Cochrane G M, Clark J H
Thorax. 1975 Jun;30(3):300-5. doi: 10.1136/thx.30.3.300.
We have examined the death certificates from all patients aged 35-64 years who were recorded as dying from asthma in Greater London Council hospitals in 1971. Of the 47 death certificates studied, nine suggested that the primary cause of death was not asthma. From the remaining 38 deaths we have obtained 36 case records and found that 15 deaths occurred outside hospital and another two patients died in hospital having been admitted in a stable state. We have examined the remaining 19 case records to find out the circumstances of death in patients with asthma who die in hospital. We have been unable to exclude the possibility that many of the deaths in hospital were avoidable. Assessment of severity in most patients was incomplete, as judged by a retrospective analysis of case records, and many of the patients would be regarded as having had insufficient treatment. Four patients did not receive corticosteroids and in a further three the dose given was small. No physiological assessment of airflow obstruction was made in over half the patients. A comparison with 19 survivors of an admission to hospital with asthma did not provide enough information to account for the deaths. The survivors were in hospital for a shorter period of time, were slightly less ill, and were given comparable treatment regimens. Both groups of patients were inadequately assessed, and sedatives were given to approximately 70% of all subjects studied. The deaths in hospital usually occurred suddenly in the early morning in general medical wards.
我们查阅了1971年大伦敦议会医院记录的所有年龄在35至64岁之间因哮喘死亡患者的死亡证明。在研究的47份死亡证明中，有9份表明死亡的主要原因并非哮喘。从其余38例死亡病例中，我们获取了36份病例记录，发现15例死亡发生在院外，另外2例患者在入院时病情稳定的情况下在医院死亡。我们检查了其余19份病例记录，以查明在医院死亡的哮喘患者的死亡情况。我们无法排除许多医院内死亡可能是可以避免的这种可能性。根据病例记录的回顾性分析判断，大多数患者的严重程度评估并不完整，而且许多患者被认为治疗不足。4例患者未接受皮质类固醇治疗，另有3例给予的剂量较小。超过半数的患者未进行气流阻塞的生理学评估。与19例哮喘入院幸存者的比较并未提供足够信息来解释这些死亡情况。幸存者住院时间较短，病情稍轻，接受的治疗方案相似。两组患者的评估都不充分，并且在所有研究对象中约70%的人使用了镇静剂。医院内的死亡通常发生在普通内科病房的清晨，且较为突然。
