Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study

BackgroundFew prospective studies have evaluated the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) criteria in emergency department (ED)settings. The aim of this study was to determine the prognostic accuracy of qSOFA compared with systemic inflammatory response syndrome (SIRS) in predicting the 28-day mortality of infected patients admitted to an ED.MethodsA prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital, Denmark, was conducted from 1 October 2017 to 31 March 2018. Patients were enrolled consecutively and data related to SIRS and qSOFA criteria were obtained from electronic triage record. Information regarding mortality was obtained from the Danish Civil Registration System. The original cut-off values of ≥2 was used to determine the prognostic accuracy of SIRS and qSOFA criteria for predicting 28-day mortality and was assessed by analyses of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI).ResultsA total of 2112 patients were included in this study. A total of 175 (8.3%) patients met at least two qSOFA criteria, while 1012 (47.9%) met at least two SIRS criteria on admission. A qSOFA criteria of at least two for predicting 28-day mortality had a sensitivity of 19.5% (95% CI 13.6% to 26.5%) and a specificity of 92.6% (95% CI 91.4% to 93.7%). A SIRS criteria of at least two for predicting 28-day mortality had a sensitivity of 52.8% (95% CI 44.8% to 60.8%) and a specificity of 52.5% (95% CI 50.2% to 54.7%). The AUROC values for qSOFA and SIRS were 0.63 (95% CI 0.59 to 0.67) and 0.52 (95% CI 0.48 to 0.57), respectively.ConclusionBoth SIRS and qSOFA had poor sensitivity for 28-day mortality. qSOFA improved the specificity at the expense of the sensitivity resulting in slightly higher prognostic accuracy overall.

Download Full-text

Prospective validation of quick Sequential Organ Failure Assessment (qSOFA) for mortality among patients with infection admitted to an emergency department

Dansk Tidsskrift for Akutmedicin ◽

10.7146/akut.v2i3.112933 ◽

2019 ◽

Vol 2 (3) ◽

pp. 26

Author(s):

Osama Bin Abdullah

Keyword(s):

Emergency Department ◽

Organ Failure ◽

Predictive Value ◽

Receiver Operating Curve ◽

Registration System ◽

Civil Registration ◽

Failure Assessment ◽

Qsofa Score ◽

Sensitivity Specificity ◽

Admission Variables

Background: Only few prospective studies have evaluated the new quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in emergency department (ED) settings. The aim of this study was to determine the prognostic value of qSOFA compared to systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality of infected patients admitted to an ED. Methods: A prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital during 01.10.2017 to 31.03.2018. All patients with suspected or documented infection on arrival to the ED, and treated with antibiotics, were included. Admission variables included in the SIRS- and qSOFA criteria were prospectively obtained from triage forms. Information regarding 28-day mortality was obtained from the Danish Civil Registration System. The diagnostic performance of qSOFA and SIRS score for predicting 28-day mortality was assessed by analyses of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC) with 95% confidence intervals (CI). Results: A total of 2,168 patients (47.42% male) were included. A total of 181 (8.35%) met at least two qSOFA criteria, and 1,046 (48.25%) met at least two SIRS criteria on admission. The overall 28-day mortality was 7.47% (95% CI 6.40-8.66%). Unadjusted odds ratio of qSOFA and SIRS for 28-day mortality was 2.93 (95% CI 1.92-4.47) vs 1.27 (95% CI 0.92-1.74), respectively. A qSOFA score of at least two for predicting 28-day mortality had a sensitivity of 19.10% (95% CI 13.40-26.00%), a specificity of 92.50% (95% CI 91.30-93.60%), a PPV and NPV of 17.10% (95% CI 11.90-23.40%) and 93.40% (95% CI 92.20-94.50%), respectively. A SIRS score of at least two for predicting 28-day mortality had a sensitivity of 53.70 (95% CI 45.70-61.60%), a specificity of 52.20% (95% CI 50.00-54.40%), a PPV and NPV of 8.32% (95% CI 6.72-10.20%) and 93.30% (95% CI 91.70-94.70%), respectively. The AUC for qSOFA and SIRS was 0.56 (95% CI 0.53-0.59) vs 0.53 (95% CI 0.49-0.57). Conclusion: Use of qSOFA had improved specificity, but with poor sensitivity, in predicting in 28-day mortality. qSOFA and SIRS showed similar discrimination potential for mortality.

Download Full-text

Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽

10.3390/diagnostics9030109 ◽

2019 ◽

Vol 9 (3) ◽

pp. 109 ◽

Cited By ~ 1

Author(s):

Ukweh ◽

Ugbem ◽

Okeke ◽

Ekpo

Keyword(s):

Predictive Value ◽

Performance Metrics ◽

Area Under The Curve ◽

Youden Index ◽

Likelihood Ratios ◽

Diagnostic Efficacy ◽

Predictive Values ◽

Resource Setting ◽

Post Test ◽

Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

Download Full-text

Predicting 1p/19q codeletion status using diffusion-, susceptibility-, perfusion-weighted, and conventional MRI in IDH-mutant lower-grade gliomas

Acta Radiologica ◽

10.1177/0284185120973624 ◽

2020 ◽

pp. 028418512097362

Author(s):

Xiefeng Yang ◽

Yu Lin ◽

Zhen Xing ◽

Dejun She ◽

Yan Su ◽

...

