Development and external validation of new nomograms by adding ECG changes (ST depression or tall T wave) and age to conventional scoring systems to improve the predictive capacity in patients with subarachnoid haemorrhage: a retrospective, observational study in Korea

ObjectivesTo develop new nomograms by adding ECG changes (ST depression or tall T wave) and age to three conventional scoring systems, namely, World Federation of Neurosurgical Societies (WFNS) scale, Hunt and Hess (HH) system and Fisher scale, that can predict prognosis in patients with subarachnoid haemorrhage (SAH) using our preliminary research results and to perform external validation of the three new nomograms.DesignRetrospective, observational studySettingEmergency departments (ED) of two university-affiliated tertiary hospital between January 2009 and March 2015.ParticipantsAdult patients with SAH were enrolled. Exclusion criteria were age <19 years, no baseline ECG, cardiac arrest on arrival, traumatic SAH, referral from other hospital and referral to other hospitals from the ED.Primary outcome measuresThe 6 month prognosis was assessed using the Glasgow Outcome Scale (GOS). We defined a poor outcome as a GOS score of 1, 2 or 3.ResultsA total of 202 patients were included for analysis. From the preliminary study, age, ECG changes (ST depression or tall T wave), and three conventional scoring systems were selected to predict prognosis in patients with SAH using multi-variable logistic regression. We developed simplified nomograms using these variables. Discrimination of the developed nomograms including WFNS scale, HH system and Fisher scale was superior to those of WFNS scale, HH system and Fisher scale (0.912 vs 0.813; p<0.001, 0.913 vs 0.826; p<0.001, and 0.885 vs 0.746; p<0.001, respectively). The calibration plots showed excellent agreement. In the external validation, the discrimination of the newly developed nomograms incorporating the three scoring systems was also good, with an area under the receiver-operating characteristic curve value of 0.809, 0.812 and 0.772, respectively.ConclusionsWe developed and externally validated new nomograms using only three independent variables. Our new nomograms were superior to the WFNS scale, HH systems, and Fisher scale in predicting prognosis and are readily available.

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Prediction of Outcome After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/strokeaha.118.023902 ◽

2019 ◽

Vol 50 (4) ◽

pp. 837-844 ◽

Cited By ~ 14

Author(s):

Carlina E. van Donkelaar ◽

Nicolaas A. Bakker ◽

Jaqueline Birks ◽

Nic J.G.M. Veeger ◽

Jan D.M. Metzemaekers ◽

...

Keyword(s):

Clinical Outcome ◽

Operating Characteristic ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Characteristic Curve ◽

External Validation ◽

World Federation ◽

Final Model ◽

Fisher Grade ◽

Temporal Validation ◽

Grading Scale

Background and Purpose— Early prediction of clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH) is still lacking accuracy. In this observational cohort study, we aimed to develop and validate an accurate bedside prediction model for clinical outcome after aSAH, to aid decision-making at an early stage. Methods— For the development of the prediction model, a prospectively kept single-center cohort of 1215 aSAH patients, admitted between 1998 and 2014, was used. For temporal validation, a prospective cohort of 224 consecutive aSAH patients from the same center, admitted between 2015 and 2017, was used. External validation was performed using the ISAT (International Subarachnoid Aneurysm Trial) database (2143 patients). Primary outcome measure was poor functional outcome 2 months after aSAH, defined as modified Rankin Scale score 4–6. The model was constructed using multivariate regression analyses. Performance of the model was examined in terms of discrimination and calibration. Results— The final model included 4 predictors independently associated with poor outcome after 2 months: age, World Federation of Neurosurgical Societies grade after resuscitation, aneurysm size, and Fisher grade. Temporal validation showed high discrimination (area under the receiver operating characteristic curve, 0.90; 95% CI, 0.85–0.94), external validation showed fair to good discrimination (area under the receiver operating characteristic curve, 0.73; 95% CI, 0.70–0.76). The model showed satisfactory calibration in both validation cohorts. The SAFIRE grading scale was derived from the final model: size of the aneurysm, age, Fisher grade, world federation of neurosurgical societies after resuscitation. Conclusions— The SAFIRE grading scale is an accurate, generalizable, and easily applicable model for early prediction of clinical outcome after aSAH.

