188 Predicting Posttraumatic Hydrocephalus: Derivation and Validation of a Risk Scoring System Based on Clinical Characteristics

Abstract INTRODUCTION Posttraumatic hydrocephalus (PTH) is a common complication of traumatic brain injury (TBI) and often has a high risk of clinical deterioration and worse outcomes. The incidence and risk factors for the development of PTH after decompressive craniectomy (DC) has been assessed in previous studies, but rare studies identify patients with higher risk for PTH among all TBI patients. This study aimed to develop and validate a risk scoring system to predict PTH after TBI. METHODS Demographics, injury severity, duration of coma, radiologic findings, and DC were evaluated to determine the independent predictors of PTH during hospitalization until 6 months following TBI through logistic regression analysis. A risk stratification system was created by assigning a number of points for each predictor and validated both internally and externally. The model accuracy was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS >Of 526 patients in the derivation cohort, 57 (10.84%) developed PTH during 6 months follow up. Age >50 (Odd ratio [OR] = 1.91, 95% confidence interval [CI] 1.09 3.75, 4 points), duration of coma = 1 w (OR = 5.68, 95% CI 2.57 13.47, 9 points), Fisher grade III (OR = 2.19, 95% CI 1.24 4.36, 5 points) or IV (OR = 3.87, 95% CI 1.93 8.43, 7 points), bilateral DC (OR = 6.13, 95% CI 2.82 18.14, 9 points), and extra herniation after DC (OR = 2.36, 95% CI 1.46 4.92, 5 points) were independently associated with PTH. Rates of PTH for the low- (0-12 points), intermediate- (13-22 points) and high-risk (23-34 points) groups were 1.16%, 35.19% and 78.57% (P < 0.0001). The corresponding rates in the validation cohort, where 17/175 (9.71%) developed PTH, were 1.35%, 37.50% and 81.82% (P < 0.0001). The risk score model exhibited good-excellent discrimination in both cohorts, with AUC of 0.839 versus 0.894 (derivation versus validation) and good calibration (Hosmer-Lemshow P = 0.56 versus 0.68). CONCLUSION A risk scoring system based on clinical characteristics accurately predicted PTH. This model will be useful to identify patients at high risk for PTH who may be candidates for preventive interventions, and to improve their outcomes.

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Development of a Sex-Specific Risk Scoring System for Predicting Cognitive Normal to Mild Cognitive Impairment (SRSS-CNMCI)

10.21203/rs.3.rs-517520/v1 ◽

2021 ◽

Author(s):

Wen Luo ◽

Hao Wen ◽

Shuqi Ge ◽

Chunzhi Tang ◽

Xiufeng Liu ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

High Risk ◽

Scoring System ◽

External Validation ◽

Scoring Systems ◽

Cutoff Point ◽

Risk Scoring ◽

Risk Scoring System

Abstract Objective: We aim to develop a sex-specific risk scoring system for predicting cognitive normal (CN) to mild cognitive impairment (MCI), abbreviated SRSS-CNMCI, to provide a reliable tool for the prevention of MCI.Methods: Participants aged 61-90 years old with a baseline diagnosis of CN and an endpoint diagnosis of MCI were screened from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database with at least one follow-up. Multivariable Cox proportional hazards models were used to identify risk factors associated with conversion from CN to MCI and to build risk scoring systems for male and female groups. Receiver operating characteristic (ROC) curve analysis was applied to determine the risk probability cutoff point corresponding to the optimal prediction effect. We ran an external validation of the discrimination and calibration based on the Harvard Aging Brain Study (HABS) database.Results: A total of 471 participants, including 240 women (51%) and 231 men (49%), aged 61 to 90 years, were included in the study cohort for subsequent primary analysis. The final multivariable models and the risk scoring systems for females and males included age, APOE ε4, Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). The scoring systems for females and males revealed C statistics of 0.902 (95% CI 0.840-0.963) and 0.911 (95% CI 0.863-0.959), respectively, as measures of discrimination. The cutoff point of high and low risk was 33% in females, and more than 33% was considered high risk, while more than 9% was considered high risk for males. The external validation effect of the scoring systems was good: C statistic 0.950 for the females and C statistic 0.965 for the males. Conclusions: Our parsimonious model accurately predicts conversion from CN to MCI with four risk factors and can be used as a predictive tool for the prevention of MCI.