Keyword(s):

Predictive Value ◽

Operating Characteristic ◽

Cerebral Blood Volume ◽

Characteristic Curve ◽

Lower Grade ◽

Dynamic Susceptibility ◽

Dynamic Susceptibility Contrast ◽

Conventional Mri ◽

Susceptibility Contrast ◽

Sensitivity Specificity

Background Isocitrate dehydrogenase (IDH)-mutant lower-grade gliomas (LGGs) are further classified into two classes: with and without 1p/19q codeletion. IDH-mutant and 1p/19q codeleted LGGs have better prognosis compared with IDH-mutant and 1p/19q non-codeleted LGGs. Purpose To evaluate conventional magnetic resonance imaging (cMRI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) for predicting 1p/19q codeletion status of IDH-mutant LGGs. Material and Methods We retrospectively reviewed cMRI, DWI, SWI, and DSC-PWI in 142 cases of IDH mutant LGGs with known 1p/19q codeletion status. Features of cMRI, relative ADC (rADC), intratumoral susceptibility signals (ITSSs), and the value of relative cerebral blood volume (rCBV) were compared between IDH-mutant LGGs with and without 1p/19q codeletion. Receiver operating characteristic curve and logistic regression were used to determine diagnostic performances. Results IDH-mutant and 1p/19q non-codeleted LGGs tended to present with the T2/FLAIR mismatch sign and distinct borders ( P < 0.001 and P = 0.038, respectively). Parameters of rADC, ITSSs, and rCBVmax were significantly different between the 1p/19q codeleted and 1p/19q non-codeleted groups ( P < 0.001, P = 0.017, and P < 0.001, respectively). A combination of cMRI, SWI, DWI, and DSC-PWI for predicting 1p/19q codeletion status in IDH-mutant LGGs resulted in a sensitivity, specificity, positive predictive value, negative predictive value, and an AUC of 80.36%, 78.57%, 83.30%, 75.00%, and 0.88, respectively. Conclusion 1p/19q codeletion status of IDH-mutant LGGs can be stratified using cMRI and advanced MRI techniques, including DWI, SWI, and DSC-PWI. A combination of cMRI, rADC, ITSSs, and rCBVmax may improve the diagnostic performance for predicting 1p/19q codeletion status.

Download Full-text

Utility of Thrombin Time in Management of Patients with Green Pit Vipers Bite

SAGE Open Medicine ◽

10.1177/2050312120966468 ◽

2020 ◽

Vol 8 ◽

pp. 205031212096646

Author(s):

Achara Tongpoo ◽

Pimjai Niparuck ◽

Charuwan Sriapha ◽

Winai Wananukul ◽

Satariya Trakulsrichai

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Operating Characteristic ◽

Fibrinogen Level ◽

Characteristic Curve ◽

International Normalized Ratio ◽

Thrombin Time ◽

Coagulation Tests ◽

Sensitivity Specificity ◽

Gold Standards

Objectives: GGreen pit vipers (GPV) envenomation causes consumptive coagulopathy mainly by thrombin-like enzymes. Fibrinogen levels are generally investigated to help evaluate systemic envenomation. However, tests of fibrinogen levels may not be available in every hospital. This study aimed to determine the sensitivity, specificity and accuracy for a range of various coagulation tests (20 minute whole blood clotting test (20WBCT), prothrombin time, international normalized ratio and thrombin time (TT)), comparing to the two gold standards performed in patients with GPV bite. Methods: This was the pilot study which we retrospectively reviewed fibrinogen level results including the hospital records of 24 GPV ( Trimeresurus albolabris or macrops) bite patients visiting Ramathibodi Hospital, Thailand during 2013–2017 with 65 results of fibrinogen levels. The fibrinogen levels <164 and <100 mg/dL were used as the standard cut-off points or gold standards as the abnormal low and critical levels, respectively. Results: Most were male. All had local effects. For fibrinogen levels <164 and <100 mg/dL, prolonged TT had the highest sensitivity of 57.1% and 82.4%; the negative predictive value of 74.5% and 93.6%; the accuracy of 81.0% and 92.1%; and the area under a receiver operating characteristic curve of 0.762 and 0.873, respectively. For fibrinogen levels <164, unclotted 20WBCT and prolonged TT had the highest specificity and positive predictive value of 100% all. For fibrinogen levels <100, unclotted 20WBCT had the highest specificity and positive predictive value of 100% both, while prolonged TT had the specificity and positive predictive value of 95.7% and 87.5%, respectively. One patient developed isolated thrombocytopenia without hypofibrinogenemia and coagulopathy. Conclusions: Among four coagulation tests, TT was the most sensitive and accurate test to indicate hypofibrinogenemia in GPV bite patients. In case of unavailable fibrinogen levels thrombin time might be investigated to help evaluate patients’ fibrinogen status. Isolated thrombocytopenia could occur in GPV envenomation.