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STUDY OF ECG CHANGES IN PRIMARY HYPOTHYROIDISM

10.36106/ijar/7508164 ◽

2019 ◽

pp. 1-1

Author(s):

Pushkar Pradip Shah

Keyword(s):

Observational Study ◽

General Hospital ◽

Subclinical Hypothyroidism ◽

Sinus Bradycardia ◽

Primary Hypothyroidism ◽

Retrospective Observational Study ◽

Ecg Changes ◽

Exclusion Criteria ◽

Medical College ◽

Tsh Levels

AIMS AND OBJECTIVE: To study ECG changes in cases of Primary hypothyroidism. MATERIAL AND METHODS: This is a retrospective observational study conducted at SKN Medical College and General Hospital, Pune. Both, overt and subclinical hypothyroid cases were selected after taking into account the inclusion and exclusion criteria. ECG and TSH levels were analysed. CONCLUSION: Both overt and subclinical hypothyroidism are associated with signicant changes in ECG; sinus bradycardia being the commonest one.

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Congestive Heart Failure in Diphtheric Myocarditis

Paediatrica Indonesiana ◽

10.14238/pi16.3-4.1976.71-80 ◽

2019 ◽

Vol 16 (3-4) ◽

pp. 71-80

Author(s):

A. M. Prasodo ◽

M. Narendra ◽

A. Joernil ◽

Wahjoenarso Wahjoenarso ◽

F. Kaspan

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Diphtheria Toxin ◽

Epigastric Pain ◽

Myocardial Damage ◽

Poor General Condition ◽

Ecg Changes ◽

X Ray ◽

T Wave ◽

St Depression

The picture of congestive heart failure in diphtheric myocarditis was mainly determined by poor general condition, hepatic enlargement + epigastric pain, dyspnea. Basal rales and peripheral edema were not observed. Cardiomegaly on X-ray examination supported the diagnosis. Congestive heart failure as a complication of diphtheric myocarditis occurred in 31.2% - 52% of cases with severe ECG changes and only in 5% of cases with ST depression or T wave changes. Of 29 cases with congestive heart failure only 3 survived. Apparently good results of digitalis treatment were obtained when only gallop rhythm, as an early sign of heart failure, was found. Extensive myocardial damage by diphtheria toxin may explain why no beneficial effect of digitalis treatment was obtained. Prophylactic digitalization before signs of congestive heart failure appeared, as suggested by several authors; was not performed in this study.

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External Validation of Different Scoring Systems for Suspected Choledocholithiasis

Digestive Surgery ◽

10.1159/000495696 ◽

2019 ◽

Vol 36 (6) ◽

pp. 530-538

Author(s):

Nicolò Tamini ◽

Davide Paolo Bernasconi ◽

Luca Gianotti

Keyword(s):

Operating Characteristic ◽

Bile Duct Stone ◽

Characteristic Curve ◽

External Validation ◽

Area Under The Curve ◽

Scoring Systems ◽

Youden Index ◽

Predictive Values ◽

Sensitivity Specificity ◽

Symptoms And Signs

Aim of the Study: The diagnosis of choledocholithiasis is challenging. Previously published scoring systems designed to calculate the risk of choledocholithiasis were evaluated to appraise the diagnostic performance. Patients and Methods: Data of patients who were admitted between 2013 and 2015 with the following characteristics were retrieved: bile stone-related symptoms and signs, and indication to laparoscopic cholecystectomy. To validate and appraise the performance of the 6 scoring systems, the acknowledged domains of each metrics were applied to the present cohort. Sensitivity, specificity, positive, negative predictive, Youden index, and receiver operating characteristic curve with the area under the curve (AUC) values of the scores were calculated. Results: Two-hundred patients were analyzed. The highest sensitivity and specificity were obtained from the Menezes’ (96.6%) and Telem’s (99.3%) metrics respectively. The Telem’s and Menezes’ scores had the best positive (75.0%) and negative (96.4%) predictive values respectively. The best accuracy, as computed by the Youden index and AUC, was found for the Soltan’s scoring system (0.628 and 0.88, respectively). Conclusion: The available scoring systems are precise only in identifying patients with a negligible risk of common bile duct stone, but overall insufficiently accurate to suggest the routine use in clinical practice.

