Prevalence of Malignant Hyperthermia Diagnosis in New York State Ambulatory Surgery Center Discharge Records 2002 to 2011

Lu, Zhen A.; Rosenberg, Henry; Brady, Joanne E.; Li, Guohua

doi:10.1213/ane.0000000000001054

Cited by 28 publications

(20 citation statements)

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“…MH susceptibility is a rare disorder. Reported prevalence of MH diagnosis in studies using hospital discharge records from administrative data ranges from 0.18 per 100,000 (95% confidence interval (CI), 0.12-0.25) in ambulatory surgery center patients to 0.96 (95% CI, 0.75-1.41) in surgical inpatients [8,9]. The low frequency of MH crises and the cost of stocking dantrolene have given rise to concern about the cost-benefit of the recommendation of the Malignant Hyperthermia Association of the United States (MHAUS) that dantrolene be made immediately available (for administration within 10 min) in operating room areas, especially in facilities with a low utilization of general anesthesia and triggering agents such as maternity units [10,11].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Guglielminotti

Rosenberg

2020

BMC Anesthesiol

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Background: The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. However, no study has examined the prevalence of MH susceptibility in obstetrics. This study aimed to assess the prevalence of MH diagnosis and associated factors in obstetric patients. Methods: Data for this study came from the National Inpatient Sample from 2003 to 2014, a 20% nationally representative sample of discharge records from community hospitals. A diagnosis of MH due to anesthesia was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 995.86. MH prevalence was estimated according to the delivery mode and patient and hospital characteristics. Results: During the 12-year study period, 47,178,322 delivery-related discharges [including 15,175,127 (32.2%) cesarean deliveries] were identified. Of them, 215 recorded a diagnosis of MH, yielding a prevalence of 0.46 per 100, 000 [95% confidence interval (CI), 0.40 to 0.52]. The prevalence of MH diagnosis in cesarean deliveries was 0.81 per 100,000 (95% CI, 0.67 to 0.97), compared with 0.29 per 100,000 (95% CI, 0.23 to 0.35) in vaginal deliveries (P < 0.001). Multivariable logistic regression revealed that cesarean delivery was associated with a significantly increased risk of MH diagnosis [adjusted rate ratio (aOR) 2.88; 95% CI, 2.19 to 3.80]. Prevalence of MH diagnosis was lower in Hispanics than in non-Hispanic whites (aOR 0.47; 95% CI, 0.29 to 0.76) and higher in the South than in the Northeast census regions (aOR 2.44; 95% CI, 1.50 to 3.96). Conclusion: The prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.

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Section: Introductionmentioning

confidence: 99%

Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Guglielminotti

Rosenberg

2020

BMC Anesthesiol

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“…The apparently similar mortality with or without dantrolene may be explained by the likelihood that mortality was reduced by dantrolene in patients who met criteria for MH, whereas mortality was also low in patients for whom dantrolene was not prescribed because their symptoms were not severe enough to meet threshold criteria for MH and warrant dantrolene treatment [ 7 ], or because their MH-like episodes were misdiagnosed and actually were caused by other syndromes treated with alternative measures. A previous study suggested that only one fourth of cases recorded as MH in hospital records represented true MH cases, whereas an equal number were attributed to other conditions [ 8 , 9 ]. In our study, a secondary subgroup inspection of individual medical records of MH patients who received dantrolene revealed that 7/13 (53.8%) were “somewhat greater than likely” to meet standardized criteria for a definite MH episode [ 44 ], compared with only 1/19 (5.26%) patients coded as having MH who did not receive dantrolene.…”

Section: Discussionmentioning

confidence: 99%

“…Estimates of the incidence of MH episodes range from 1:5,000 to 1:100,000 general anesthetics [ 3 , 7 ]. However, the true incidence of MH episodes in hospital is uncertain as the accuracy of discharge records which have been used to identify MH cases has been questioned [ 8 ]. For example, in a recent report of hospital billing records in which patients with a discharge diagnosis of MH were identified, only 23.4% had a likely MH episode while 23.4% had hyperthermia attributed to other causes when their medical records were reviewed by an expert panel of anesthesiologists [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Intravenous dantrolene in hypermetabolic syndromes: a survey of the U.S. Veterans Health Administration database

