Low daily MEWS scores as predictors of low-risk hospitalized patients

QJM ◽  
2019 ◽  
Vol 113 (1) ◽  
pp. 20-24
Author(s):  
J Mizrahi ◽  
J Kott ◽  
E Taub ◽  
N Goolsarran
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Primary Outcome ◽  
Hospital Setting ◽  
Warning System ◽  
Low Risk ◽  
Individual Risk ◽  
Efficient Resource ◽  
Risk Patients ◽  
Formal Recognition

Summary Background The Modified Early Warning System (MEWS) is a well-validated tool used by hospitals to identify patients at high risk for an adverse event to occur. However, there has been little evaluation into whether a low MEWS score can be predictive of patients with a low likelihood of an adverse event. Aim The present study aims to evaluate the MEWS score as a method of identifying patients at low risk for adverse events. Design Retrospective cohort study of 5676 patient days and analysis of associated MEWS scores, medical comorbidities and adverse events. The primary outcome was the association of average daily MEWS scores in those who had an adverse event compared with those who did not. Results Those with an average MEWS score of >2 were over 9 times more likely to have an adverse event compared with those with an average MEWS score of 1–2, and over 15 times more likely to have an adverse event compared to those with an average MEWS score of <1. Conclusions Our study shows that those with average daily MEWS scores <2 are at a significantly lower likelihood of having an adverse event compared with a score of >2, deeming them ‘low-risk patients’. Formal recognition of such patients can have major implications in a hospital setting, including more efficient resource allocation in hospitals and better patient satisfaction and safety by adjusting patient monitoring according to their individual risk profile.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

scholarly journals Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

2017 ◽  
Vol 05 (02) ◽  
pp. E110-E115 ◽  
Author(s):  
Dharshan Sathananthan ◽  
Edward Young ◽  
Garry Nind ◽  
Biju George ◽  
Angelie Ashby ◽  
...  
Keyword(s):  
Adverse Events ◽  
Selection Criteria ◽  
Low Risk ◽  
Propofol Sedation ◽  
Tertiary Teaching ◽  
Risk Patients ◽  
Tertiary Teaching Hospital ◽  
Patient Selection Criteria ◽  
Balanced Propofol Sedation ◽  
A Prospective Study

Abstract Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used.

scholarly journals Switching to an Infliximab Biosimilar Was Safe and Effective in Dutch Sarcoidosis Patients

Cells ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 441
Author(s):  
Bas J. M. Peters ◽  
Anish Bhatoe ◽  
Adriane D. M. Vorselaars ◽  
Marcel Veltkamp
Keyword(s):  
Adverse Event ◽  
Cohort Study ◽  
Adverse Events ◽  
Inflammatory Response ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Single Center ◽  
Secondary Endpoints ◽  
Trough Levels

The effect of switching from originator infliximab to biosimilar infliximab in patients with sarcoidosis is unknown. The objective of this study is to investigate the effect of switching from Remicade® or Inflectra® to Flixabi® in patients with severe refractory sarcoidosis. This single center retrospective cohort study was performed at St Antonius Hospital Nieuwegein, The Netherlands. All patients diagnosed with severe refractory sarcoidosis receiving Remicade® or Inflectra® switched to Flixabi®. The primary outcome was infliximab discontinuation within 6 months of switching. Secondary endpoints included adverse events and loss of clinical, functional, or inflammatory response. Out of 86 patients who switched to Flixabi®, 79 patients had complete data. None of the 79 patients discontinued infliximab during the first 6 months after switching. Five patients reported an adverse event related to Flixabi® treatment. We found no change from baseline in FVC, FEV1, DLCOc, 6MWT, and infliximab trough levels 26 weeks after switching. An improvement in physical functioning of 7.3 ± 13.4 points (p = 0.002) with RAND/SF36 and in biomarker sIL-2R (−475.58 ± 1452.39; p = 0.005) was observed. Switching from originator infliximab Remicade® or biosimilar infliximab Inflectra® to biosimilar infliximab Flixabi® did not result in treatment discontinuation or loss of clinical/functional/inflammatory remission.