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The Efficacy of Risk Score System Establishment and Methylprednisolone Stratification Treatment for Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Retrospective (development) and a Prospective (validation) Study

Blood ◽

10.1182/blood-2019-123952 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4501-4501

Author(s):

Xiaoyu Zhu ◽

Jiang Zhu ◽

Baolin Tang ◽

Kaidi Song ◽

Linlin Jin ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Risk Score ◽

Cumulative Incidence ◽

Scoring System ◽

Cord Blood Transplantation ◽

High Risk Factors ◽

Risk Scoring ◽

Risk Scoring System ◽

Different Doses

Introduction Pre-engraftment syndrome (PES) is a common immune reaction prior to neutrophil engraftment after unrelated cord blood transplantation (UCBT), with a unique clinical manifestation of non-infectious fever and skin rash. The reported incidence of PES ranges from 20% to 78%. Although many researchers believe that PES is associated with a high incidence of acute graft-versus-host disease (GVHD) but not with transplant-related mortality (TRM) , relapse, or overall survival (OS), they did not stratify the risk factors of PES, and how to carry out different doses of methylprednisolone (MP) stratified intervention therapy still remains unknown. Method s First, 136 hematological malignancy patients treated with UCBT from April 2000 to February 2012 in our transplantation center were retrospectively analysis. Among them, 92 patients occurred PES. High-risk factors for 180-day TRM in PES patients were established by univariate and multivariate analysis. Then, from January 2013 to August 2016, 221 PES patients were scored according to the risk scoring system and stratified treated with different doses of MP. Finally, in order to validate the efficacy of MP stratification treatment, we conducted a prospective, open label and non-randomized clinical trial including 240 PES patients who underwent UCBT from September 2016 to December 2018. This trial is registered at www.chictr.org.cn as ChiCTR-ONC-16009013. Results The cumulative incidence of neutrophil and platelet engraftment was significantly higher in PES group than non-PES group (97.8% vs 70.5%, P<0.001; 75.0% vs 54.5%, P=0.05). In 92 PES patients, multivariate analysis showed that failed MP treatment, multiple clinical symptoms and early onset of PES were independent high risk factors affecting180-day TRM. One high risk factor was scored as 1. The 92 PES patients were divided into PES-0, PES-1,PES-2 and PES-3, and the higher the score, the higher the TRM (17.7% vs 21.9% vs 62.5% vs 100%,respectively; P<0.001), and the lower the OS (68.3% vs 56.2% vs 25.0% vs 0%, respectively; P<0.001). Then, from January 2013 to August 2016, 221 PES patients were scored as PES-0, PES-1 and PES-2 according to the following two high risk factors (multiple clinical symptoms and early onset of PES) and stratified treated with different doses of MP (0.5mg/kg/d for PES-0, 1mg/kg/d for PES-1 and 2mg/kg/d for PES-2). Compared to the previous PES patients with the same risk score, the 180-day TRM of PES-1 and PES-2 patients was significantly reduced and the OS, disease free survival (DFS), and GVHD-free and Relapse-free survival (GRFS) were significantly increased after stratified treatment. The results in the prospective trial were similar to the retrospective study. In addition, although stratified therapy could significantly improve the prognosis of PES-2 patients cohort, the cumulative incidence of acute GVHD and GRFS are still the worst compared with other risk score patients. Therefore, how to improve the outcomes of PES-2 patients remains to be further studied. Conclusion s PES after UCBT is benefit for engraftment, but should be graded according the risk scoring system. Different doses of MP stratified intervention therapy can significantly improve the prognosis of severe PES patients. The risk scoring system of PES after UCBT and MP stratification treatment are worthy of clinical application. But the cumulative incidence of acute GVHD and GRFS in severe PES patients still need to be ameliorated in the further study. Disclosures No relevant conflicts of interest to declare.

