scholarly journals Sepsis in Obstetrics Score (SOS) utility and validation for triaging patients with obstetric sepsis in the emergency department: Evidence from a low income health care setting

2018 ◽  
Vol 12 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Rachna Agarwal ◽  
Rajesh Kumar Yadav ◽  
Medha Mohta ◽  
Meera Sikka ◽  
Gita Radhakrishnan
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Severe Sepsis ◽  
Positive Predictive Value ◽  
Organ Failure ◽  
Predictive Value ◽  
Illness Severity ◽  
Culture Positivity ◽  
Severity Scores ◽  
In Pregnancy

Background Illness severity scores commonly used in critical care settings are not considered appropriate in obstetric practice as they do not account for pregnancy physiology. A new illness severity score called the ‘Sepsis in Obstetrics Score’ (SOS) was introduced by Albright et al. for triaging patients with sepsis in pregnancy in an emergency department setting. Objectives We aimed to determine whether this score could predict the need for critical care support using the presence of organ failure as the identification criteria. Severity and culture positivity in pregnancy-associated sepsis was also assessed. Materials and methods All pregnant, postabortal and postpartum women with suspected sepsis were enrolled (as per systemic inflammatory response syndrome criteria) were enrolled. Severe pregnancy-associated sepsis was defined as dysfunction of one or more organs due to sepsis. The severity of pregnancy-associated sepsis was graded according to the number of organ failures. A SOS cut off of 6 was taken for statistical analysis. Results Out of 100 women with pregnancy-associated sepsis, ‘severe sepsis’ was present in 58%. When the SOS test performance was compared with the severity of pregnancy-associated sepsis, it had sensitivity of 68.9% and specificity of 80.9%, positive predictive value of 83% and negative predictive value 65% to predict severe sepsis. The area under curve for the SOS detecting severe pregnancy-associated sepsis was 0.810. SOS predicted organ failure in pregnancy-associated sepsis and this was statistically significant for all organs involved. Culture positivity did not correlate with the SOS in our study. Conclusions Sepsis in Obstetrics Score correlated well with organ failure in pregnancy-associated sepsis. It had a high positive predictive value (83%) for severe sepsis.

The prognostic performance of the predisposition, infection, response and organ failure (PIRO) classification in high-risk and low-risk emergency department sepsis populations: comparison with clinical judgement and sepsis category

2013 ◽  
Vol 31 (4) ◽  
pp. 292-300 ◽  
Author(s):  
Bas de Groot ◽  
Joost Lameijer ◽  
Ernie R J T de Deckere ◽  
Alice Vis
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Organ Failure ◽  
Illness Severity ◽  
Low Risk ◽  
Clinical Judgement ◽  
Prognostic Performance ◽  
Severity Scores ◽  
Infection Response ◽  
High Risk Cohort

ObjectiveTo compare the prognostic performance of the predisposition, infection, response and organ failure (PIRO) score with the traditional sepsis category and clinical judgement in high-risk and low-risk Dutch emergency department (ED) sepsis populations.MethodsProspective study in ED patients with severe sepsis and septic shock (high-risk cohort), or suspected infection (low-risk cohort). Outcome: 28-day mortality. Prognostic performance of PIRO, sepsis category and clinical judgement were assessed with Cox regression analysis with correction for quality of ED treatment and disposition. Illness severity measures were divided into four groups with the lowest illness severity as reference category; discrimination was quantified by receiver operator characteristics with area under the curve (AUC) analysis.ResultsDeath occurred in 72/323 (22%, high-risk) and 23/385 (6%, low-risk) patients. For the low-risk cohort, corrected HRs (95% CI) for categories 2–4 were 2.0 (0.4 to 11.9), 4.3 (0.8 to 24.7) and 17.8 (2.8 to 113.0: PIRO); 0.5 (0.05 to 5.4), 2.1 (0.2 to 21.8) and 7.5 (0.6 to 92.9: sepsis category). Patients discharged home (category 1) all survived. HRs were 4.5 (0.5 to 39.1) and 13.6 (4.3 to 43.5) for clinical judgement categories 3–4. Prognostic performance was consistently better in the low-risk than in the high-risk cohort. For PIRO AUCs were 0.68 (0.61 to 0.74; high-risk) and 0.83 (0.75 to 0.91; low-risk); for sepsis category AUCs were 0.50 (0.42 to 0.57; high-risk) and 0.73 (0.61 to 0.86; low-risk); for clinical judgement AUCs were 0.69 (0.60 to 0.78; high-risk) and 0.84 (0.73 to 0.96; low-risk).ConclusionsThe accuracy and discriminative performance of the PIRO score and clinical judgement are similar, but better than the sepsis category. Prognostic performance of illness severity scores is less in high-risk cohorts, while in high-risk populations a risk stratification tool would be most useful.

Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Robert J. Sepanski ◽  
Arno L. Zaritsky ◽  
Sandip A. Godambe
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Positive Predictive Value ◽  
Firing Rate ◽  
Predictive Value ◽  
Assessment Tool ◽  
Predictive Tool ◽  
High Severity ◽  
Electronic Assessment ◽  
Ed Visits

AbstractObjectivesElectronic alert systems to identify potential sepsis in children presenting to the emergency department (ED) often either alert too frequently or fail to detect earlier stages of decompensation where timely treatment might prevent serious outcomes.MethodsWe created a predictive tool that continuously monitors our hospital’s electronic health record during ED visits. The tool incorporates new standards for normal/abnormal vital signs based on data from ∼1.2 million children at 169 hospitals. Eighty-two gold standard (GS) sepsis cases arising within 48 h were identified through retrospective chart review of cases sampled from 35,586 ED visits during 2012 and 2014–2015. An additional 1,027 cases with high severity of illness (SOI) based on 3 M’s All Patient Refined – Diagnosis-Related Groups (APR-DRG) were identified from these and 26,026 additional visits during 2017. An iterative process assigned weights to main factors and interactions significantly associated with GS cases, creating an overall “score” that maximized the sensitivity for GS cases and positive predictive value for high SOI outcomes.ResultsTool implementation began August 2017; subsequent improvements resulted in 77% sensitivity for identifying GS sepsis within 48 h, 22.5% positive predictive value for major/extreme SOI outcomes, and 2% overall firing rate of ED patients. The incidence of high-severity outcomes increased rapidly with tool score. Admitted alert positive patients were hospitalized nearly twice as long as alert negative patients.ConclusionsOur ED-based electronic tool combines high sensitivity in predicting GS sepsis, high predictive value for physiologic decompensation, and a low firing rate. The tool can help optimize critical treatments for these high-risk children.

Development of a Screen for Ongoing Intimate Partner Violence

2003 ◽  
Vol 18 (2) ◽  
pp. 131-141 ◽  
Author(s):  
Steve J. Weiss ◽  
Amy A. Ernst ◽  
Elaine Cham ◽  
Todd G. Nick
Keyword(s):  
Emergency Department ◽  
Intimate Partner Violence ◽  
Positive Predictive Value ◽  
Partner Violence ◽  
Predictive Value ◽  
Spouse Abuse ◽  
Assessment Tool ◽  
Positive Likelihood Ratio ◽  
Intimate Partner ◽  
Survey Tool

A five-question Ongoing Abuse Screen (OAS) was developed to evaluate ongoing intimate partner violence. Our hypothesis was that the OAS was more accurate and more likely to reflect ongoing intimate partner violence than the AAS when compared to the Index of Spouse Abuse (ISA). The survey included the ISA, the OAS, and the AAS. During the busiest emergency department hours, a sampling of 856 patients completed all aspects of the survey tool. Comparisons were made between the two scales and the ISA. The accuracy, positive predictive value, and positive likelihood ratio were 84%, 58%, and 6.0 for the OAS and 59%, 33%, and 2.0 for the AAS. The OAS was more accurate, had a better positive predictive value, and was three times more likely to detect victims of ongoing intimate partner violence than the AAS. Because the OAS was still not accurate enough, we developed a new screen, based on the ISA, titled the Ongoing Violence Assessment Tool (OVAT).