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Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study

BMC Emergency Medicine ◽

10.1186/s12873-021-00410-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joseph Miller ◽

Yiyang Wu ◽

Rawan Safa ◽

Georgiana Marusca ◽

Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Primary Outcome ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality

Abstract Background Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes. Results The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8–10.8) for 1 point, 12.0 (95% CI 4.9–29.4) for 2 points, and 41.7 (95% CI 15.8–110.1) for 3 points (c-statistic = 0.77). Conclusion An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

10.21203/rs.3.rs-76144/v1 ◽

2020 ◽

Author(s):

Joseph Miller ◽

Yiyang Wu ◽

Rawan Safa ◽

Georgiana Marusca ◽

Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality ◽

Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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External Validation and Comparison of Clostridioides difficile Severity Scoring Systems

Clinical Infectious Diseases ◽

10.1093/cid/ciab737 ◽

2021 ◽

Author(s):

D Alexander Perry ◽

Daniel Shirley ◽

Dejan Micic ◽

C Pratish Patel ◽

Rosemary Putler ◽

...

Keyword(s):

Characteristic Curve ◽

External Validation ◽

Predictive Ability ◽

Scoring Systems ◽

Receiver Operator Characteristic Curve ◽

Adverse Outcomes ◽

Risk Scores ◽

Clostridioides Difficile ◽

Multicenter Cohort ◽

Severity Scores

Abstract Background Many models have been developed to predict severe outcomes from Clostridioides difficile infection. These models are usually developed at a single institution and largely are not externally validated. This aim of this study was to validate previously published risk scores in a multicenter cohort of patients with CDI. Methods Retrospective study on four separate inpatient cohorts with CDI from three distinct sites: The Universities of Michigan (2010-2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive testing. Both within each cohort and combined across all cohorts, published CDI severity scores were assessed and compared to each other and the IDSA guideline definitions of severe and fulminant CDI. Results A total of 3,646 patients were included for analysis. Including the two IDSA guideline definitions, fourteen scores were assessed. Performance of scores varied within each cohort and in the combined set (mean area under the receiver operator characteristic curve(AUC 0.61, range 0.53-0.66). Only half of the scores had performance at or better than IDSA severe and fulminant definitions (AUCs 0.64 and 0.63, respectively). Most of the scoring systems had more false than true positives in the combined set (mean: 81.5%, range:0-91.5%). Conclusions No published CDI severity score showed stable, good predictive ability for adverse outcomes across multiple cohorts/institutions or in a combined multicenter cohort.

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Accuracy of the qSOFA Score and RED Sign in Predicting Critical Care Requirements in Patients with Suspected Infection in the Emergency Department: A Retrospective Observational Study

Medicina ◽

10.3390/medicina56010042 ◽

2020 ◽

Vol 56 (1) ◽

pp. 42

Author(s):

Jong Eun Park ◽

Sung Yeon Hwang ◽

Ik Joon Jo ◽

Min Seob Sim ◽

Won Chul Cha ◽

...