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Predicting posttraumatic hydrocephalus: derivation and validation of a risk scoring system based on clinical characteristics

Metabolic Brain Disease ◽

10.1007/s11011-017-0008-2 ◽

2017 ◽

Vol 32 (5) ◽

pp. 1427-1435 ◽

Cited By ~ 13

Author(s):

Hao Chen ◽

Fang Yuan ◽

Shi-Wen Chen ◽

Yan Guo ◽

Gan Wang ◽

...

Keyword(s):

Scoring System ◽

Clinical Characteristics ◽

Risk Scoring ◽

Risk Scoring System

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Derivation and Validation of the Cancer READMIT Score: A Readmission Risk Scoring System for Patients With Solid Tumor Malignancies

JCO Oncology Practice ◽

10.1200/op.20.01077 ◽

2021 ◽

pp. OP.20.01077

Author(s):

Joanna-Grace M. Manzano ◽

Heather Lin ◽

Hui Zhao ◽

Josiah Halm ◽

Maria E. Suarez-Almazor

Keyword(s):

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Solid Tumor ◽

Scoring System ◽

Operating Characteristic ◽

Characteristic Curve ◽

Risk Scoring ◽

Operating Characteristic Curve ◽

Risk Scoring System ◽

Readmission Risk

PURPOSE Readmissions for the medical treatment of cancer have traditionally been excluded from readmission measures under the Hospital Readmissions Reduction Program. Patients with cancer often have higher readmission rates and may need heightened support to ensure effective care transitions after hospitalization. Estimating readmission risk before discharge may assist in discharge planning efforts and help promote care coordination at time of discharge. PATIENTS AND METHODS We developed and validated a readmission risk scoring system among a cohort of adult cancer patients with solid tumor admitted at a comprehensive cancer center. Multivariate logistic regression analysis was used to develop the model. The model's discriminative capacity was evaluated through a receiver operating characteristic curve analysis. We further compared the performance of the developed score with existing risk scores for 30-day readmission. RESULTS The 30-day unplanned readmission rate in the total cohort was 16.0% (n = 1,078 of 6,720). After multivariate analysis, Cancer site, Recent emergency room visit within 30 days, non-English primary language, Anemia defined as hemoglobin < 10 g/dL, > 4 Days length of stay during the index admission, unmarried Marital status, Increased white blood cell count > 11 × 109/L, and distant Tumor spread were significantly associated with risk of unplanned 30-day readmission. The derived score, which we call the Cancer READMIT score, had modest discriminatory performance in predicting readmissions (area under the curve for the model receiver operating characteristic curve = 0.647). CONCLUSION The Cancer READMIT score was able to predict 30-day unplanned readmissions to our institution with fairly modest performance. External validation of our derived risk scoring system is recommended.

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A Risk Scoring System to Identify Emergency Department Patients With Heart Failure at High Risk for Serious Adverse Events

Academic Emergency Medicine ◽

10.1111/acem.12056 ◽

2013 ◽

Vol 20 (1) ◽

pp. 17-26 ◽

Cited By ~ 62

Author(s):

Ian G. Stiell ◽

Catherine M. Clement ◽

Robert J. Brison ◽

Brian H. Rowe ◽

Bjug Borgundvaag ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

High Risk ◽

Adverse Events ◽

Scoring System ◽

Serious Adverse Events ◽

Patients With Heart Failure ◽

Risk Scoring ◽

Emergency Department Patients ◽

Risk Scoring System

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A risk scoring system to identify travellers who qualify for pre-exposure rabies vaccination

Journal of Travel Medicine ◽

10.1093/jtm/taaa168 ◽

2020 ◽

Vol 27 (7) ◽

Cited By ~ 1

Author(s):

Mieke Croughs ◽

Patrick Soentjens

Keyword(s):

High Risk ◽

Scoring System ◽

Evidence Based ◽

Risk Scoring ◽

Risk Predictors ◽

Risk Scoring System ◽

Rabies Vaccination

We want to introduce a free online scoring system to identify high risk travellers who qualify for pre-travel rabies vaccination. The system uses evidence based risk predictors and the probable availability of HRIG at the destination.

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