Abstract 316: Missing Data and the SOFA Score in Cardiac Arrest Research: A Scoping Review

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Anne V Grossestreuer ◽  
Tuyen Yankama ◽  
Ari Moskowitz ◽  
Long H Ngo ◽  
Michael Donnino
Keyword(s):  
Cardiac Arrest ◽  
Missing Data ◽  
Scoping Review ◽  
Sofa Score ◽  
English Language ◽  
Primary Outcome ◽  
Vital Signs ◽  
Sensitivity Analyses ◽  
Inclusion Criteria ◽  
Time Points

Introduction: The Sequential Organ Failure Assessment (SOFA) score is often used as an outcome or exposure in cardiac arrest studies. SOFA requires lab values and vital signs at certain time points which often results in missing data. How this missing data is handled is unknown. Methods: We performed a scoping review of PubMed, EMBASE, and Web of Science. English language peer-reviewed manuscripts were included. Titles/abstracts were screened by two independent reviewers to assess if they met inclusion criteria. Studies that met inclusion criteria were retrieved in full; those that did not were excluded. Disagreements between reviewers were resolved by a third reviewer. Results: The initial search provided 408 abstracts, 142 underwent full-text review (kappa: 0.91), and 66 were included (5 randomized controlled trials, 26 prospective and 25 retrospective studies). The studies had a median of 151 (IQR: 55, 278) subjects. SOFA was used as an outcome in 36 (55%) and a primary outcome in 10 (15%). Only 27 (41%) studies reported a method to handle missing SOFA data. The most common method was to exclude subjects with missing data (81%). Other methods were use of maximum SOFA while subjects were alive (11%), modified SOFA after excluding subjects who died prior to the timepoint (11%), and earlier and later SOFA to impute values (4%). When SOFA was the primary outcome, 4 (40%) reported a method; 3 (75%) excluded subjects and one (25%) used modified SOFA. Two studies conducted sensitivity analyses to test assumptions used to handle missing SOFA (one imputed values for death/discharge, one adjusted for mortality difference prior to SOFA measurement). Only 9 studies (14%) mentioned quantity of missing SOFA, ranging from 0-76% (median: 10% [IQR: 6%, 42%]). In the 50 studies using SOFA at time points after baseline, only 11 (22%) mentioned mortality prior to SOFA measurement; when mentioned, it ranged from 3%-76% with a median of 12% (IQR: 6%-35%). Conclusion: Missing data for SOFA scores used in cardiac arrest studies is pervasive yet often not acknowledged and/or handled with described or consistent methods. These findings illustrate that studies using SOFA may exhibit substantial bias and results could be misinterpreted, particularly if patients with missing data are excluded.

Abstract 13213: The Prognostic Role of Serum Neutrophil Gelatinase Associated Lipocalin in Out of Hospital Cardiac Arrest Patients Who Underwent Targeted Temperature Management

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Changjoo An ◽  
Jung Soo Park ◽  
Changshin Kang ◽  
Yeonho You
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
False Positive Rate ◽  
Neuron Specific Enolase ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Time Points ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase ◽  
Hospital Cardiac Arrest

This study investigated the prognostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). The study included 85 comatose adult patients with OHCA who underwent TTM between May 2018 and December 2020. Serum NGAL and neuron-specific enolase (NSE) were measured at 24-h intervals until 72 h after return of spontaneous circulation (ROSC). The primary outcome was neurological status at 3 months after OHCA. Forty-nine patients (57.6%) had a poor neurological outcome; NGAL levels at all time points measured were significantly higher in these patients than in those with a good outcome (p<0.01). NGAL showed lower maximal sensitivity (95% CI) under a false-positive rate of 0% for the primary outcome compared with NSE (18.2% [95% CI 8.2-32.7] vs. 66.7% [95% CI 50.5-80.4]). Combination of NGAL with NSE at 48 h showed the highest sensitivity (69.1% [95% CI 52.9-82.4]) and had the highest AUC (0.91 [95% CI 0.81-0.96]) for a poor outcome. The prognostic performance of NGAL alone was inadequate at all time points. However, NGAL obtained at 24 and 48 h after ROSC showed improved sensitivity when combined with NSE. NGAL should be considered as an additional biomarker to improve accuracy for prognostication in these patients.

scholarly journals Factors Predicting Cardiac Arrest in the Intensive Care Unit: A Matched Case-Control Study

