scholarly journals Retrospective evaluation of the BIG score to predict mortality in pediatric blunt trauma

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 592-599 ◽  
Author(s):  
Charlotte Grandjean-Blanchet ◽  
Guillaume Emeriaud ◽  
Marianne Beaudin ◽  
Jocelyn Gravel
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Primary Analysis

AbstractObjectivesThis study’s objective was to measure the criterion validity of the BIG score (a new pediatric trauma score composed of the initial base deficit [BD], international normalized ratio [INR], and Glasgow Coma Scale [GCS]) to predict in-hospital mortality among children admitted to the emergency department with blunt trauma requiring an admission to the intensive care unit, knowing that a score <16 identifies children with a high probability of survival.MethodsThis was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016. Participants were all children admitted to the emergency department for a blunt trauma requiring intensive care unit admission or who died in the emergency department. The primary analysis was the association between a BIG score ≥16 and in-hospital mortality.ResultsTwenty-eight children died among the 336 who met the inclusion criteria. Two hundred eighty-four children had information on the three components of the BIG score, and they were included in the primary analysis. A BIG score ≥16 demonstrated a sensitivity of 0.93 (95% confidence interval [CI]: 0.76-0.98) and specificity of 0.83 (95% CI: 0.78-0.87) to identify mortality. Using receiver operating characteristic curves, the area under the curve was higher for the BIG score (0.97; 95% IC: 0.95-0.99) in comparison to the Injury Severity Score (0.78; 95% IC: 0.71-0.85).ConclusionIn this retrospective cohort, the BIG score was an excellent predictor of survival for children admitted to the emergency department following a blunt trauma.

scholarly journals LO63: External validation of the BIG score to predict mortality in pediatric blunt trauma

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S49-S50
Author(s):  
C. Grandjean-Blanchet ◽  
J. Gravel ◽  
G. Emeriaud ◽  
M. Beaudin
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Data Abstraction ◽  
Primary Analysis ◽  
Worst Case

Introduction: The BIG score is a new pediatric trauma score composed of the admission base deficit (BD), the international normalized ratio (INR) and the Glasgow Coma Scale (GCS). A score&lt;16 identifies children with a high probability of survival following blunt trauma.The objective of this study was to measure the criterion validity of the BIG score to predict in-hospital mortality among children visiting an emergency department with blunt trauma requiring an admission to the intensive care unit. Methods: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016. Participants were all children (&lt;18 years) visiting the emergency department for a blunt trauma requiring intensive care unit admission or who died at the emergency department. All charts were reviewed by a member of the research team using a standardized report form. To insure quality of data abstraction, 10% of the charts were reviewed in duplicate by a second rater blinded to the first evaluation. The primary outcome was in-hospital mortality. Baseline demographics, initial components of the BIG score, Injury Severity Score (ISS) and disposition were extracted. The primary analysis was the association between a BIG score ≥16 and in-hospital mortality. It was calculated that the inclusion of at least 25 deaths would provide confidence intervals of +/- 0.20 for proportions in the worst-case scenario. Results: Twenty-eight children died among the 336 who met the inclusion criteria. The inter-rater agreement for data abstraction was excellent with kappa scores or intraclass correlation coefficients higher than 0.8 for all variables. Two hundred eighty-four children had information on the three components of the BIG score and they were included in the primary analysis. A BIG score ≥16 demonstrated a sensitivity of 0.93 (95%CI: 0.76-0.98) and specificity of 0.83 (95%CI 0.78-0.87) to identify mortality. Using ROC curves, the area under the curve was higher for the BIG score (0.97; 95%IC: 0.95-0.99) in comparison to the ISS (0.78; 95%IC: 0.71-0.85). Conclusion: The BIG score is an excellent predictor of survival for children visiting the emergency department following a blunt trauma.

Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study

2019 ◽  
Vol 35 (11) ◽  
pp. 1278-1284
Author(s):  
Barry Kelly ◽  
Johann Patlak ◽  
Shahzad Shaefi ◽  
Dustin Boone ◽  
Ariel Mueller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Assessment Score ◽  
Failure Assessment ◽  
Discriminative Value

Objective: To compare the discriminative value of the quick-sequential organ failure assessment score (qSOFA) to SOFA in a critically ill population, in which a microbial pathogen was isolated within 48 hours of admission to intensive care. Design: Retrospective cohort study. Setting: Academic tertiary referral center from July 2008 to June 2017. Patients: Hospitalized patients admitted to intensive care unit. Interventions: None. Measurements and Main Results: The primary outcome was in-hospital mortality for all patients with confirmed positive microbiological cultures within 48 hours of admission to intensive care unit (ICU). Subgroup analysis was performed on patients with pathogenic bacteremia or positive cultures in cerebrospinal fluid. Of the 11 415 patients analyzed with positive microbiology specimens within 48 hours of admission, 2933 (25.7%) had a qSOFA ≥2. Of these, 16.6% reached the primary outcome of in-hospital mortality. Unsurprisingly, the discriminative value of qSOFA on admission was significantly worse than that of SOFA (0.73 vs 0.76; P = .0004), despite observing a significant association between qSOFA category and in-hospital mortality ( P < .0001). In secondary analyses, similar observations were found using qSOFA within 6 and 24 hours of ICU admission. When analysis was focused on patients with pathogenic bacteremia or positive cerebrospinal fluid (CSF) cultures (n = 1646), there was no significant difference between the discriminative value of qSOFA and SOFA (0.75 vs 0.78; P = .17). Conclusions: Quick-sequential organ failure assessment score at admission was not superior to SOFA in predicting in-hospital mortality in patients with positive clinical cultures within 48 hours of admission to ICU. Quick-sequential organ failure assessment score at admission to the ICU was associated with mortality and showed reasonable calibration and discrimination. When the analysis was focused on patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminatory those who will die from sepsis.

“Shift Work” Improves Survival and Reduces Intensive Care Unit Use in Seriously Injured Patients

2007 ◽  
Vol 73 (2) ◽  
pp. 185-191
Author(s):  
Luke Y. Shen ◽  
Stephen D. Helmer ◽  
Jennifer Huang ◽  
Gerayu Niyakorn ◽  
R. Stephen Smith
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Shift Work ◽  
Continuity Of Care ◽  
Injury Severity ◽  
Severely Injured ◽  
Trauma Service ◽  
Injured Patients

We assessed whether a trauma service model with an emphasis on continuity of care by using “shift work” will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n = 4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. During Period I (May 1, 2002 to April 30, 2003), a rotating off-service team provided initial management between 5:00 PM and 7:00 AM. The “day team” provided all other care and was responsible for continuity of care. In Period II (May 1, 2003 to April 30, 2004), a dedicated trauma service consisting of two resident teams evaluated all injured patients. Variables included hospital and intensive care unit length of stay (LOS), mechanical ventilation requirements, hospital mortality, and hospital care costs. Demographics and injury mechanism for both periods were similar, but Injury Severity Score (ISS) in Period II was greater (ISS, 8.2% vs 7.2%, P < 0.0001; ISS > 15, 18.5% vs 15.4%). In the more severely injured (ISS > 15), patients in Period II had shorter hospital LOS (8.6 vs 9.7 days, P = 0.98), a shorter ICU LOS (5.5 vs 7.7 days, P = 0.039), shorter mechanical ventilator requirements (5.5 vs 7.7 days, P = 0.32), improved hospital mortality rate (19.9% vs 26.8%, P = 0.029), and decreased hospital costs ($19,146 vs $21,274, P = 0.36). On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.

scholarly journals Renal Replacement Therapy in Intensive Care Unit at a Tertiary Care Center in Nepal

2019 ◽  
Vol 21 (1) ◽  
pp. 74-79
Author(s):  
Pramod Kumar Chhetri ◽  
DN Manandhar ◽  
P Poudel ◽  
S Baidya ◽  
SB Raju ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Intermittent Hemodialysis ◽  
Low Efficiency

