External validation of 4C ISARIC mortality score in the setting of a Saudi Arabian ICU. Retrospective study

AbstractCOVID-19 pandemic has burdened healthcare systems, necessitating the development of mortality prediction scores to guide clinical decisions and resource allocation. 4C ISARIC mortality score was developed and validated on a British cohort.ObjectivesExternal validation of the score in the setting of a large Saudi Arabian ICU.MethodRetrospective chart review of COVID-19 patients admitted to ICU of King Saud Medical City, Riyadh, Saudi Arabia. Collecting data to calculate the score, then fitting a ROC curve against known patients’ outcome.ResultsCohort included 1493 patients with 38% mortality, AUC of the score was 0.81 (95% CI: 0.79 – 0.83, p < 0.001), correctly classifying 72.67% of the cohort. Cut-off value of > 9 had sensitivity of 70.5% (95% CI: 66.6 – 74.3), specificity 73.97% (95% CI: 71 – 76.8), positive predictive value 62.4% (95% CI: 59.5 – 65.2), and negative predictive value 80.2% (95% CI: 78.2 – 82.4).Conclusion4C ISARIC mortality risk score performed well with a good discriminatory ability for critically ill patients admitted to ICU in our setting. Cut-off > 9 was the optimal criterion.

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Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura

PEDIATRICS ◽

10.1542/peds.111.1.87 ◽

2003 ◽

Vol 111 (1) ◽

pp. 87-90

Author(s):

Derick Holt ◽

Justin Brown ◽

Kelly Terrill ◽

Robert Goldsby ◽

Rebecka L. Meyers ◽

...

Keyword(s):

Intravenous Immunoglobulin ◽

Immune Thrombocytopenic Purpura ◽

Predictive Value ◽

Chart Review ◽

Objective Response ◽

Retrospective Chart Review ◽

Poor Response ◽

Thrombocytopenic Purpura ◽

Excellent Response ◽

Chronic Itp

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children. Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets >150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets <50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable. Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response. Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.

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Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz091 ◽

2019 ◽

Vol 152 (6) ◽

pp. 742-746 ◽

Cited By ~ 1

Author(s):

Robyn C Reed ◽

M Cristina Pacheco

Keyword(s):

Predictive Value ◽

Gold Standard ◽

Chart Review ◽

Retrospective Chart Review ◽

Mucosal Injury ◽

Clinical Suspicion ◽

Duodenal Biopsy ◽

Biopsy Specimens ◽

Active Inflammation ◽

Intraepithelial Lymphocytosis

Abstract Objectives Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. Methods A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. Results One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. Conclusions Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

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External Validation of the HLH-2004 Diagnostic Criteria and H-Score for Diagnosis of Hemophagocytic Lymphohistiocytosis in Adults

Blood ◽

10.1182/blood-2020-138589 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 44-45

Author(s):

Jennifer Croden ◽

Jennifer Grossman ◽

Haowei Sun

Keyword(s):

Bone Marrow ◽

Diagnostic Criteria ◽

Validation Study ◽

Predictive Value ◽

Hemophagocytic Lymphohistiocytosis ◽

Chart Review ◽

External Validation ◽

Advisory Board ◽

Discriminatory Power ◽

C Statistic

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome associated with multi-organ failure and death. Diagnosis in adult patients is currently based on the HLH-2004 diagnostic criteria; however, these criteria were developed for pediatric HLH and have not been formally validated in adults. An alternative diagnostic score, the H-score, was developed for adults with reactive HLH. There have been few external validation studies comparing the diagnostic accuracy between the HLH-2004 criteria and H-score, mostly in critically ill patients. In this external validation study, we aimed to compare the discriminatory power of these two diagnostic criteria in predicting HLH in a multicenter cohort of adults with suspected HLH. Methods: We identified all adult inpatients (≥18 years) with an International Classification of Diseases (ICD) code for HLH in the province of Alberta, Canada from January 1999 to December 2019. Following independent chart review by two reviewers, cases were classified as positive, negative, or indeterminate cases of HLH. The HLH-2004 diagnostic criteria and H-score were determined for each case. The following performance characteristics of the diagnostic scoring systems were calculated: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). C-statistic was calculated from the receiver operator curve (ROC) analysis. Results: Data on 101 patients were collected. The median age was 46 years (range 18-88), 66 (65%) were male. Active malignancy within 6 months of presentation, infections, and autoimmune diseases were present in 31%, 36%, and 18%, respectively. Of the 96 patients who underwent bone marrow aspirate and biopsy, hemophagocytosis was present in 79 (82%). Using chart review as the gold standard, 89 (88%) patients were determined to have HLH, whereas 5 (5%) and 7 (7%) were reclassified as negative and indeterminate cases, respectively. 83 (82%) patients met ≥5 of the 8 HLH-2004 diagnostic criteria; using the HLH-2004 criteria missed 8 cases of HLH. The sensitivity and specificity of HLH-2004 criteria was 91.0% and 83.3%, respectively, with a PPV of 97.6% and an NPV of 55.6%. The median overall H-score was 238 (range 129-337). An H-Score cut-off of >169 (established as the optimal cut-off from the original derivation and validation paper) predicted HLH with a sensitivity of 95.5%, specificity of 16.7%, PPV of 89.5%, and NPV of 33.3%. The discriminatory power improved with an H-Score cut-off >210, with a sensitivity of 86.5%, specificity of 66.7%, PPV of 95.1%, and NPV of 40.0%. The c-statistics for the HLH-2004 criteria and the H-Score were 0.872 and 0.737, respectively. In the malignant subgroup, all patients fulfilled the HLH-2004 criteria and all were deemed to have HLH upon chart review. All but one had an H-Score >169, with a median H-Score of 238 (range 168-304) in the malignant group. Conclusion: In our highly selected patient population with suspected HLH, the HLH-2004 had better discriminatory power than the H-Score, with a high sensitivity and specificity and excellent c-statistic >0.80. An H-Score cut-off of >169 was highly sensitive but non-specific in identifying adults with HLH. The validity and applicability of our study is limited by a high prevalence of chart-confirmed HLH in our sample. We are completing ongoing data collection to expand our validation study in a cohort of adults with hyperferritinemia who underwent bone marrow evaluation and/or sCD25 testing. Disclosures Sun: Sanofi: Other: Advisory board; Octapharma: Other: Advisory board; Octapharma: Research Funding; Novo Nordisk: Other: Advisory board; Pfizer: Other: Advisory board.