2021 ◽  
Author(s):  
Wentao Sang ◽  
Yuhui Pan ◽  
Xue Zhao ◽  
Shuo Wu ◽  
Wen Zheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Case Control Study ◽  
Vital Signs ◽  
Case Control ◽  
Time Points ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Abstract Background: Early detection and intervention of disease deterioration are the keys to reducing the incidence of preventable intensive care unit cardiac arrest (ICU-CA). We aimed to investigate the ICU-CA predictive factors, including vital signs and laboratory indicators, and to analyze the performance of trends value of those factors on predicting ICU-CA. Methods: We conducted a matched case-control study at Qilu Hospital of Shandong University. Data on adult patients in ICU who suffered a cardiac arrest (CA) were retrospectively collected from 2016 to 2019, including vital signs and laboratory indicators at 48, 36, 24, 12, and 8 hours before ICU-CA. These cases were matched (ward, sex, and admission data) with controls (no ICU-CA) at a 1:2 ratio. Univariable logistic regression was used for statistical comparisons between cases and controls, and multivariate logistic regression was used to investigate the independent associations of indicators and their tendency with ICU-CA at given time points. The area under receiver operating characteristic (AUROC) was used to evaluate the predictive performance on ICU-CA.Results: Of 6164 ICU patients, 1042 patients suffered an ICU-CA during the 3 years. After careful screening, a total of 427 patients were included as the cases in the study, and 790 patients were included as controls. The vital signs and laboratory indicators at 8h before cardiac arrest, such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation (SaO2), hemoglobin (HGB), potassium (K+), sodium (Na+), lactic acid (Lac), and pH all can predict the ICU-CA. The mean value, maximum value, minimum value, and range of these indicators were related to the occurrence of ICU-CA, and the trend values were more accurate than the current value for the variability in laboratory indicators. Conclusions: The ability of trends value of laboratory indicators for predicting ICU-CA was more accurate than the value at given time points for the variability in laboratory indicators. Adding trends of laboratory indicators may increase the accuracy of models designed to detect critical illness in ICU. Trial registration: ClinicalTrials.gov Identifier: NCT04670458.

Cryotherapy and compression in sports injury management: a scoping review

2021 ◽  
Vol 28 (10) ◽  
pp. 1-19
Author(s):  
Jill Alexander ◽  
James Selfe ◽  
Olivia Greenhalgh ◽  
David Rhodes
Keyword(s):  
Scoping Review ◽  
English Language ◽  
Sports Injury ◽  
Free Text ◽  
Inclusion Criteria ◽  
Current Position ◽  
Medical Subject Headings ◽  
Comprehensive Review ◽  
Injury Management ◽  
Therapeutic Benefits

Background/Aims For the management of sports injury, cryotherapy is commonly applied, yet modalities differ extensively in application including levels of compression. The aim of this study was to provide a comprehensive review of the current position in the literature on contemporary cryo-compression applications for musculoskeletal sports injury management. Methods A total of eight databases were searched: Sport Discus, Science Direct, CINHAL, Scopus, PubMed, Cochrane, ProQuest and MEDLINE. Publications were restricted to 30 years and had to be in the English language. Medical subject headings, free-text words, and limiting descriptors for concepts related to cryotherapy and compression for sports injury were applied. Inclusion criteria determined at least one modality of cryotherapy treatment applied simultaneous to compression or as a comparison, relevant to sports injury management. Modalities included cryo-compressive devices and gel/ice packs, in association with concomitant compression. Male, female, healthy and injured participants were included. Two reviewers independently selected eligible articles, resulting in 22 studies meeting the inclusion criteria following full-text appraisal. Results Inconsistent methodologies, low sample sizes and variability in outcome measures provided uncertainty over optimum protocols. A lack of previous understanding in the protocols in the available literature for isolated cryotherapy/compression applications prevents understanding of the therapeutic benefits of combined cryo-compression. No definitive agreement behind optimal cryo-compression applications were identified collectively from studies other than the consensus that compression aids the magnitude of cooling. Conclusions Although compression appears a useful adjunct to cooling modalities for the management of sports injury, no definitive agreement on optimum compression concurrent with cooling protocols were drawn from the studies. This was because of several methodological gaps in reporting throughout studies, highlighting a lack of studies that represent applications of compression and cryotherapy within a sporting context or applied nature within the available research.

scholarly journals A scoping review of COVID-19 experiences of people living with dementia

2021 ◽  
Vol 112 (3) ◽  
pp. 400-411
Author(s):  
Juanita-Dawne R. Bacsu ◽  
Megan E. O’Connell ◽  
Claire Webster ◽  
Lisa Poole ◽  
Mary Beth Wighton ◽  
...  
Keyword(s):  
Scoping Review ◽  
English Language ◽  
Neuropsychiatric Symptoms ◽  
Original Research ◽  
Inclusion Criteria ◽  
Letters To The Editor ◽  
People With Dementia ◽  
Care Partners ◽  
Services And Supports ◽  
The Impact