Download Full-text

A negative D-dimer identifies patients at low risk of death within 30 days: a prospective observational emergency department cohort study

QJM ◽

10.1093/qjmed/hcz140 ◽

2019 ◽

Vol 112 (9) ◽

pp. 675-680 ◽

Cited By ~ 3

Author(s):

L E Lyngholm ◽

C H Nickel ◽

J Kellett ◽

S Chang ◽

T Cooksley ◽

...

Keyword(s):

Emergency Department ◽

Vital Signs ◽

Low Risk ◽

Clinical Indication ◽

Medical Patients ◽

Prognostic Information ◽

Registration System ◽

Civil Registration ◽

Risk Of Death ◽

D Dimer

Abstract Objective To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. Design In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. Setting The Hospital of South West Jutland. Patients All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. Main results The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02–0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. Conclusion Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.

Download Full-text

Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-017-3068-7 ◽

2017 ◽

Vol 36 (12) ◽

pp. 2361-2369 ◽

Cited By ~ 22

Author(s):

J. González del Castillo ◽

◽

A. Julian-Jiménez ◽

F. González-Martínez ◽

J. Álvarez-Manzanares ◽

...

Keyword(s):

Emergency Department ◽

Prognostic Accuracy ◽

Qsofa Score ◽

Sirs Criteria

Download Full-text

Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

Advances in Emergency Medicine ◽

10.1155/2014/241935 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Case Newsom ◽

Rebecca Jeanmonod ◽

Karl Weller ◽

Nabil Boutros ◽

Mark Reiter ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Congestive Heart Failure ◽

Chest Pain ◽

Alcohol Abuse ◽

Decision Rule ◽

Predictive Value ◽

Breath Sounds ◽

History Of ◽

Sensitivity Specificity

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

Download Full-text

Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department

BMJ Open ◽

10.1136/bmjopen-2021-048795 ◽

2021 ◽

Vol 11 (9) ◽

pp. e048795

Author(s):

Bram Kok ◽

Frederik Schuit ◽

Arthur Lieveld ◽

Kaoutar Azijli ◽

Prabath WB Nanayakkara ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Diagnostic Accuracy ◽

Prospective Observational Study ◽

Lung Ultrasound ◽

Final Diagnosis ◽

Likelihood Ratios ◽

Reverse Transcription Pcr ◽

Registration Number ◽

Sensitivity Specificity

BackgroundBedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy.DesignA multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED.Setting/patientsAdult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR.MeasurementsWe assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard.ResultsBetween 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16.ConclusionIdentifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement.Trial registration numberNL8497.

Download Full-text

Diagnostic accuracy of a urine dipstick for detecting albuminuria in hypertensive patients

F1000Research ◽

10.12688/f1000research.25564.3 ◽

2021 ◽

Vol 9 ◽

pp. 1244

Author(s):

Phornwipa Panta ◽

Win Techakehakij

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Operating Characteristic ◽

Characteristic Curve ◽

Hypertensive Patients ◽

Spot Urine ◽

Urine Dipstick ◽

Urine Albumin ◽

Low Sensitivity ◽

Sensitivity Specificity

Background: Screening for albuminuria is generally recommended among patients with hypertension. While the urine dipstick is commonly used for screening urine albumin, there is little evidence about its diagnostic accuracy among these patients in Thailand. This study aimed to assess the diagnostic accuracy of a dipstick in Thai hypertensive patients for detecting albuminuria. Methods: This study collected the data of 3,067 hypertensive patients, with the results of urine dipstick and urine albumin-to-creatinine ratio (ACR) from random single spot urine being examined in the same day at least once, at Lampang Hospital, Thailand, during 2018. For ACR, a reference standard of ≥ 30 mg/g was applied to indicate the presence of albuminuria. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the trace result from dipsticks were 53.6%, 94.5%, 86.5%, and 75.5%, respectively. The area under the receiver operating characteristic curve of the dipstick was 0.748. Conclusion: Using the dipstick for screening albuminuria among hypertensive patients should not be recommended for mass screening due to its low sensitivity. In response to high PPV, a trace threshold of the dipstick may be used to indicate presence of albuminuria.

Download Full-text

Validation of the Indonesian Version of Modified Checklist for Autism in Toddlers: a diagnostic study

Paediatrica Indonesiana ◽

10.14238/pi60.3.2020.159-65 ◽

2020 ◽

Vol 60 (3) ◽

pp. 159-65

Author(s):

Hendra Salim ◽

Soetjiningsih Soetjiningsih ◽

I Gusti Ayu Trisna Windiani ◽

I Gede Raka Widiana ◽

PITIKA ASPR

Keyword(s):

Predictive Value ◽

Characteristic Curve ◽

Area Under The Curve ◽

Negative Likelihood Ratio ◽

Autism Spectrum ◽

Diagnostic Study ◽

Diagnostic Validity ◽

Dsm Iv ◽

Pediatric Outpatients ◽

Sensitivity Specificity

Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated. Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia. Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value. Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions. Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.

Download Full-text