et al. 2022

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Background Intravenous dantrolene is often prescribed for hypermetabolic syndromes other than the approved indication of malignant hyperthermia (MH). To clarify the extent of and indications for dantrolene use in conditions other than MH, we sought to document current practices in the frequency, diagnoses, clinical characteristics and outcomes associated with dantrolene treatment in critical care settings. Methods Inpatients receiving intravenous dantrolene from October 1, 2004 to September 30, 2014 were identified retrospectively in the U.S. Veterans Health Administration national database. Extracted data included; diagnoses of hypermetabolic syndromes; triggering drugs; dantrolene dosages; demographics; vital signs; laboratory values; in-hospital mortality; complications; and lengths of stay. Frequency and mortality of patients who did not receive dantrolene were obtained in selected diagnoses for exploratory comparisons. Results Dantrolene was administered to 304 inpatients. The most frequent diagnoses associated with dantrolene treatment were neuroleptic malignant syndrome (NMS; N = 108, 35.53%) and sepsis (N = 47, 15.46%), with MH accounting for only 13 (4.28%) cases. Over half the patients had psychiatric comorbidities and received psychotropic drugs before dantrolene treatment. Common clinical findings in patients receiving dantrolene included elevated temperature (mean ± SD; 38.7 ± 1.3 °C), pulse (116.33 ± 22.80/bpm), respirations (27.75 ± 9.58/min), creatine kinase levels (2,859.37 ± 6,646.88 IU/L) and low pO2 (74.93 ± 40.16 mmHg). Respiratory, renal or cardiac failure were common complications. Mortality rates in-hospital were 24.01% overall, 7.69% in MH, 20.37% in NMS and 42.55% in sepsis, compared with mortality rates in larger and possibly less severe groups of unmatched patients with MH (5.26%), NMS (6.66%), or sepsis (41.91%) who did not receive dantrolene. Conclusions In over 95% of cases, dantrolene administration was associated with diagnoses other than MH in critically-ill patients with hypermetabolic symptoms and medical and psychiatric comorbidities. Exploratory survey data suggested that the efficacy and safety of dantrolene in preventing mortality in hypermetabolic syndromes other than MH remain uncertain. However, randomized and controlled studies using standardized criteria between groups matched for severity are essential to guide practice in using dantrolene.

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“…Die Inzidenz des malignen Hyperthermiesyndroms (MHS), einer schweren Nebenwirkung auf ein halogenes volatiles Narkotikum, beträgt etwa 1 pro100.000 bis 1 pro 500.000 durchgeführte Narkosen [16][17][18]. Die genetische Disposition dürfte jedoch noch deutlich häufiger vorkommen.…”

Section: Malignes Hyperthermiesyndromunclassified

Maligne hypertherme Syndrome auf der Intensivstation

Grander

2016

Med Klin Intensivmed Notfmed

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Malignant hyperthermia is a life-threatening disease caused by derangement of the autonomic nerve system and hypermetabolism of the peripheral musculature. Commonly body core temperatures of more than 40 °C will be found in this disease which is caused mostly by psychopharmacological drugs like antidepressants, neuroleptics but also antibiotics, pain killers, anti-Parkinson drugs, and volatile anesthetics. The inducers of malignant hyperthermia interact with postsynaptic receptors (serotonin, anticholinergics) or muscular intracellular structures responsible for calcium utilization (volatile anesthetics, succinylcholine). Rarely malignant hyperthermia is a consequence of mental stress or vigorous exercise and or heat. Malignant hyperthermic syndromes lead to a severe dysbalance of the autonomic nerve system accompanied by rhabdomyolysis, disseminated intravascular coagulopathy, and finally multi-organ failure. Accordingly, medical management is primarily directed to stabilize vital functions, withdrawal of the causing drug, and if possible antagonizing toxic substances. The leading symptom hyperthermia needs to be treated physically with available cooling systems.

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Prevalence of Malignant Hyperthermia Diagnosis in New York State Ambulatory Surgery Center Discharge Records 2002 to 2011

Abstract: The prevalence of recorded MH diagnosis in ASC patients is approximately 1 per 500,000 and varies considerably with surgical procedures.

Cited by 28 publications

References 12 publications

Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Intravenous dantrolene in hypermetabolic syndromes: a survey of the U.S. Veterans Health Administration database

Maligne hypertherme Syndrome auf der Intensivstation

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