Abstract Objectives Compared with the general population, people living with dementia have been unequivocally affected by the COVID-19 pandemic. However, there is a paucity of knowledge on the COVID-19 impact on people with dementia and their care partners. The objective of this scoping review was to synthesize the existing literature on the COVID-19 experiences of people with dementia and their care partners. Methods Following Arksey and O’Malley’s scoping review framework, we searched five electronic databases (Scopus, PubMed, CINAHL, EMBASE, and Web of Science) and an online search engine (Google Scholar). Inclusion criteria consisted of English-language articles focusing on the COVID-19 experiences of people with dementia and their care partners. Synthesis Twenty-one articles met our inclusion criteria: six letters to the editor, seven commentaries, and eight original research studies. In the literature, five main themes were identified: (i) care partner fatigue and burnout; (ii) lack of access to services and supports; (iii) worsening neuropsychiatric symptoms and cognitive function; (iv) coping with COVID-19; and (v) the need for more evidence-informed research. Factors such as living alone, having advanced dementia, and the length of confinement were found to exacerbate the impact of COVID-19. Conclusion Urgent action is needed to support people living with dementia and their care partners in the pandemic. With little access to supports and services, people with dementia and their care partners are currently at a point of crisis. Collaboration and more evidence-informed research are critical to reducing mortality and supporting people with dementia during the pandemic.

scholarly journals Experience on Prenatal Gentle Yoga Exercise during Pregnancy: A Scoping Review

2020 ◽  
Author(s):  
Migita Vidia Amita ◽  
◽  
Sri Ratnaningsih ◽  
Keyword(s):  
Scoping Review ◽  
English Language ◽  
Critical Appraisal ◽  
Negative Impact ◽  
Data Extraction ◽  
Well Being ◽  
Free Access ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Exercise During Pregnancy

ABSTRACT Background: The accelerated pace of physical and psychological changes during pregnancy can cause discomfort for pregnant women. Several studies claimed that maternal stress, depression, and anxiety level have a negative impact on birth outcomes. Yoga is a well-known exercise for emotional relaxation therapy. This study aimed to investigate the benefits of prenatal yoga exercise during pregnancy. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selec­tion; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included Willey Online library, PubMed, and ScienceDirect databases. The inclusion criteria were English-language, full-text, and free access articles published between 2009 and 2019. The selected articles were appraised by Joanna Briggs Institute Critical Appraisal tools. The data were reported by the PRISMA flow chart. Results: A total of 2,232 articles obtained from the search database, in which 2,093 articles were irrelevant, 95 duplicates, and 24 articles unmet inclusion criteria were excluded. Based on the selected 20 articles, eleven articles obtained A grade, and nine articles obtained B grade with quantitative (RCT, quasi-experiment, cross-sectional) and qualitative (focus group discussion) study designs. For main thematic findings reviewed were physical, psychological, labor process, and fetal benefits of prenatal gentle yoga exercise during pregnancy. Conclusion: Prenatal gentle yoga exercise has benefits for both mother and fetus, especially the psychological well-being of mothers by reducing stress and anxiety. Active participation of husbands is required to enhance the effectiveness of prenatal yoga. Keywords: prenatal gentle yoga, pregnancy, benefit Correspondence: Migita Vidia Amita. Faculty of Public Health, Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi (Ring Road Barat) No. 63 Mlangi, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: [email protected]. Mobile: +6281466841970. DOI: https://doi.org/10.26911/the7thicph.03.74

scholarly journals EMR Precharting Efficiency in Internal Medicine: A Scoping Review

2021 ◽  
Vol 8 ◽  
pp. 238212052110324
Author(s):  
Chip A Bowman ◽  
Horatio Holzer
Keyword(s):  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Grey Literature ◽  
Health Record ◽  
Inclusion Criteria ◽  
Medical Undergraduate ◽  
Education Medical ◽  
Scholarly Data ◽  
Potential Improvement

Purpose: The act of precharting, or navigating the EMR to review a patient’s recent vitals, labs, notes, and other results, is something that is required of every clinician prior to effective rounding on patients. The purpose of this scoping review is to review the extant literature on precharting. Methods: Scholarly data through OVID on Medscape and grey literature were systematically searched with extensive inclusion criteria including the terms “Pre-round” “precharting” as well as “student” “education” or “teach” adjacent to “EMR” or “electronic medical record” or “electronic health record” or “documentation.” We collated this with “education, medical, undergraduate,” or “Students/medical.” Results: As of September 23, 2020, 241 scholarly articles were identified. No grey literature were identified. Inclusion criteria included full article access, English language, and covering the precharting topic. Seventeen articles met inclusion criteria and were included in the review. These articles included 1 direct observational study, 1 retrospective study, 2 qualitative studies, 5 EMR workshop trainings, 1 perspective piece, 1 curriculum analysis, and 6 articles based on survey measures. Of these articles, the majority were published recently, with 8 of the 17 published since 2018. Summary of the limited existing literature can be distilled into 3 findings: a need for timely EMR data extraction, the potential optimization of EMR workflow, and the benefit of time intensive EMR trainings. Conclusions: This scoping review explored the existing scholarly and grey literature to summarize the review of precharting and education surrounding navigating the EMR for medical students as a means of exploring the topic to determine current practices and identify areas of potential improvement.