scholarly journals Nurse Administered Propofol Sedation (NAPS) versus On-call Anesthesiologist Administered Propofol Sedation (OAPS) in Elective Colonoscopy

2020 ◽  
Vol 29 (4) ◽  
pp. 579-585
Author(s):  
Kasenee Tiankanon ◽  
Parit Mekaroonkamol ◽  
Rapat Pittayanon ◽  
Pradermchai Kongkam ◽  
Sutep Gonlachanvit ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Propensity Score Matching ◽  
Low Risk ◽  
Mean Deviation ◽  
Intubation Time ◽  
Cecal Intubation ◽  
Propofol Sedation ◽  
Cecal Intubation Time ◽  
Risk Patients

Background and Aims: As on-call anesthesiologist administered propofol sedation (OAPS) is costly and not readily available in all endoscopy units, endoscopy nurse administered propofol sedation (NAPS) can be an effective alternative. This study aimed to compare the dosage of propofol used by NAPS versus OAPS, cardiopulmonary adverse events and recovery time in low risk patients undergoing outpatient elective colonoscopy. Methods: A retrospective propensity score-matched cohort study was conducted. Electronic medical records of elective colonoscopies performed by 3 experienced endoscopists from January 2016 to December 2019 were retrieved. OAPSs were performed by 10 certified anesthesiologists while NAPSs were performed by 8 experienced registered endoscopy nurses. Baseline characteristics, performing endoscopist, cecal intubation time, withdrawal time, propofol dosage per procedure, and adverse events were collected and analyzed using 3:1 (NAPS:OAPS) propensity score matching by age, performing endoscopist and difficulty of colonoscopy as co-variates with standardized mean deviation of <0.1. Results: 278 eligible patients were included. After propensity score matching, there were 189 patients in NAPS and 63 in OAPS group for analysis. Demographic data were not different between the two groups. All procedures were technically successful with no difference in cecal intubation time (6.0±4 min vs 6.8±4 min; p=0.13) or total procedural time (17.2±16 min vs 16.3±6 min; p=0.66). Propofol dosage/kg/hour were significantly lower in the NAPS group, (11.4±4 mg/kg/hour vs. 16.6±8 mg/kg/hour; p<0.001). There were less minor cardiopulmonary adverse events in NAPS when compared to the OAPS group (2.2% vs 4.7%; p=0.014). Conclusions: NAPS in elective colonoscopy in low-risk patients is as effective as OAPS but requires a significant lower dosage of propofol. Minor cardiopulmonary adverse events were recorded in the NAPS group compared to OAPS.

Comparative Analysis of Obstetric Hemorrhage Risk Prediction Tools

2021 ◽  
Author(s):  
Francis M. Hacker ◽  
Jaclyn M. Phillips ◽  
Lara S. Lemon ◽  
Hyagriv N. Simhan
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Prediction ◽  
Scoring Systems ◽  
Low Risk ◽  
Individual Risk ◽  
Medium Risk ◽  
Risk Patients ◽  
Hemorrhage Risk ◽  
Individual Risk Factors

Objective Hemorrhage risk prediction tools were developed in response to rising rates of obstetric hemorrhage (OBH). The California Maternal Quality Care Collaborative (CMQCC) risk prediction tool classifies patients as low, medium, and high risk for OBH based on individual risk factors. At our institution, Magee-Womens Hospital (MWH), a unique OBH risk prediction tool was derived from the CMQCC tool that differs through its use of weighted risk factors and distinctive laboratory value cutoffs. Our objective is to compare this enhanced institution-specific tool to the CMQCC tool. Study Design This study was a retrospective cohort analysis of delivery admissions from a single health care network. Admission OBH risk scores were assigned to each patient using both the MWH and CMQCC scores. Cohen's kappa estimated agreement. Scoring systems and maternal outcomes were compared using chi-square test. Composite morbidity included transfusion, hysterectomy, uterine artery embolization, and intensive care unit admission. Results A total of 21,843 delivery admissions were included. A moderate association was observed between scoring systems (kappa 0.41, p < 0.001). The CMQCC tool categorized 16,184 (74%) patients as low risk, 4,664 (21%) as medium risk, and 995 (5%) as high risk. The MWH tool categorized 13,137 (60%) patients as low risk, 8,113 (37%) as medium risk, and 593 (3%) as high risk. The MWH score recategorized CMQCC low-risk patients to a higher stratum 26% of the time. CMQCC high-risk patients were recategorized to a lower stratum 82% of the time. Both the MWH and CMQCC tools were able to differentiate OBH-related morbidity across risk strata. The MWH tool independently predicted risk of composite morbidity within each stratum of the CMQCC score. Conclusion Both the MWH and CMQCC tools independently distinguish risk of composite morbidity. Adding weighted values to individual risk factors further discriminates risk of morbidity. This suggests it may be reasonable to adapt the CMQCC tool to reflect institutional populations and resources. Key Points

3036Identifying low-risk patients eligible for early discharge after ST-segment elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P M Azevedo ◽  
T Mota ◽  
J Bispo ◽  
J Guedes ◽  
D Carvalho ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Mortality ◽  
Early Discharge ◽  
Low Risk ◽  
Complete Revascularization ◽  
Serious Adverse Events ◽  
St Segment Elevation ◽  
St Segment ◽  
Risk Patients ◽  
One Year

Abstract Introduction Early discharge after ST-segment elevation myocardial infarction (STEMI) should be considered in low-risk patients after successful percutaneous coronary intervention (PCI) to reduce healthcare costs and improve resource utilization. The Zwolle criteria is recommended by current guidelines for the identification of low-risk patients but a new score, the FASTEST score, has recently demonstrated to add prognostic value over Zwolle score in small and unicentric studies. Purpose Assess if FASTEST score could better identify low-risk patients compared to Zwolle in a contemporary nationwide cohort of patients with STEMI who underwent primary PCI and complete revascularization. Methods Multicentric observational study of consecutive patients with ACS recorded in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between October 2010 and January 2019. Patients who underwent primary PCI and received complete revascularization were included, and those with missing data for score calculation were excluded. The FASTEST score awards 1 point for each: femoral access, age>65, LVEF<50, TIMI<3; creatinine >1.5 mg/dl; stenosis of the left main coronary artery; and Killip≥2. The Zwolle score was calculated for comparison. The rate of hospital mortality and a composite of serious adverse events (heart failure, cardiogenic shock, re-infarction, mechanical complication, ventricular arrhythmia and major hemorrhage) was compared between low-risk patients as classified by FASTEST (score=0) or Zwolle (score≤3). One-year mortality and cardiovascular rehospitalization was compared between the two groups. Results We included 3322 patients (77.4% male, mean age 62±13 years, 49.5% with anterior STEMI). The FASTEST score identified 855 (25.8%) and Zwolle 2353 (70.7%) low-risk patients. Discrimination by AUC for hospital mortality was 0.92 (95% CI 0.91–0.93) for FASTEST score, significantly higher than Zwolle (0.83 (95% CI 0.82–0.84), p<0.001 for comparison) (Fig.1). Overall hospital mortality was 2.8%. 1 patient died in low-risk FASTEST compared to 24 (1%) in low-risk Zwolle (p=0.01). Low-risk Zwolle patients were more likely to suffer serious hospital adverse events compared with FASTEST score low-risk (19.5% vs 8.5%, p<0.001). At one-year, 1384 patients had follow-up data. Mortality was significantly lower in low-risk FASTEST than Zwolle (1.5% vs 4.6%, p<0.001) and a tendency for less cardiovascular rehospitalization was also noted (5.4% vs 7.5%, p=0.08). Figure 1. ROC-AUC for hospital mortality Conclusion Approximately one in every four patients were classified as low-risk according to FASTEST score, in contrast with 70% for Zwolle score. Low-risk FASTEST score patients exhibited significantly less hospital mortality (1 patient), hospital serious adverse events and 1-year mortality compared with low-risk Zwolle patients. FASTEST score demonstrated better discriminatory capacity for hospital mortality than Zwolle score and its use for risk stratification should be preferred.

scholarly journals From the Immune Profile to the Immunoscore: Signatures for Improving Postsurgical Prognostic Prediction of Pancreatic Neuroendocrine Tumors

2021 ◽  
Vol 12 ◽  
Author(s):  
Miaoyan Wei ◽  
Jin Xu ◽  
Jie Hua ◽  
Qingcai Meng ◽  
Chen Liang ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Low Risk ◽  
Individual Risk ◽  
Recurrence Free Survival ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival ◽  
Training Cohort ◽  
Immune Infiltration ◽  
Risk Patients ◽  
Prognostic Prediction

ObjectiveImmune infiltration plays an important role in tumor development and progression and shows promising prognostic value in numerous tumors. In this study, we aimed to identify the role of immune infiltration in pancreatic neuroendocrine tumors (Pan-NETs) and to establish an Immunoscore system to improve the prediction of postsurgical recurrence-free survival.MethodsTo derive transcriptional signatures and deconvolute specific immune populations, two GEO datasets containing 158 Pan-NET patients were reanalyzed to summarize the immune infiltration landscape and identify immune-related signatures. Using real-time reverse transcription-polymerase chain reaction, immunofluorescence and immunochemistry methods, candidate signatures were further detected. The least absolute shrinkage and selection operator (LASSO) logistic regression model used statistically significant survival predicators in the training cohort (n=125) to build an Immunoscore system. The prognostic and predictive accuracy was validated in an external independent cohort of 77 patients.ResultsThe immune infiltration profile in Pan-NETs showed significant heterogeneity, among which accumulated immune cells, T lymphocytes and macrophages were predominant. Fourteen statistically significant immune-related signatures were further identified in the screening cohort. The Immunoscore system for Pan-NETs (ISpnet) consisting of six immune features (CCL19, IL-16, CD163, IRF4, CD8PT and CD8IT) was constructed to classify patients as high and low risk in the training cohort (cutoff value = 2.14). Low-risk patients demonstrated longer 5-year recurrence-free survival (HR, 0.061; 95% CI, 0.026 to 0.14; p &lt; 0.0001), with fewer recurrences and better prognoses. To predict the individual risk of recurrence, a nomogram incorporating both immune signatures and clinicopathological characteristics was developed.ConclusionOur model, ISpnet, captures immune feature-associated prognostic indicators in Pan-NETs and represents the first immune feature-based score for the postsurgical prognostic prediction. The nomogram based on the ISpnet and independent clinical risk factors might facilitate decision-making regarding early recurrence risk monitoring, identify high-risk patients in need of adjuvant therapy, and provide auxiliary guidance for patients with Pan-NETs that may benefit from immunotherapy in clinical trials.

Incident Co-Morbidities in Patients with Atrial Fibrillation Initially with a CHA2DS2-VASc Score of 0 (Males) or 1 (Females): Implications for Reassessment of Stroke Risk in Initially ‘Low-Risk’ Patients

2019 ◽  
Vol 119 (07) ◽  
pp. 1162-1170 ◽  
Author(s):  
Tze-Fan Chao ◽  
Jo-Nan Liao ◽  
Ta-Chuan Tuan ◽  
Yenn-Jiang Lin ◽  
Shih-Lin Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Adverse Events ◽  
Ischaemic Stroke ◽  
Stroke Risk ◽  
Temporal Trends ◽  
Low Risk ◽  
Stroke Risk Factor ◽  
Timing Interval ◽  
Risk Patients

