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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Revisiting the effect of referral bias on the clinical spectrum of infective endocarditis in adults
European Journal of Clinical Microbiology and Infectious Diseases, Volume 29, No. 10, Year 2010
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Description
Referral bias occurs because of the clustering of patients at tertiary care centers. This may result in the distortion of observed clinical manifestations of rare diseases. This analysis evaluates the effect of referral bias on the epidemiology of infective endocarditis (IE) in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS). This is a prospective multicenter cohort study comparing transferred and non-transferred patients with IE. Factors independently associated with transfer status were evaluated using multivariable logistic regression. A total of 2,760 patients were included in the analysis, of which 1,164 (42.2%) were transferred from other medical centers. Transferred patients more often underwent surgery for IE (odds ratio [OR]∈=∈2.5; 95% confidence interval [CI] 1.9-3.2). They were also more likely to have complications such as stroke (OR∈=∈1.5; 95% CI 1.3-1.9), heart failure (OR∈=∈1.4; 95% CI 1.1-1.6), and new valvular regurgitation (OR∈=∈1.3; 95% CI 1.1-1.6). The in-hospital mortality rates were similar in both groups. Patients with IE who require surgery and suffer complications are referred to tertiary hospitals more frequently than patients with an uncomplicated course. Hospital transfer has no obvious effect on the in-hospital mortality. Referral bias should be taken into consideration when describing the clinical spectrum of IE. © 2010 Springer-Verlag.
Authors & Co-Authors
Kanafani, Zeina A.
Lebanon, Beirut
American University of Beirut Medical Center
Kanj, Souha S.
Lebanon, Beirut
American University of Beirut Medical Center
Cabell, Christopher H.
United States, Durham
Duke University
United States, Durham
Duke Clinical Research Institute
Cecchi, Enrico
Italy, Turin
Ospedale Maria Vittoria
de Oliveira Ramos, Auristela Isabel
Brazil, Sao Paulo
Instituto Dante Pazzanese de Cardiologia
Lejko-Zupanc, Tatjana
Slovenia, Ljubljana
Univerzitetni Klinični Center Ljubljana
Pappas, Paul A.
United States, Durham
Duke Clinical Research Institute
Giamerellou, H.
Greece, Athens
Attikon University Hospital
Gordon, David Llewellyn
Australia, Adelaide
Flinders Medical Centre
Michelet, Christian
France, Rennes
Pontchaillou University
Muñoz, Patricia E.
Spain, Madrid
Hospital General Universitario Gregorio Marañón
Pachirat, O.
Thailand, Khon Kaen
Khon Kaen University
Peterson, Gail E.
United States, Richardson
The University of Texas at Dallas
Tan, Ru San
Singapore, Singapore City
National Heart Centre Singapore
Tattevin, Pierre
France, Rennes
Pontchaillou University
Thomas, Vinod
India
Medical College Calicut
Wang, Andrew
United States, Durham
Duke University
Wiesbauer, Franz
Austria, Vienna
Allgemeines Krankenhaus Wien
Sexton, Daniel John
United States, Durham
Duke University
Statistics
Citations: 51
Authors: 19
Affiliations: 15
Identifiers
Doi:
10.1007/s10096-010-0983-2
ISSN:
09349723
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative