scholarly journals Shock Index in the early assessment of febrile children at the emergency

2021 ◽  
pp. archdischild-2020-320992
Author(s):  
Nienke N Hagedoorn ◽  
Joany M Zachariasse ◽  
Dorine Borensztajn ◽  
Elise Adriaansens ◽  
Ulrich von Both ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Bacterial Infection ◽  
Diagnostic Value ◽  
Shock Index ◽  
Likelihood Ratios ◽  
Early Assessment ◽  
Serious Illness ◽  
Icu Admission ◽  
High Shock ◽  
Sensitivity Specificity

Objective(1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children.Design/settingObservational study in 11 European EDs (2017–2018).PatientsFebrile children with measured blood pressure.Main outcome measuresSerious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs).ResultsOf 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8.ConclusionsHigh Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.

scholarly journals Association between hypotension and serious illness in the emergency department: an observational study

2019 ◽  
Vol 105 (6) ◽  
pp. 545-551 ◽  
Author(s):  
Nienke N Hagedoorn ◽  
Joany M Zachariasse ◽  
Henriette A Moll
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Observational Study ◽  
Life Support ◽  
Hospital Admissions ◽  
Blood Pressure Measurement ◽  
Early Warning Score ◽  
Shock Index ◽  
Serious Illness ◽  
Icu Admission

BackgroundThe value of routine blood pressure measurement in the emergency department (ED) is unclear.ObjectiveTo determine the association between hypotension in addition to tachycardia and the Shock Index for serious illness.DesignObservational study.SettingUniversity ED (2009–2016).Participants, methods and main outcomesRoutine data collected from consecutive children <16 years. Using logistic regression, we assessed the association between hypotension (adjusted for tachycardia) and Shock Index (ratio heart rate/blood pressure [BP]) for serious illness. The predictive accuracy (sensitivity, specificity) for hypotension and Shock Index was determined for serious illness, defined as intensive care unit (ICU) and hospital admissions.ResultsWe included 10 698 children with measured BP. According to three age-adjusted clinical cut-offs (Advanced Paediatric Life Support, Paediatric Advanced Life Support and Paediatric Early Warning Score), hypotension was significantly associated with ICU admission when adjusted for tachycardia (range OR 2.6–5.3). Hypotension showed low sensitivity (range 0.05–0.12) and high specificity (range 0.95–0.99) for ICU admission. Combining hypotension and tachycardia did not change the predictive value for ICU admission. Similar results were found for hospitalisation. Shock index was associated with serious illness. However, no specific cut-off value was identified in different age groups.ConclusionsHypotension, adjusted for tachycardia, is associated with serious illness, although its sensitivity is limited. Shock index showed an association with serious illness, but no acceptable cut-off value could be identified. Routine BP measurement in all children to detect hypotension has limited value in the ED. Future studies need to confirm which patients could benefit from BP measurement.

Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma

2014 ◽  
Vol 8 (4) ◽  
pp. 326-332 ◽  
Author(s):  
Ari M. Lipsky ◽  
Yoram Klein ◽  
Adi Givon ◽  
Moti Klein ◽  
Jeffrey S. Hammond ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Trauma Patients ◽  
Likelihood Ratios ◽  
Icu Admission ◽  
Number Of Patients ◽  
Definition Of ◽  
Sensitivity Specificity ◽  
Blast Trauma ◽  
Injured Patients

ABSTRACTObjectiveWe investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.MethodsWe conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.ResultsA total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.ConclusionsTriage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (Disaster Med Public Health Preparedness. 2014;0:1–7)

scholarly journals The Auxiliary Diagnostic Value of a Novel Wearable Electrocardiogram-Recording System for Arrhythmia Detection: Diagnostic Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Shaomin Zhang ◽  
Hong Xian ◽  
Yi Chen ◽  
Yue Liao ◽  
Nan Zhang ◽  
...  
Keyword(s):  
Predictive Value ◽  
Negative Likelihood Ratio ◽  
Diagnostic Value ◽  
Recording System ◽  
Recording Device ◽  
Likelihood Ratios ◽  
Premature Ventricular Contractions ◽  
Low Sensitivity ◽  
Sensitivity Specificity ◽  
Electrocardiogram Ecg