 Acute kidney injury is a major complication in intensive care unit patients. It is associated with increased in-hospital mortality and length of stay. The provision of renal replacement therapy in intensive care is not widely available in resource poor countries like Nepal. The study aims to look into clinical profile and outcome of patients who received renal replacement therapy in intensive care unit. It was an observational study done from 1st October 2016 till 30th September 2017. Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacement therapy were recorded. Statistical package for the social sciences version 17 was used for statistical analysis. There were total of 649 admissions in intensive care, among which 148 had kidney related complications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, urea and creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/ dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacement therapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysis as the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septic shock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significant for in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation which was statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis can be done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Song-I Lee ◽  
Younsuck Koh ◽  
Jin Won Huh ◽  
Sang-Bum Hong ◽  
Chae-Man Lim
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Medical Reason ◽  
Chronic Heart Disease

<b><i>Introduction:</i></b> An increase in age has been observed among patients admitted to the intensive care unit (ICU). Age is a well-known risk factor for ICU readmission and mortality. However, clinical characteristics and risk factors of ICU readmission of elderly patients (≥65 years) have not been studied. <b><i>Methods:</i></b> This retrospective single-center cohort study was conducted in a total of 122-bed ICU of a tertiary care hospital in Seoul, Korea. A total of 85,413 patients were enrolled in this hospital between January 1, 2007, and December 31, 2017. The odds ratio of readmission and in-hospital mortality was calculated by logistic regression analysis. <b><i>Results:</i></b> Totally, 29,503 patients were included in the study group, of which 2,711 (9.2%) had ICU readmissions. Of the 2,711 readmitted patients, 472 patients were readmitted more than once (readmitted 2 or more times to the ICU, 17.4%). In the readmitted patient group, there were more males, higher sequential organ failure assessment (SOFA) scores, and hospitalized for medical reasons. Length of stay (LOS) in ICU and in-hospital were longer, and 28-day and in-hospital mortality was higher in readmitted patients than in nonreadmitted patients. Risk factors of ICU readmission included the ICU admission due to medical reason, SOFA score, presence of chronic heart disease, diabetes mellitus, chronic kidney disease, transplantation, use of mechanical ventilation, and initial ICU LOS. ICU readmission and age (over 85 years) were independent predictors of in-hospital mortality on multivariable analysis. The delayed ICU readmission group (&#x3e;72 h) had higher in-hospital mortality than the early readmission group (≤72 h) (20.6 vs. 16.2%, <i>p</i> = 0.005). <b><i>Conclusions:</i></b> ICU readmissions occurred in 9.2% of elderly patients and were associated with poor prognosis and higher mortality.

scholarly journals Validation of Modified Paediatric Triage Score in a Tertiary Care Hospital

2020 ◽  
Author(s):  
Bandya Sahoo ◽  
Reshmi Mishra ◽  
Mukesh Kumar Jain ◽  
Sibabratta Patnaik
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Scoring System ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Clinical Variables ◽  
Icu Admission ◽  
Physical Variables

Introduction: The global burden of paediatric mortality is high and majority of the deaths are preventable by providing timely access to specialised emergency care. An appropriate triage in a busy emergency department can identify the sickest patient for early intervention. Aim: To develop a simple score based on physical variables alone and assess its validation so as to predict Intensive Care Unit (ICU) admission. Materials and Methods: This prospective hospital based study included 936 children, aged 1 month to 18 years. Baseline demographic data along with clinical variables were noted in a pre-designed proforma at the time of admission. A scoring system was developed based on severity of various clinical variables i.e., heart rate, respiratory rate, respiratory effort, Oxygen Saturation (SpO2), Capillary Refill Time (CFT), temperature, level of consciousness and behaviour. The outcome i.e., admission to ward or Pediatric Intensive Care Unit (PICU) of the patient was correlated with the study variables and total score. An association of modified PETS with the PICU admission was done using Chi-square test. A p-value of <0.01 was considered as statistically significant. Results: The modified Paediatric Triage Score (PETS) which is developed based on eight physical variables, is reliable in discriminating the children with ward and ICU admission. A score of ≥6 leads to 14.8 times higher risk of getting admitted to ICU as compared to a child with score of <6. A cut-off of ≥6 for modified PETS score has a sensitivity of 79.6% and specificity of 79.2% in predicting ICU admission. Conclusion: This simple clinically developed scoring system based on physical variables alone with an optimal cut-off of ≥6 can predict severity of illness and need for PICU admission in Emergency Department with acceptable validity and can serve as a potentially excellent screening tool.

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