Keyword(s):

Emergency Department ◽

Critical Care ◽

Observational Study ◽

Characteristic Curve ◽

Altered Mental Status ◽

Retrospective Observational Study ◽

Suspected Infection ◽

Combined Use ◽

Qsofa Score ◽

Care Requirements

Background and objectives: We aimed to compare the accuracy of positive quick sequential organ failure assessment (qSOFA) scores and the RED sign in predicting critical care requirements (CCRs) in patients with suspected infection who presented to the emergency department (ED). Materials and Methods: In this retrospective observational study, we examined adult patients with suspected infection in the ED from June 2018 to September 2018. A positive qSOFA (qSOFA+) was defined as the presence of ≥2 of the following criteria: altered mental status (AMS), systolic blood pressure (SBP) < 100 mmHg, and respiratory rate (RR) ≥ 22 breaths/min. A positive RED sign (RED sign+) was defined as the presence of at least one of the RED sign criteria: AMS, skin mottling, SBP < 90 mmHg, heart rate >130 beats/min, or RR > 30 breaths/min. A qSOFA/RED+ was defined as the presence of qSOFA+ or RED+. We applied these tools twice using the initial values upon ED arrival and all values within 2 h after ED arrival. The accuracy of qSOFA+, RED+, and qSOFA/RED+ in predicting CCR was assessed. Results: Data from 5353 patients with suspected infection were analyzed. The area under the receiver operating characteristic curve (AUC) of RED+ (0.67, 95% confidence interval [CI]: 0.65–0.70) and that of qSOFA/RED+ (0.68, 95% CI: 0.66–0.70, p < 0.01) were higher than the AUC of qSOFA+ (0.59, 95% CI: 0.57–0.60) in predicting CCR on ED arrival. The qSOFA/RED+ within 2 h showed the highest accuracy (AUC 0.72, 95% CI: 0.70–0.75, p < 0.001). Conclusions: The accuracy of the RED sign in predicting CCR in patients with suspected infection who presented at ED was better than that of qSOFA. The combined use of the RED sign and qSOFA (positive qSOFA or RED sign) showed the highest accuracy.

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Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

10.21203/rs.3.rs-75848/v1 ◽

2020 ◽

Author(s):

Joseph Miller ◽

MD ◽

Rawan Safa ◽

Georgiana Marusca ◽

BS Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality ◽

Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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Abstract TP13: External Validation of Stroke Prognostication Scales - A Retrospective Cohort Study

Stroke ◽

10.1161/str.51.suppl_1.tp13 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Nauman Jahangir ◽

Nicholas Lanzotti ◽

Kyle Gollon ◽

Mehwish Farooqi ◽

Michael Buhnerkempe ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Characteristic Curve ◽

External Validation ◽

Area Under The Curve ◽

Predictive Ability ◽

Scoring Systems ◽

Predictive Performance ◽

Discriminatory Ability ◽

Single Center Study

Introduction: In recent years, many scoring models have been proposed to predict clinical outcomes after acute ischemic stroke. Aim of our study was to perform a comparative analysis of these scoring systems to assess predictive reliability. Method: This retrospective single center study included 166 community-based patients presenting with an acute ischemic stroke between 2015 and 2018 who had undergone mechanical thrombectomy with or without IV r-tPA administration prior to the procedure. Patients with unknown 90 day Modified Ranking Scale (mRS) were excluded from the study. We included SPAN-100, THRIVE, HIAT2, iScore , TPI, DRAGON, ASTRAL and HAT predictive models to our study. To predict MRS at 90 days, we first dichotomize mRS into two groups: scores of 0 and 1 and scores 2 and above. We then used logistic regression to find the association between a stroke score and the probability of having a 90-day mRS of 2 or above. Separate univariate logistic regressions were fit for each stroke score. We assessed the ability of each stroke score to predict 90-day mRS using the area-under-the-curve (AUC) of the receiver operating characteristic curve (ROC - plot of sensitivity against 1-specificity). AUC values range from 0.5 to 1 with values above 0.7 showing good discriminatory ability. Results: SPAN-100, HIAT2, iScore, and ASTRAL scores have similar predictive ability with AUC values over 0.7 (Table 1). The ASTRAL score had the highest predictive ability with a score above 31.5 indicating a high likelihood of a 90-day MRS ≥ 2 (Table 1). The TPI, DRAGON, and HAT scores all had AUCs below 0.65 indicating poor predictive performance in our data. Conclusion: The SPAN-100, HIAT2, iScore, and ASTRAL scores reliably predicts 90-day mRS of 2 or greater in patients with acute ischemic stroke.

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