scholarly journals LO31: Identification of high risk factors associated with 30 day serious adverse events among syncope patients transported to the emergency department by emergency medical services

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S38
Author(s):  
L. Yau ◽  
M.A. Mukarram ◽  
S. Kim ◽  
K. Arcot ◽  
K. Thavorn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Heart Disease ◽  
High Risk ◽  
Clinical Decision ◽  
Decision Tool ◽  
Serious Adverse Events ◽  
Factors Associated ◽  
High Risk Factors ◽  
Pathways Of Care

Introduction: The majority of syncope patients transported to the emergency department (ED) by emergency medical services (EMS) are low-risk with very few suffering serious adverse events (SAE) within 30-days and over 50% are diagnosed with vasovagal syncope. These patients can potentially be diverted by EMS to alternate pathways of care (primary care or syncope clinic) if appropriately identified. We sought to identify high-risk factors associated with SAE within 30-days of ED disposition as a step towards developing an EMS clinical decision tool. Methods: We prospectively enrolled adult syncope patients who were transported to 5 academic EDs by EMS. We collected standardized variables at EMS presentation from history, clinical examination and investigations including ECG and ED disposition. We also collected concerning symptoms identified and EMS interventions. Adjudicated SAE included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, hemorrhage and procedural interventions. Multivariable logistic regression was used for analysis. Results: 990 adult syncope patients (mean age 58.9 years, 54.9% females and 16.8% hospitalized) were enrolled with 137 (14.6%) patients suffering SAE within 30-days of ED disposition. Of 42 candidate predictors, we identified 5 predictors that were significantly associated with SAE on multivariable analysis: ECG abnormalities [OR=1.77; 95%CI 1.36-2.48] (non-sinus rhythm, high degree atrioventricular block, left bundle branch block, ST-T wave changes or Q waves), cardiac history [OR=2.87; 95%CI 1.86-4.41] (valvular or coronary heart disease, cardiomyopathy, congestive heart failure, arrhythmias or device insertions), EMS interventions or concerning symptoms [OR=4.88; 95%CI 3.13- 7.62], age >50 years [OR=3.18; 95%CI 1.68-6.02], any abnormal vital signs [OR=1.58; 95%CI 1.03-2.42] (any EMS systolic blood pressure >180 or <100 mmHg, heart rate <50 or >100/minute, respiratory rate >25/minute, oxygen saturation <91%). [C-statistic: 0.81; Hosmer Lemeshow p=0.30]. Conclusion: We identified high-risk factors that are associated with 30-day SAE among syncope patients transported to the ED by EMS. This will aid in the development of a clinical decision tool to identify low-risk patients for diversion to alternate pathways of care.

scholarly journals P121: Derivation of a clinical decision tool for predicting adverse outcomes among emergency department patients with lower gastrointestinal bleeding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S99-S100
Author(s):  
R. Ramaekers ◽  
C. Leafloor ◽  
J. J. Perry ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Clinical Decision ◽  
Lower Gastrointestinal Bleeding ◽  
Bloody Stool ◽  
Decision Tool ◽  
Serious Adverse Events

Introduction: Lower gastrointestinal bleeding (LGIB) can result in serious adverse events, including recurrent bleeding, need for intervention and death. Endoscopy is important in the management of LGIB, however gastroenterologists have limited resources to safe endoscopy. Risk stratification of LGIB patients can aid physicians in disposition decisions. Objective: to develop a clinical decision tool to accurately identify LGIB patients presenting to the emergency department (ED) who are at risk for 30-day serious adverse events. Methods: We conducted a health records review and included 372 adult ED patients who presented with an acute LGIB. The outcome was a 30-day composite outcome consisting of all-cause death, recurrent LGIB, need for intervention to control the bleed and ICU admission. A second researcher confirmed data-collection of 10% of the data and we calculated a -value for inter-rater reliability. We analyzed the data using stepwise backwards selection and SELECTION=SCORE option and calculated the diagnostic accuracy of the final model. Results: Age 75 years, hemoglobin 100 g/L, INR 2.0, a bloody stool in the ED and a past medical history of colorectal polyps were significant predictors in the multivariable regression analysis. The AUC was 0.83 (95% CI 0.77-0.89), sensitivity 0.96 (0.90-1.00), specificity 0.53 (0.48-0.59), and negative likelihood ratio 0.08 (0.02-0.30) for a cut-off score of 1. Conclusion: This model showed good ability to identify LGIB patients at low risk for adverse events as evidenced by the high AUC, sensitivity and negative likelihood ratio. Future, large prospective studies should be done to confirm the data, after which it should be validated and implemented.

