scholarly journals Point-of-care lung ultrasound predicts severe disease and death due to COVID-19: a prospective cohort study.

2022 ◽  
Author(s):  
Paul W Blair ◽  
Trishul Siddharthan ◽  
Gigi Liu ◽  
Jiawei Bai ◽  
Joshua East ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Progression ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Tertiary Care ◽  
High Flow ◽  
Pleural Line ◽  
High Flow Oxygen

Objective: The clinical utility of point-of-care lung ultrasound (LUS) for disease severity triage of hospitalized patients with COVID-19 is unclear. Design: Prospective cohort study Setting: A large tertiary care center in Maryland, USA between April 2020 to September 2021. Patients: Hospitalized adults (18 years of age or greater) with positive SARS-CoV-2 RT-PCR results. Interventions: None. Measurements and Main Results: All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean Lung Ultrasound Score (ranging from 0 to 3) across lung zones (mLUSS) was determined. The primary outcome was time to ICU-level care, defined as high flow oxygen, noninvasive, or mechanical ventilation, within 28-days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 59 years and 114 (43.2) % of participants were female. The median mLUSS was 1 (interquartile range: 0.5 to 1.3). Following enrollment, 29 (11.0%) participants went on to require ICU-level care and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (aHR = 3.63; 95% CI: 1.23 to 10.65) and 28-day mortality (aHR = 4.50; 95% CI: 1.52 to 13.31). Pleural line abnormalities were independently associated with disease progression to ICU-level care (aHR = 18.86; CI: 1.57 to 226.09). Conclusions: Participants with a mLUSS of 1 or more or pleural line changes on LUS had an increased likelihood of subsequent requirement of high flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

scholarly journals Normal renal sonogram identifies renal colic patients at low risk for urologic intervention: a prospective cohort study

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Justin W. Yan ◽  
Shelley L. McLeod ◽  
Marcia L. Edmonds ◽  
Robert J. Sedran ◽  
Karl D. Theakston
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Medical Records ◽  
Prospective Cohort ◽  
Renal Colic ◽  
Tertiary Care ◽  
Low Risk ◽  
Ureteric Stone ◽  
Tertiary Care Centre ◽  
Imaging Department

AbstractIntroductionDetermining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively.MethodsThis was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit.ResultsOf 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings.ConclusionA normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.

scholarly journals P143: A prospective cohort study characterizing 30-day recurrent emergency department visits for hyperglycemia

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S116
Author(s):  
J. Yan ◽  
D. Azzam ◽  
M. Columbus ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Diabetes Management ◽  
Care Delivery ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Local Health

Introduction: Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), often recur in patients who have poorly controlled diabetes. Identification of those at risk for recurrent hyperglycemia visits may improve health care delivery and reduce ED utilization for these patients. The objective of this study was to prospectively characterize patients re-presenting to the emergency department (ED) for hyperglycemia within 30 days of an initial ED visit. Methods: This is a prospective cohort study of patients ≥18 years presenting to two tertiary care EDs (combined annual census 150,000 visits) with a discharge diagnosis of hyperglycemia, DKA or HHS from Jul 2016-Nov 2018. Trained research personnel collected data from medical records, telephoned patients at 10-14 days after the ED visit for follow-up, and completed an electronic review to determine if patients had a recurrent hyperglycemia visit to any of 11 EDs within our local health integration network within 30 days of the initial visit. Descriptive statistics were used where appropriate to summarize the data. Results: 240 patients were enrolled with a mean (SD) age of 53.9 (18.6) years and 126 (52.5%) were male. 77 (32.1%) patients were admitted from their initial ED visit. Of the 237 patients (98.8%) with 30-day data available, 55 (23.2%) had a recurrent ED visit for hyperglycemia within this time period. 21 (8.9%) were admitted on this subsequent visit, with one admission to intensive care and one death within 30 days. For all patients who had a recurrent 30-day hyperglycemia visit, 22/55 (40.0%) reported having outpatient follow-up with a physician for diabetes management within 10-14 days of their index ED visit. 7/21 (33.3%) patients who were admitted on the subsequent visit had received follow-up within the same 10-14 day period. Conclusion: This prospective study builds on our previous retrospective work and describes patients who present recurrently for hyperglycemia within 30 days of an index ED visit. Further research will attempt to determine if access to prompt follow-up after discharge can reduce recurrent hyperglycemia visits in patients presenting to the ED.

Association of Fluid Overload With Kidney Disease Progression in Advanced CKD: A Prospective Cohort Study

2014 ◽  
Vol 63 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Yi-Chun Tsai ◽  
Jer-Chia Tsai ◽  
Szu-Chia Chen ◽  
Yi-Wen Chiu ◽  
Shang-Jyh Hwang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Disease ◽  
Disease Progression ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fluid Overload ◽  
Kidney Disease Progression
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