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The Sensitivity and Specificity of Touch Preparation for Rapid Diagnosis of Invasive Fungal Sinusitis: A Pilot Study

Ear Nose & Throat Journal ◽

10.1177/0145561319840853 ◽

2019 ◽

Vol 100 (1) ◽

pp. 55-59

Author(s):

Theodore A. Schuman ◽

Josephine H. Nguyen ◽

Joshua C. Yelverton ◽

Jorge A. Almenara ◽

Celeste N. Powers

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Chart Review ◽

Retrospective Chart Review ◽

Rapid Diagnosis ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Touch Preparation ◽

Pathologic Analysis ◽

Initial Results

Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; two of these patients underwent 2, and 1 patient had 3 separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23-0.85), specificity was 100% (95% CI: 0.60-1.00), positive predictive value was 100% (95% CI: 0.46-1.00), and negative predictive value was 67% (95% CI: 0.35-0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criteria for determining the need for surgical intervention.

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850. External Validation of the Methicillin-Resistant Staphylococcus aureus Bacteremia Score

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1039 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S466-S466

Author(s):

Ellen Boyle ◽

Emily Dorgan ◽

Cali Lunowa ◽

Kyle C Molina ◽

Tanner M Johnson ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Predictive Value ◽

Methicillin Resistant Staphylococcus Aureus ◽

External Validation ◽

Apache Ii ◽

Discriminatory Ability ◽

Methicillin Resistant ◽

Staphylococcus Aureus Bacteremia ◽

All Cause Mortality ◽

Sensitivity Specificity

Abstract Background Predictive scoring systems, such as the Pitt Bacteremia Score (PBS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II), can optimize clinical decisions and provide adjustment for confounding among patients with Methicillin-Resistant Staphylococcus aureus bacteremia (MRSAB). The recently introduced MRSAB score demonstrated superior discriminatory ability in mortality prediction compared to APACHE-II and PBS, however external validation is lacking. Methods Single center, retrospective cohort study of adult patients admitted to University of Colorado Hospital from 2013–2020 with initial episode of MRSAB were included. Patients transferred from an outside hospital, left against medical advice, or died/pursued comfort care within 24 hours of index culture were excluded. The primary outcome was discrimination of 30-day all-cause mortality. The discriminatory abilities of APACHE-II, PBS and MRSAB were compared using receiver operating characteristic (ROC) analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed, and optimal MRSAB score was identified by Youden Index. Results Overall, 170 patients met study inclusion. The median (IQR) age was 57 (47-66) years, 69% were male, and 19% were in an ICU during blood culture collection. The most common infection sites were skin and soft tissue (41%), musculoskeletal (23%), and line-related (19%), whereas endovascular (14%) infections were less common. The median (IQR) PBS, APACHE-II and MRSAB scores were 2 (0-4),17 (12-23), and 6.5 (3-11), respectively. Thirty-day all-cause mortality was 12.9%. ROC curve analysis revealed an area (95% CI) for the APACHE-II, PBS, and MRSAB scores of 0.84 (0.77-0.92), 0.71 (0.57-0.85), 0.79 (0.68-0.90), respectively. A threshold MRSAB score of ≥10 was identified, whereby mortality was 3.6% with MRSAB < 10, and 30% with MRSAB ≥10. A MRSAB ≥10 had a sensitivity, specificity, PPV and NPV with corresponding 95% CIs of 0.82 (0.63-0.94), 0.72 (0.68-0.79), 0.30(0.19-0.42) and 0.96(0.92-0.99), respectively. Receiver operator characteristic (ROC) curves for the prediction of 30-day mortality Conclusion The MRSAB score is a useful predictive scoring model, with discriminatory ability comparable to APACHE-II, and excellent NPV at ≥10. Our findings support routine clinical and research application. Disclosures matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

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Tongue Blade Bite Test Predicts Mandible Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0035-1567812 ◽

2016 ◽

Vol 9 (2) ◽

pp. 121-124 ◽

Cited By ~ 1

Author(s):

John Neiner ◽

Rachael Free ◽

Gloria Caldito ◽

Tara Moore-Medlin ◽

Cherie-Ann Nathan

Keyword(s):

Predictive Value ◽

Chart Review ◽

Pediatric Patients ◽

Pediatric Population ◽

Retrospective Chart Review ◽

High Sensitivity ◽

Ct Scans ◽

Facial Trauma ◽

Institutional Review ◽

Mandible Fractures

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility.

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