scholarly journals Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19 Pneumonia: A Multicenter Study

2020 ◽  
Author(s):  
Yun Yang ◽  
Xiaofei Zhu ◽  
Jian Huang ◽  
Cui Chen ◽  
Yang Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Validation Cohort ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Training Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
High Risk Factors ◽  
Cox Analysis

Abstract Background & Aims: To develop an effective model of predicting fatal Outcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.862, [95% CI 0.763-0.961], sensitivity 92.9%, specificity 64.5%); in validation cohort 2 (AUC 0.811, [95% CI 0.698-0.924], sensitivity 77.3%, specificity 73.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients.

scholarly journals Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19: A Multicenter Study

2021 ◽  
Author(s):  
Yun Yang ◽  
Xiaofei Zhu ◽  
Jian Huang ◽  
Cui Chen ◽  
Yang Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Validation Cohort ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Training Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
High Risk Factors ◽  
Cox Analysis

Abstract Background & Aims: To develop an effective model of predicting fatalOutcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.811, [95% CI 0.763-0.961], sensitivity 77.3%, specificity 73.5); in validation cohort 2 (AUC 0.862, [95% CI 0.698-0.924], sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of interleukin-6 (IL-6) receiving tocilizumab was better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (p = 0.105 for training cohort, p = 0.133 for validation cohort 1, and p = 0.210 for validation cohort 2).Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.

Analysis of Risk Factors Related to Complications of Puncture Biopsy in Lung Cancer Patients Under Image Guidance

2021 ◽  
Vol 11 (1) ◽  
pp. 47-52
Author(s):  
Degang Yin ◽  
Kan Feng ◽  
Biao Yan ◽  
Jiansheng Wang ◽  
Qinming Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Complication Rate ◽  
Lung Cancer Patients ◽  
Factors Associated ◽  
Lesion Diameter ◽  
High Risk Factors ◽  
Needle Penetration

To investigate the risk factors of complications in lung cancer patients after CT image-guided percutaneous lung biopsy (PTNB), in this study, 110 patients admitted to Xixi Hospital from January 30, 2017 to June 30, 2019 were selected for PTNB, and the basic characteristic information, lesion diameter, number of needle penetration, depth of needle penetration, physiological results of biopsy, postoperative concurrent symptoms, and success rate of biopsy were recorded. In addition, multivariate Logistic regression model (MLRM) was adopted to explore the correlation between various correlated characters and concurrent symptoms. The results showed that the biopsy pathological results were 53 cases of adenocarcinoma, 31 patients with squamous cell carcinoma, 8 patients with thymic carcinoma, 7 patients with small cell carcinoma and 11 patients with lymph carcinoma, and the success rate of needle biopsy was 100% by comparison with the final diagnosis. Among them, 35 patients developed pneumothorax symptoms postoperatively with a complication rate of 31.82%, 22 patients developed hemoptysis postoperatively with a complication rate of 20%, and 6 patients developed infection with a complication rate of 5.45%. The results of regression analysis showed that pneumothorax and hemoptysis were positively correlated with the number of de needles (P < 0.05), and negatively correlated with lesion diameter (P < 0.05). In addition, pneumothorax was also significantly positively correlated with age (P < 0.05), and infection was significantly positively correlated with the number of puncture needles (P < 0.05). Therefore, the main complications after PTNB are pneumothorax and hemoptysis, the high risk factors associated with pneumothorax include lesion diameter, number of puncture needles and age, the high risk factors associated with hemoptysis include lesion diameter and number of puncture needles, and the risk factors associated with infection are number of puncture needles.

scholarly journals LO03: Application and usefulness of outpatient cardiac testing among emergency department patients with syncope

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S28
Author(s):  
O. Cook ◽  
M.A. Mukarram ◽  
S. Kim ◽  
K. Arcot ◽  
M. Taljaard ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
High Risk ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Structural Heart Disease ◽  
Serious Adverse Events ◽  
High Risk Patients ◽  
Risk Patients ◽  
Cardiac Testing

Introduction: 2.6% of emergency department (ED) syncope patients will have underlying cardiac serious conditions (e.g. arrhythmia, serious structural heart disease) identified within 30-days of disposition. If those at risk are discharged home, outpatient cardiac testing can detect underlying arrhythmias and structural heart disease, and thereby improve patient safety. We describe the frequency of outpatient referrals for cardiac testing and the proportion of cardiac serious adverse events (SAE) among high risk and non-high (low and medium) risk ED syncope patients, as defined by the Canadian Syncope Risk Score (CSRS). Methods: We conducted a multicenter prospective cohort study to enroll adult syncope patients across five large tertiary care EDs. We collected demographics, medical history, disposition, CSRS value, outpatient referrals and testing results (holter, echocardiography), and cardiac SAE. Adjudicated 30-day SAE included death due to unknown cause, myocardial infarction, arrhythmia, and structural heart disease. We used descriptive analysis. Results: Of 4,064 enrolled patients, a total of 955 patients (23%) received an outpatient referral (mean age 57.7 years, 52.1% female). Of the 299 patients (7%) hospitalized, 154 received outpatient cardiac testing after discharge. Among the 3,765 patients discharged home from the ED, 40% of the non-high risk patients (305/756) and 56% of the high risk patients (25/45) received outpatient cardiac testing. Of all patients who received outpatient cardiac testing, 4 patients (0.8%) had serious cardiac conditions identified and all were arrhythmias. Among those with no cardiac testing, 5 patients (0.9%) suffered cardiac SAE (80% arrhythmias) outside the hospital. Of the 20 (44%) high risk patients who did not receive outpatient cardiac testing, 2 (10%) patients suffered arrhythmias outside the hospital. While among the 451 non-high risk patients, only 0.8% suffered arrhythmia outside the hospital. Conclusion: Outpatient cardiac testing among ED syncope patients is largely underutilized, especially among high risk patients. Better guidelines for outpatient cardiac testing are needed, as current practice is highly variable and mismatched with patient risk.

scholarly journals Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19: A Multicenter Study

2020 ◽  
Author(s):  
Giorgio Bozzini ◽  
Matteo Maltagliati ◽  
Umberto Besana ◽  
Lorenzo Berti ◽  
Alberto Calori ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Validation Cohort ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Training Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
High Risk Factors ◽  
Cox Analysis

Abstract Background & Aims: To develop an effective model of predicting fatalOutcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.811, [95% CI 0.763-0.961], sensitivity 77.3%, specificity 73.5); in validation cohort 2 (AUC 0.862, [95% CI 0.698-0.924], sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of interleukin-6 (IL-6) receiving tocilizumab was better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (p = 0.105 for training cohort, p = 0.133 for validation cohort 1, and p = 0.210 for validation cohort 2).Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.

scholarly journals Tumor Characteristics Predicting Perineural Invasion in Cutaneous Squamous Cell Carcinoma Identified by Stepwise Logistic Regression Analysis

2018 ◽  
Author(s):  
Brandon T Beal ◽  
Maulik M Dhandha ◽  
Melinda B Chu ◽  
Vamsi Varra ◽  
Eric S Armbrecht ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Logistic Regression ◽  
High Risk ◽  
Cell Carcinoma ◽  
Perineural Invasion ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Stepwise Logistic Regression ◽  
Factors Associated ◽  
High Risk Factors

Background: Perineural invasion (PNInv) is a significant risk factor for metastasis and death in cutaneous squamous cell carcinoma (cSCC).  Despite this known association, factors contributing to the presence of PNInv are not well characterized.Aims: To determine risk factors associated with the presence of PNInv using the high-risk cSCC criteria developed by the National Comprehensive Cancer Network (NCCN).Methods: After receiving Institutional Review Board approval for this retrospective review, the presence of NCCN high-risk factors for cSCC were recorded for patients treated at a tertiary referral academic medical center, from January 1, 2010 to March 31, 2012. Stepwise logistic regression was used to identify factors associated with the presence of PNInv.Results: PNInv was present in 34 of 507 cSCCs (6.7%). Moderately or poorly differentiated histology (P < .001, OR 6.6 [95% CI, 3.2-13.7]), acantholytic, adenosquamous, or desmoplastic subtype (P =.01, OR 1.8 [95% CI, 0.8-4.2]), and tumors in areas M (≥10mm) and H ( ≥6mm) (P = .05, OR 5.0 [95% CI, 1.2-21.0]) were significantly associated with the presence of PNInv.Conclusions:  This data suggests clinicians should have a higher suspicion and may be able to identify PNInv in high-risk cSCC based on the presence of specific high-risk factors.

