scholarly journals Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041022
Author(s):  
Suchart Booraphun ◽  
Viriya Hantrakun ◽  
Suwatthiya Siriboon ◽  
Chaiyaporn Boonsri ◽  
Pulyamon Poomthong ◽  
...  
Keyword(s):  
Observational Study ◽  
Retrospective Analysis ◽  
Sofa Score ◽  
Prospective Observational Study ◽  
Standard Of Care ◽  
Exposed Group ◽  
Sepsis Management ◽  
Risk Of Death ◽  
Study Hospital ◽  
Sepsis Care

ObjectiveTo evaluate the effectiveness of a Sepsis Fast Track (SFT) programme initiated at a regional referral hospital in Thailand in January 2015.DesignA retrospective analysis using the data of a prospective observational study (Ubon-sepsis) from March 2013 to January 2017.SettingGeneral medical wards and medical intensive care units (ICUs) of a study hospital.ParticipantsPatients with community-acquired sepsis observed under the Ubon-sepsis cohort. Sepsis was defined as modified Sequential Organ Failure Assessment (SOFA) Score ≥2.Main exposureThe SFT programme was a protocol to identify and initiate sepsis care on hospital admission, implemented at the study hospital in 2015. Patients in the SFT programme were admitted directly to the ICUs when available. The non-exposed group comprised of patients who received standard of care.Main outcomeThe primary outcome was 28-day mortality. The secondary outcomes were measured sepsis management interventions.ResultsOf 3806 sepsis patients, 903 (24%) were detected and enrolled in the SFT programme of the study hospital (SFT group) and 2903 received standard of care (non-exposed group). Patients in the SFT group had more organ dysfunction, were more likely to receive measured sepsis management and to be admitted directly to the ICU (19% vs 4%). Patients in the SFT group were more likely to survive (adjusted HR 0.72, 95% CI 0.58 to 0.88, p=0.001) adjusted for admission year, gender, age, comorbidities, modified SOFA Score and direct admission to the ICUs.ConclusionsThe SFT programme is associated with improved sepsis care and lower risk of death in sepsis patients in rural Thailand, where some critical care resources are limited. The survival benefit is observed even when all patients enrolled in the programme could not be admitted directly into the ICUs.Trial registration numberNCT02217592.

scholarly journals A prospective observational study testing liquid crystal phase change type thermometer placed on skin against oesophageal/pharyngeal placed thermometers in participants undergoing general anesthesia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
G. Simpson ◽  
R. N. Rodseth
Keyword(s):  
Observational Study ◽  
Surface Temperature ◽  
General Anaesthesia ◽  
Prospective Observational Study ◽  
Standard Of Care ◽  
Skin Surface ◽  
Temperature Monitoring ◽  
Skin Surface Temperature ◽  
Limits Of Agreement ◽  
Non Invasive

Abstracts Background Patient outcomes are influenced by intraoperative temperature management. Oesophageal/pharyngeal temperature monitoring is the standard of care at our institute but is not well tolerated in awake patients. Many non-invasive temperature monitors have been studied. Only the TraxIt® Wearable Children’s Underarm Thermometer which contains liquid crystals that undergo phase changes according to temperature is available at our institution. We tested these non-invasive monitors against our standard of care which is the oesophageal/pharyngeal temperature monitor. Methods We conducted a prospective observational study of 100 patients receiving general anaesthesia for elective surgery. Patients were eligible for inclusion if they were ≥ 18 years old, were planned to have a general anaesthetic > 60 min during which no body cavity (chest or abdomen) would be opened. Patient temperature was measured with an oesophageal/pharyngeal thermistor probe and skin surface temperature monitors placed over the forehead, in the axilla, over the sternum, and behind the ear (over major vessels to the brain). Temperatures were recorded and then analysed using Altman-Bland plots. Pre-determined clinically relevant limits of agreement were set at −/+ 0.5 °C. Results From the 100 patients we collected 500 data points for each monitor with an average monitoring time of 102 min (30–300 min) across a range of surgical procedures. None of the skin surface temperature monitors achieved the pre-determined limits of agreement and results were impacted by the use of a forced air warmer. Conclusion The TraxIt® Wearable Children’s Underarm Thermometers are not suitable for temperature monitoring during general anaesthesia.

scholarly journals The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Thomas Karlsson ◽  
Maria Jiménez-Herrera ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Risk Of Death ◽  
Computerised Decision Support System ◽  
Field Assessment ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Life Threatening ◽  
Triage Level

Abstract Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases. Conclusions The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.

scholarly journals Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

2020 ◽  
Author(s):  
Marcus J Lyall ◽  
Nazir I Lone
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Severity Of Illness ◽  
Medical Attention ◽  
Hospital Death ◽  
Hospital Inpatient ◽  
Day Hospital ◽  
Risk Of Death ◽  
Ambulance Transport ◽  
Emergency Ambulance

AbstractObjectivesTo understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.DesignA prospective observational studySetting3 large acute medical receiving units in NHS Lothian, Scotland. Participants: Non-covid-19 acute admissions (n = 1756) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the United Kingdom on 23rd March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n = 14961).Main outcome measuresPatient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.ResultsNon-covid-19 acute medical admissions reduced by a mean 43.8% (95% CI 27.3, 59.4) across all 3 sites in comparison to the mean of the preceding 5 years P < 0.001. The reduction in admissions predominated in the over 75 age category and a greater proportion arrived by emergency ambulance transport. Non-covid-19 admissions during lockdown had a greater incidence of severe renal injury, hyperlactataemia and over twice the risk of hospital death within 7 days 5.01% vs 2.49% which persisted after adjustment for confounders (OR 2.17, 95% CI 1.70,2.73, P < 0.0001)ConclusionsThese data support current fears that patients are delaying seeking medical attention for acute illness which is associated with worsening clinical parameters and a higher risk of death following admission.

scholarly journals Morbidity and mortality pattern of intramural and extramural neonate: a prospective observational study

2021 ◽  
Vol 8 (6) ◽  
pp. 1006
Author(s):  
Rajkumar M. Meshram ◽  
Dipty L. Jain ◽  
Mohini U. Apte ◽  
Abhishek Denge
Keyword(s):  
Observational Study ◽  
Respiratory Distress ◽  
Prospective Observational Study ◽  
Very Low Birth Weight ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Mortality Pattern ◽  
Female Ratio ◽  
Common Cause ◽  
Risk Of Death

Background: Neonatal period carries higher risk of death inspite of advances in perinatal and neonatal services. The objective of the study was to assess the morbidity/mortality pattern of intramural and extramural neonates.Methods: Prospective observational study was undertaken on all intramural and extramural neonates who fulfill the inclusion criteria at a tertiary institute for one year. Morbidity and mortality patterns were analyzed.Results: A total 1770 intramural and 997 extramural neonates required admission during the study period. Mortality rate in intramural neonate was 22.26% while in extramural neonate was 28.79%. The male to female ratio was 1.27:1 in intramural while 1.3:1 in extramural neonates. Preterm neonates with extremely/very low birth weight were predominant in intramural group and term neonates in extramural group (p<0.001). Maternal illness during pregnancy were significantly more in mothers of extramural neonates compared to that of intramural neonates (p<0.001). Lethargy and hypothermia was significantly more in extramural group (p<0.001) while respiratory distress was significantly higher in intramural group (p=0.01). The leading causes of admission in intramural neonates was prematurity with respiratory distress syndrome (31.64%) while sepsis (37.01%) in extramural group of neonates. Preterm birth complication (51.52%) was the common cause of mortality in intramural neonates while sepsis (42.16%) in extramural neonates.Conclusions: Sepsis is the most common cause of morbidity/mortality in extramural neonates while prematurity and its complication in intramural neonates.

scholarly journals Cachexia at Diagnosis adversely predicts outcomes in patients with Aggressive B-Cell NHL receiving standard of care treatment: A Prospective Observational Study from India

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2907-2907
Author(s):  
Vivek S Radhakrishnan ◽  
Reena Nair ◽  
Anwesha Patra ◽  
Saurabh Jayant Bhave ◽  
Jeevan Kumar Garg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Observational Study ◽  
B Cell ◽  
Research Funding ◽  
Prospective Observational Study ◽  
Univariate Analysis ◽  
Standard Of Care ◽  
High Grade ◽  
Actuarial Survival