Background: AMAZFIT®, a novel wearable electrocardiogram (ECG)-recording system is used for the measurement, acquisition, and storage of single-lead cardiac waveforms for adults. The aim of the study was to evaluate the accuracy of AMAZFIT® for diagnosing arrhythmia in older patients.Methods: From May to December 2019, we recruited 291 elderly individuals with an average age of 78±10 years old, and 41.9% women. All cardiac waveforms were obtained from the AMAZFIT® which included limb and chest leads. Two trained technicians reviewed all ECG data to determine cardiac rhythm using standard diagnostic criteria. We evaluated the accuracy of AMAZFIT® for identifying arrhythmia by comparing the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios with those of a standard 12-lead ECG.Results: Of the 291 participants, 197 older adults had arrhythmias, including AF (n = 119), first-degree AVB (n = 28), PACs (n = 25), and PVCs (n = 28). Three of these participants had arrhythmias of AF and PVCs. Chest lead data from 100% and limb lead data from 4.7% of the participants were analyzed. An evaluation of AMAZFIT® for atrial fibrillation (AF) reported a sensitivity, specificity, PPV, NPV PLR, and negative likelihood ratio (NLR) of 93.28, 95.35, 93.28, 95.35, 20.06, and 0.07%, respectively. AMAZFIT® also demonstrated excellent sensitivity for premature atrial contractions (PACs) (84.00%) and premature ventricular contractions (PVCs) (89.29%). However, the device demonstrated a low sensitivity for first-degree atrioventricular block (32.14%).Conclusions: The AMAZFIT® showed significantly higher sensitivity and specificity for AF, PACs, and PVCs. This portable ECG-recording device based on an algorithm has a potential auxiliary diagnostic value for identifying arrhythmia compared with a standard 12-lead ECG device.

scholarly journals Efficacy of Yale observation scale to detect serious bacterial infection in febrile children aged one to 36 months

2015 ◽  
Vol 1 (2) ◽  
pp. 23-26
Author(s):  
Prerana Kansakar ◽  
Prakash Sundar Shrestha ◽  
Merina Shrestha
Keyword(s):  
Bacterial Infection ◽  
Febrile Illness ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Predictive Values ◽  
Serious Illness ◽  
Observation Scale ◽  
Yale Observation Scale ◽  
Sensitivity Specificity

Introductions: In most children aged 1-36 months, the cause of a febrile illness is a self limiting viral infection. It is very difficult to distinguish these from serious bacterial infection. Objective of this study is to assess the efficacy of the Yale Observation Scale (YOS) to detect serious bacterial infection in febrile children aged 1-36 months.Methods: YOS scores were assigned as a part of a cross- sectional study in 100 children presenting in Tribhuvan University teaching hospital with fever to divide the child into well- looking if YOS ≤10 or ill- looking if YOS >10. Then the history, examination and necessary investigation was performed to come to a diagnosis of non- serious illness and serious bacterial infection.Results: Serious bacterial infection was found in 33(33%) of the patients. The sensitivity, specificity, positive and negative predictive values for a YOS score greater than 10 to detect serious bacterial infection were 45.45%, 88.05%%, 65.21% and 76.62%, respectively.Conclusions: A YOS ≤10 predicts non-serious illness while a YOS>10 does not necessarily indicate serious bacterial infection and should undergo further evaluation to confirm serious bacterial infection.

scholarly journals An Evaluation of the Arcus Corneae For Age Estimation

2019 ◽  
Vol 9 (3-4) ◽  
pp. 155-162
Author(s):  
Boonsak Hanterdsith
Keyword(s):  
Predictive Value ◽  
Interobserver Reliability ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Likelihood Ratios ◽  
Chi Square ◽  
Cross Sectional ◽  
Predictive Values ◽  
Sensitivity Specificity

Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen’s kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.

scholarly journals Diagnostic Value of Autoantibodies in Lung Cancer: a Systematic Review and Meta-Analysis

2018 ◽  
Vol 51 (6) ◽  
pp. 2631-2646 ◽  
Author(s):  
Jiangyue Qin ◽  
Ni Zeng ◽  
Ting Yang ◽  
Chun Wan ◽  
Lei Chen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Diagnostic Accuracy ◽  
Test Performance ◽  
Meta Analysis ◽  
Cyclin B1 ◽  
Diagnostic Value ◽  
Likelihood Ratios ◽  
Summary Receiver Operating Characteristic ◽  
Mixed Effect ◽  
Sensitivity Specificity

