NUTR 230C: Interpreting Nutrition Evidence

Definition:

“A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), and looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and the disease.

Case control studies are observational because no intervention is attempted and no attempt is made to alter the course of the disease. The goal is to retrospectively determine the exposure to the risk factor of interest from each of the two groups of individuals: cases and controls. These studies are designed to estimate odds.

Case control studies are also known as "retrospective studies" and "case-referent studies.”¹

Why this study type is used:

• Good for studying rare conditions or diseases¹
•  Less time needed to conduct the study because the condition or disease has already occurred ¹
• Lets you simultaneously look at multiple risk factors¹
• Useful as initial studies to establish an association¹
• Can answer questions that could not be answered through other study designs¹

Format and features:

•  Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement checklist for case-control studies ²
  
  

A case-control study of readmission to the intensive care unit after cardiac surgery.

Benetis R, Sirvinskas E, Kumpaitiene B, Kinduris S.

Med Sci Monit. 2013 Feb 28; 19:148-52.

Abstract

Background: 
The aim of this study was to identify predictors of repeated admission to the intensive care unit (ICU) of patients who underwent cardiac surgery procedures.

Material and Methods:
This retrospective study analyzed 169 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2009 and December 2010. The case group contained 54 patients who were readmitted to the ICU during the same hospitalization and the control group comprised 115 randomly selected patients.

Results:
Logistic regression analysis revealed that independent predictors for readmission to the ICU after CABG were: older age of patients (odds ratio [OR] 1.04; CI 1.004-1.08); body mass index (BMI) >30 kg/m2 (OR 2.55; CI 1.31-4.97); EuroSCORE II >3.9% (OR 3.56; CI 1.59-7.98); non-elective surgery (OR 2.85; CI 1.37-5.95); duration of operation >4 h (OR 3.44; CI 1.54-7.69); bypass time >103 min (OR 2.5; CI 1.37-4.57); mechanical ventilation >530 min (OR 3.98; CI 1.82-8.7); and postoperative central nervous system (CNS) disorders (OR 3.95; CI 1.44-10.85). The hospital mortality of patients who were readmitted to the ICU was significantly higher compared to the patients who did not require readmission (17% vs. 3.8%, p=0.025).

Conclusions:
Identification of patients at risk of ICU readmission should focus on older patients, those who have higher BMI, who underwent non-elective surgery, whose operation time was more than 4 hours, and who have postoperative CNS disorders. Careful optimization of these high-risk patients and caution before discharging them from the ICU may help reduce the rate of ICU readmission, mortality, length of stay, and cost.

1.  Himmelfarb Health Sciences Library (The George Washington University). Study Design 101: Case Control Study 2011; http://www.gwumc.edu/library/tutorials/studydesign101/casecontrols.html. Accessed March 1, 2013.

2.   Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). STROBE checklist for case-control. [2007]; http://www.strobe-statement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_case-control.pdf. Accessed March 1, 2013.