Background and Objectives:Cancer associated malnutrition and cachexia is an important determinant of the patient's short and long term outcomes. This prospective study was conducted to determine the association between cachexia at diagnosis and overall survival of patients with aggressive B-cell non-Hodgkin's Lymphoma (ABNHL) Methods:This investigator initiated single centre prospective observational study was conducted at the Tata Medical Center, Kolkata, India between Jan 2015 and Mar 2019 after IRB approval. Patients diagnosed with ABNHL receiving standard of care chemo-immunotherapy were eligible. This study was supported by an educational research grant from Baxter to our institution. All patients who consented to participate were screened for cachexia at entry using a modified Subjective Global Assessment (SGA) tool (1). Baseline clinical factors of prognostic importance including stage, IPI score, etc. were recorded. All statistical analysis was carried out using EpiInfo-ver.7 software. Results:239 patients diagnosed with high grade B-NHL were recruited. The study group included 89 women and 150 men, and 77 (32.1%) were older than 65 years. 130 (54.3%) patients received private care. 88(36.8%) had IPI stage high-intermediate plus high grade; 136 (56.9%) had Ann Arbor stage III plus IV disease; 40 (16.7%) had extra-nodal NHL; 96 (40.1%) had weight loss and 107(44.7%) had reduced food intake. Cachexia scores estimated by the modified SGA tool was SGA-A in 101, SGA-B in 120 and SGA-C in 18 patients. Only 37 (15.4%) had been subjected to screening for malnutrition prior to cancer treatment. 44 (20.5%) patients experienced neutropenic sepsis during treatment. At a median follow up of 457 days, 69% achieved complete remission at the end of initial therapy, 50 (20.9%) patients died during the study period. In univariate analysis, SGA, IPI, Stage and age groups were statistically significant prognostic markers. The 2-year actuarial survival of all patients adjusted for SGA, IPI and Stage was 72%. The two-year actuarial survival in the SGA-A, SGA-B, and SGA-C groups were respectively 80%, 68% and 45% (p<0.001). In a multivariate analysis using cox proportional hazards method the hazard ratio for SGA B was 1.67 (0.94-2.97), and SGA-C was 3.65, after adjusting for IPI and stage groups (p=0.0137).The follow up is continuing and final multivariate analysis will be done when sufficient events have occurred. Conclusions:Cachexia at diagnosis is an important independent prognostic biomarker in patients with ABNHL. The role of routine screening for cachexia before initiating treatments and providing individualized medical nutrition therapy along with physical therapy during chemotherapy to prevent worsening of cachexia and improve survival needs evaluation. References: 1.Shirodkar M etal, Indian J Gastroenterol.2005; 24:246-50 Figure Disclosures Patra: Baxter: Research Funding. Mallath:Otsuka Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Speakers Bureau; GlaxoSmithKline: Research Funding; Baxter: Research Funding; Otsuka Pharmaceuticals: Honoraria; Bristol-Myers Squibb: Honoraria; Bayer-Zydus Pharma: Honoraria; Sayre-Therapeutics: Honoraria.

Accuracy for mortality prediction with additive biomarkers including interleukin-6 in critically ill patients: a multicenter prospective observational study

2020 ◽  
Author(s):  
Ryo Yamamoto ◽  
Junichi Sasaki ◽  
Takayuki Shibusawa ◽  
Taka-aki Nakada ◽  
Toshihiko Mayumi ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Mortality Prediction ◽  
University Hospitals ◽  
Discrimination Power

Abstract Background: Several inflammation markers have been reported to be associated with unfavorable clinical outcomes in critically ill patients. We aimed to elucidate whether serum IL-6 concentration considered with sequential organ failure assessment (SOFA) score can better predict mortality in critically ill patients.Methods: A prospective observational study was conducted at five university hospitals in 2016–2018. Critically ill adult patients who met ≥2 systemic inflammatory response syndrome criteria on admission were included, and those who died or discharged within 48 hours were excluded. Inflammatory biomarkers including interleukin (IL) -6, -8, and -10, tumor necrosis factor-α, and procalcitonin were blindly measured daily for 3 days. Area under the receiver operating characteristic curve (AUROC) for SOFA score at Day 2 according to 28-day mortality was calculated as a baseline. Combination models of SOFA score and additional biomarkers were developed using logistic regression, and AUROC calculated in each model was compared with the baseline.Results: Among 161 patients included in the study, 18 (11.2%) did not survive at Day 28. Univariate analysis for each biomarker identified that the IL-6 (Days 1–3), IL-8 (Days 0–3), and IL-10 (Days 1–3) were higher in non-survivors versus survivors. Analyses of 28-day mortality prediction by a single biomarker showed IL-6, -8, and -10 at Days 1–3 had a significant discrimination power, and the IL-6 at Day 3 had the highest AUROC (0.766 [0.656–0.876]). Baseline AUROC for SOFA score predicting 28-day mortality was 0.776 (0.672–0.880). The combination model using additional IL-6 concentration at Day 3 had higher AUROC than baseline (AUROC = 0.844, AUROC improvement = 0.068 [0.002–0.133]), whereas other biomarkers did not improve accuracy in predicting 28-day mortality.Conclusions: Accuracy for 28-day mortality prediction was improved by adding serum IL-6 concentration to SOFA score.Trial registration: N/A (This study did not include any health-related interventions)

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