Background/Aims: Recently, many studies have demonstrated that various tumor-associated autoantibodies have been detected in early stages of lung cancer. Therefore, we conducted a meta-analysis to comprehensively evaluate available evidence on the diagnostic value of autoantibodies against tumor-associated antigens in lung cancer. Methods: We systematically searched PubMed, Scopus, Web of Science and other databases through 23 March 2018. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. We used the bivariate mixed-effect models to calculate pooled values of sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratios and associated 95% confidence intervals. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. Deek’s funnel plot was used to detect publication bias. Results: Review of 468 candidate articles identified fifty-three articles with a total of 11,515 patients for qualitative review and meta-analysis. Pooled sensitivity, specificity and area under the SROC curve were as follows for tumor-associated autoantibodies against the following proteins: p53, 0.19, 0.98, 0.82; NY-ESO-1, 0.17, 0.98, 0.90; Survivin, 0.19, 0.99, 0.96; c-myc, 0.14, 0.98, 0.45; Cyclin B1, 0.18, 0.98, 0.91; GBU4-5, 0.07, 0.98, 0.91; CAGE, 0.14, 0.98, 0.90; p16, 0.08, 0.97, 0.91; SOX2, 0.14, 0.99, 0.93; and HuD, 0.17, 0.99, 0.82. Conclusion: Each tumor-associated autoantibody on its own showed excellent diagnostic specificity for lung cancer but inadequate sensitivity. Our results suggest that combinations or panels of tumor-associated autoantibodies may provide better sensitivity for diagnosing lung cancer, and the diagnostic accuracy of tumor-associated autoantibodies should be validated in more studies.

scholarly journals A Prospective Case Control Study To Evaluate The CRADLE Vital Signs Alert Device For Detection Of Patients With Clinically Important Malaria In Refugee Settings

2020 ◽  
Author(s):  
Katy Kuhrt ◽  
Paul T Seed ◽  
Andrew H Shennan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Severe Malaria ◽  
Low Cost ◽  
Severe Disease ◽  
Vital Signs ◽  
Trial Registration ◽  
Control Group ◽  
Shock Index ◽  
Likelihood Ratios

Abstract Background: Malaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods: CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.Results: Five hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.Conclusion: Malaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial Registration: This is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.

scholarly journals Diagnostic Value of Sonographic Features in Distinguishing Malignant Partially Cystic Thyroid Nodules: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xinlong Shi ◽  
Ruifeng Liu ◽  
Luying Gao ◽  
Yu Xia ◽  
Yuxin Jiang
Keyword(s):  
Systematic Review ◽  
Thyroid Nodules ◽  
Meta Analysis ◽  
High Specificity ◽  
Diagnostic Value ◽  
Systematic Evaluation ◽  
Cochrane Library ◽  
Likelihood Ratios ◽  
Receiver Operating Characteristic Curves ◽  
Sensitivity Specificity

Ultrasonography (US) is one of the most important methods for the management of thyroid nodules, which can be classified as solid, partially cystic, or cystic by composition. The various Thyroid Imaging Reporting and Data System classifications pay more attention to solid nodules and have reported pertinent US features associated with malignancy. However, the likelihood of malignancy of partially cystic thyroid nodules (PCTNs) is 3.3–17.6%, and few studies have systematically discussed the value of US in differentiating such entities. Therefore, we deemed it necessary to perform a systematic evaluation of US features in recognizing malignant PCTNs. Our systematic review and meta-analysis aimed to assess the value of US features in predicting malignant PCTNs. We searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases to find studies that researched US features of PCTNs and that were published before June 2020. Review Manager 5.3 was used to summarize suspicious US features and calculate the sensitivity, specificity, and likelihood ratios. MetaDiSc 1.4 was used to estimate receiver operating characteristic curves and calculate areas under the curves (AUCs). Our review included eight studies with a total of 2,004 PCTNs. Seven features were considered to be associated with malignancy. High specificity (&gt;0.9) was found in nodules with a taller-than-wide shape, those that were spiculated/microlobulated or with an ill-defined margin, those with microcalcification, and a non-smooth rim. Among US features, eccentric configuration, microcalcification, and marked or mild hypoechogenicity were more reliable in predicting malignancy (AUC: 0.9592, 0.8504, and 0.8092, respectively). After meta-analysis, we recommend combining PCTN US features including an eccentric internal solid portion, marked or mild hypoechogenicity, and presence of microcalcification to better identify malignant nodules. More studies are needed to explore and improve the diagnostic value of US in PCTNs.

scholarly journals ‘A Prospective Case Control Study to Evaluate The CRADLE Vital Signs Alert Device For Detection of Patients With Clinically Important Malaria in Refugee Settings’.

2021 ◽  
Author(s):  
Katy Kuhrt ◽  
Paul T Seed ◽  
Andrew H Shennan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Severe Malaria ◽  
Low Cost ◽  
Severe Disease ◽  
Vital Signs ◽  
Trial Registration ◽  
Control Group ◽  
Shock Index ◽  
Likelihood Ratios

Abstract BackgroundMalaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.ResultsFive hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.ConclusionMalaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial RegistrationThis is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.

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