated that a total of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error, which the researchers say now translates to 9.5 percent of all deaths each year in the U.S.

According to the CDC, in 2013, 611,105 people died of heart disease, 584,881 died of cancer and 149,205 died of chronic respiratory disease — the top three causes of death in the U.S. The newly calculated figure for medical errors puts this cause of death behind cancer but ahead of respiratory disease.

“Top-ranked causes of death as reported by the CDC inform our country's research funding and public health priorities,” says Makary. “Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves.”

The researchers caution that most of medical errors aren't due to inherently bad doctors, and that reporting these errors shouldn't be addressed by punishment or legal action.

Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.

“Unwarranted variation is endemic in health care. Developing consensus protocols that streamline the delivery of medicine and reduce variability can improve quality and lower costs in health care. More research on preventing medical errors from occurring is needed to address the problem,” says Makary.

Michael Daniel of Johns Hopkins is a co-author on the study.

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Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

Source: https://www.sciencedaily.com/releases/2016/05/160504085309.htm

A guide to AFM, the rare, polio- illness making young children sick

Upper Respiratory Infections | Johns Hopkins Medicine

A fast-acting, polio- illness has sickened 62 young children, with an average age of 4, in 22 U.S. states so far this fall.

Acute flaccid myelitis, or AFM, starts out as a respiratory condition and may quickly progress to physical disability within hours.

Some patients experience long-term paralysis requiring ongoing care, but others may fully recover, according to Carlos Pardo-Villamizar, a neurological disease expert at the Johns Hopkins University School of Medicine who recently authored a paper on AFM published last month in Developmental Medicine and Child Neurology.

“If children develop an upper-respiratory infection and there is any hint of muscle weakness, those patients need to be evaluated rapidly by a pediatrician and an emergency department.”

Carlos Pardo-Villamizar

Neurological disease expert

The cause of AFM is unclear, leaving parents wondering how to protect their children. Pardo-Villamizar and other experts from Johns Hopkins have been sharing what they know about the outbreak and prevention with news outlets recently.

The chief takeaways? Wash your hands, cover your sneezes and coughs, and contact a doctor if your child experiences muscle weakness in the arms or legs.

What is AFM and what are its symptoms?

Acute flaccid myelitis is a rare condition that attacks the nervous system—specifically the area of the spinal cord called gray matter—causing muscles and reflexes to weaken, according to the Centers for Disease Control.

Patients may suddenly experience weakness in their arms and legs, drooping of the face and eyelids, and slurred speech, along with difficulty breathing, moving their eyes, or swallowing. “In very rare cases, it is possible that the process in the body that triggers AFM may also trigger other serious neurologic complications that could lead to death,” according to the CDC website.

What causes AFM?

AFM could be caused by one or more viruses, Pardo-Villamizar told HealthDay, with Enterovirus D68—a virus from the same family as polio—as the chief suspect. That virus was closely linked to the 2014 outbreak, he says.

The damage caused by AFM could also be caused by the immune system, Pardo-Villamizar says in an interview with Kaiser Health News. “At this moment, we don't know if it's a virus that is coming and producing direct damage of the gray matter in the spinal cord, or if a virus is triggering immunological responses that produce a secondary damage in the spinal cord.”

Does AFM have a season, the flu?

AFM outbreaks coincide with cold and flu season, so it can easily go undetected at first, says Aaron Michael Milstone, an associate epidemiologist and an associate professor of pediatrics at Hopkins.

“Just about every parent who has a young child, sometime in October or the winter, their child will have some cold or low-grade fever or something,” Milstone told HuffPost.

“They're presenting with weakness in some part of their body. It could be an arm, it could be a leg, it could be more.” he says of the patients' symptoms. “Sometimes it stops there, sometimes it progresses. And as you would expect, it's very scary for parents.”

Is AFM a new disease?

No, though the number of confirmed cases has generally been on the rise 2014. From August 2014 through September 2018, the CDC confirmed a total of 386 cases of AFM across the U.S.—120 cases in 34 states in 2014, 22 cases in 17 states in 2015, 149 cases in 39 states in 2016, and 36 cases in 16 states in 2017.

“AFM has been occurring in waves about every two years,” according to infectious disease expert Amesh A. Adalja, senior scholar at the Johns Hopkins Center for Health Security, in an interview with SELF. “It always ends up being a new news story. But this isn't something people have been ignoring. It's something they've been actively investigating since 2014.”

More than half of all U.S. states have had confirmed or possible cases this year. The states reporting confirmed cases are Arizona, Colorado, Georgia, Indiana, Iowa, Massachusetts, Minnesota, New Jersey, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, and Wisconsin.

States reporting suspected cases or cases under investigation are Alabama, Arkansas, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Montana, Nebraska, Nevada, New York, North Carolina, Oklahoma, and Washington.

How concerned are health experts?

As alarming as the news is, AFM is still unusual. The CDC estimates that less than one every one million people in the United States will get AFM each year. Pardo-Villamizar told HealthDay that most children who contract an enterovirus only suffer an upper-respiratory infection.

Priya Duggal, a genetic epidemiologist at the Johns Hopkins Bloomberg School of Public Health who is studying whether some patients may have a genetic vulnerability to the virus, told Science that AFM is “pretty rare, but it's pretty devastating. And it appears that it's cyclical. It's not going away.”

What can parents do to protect their children?

There is no vaccine to prevent AFM. Experts suggest employing the same good hygiene habits used to fight off colds and flu: frequent hand-washing and covering coughs and sneezes. Parents should also watch their sick children for any signs of weakness in the arms or legs, Pardo-Villamizar told HealthDay.

“If children develop an upper-respiratory infection and there is any hint of muscle weakness, those patients need to be evaluated rapidly by a pediatrician and an emergency department,” he says. “They need to be followed very carefully, because this is a very aggressive disease. In a matter of hours, the children are paralyzed. They may need respiratory support.”

Source: https://hub.jhu.edu/2018/10/19/guide-to-paralyzing-illness-acute-flaccid-myelitis/