scholarly journals Validation of a Clinical Decision Rule to Identify Risk Factors Associated With Multidrug-Resistant Urinary Pathogens in the Emergency Department

2018 ◽  
Vol 53 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Brett A. Faine ◽  
Nicholas Mohr ◽  
Priyanka Vakkalanka ◽  
Ari S. Gao ◽  
Stephen Y. Liang
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Nursing Home ◽  
Decision Rule ◽  
Validation Cohort ◽  
Clinical Decision ◽  
Multidrug Resistant ◽  
Clinical Decision Rule ◽  
Factors Associated ◽  
Home Residency

Background: Antimicrobial resistance remains a significant obstacle for clinicians when treating patients presenting to the emergency department (ED) with urinary tract infections. Objective: The goal of the proposed study was to validate a previously developed clinical decision rule identifying risk factors for multidrug-resistant (MDR) urinary pathogens. Methods: We conducted a validation study of a previously published clinical decision rule to identify patients with MDR urinary pathogens using a cohort from an urban academic center ED with annual census over 80 000. Using our previously identified clinical risk factors, we determined the sensitivity, specificity, positive likelihood ratio (+LR), and negative LR (−LR) to estimate measures of precision of our clinical decision rule in the validation cohort. Results: Factors associated with MDR urinary pathogen included sex, recent hospitalization, nursing home residency, and catheter placement. Using our previously defined threshold of greater than 1 risk factor, the adjusted model in the validation cohort identified that only nursing home residency was associated with positive MDR pathogen (adjusted odds ratio = 4.13; 95% CI = 1.95-8.77). The clinical decision rule in the validation cohort yielded a sensitivity of 56.4%, specificity of 66.3%, +LR of 1.7, and −LR of 0.7. Conclusion and Relevance: Our clinical decision rule to identify patients at risk for MDR urinary pathogens was unable to be validated in the setting of different antimicrobial resistance patterns. Future studies should evaluate an improved clinical decision rule identifying risk factors associated with MDR pathogens that performs well in varying patient populations.

scholarly journals Community Self-Efficacy of Coronary Heart Disease Based on Characteristic Risk Factors

2018 ◽  
Vol 3 (2) ◽  
pp. 65
Author(s):  
Eka Afrima Sari ◽  
Seizi Prista Sari ◽  
Sri Hartati Pratiwi
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Self Efficacy ◽  
Smoking Behavior ◽  
High Risk Factors ◽  
Risk Factor Data ◽  
Factor Data

Coronary heart disease is one of the main causes of mortality rate in the world.  This disease is affected by several risk factors. People who have high or moderate risk factors for coronary heart disease should have good preventive behavior, but this also requires a good level of self-efficacy as well, so that the expected behavior can be performed. This study aimed to determine the level of community self-efficacy of coronary heart disease based on characteristic risk factors. This research used a descriptive quantitative approach. Participant consisted of 70 people in Desa Limusgede, West Java, Indonesia acquired through a non-probability technique of purposive sampling. Self-efficacy was measured using a self-efficacy questionnaire (validity value in the range of 0.484 to 0.773 and reliability value 0.862) while risk factor data were determined by age, body mass index, blood pressure, smoking behavior, diabetes mellitus, and physical activity which were referenced by Jakarta Cardiovascular Score. Data were analyzed using median and frequency distribution. The results showed that median (minimum-maximum score) of self-efficacy is 26.00 (11-41), most of the respondent (62.86%) had high self-efficacy of coronary heart disease and more than a half respondent (47.14%) had moderate and high-risk factors for cardiovascular disease. Further, almost half the respondent who had high self-efficacy also had moderate and high-risk factors for cardiovascular disease. So, the health professional must concern in activities to decrease the level of cardiovascular risk factors, such as health education, health promotion, and disease prevention.

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