scholarly journals Positive Predictive Value of ICD-10-CM Definitions for Adolescent Intentional Self-Harm: An Emergency Department Medical Record Review

2020 ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia F Costich
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Positive Predictive Value ◽  
Medical Record ◽  
Predictive Value ◽  
Suicide Attempts ◽  
Pediatric Population ◽  
Icd 10 ◽  
Self Harm ◽  
Coding Guidelines

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study proposed a definition for identifying intentional self-harm injuries (ISHIs) in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and sought to estimate: (1) the definition’s positive predictive value (PPV) in a pediatric population treated in one Kentucky ED, and (2) the proportion of Intentional self-harm injuries (ISHIs) with intent to die (i.e., suicide attempt) that cannot be captured by ICD-10-CM codes and can only be identified by a medical record abstraction. Methods The study definition captured initial encounters for ISHIs based on first valid external cause-of-injury self-harm codes in the ICD-10-CM range X71-X83, T14.91, T36-T65, or T71. Medical records for a random sample of 207 ED discharge records were reviewed following a specified protocol. The PPV for the study definition was reported with its 95% confidence interval (95%CI). Results The estimated PPV for the study definition’s ability to capture true ISHIs was 88.9%, 95%CI (83.8%, 92.8%). The estimated percentage of ISHIs with intent to die was 45.9%, 95%CI (47.1%, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines allow assignment of this code only when the mechanism of the suicide attempt is unknown. Conclusions This study demonstrated a critical shortcoming in U.S. morbidity surveillance. The ICD-10-CM coding system and coding guidelines do not allow accurate identification of ISHIs with intent to die; modifications are needed to address this issue.

scholarly journals DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Chest Trauma ◽  
Accurate Diagnosis ◽  
Trauma Patients ◽  
Chest Ultrasound

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

Cholangitis: Analysis of Admission Prognostic Indicators and Outcomes

2007 ◽  
Vol 73 (10) ◽  
pp. 949-954 ◽  
Author(s):  
David K. Rosing ◽  
Christian De Virgilio ◽  
Alex T. Nguyen ◽  
Monica El Masry ◽  
Amy H. Kaji ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Organ Failure ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Acute Cholangitis ◽  
Adverse Outcomes ◽  
Prognostic Indicators ◽  
Therapeutic Modalities ◽  
Charcot’S Triad ◽  
Sensitivity Specificity

Acute cholangitis is a life-threatening complication of biliary obstruction that is exacerbated by delays in diagnosis and treatment. Since the introduction of endoscopic retrograde cholangiography and endoscopic therapeutic modalities, few investigations have addressed admission prognostic indicators of adverse outcomes. A retrospective review of all patients with a diagnosis of acute cholangitis from 1995 to 2005 was performed. Primary endpoints were organ failure and death. One-hundred and seventeen patients met criteria for acute cholangitis. Only 49 (42%) had Charcot's triad and 3 (3%) had Reynolds’ pentad. One-hundred and four (89%) patients underwent biliary decompression, of which 79 (76%) were treated by endoscopic methods. There were 29 (25%) cases of organ failure and 9 (8%) deaths. The admission white blood cell (WBC) count ( P = 0.0003) and total bilirubin (TBili) ( P = 0.04) were statistically significant predictors of organ failure or death. With an admission of WBC ≥ 20,000 cells/mm3, the sensitivity, specificity, positive predictive value, and negative predictive value for organ failure and death were 50 per cent, 92 per cent, 63 per cent, and 88 per cent, respectively. A TBili of ≥10 mg/dL had sensitivity, specificity, positive predictive value, and negative predictive value of 56 per cent, 85 per cent, 21 per cent, and 96 per cent, respectively for predicting death. Admission WBC ≥ 20,000 cells/mm3 and TBili ≥ 10 mg/dL are selective predictors of adverse outcomes in acute cholangitis.

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