Background Oral anticoagulants (OACs) are not recommended for ‘low-risk’ patients with atrial fibrillation (AF). We investigated the incidences of new risk factors developing, and the temporal trends in the CHA2DS2-VASc score in initially ‘low-risk’ AF patients. Second, we propose a reasonable timing interval at which stroke risk should be reassessed for such AF patients. Methods We studied 14,606 AF patients who did not receive anti-platelet agents or OACs with a baseline CHA2DS2-VASc score of 0 (males) or 1 (females). The CHA2DS2-VASc scores of patients were followed up and updated until the occurrence of ischaemic stroke or mortality or 31 December 2011. The associations between the prescription of warfarin and risk of adverse events once patients' scores changed were analysed. Decile values of durations to incident co-morbidities and from the acquirement of new co-morbidities to ischaemic stroke were studied. Results During a mean follow-up of 4 years, 7,079 (48.5%) patients acquired at least one new stroke risk factor component(s) with annual risks of 6.35% for hypertension, 3.68% for age ≥ 65 years, 2.77% for heart failure, 1.99% for diabetes mellitus and 0.33% for vascular diseases. The incidence for CHA2DS2-VASc score increments was 12.1%/year. Initiation of warfarin was associated with a lower risk of adverse events (adjusted hazard ratio, 0.530; 95% confidence interval, 0.371–0.755). Among 6,188 patients who acquired new risk factors, 80% would acquire these co-morbidities after 4.2 months of AF diagnosis. The duration from the acquirement of incident co-morbidities to the occurrence of ischaemic stroke was longer than 4.4 months for 90% of the patients. Conclusion The CHA2DS2-VASc score increases in approximately 12% of initially ‘low-risk’ AF patients each year, and the initiation of warfarin once the score changed was associated with a better prognosis. Three to four months may be a reasonable timing interval at which stroke risk should be reassessed so that OACs could be prescribed in a timely manner for stroke prevention.

scholarly journals Validation of the STRATIFY Falls Risk Assessment Tool in a Japanese Acute Care Hospital Setting

2016 ◽  
Vol 9 (2) ◽  
pp. 277 ◽  
Author(s):  
Shin-ichi Toyabe ◽  
Thoshihiro Kaneko ◽  
Akira Suzuki ◽  
Ayuko Yasuda
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Acute Care ◽  
Hospital Setting ◽  
Assessment System ◽  
Low Risk ◽  
Falls Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Inpatient Falls

<p>Patient falls are the most frequent adverse events that occur in a hospital. Prevention of inpatient falls is performed by a strategy to target patients at high risk for falls determined by a falls risk assessment system such as the STRATIFY tool. However, the performance of the STRATIFY tool in a Japanese hospital setting has not been determined. We tried to verify the performance of the STRATIFY tool for predicting falls in acutely hospitalized patients in Japan by a multi-center study. A total of 113,413 patients admitted to four acute cares national university hospitals during the period from April 2010 to March 2012 were studied. Inpatient falls per 1,000 patient-days varied from 1.42 to 2.92 in the four hospitals. The STRATIFY score was calculated on the basis of data extracted electronically from the hospital information system. Although the distribution of STRATIFY scores differed significantly among the four hospitals, logistic regression analysis and survival analysis showed that the proportion of high-risk patients who fell was significantly larger than the proportion of low-risk patients in all of the four hospitals. The odds ratio and hazard ratio for high-risk patients versus low-risk patients were 2.5 to 4.3 (combined estimate, 3.9 (95% confidence interval (95% CI), 2.1 to 7.6) and 1.8 to 5.1 (combined estimate, 3.1 (95% CI, 2.1 to 4.6)), respectively. The results suggest that the STRATIFY tool can be used as a screening tool to detect patients at high risk for falls in a Japanese acute care setting as used commonly in other countries. </p>

Sign in / Sign up

Export Citation Format

Share Document