scholarly journals Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review

2020 ◽  
pp. 089198872092471
Author(s):  
Catherine M. Alexander ◽  
Anthony Martyr ◽  
Sharon A. Savage ◽  
Robin G. Morris ◽  
Linda Clare
Keyword(s):  
Scoping Review ◽  
Clinical Utility ◽  
English Language ◽  
Well Being ◽  
Personal Health ◽  
Inclusion Criteria ◽  
Search Terms ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Pick Disease

Background: Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. Method: A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. Results: We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. Conclusions: Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.

scholarly journals Use of SOFA score in cardiac arrest research: A scoping review

2020 ◽  
Vol 4 ◽  
pp. 100040
Author(s):  
Anne V. Grossestreuer ◽  
Tuyen T. Yankama ◽  
Ari Moskowitz ◽  
Long Ngo ◽  
Michael W. Donnino
Keyword(s):  
Cardiac Arrest ◽  
Scoping Review ◽  
Sofa Score

Treatment of missing data in follow-up studies of randomised controlled trials: A systematic review of the literature

2017 ◽  
Vol 14 (4) ◽  
pp. 387-395 ◽  
Author(s):  
Thomas R Sullivan ◽  
Lisa N Yelland ◽  
Katherine J Lee ◽  
Philip Ryan ◽  
Amy B Salter
Keyword(s):  
Statistical Analysis ◽  
Missing Data ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Sensitivity Analyses ◽  
Follow Up Studies ◽  
Statistical Approaches ◽  
Randomised Controlled

Background/aims: After completion of a randomised controlled trial, an extended follow-up period may be initiated to learn about longer term impacts of the intervention. Since extended follow-up studies often involve additional eligibility restrictions and consent processes for participation, and a longer duration of follow-up entails a greater risk of participant attrition, missing data can be a considerable threat in this setting. As a potential source of bias, it is critical that missing data are appropriately handled in the statistical analysis, yet little is known about the treatment of missing data in extended follow-up studies. The aims of this review were to summarise the extent of missing data in extended follow-up studies and the use of statistical approaches to address this potentially serious problem. Methods: We performed a systematic literature search in PubMed to identify extended follow-up studies published from January to June 2015. Studies were eligible for inclusion if the original randomised controlled trial results were also published and if the main objective of extended follow-up was to compare the original randomised groups. We recorded information on the extent of missing data and the approach used to treat missing data in the statistical analysis of the primary outcome of the extended follow-up study. Results: Of the 81 studies included in the review, 36 (44%) reported additional eligibility restrictions and 24 (30%) consent processes for entry into extended follow-up. Data were collected at a median of 7 years after randomisation. Excluding 28 studies with a time to event primary outcome, 51/53 studies (96%) reported missing data on the primary outcome. The median percentage of randomised participants with complete data on the primary outcome was just 66% in these studies. The most common statistical approach to address missing data was complete case analysis (51% of studies), while likelihood-based analyses were also well represented (25%). Sensitivity analyses around the missing data mechanism were rarely performed (25% of studies), and when they were, they often involved unrealistic assumptions about the mechanism. Conclusion: Despite missing data being a serious problem in extended follow-up studies, statistical approaches to addressing missing data were often inadequate. We recommend researchers clearly specify all sources of missing data in follow-up studies and use statistical methods that are valid under a plausible assumption about the missing data mechanism. Sensitivity analyses should also be undertaken to assess the robustness of findings to assumptions about the missing data mechanism.

scholarly journals Prehospital Triage Tools across the World: A Scoping Review of the Published Literature

2021 ◽  
Author(s):  
Smitha Bhaumik ◽  
Merhej Hannun ◽  
Chelsea Dymond ◽  
Kristen DeSanto ◽  
Whitney Barrett ◽  
...  
Keyword(s):  
Scoping Review ◽  
English Language ◽  
Pediatric Population ◽  
Vital Signs ◽  
High Income ◽  
Prehospital Emergency Care ◽  
Vessel Occlusion ◽  
The World ◽  
Prehospital Triage ◽  
Trauma Triage

Abstract BackgroundAccurate triage of the undifferentiated patient is a critical task in prehospital emergency care. This scoping review aims to identify published tools used for prehospital triage across the world and describe their performance characteristics.MethodsA comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. ResultsOf 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n=19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies, and resulting articles, were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. The general triage tools aggregated prehospital vital signs, mental status assessments, and sometimes, features of the history, exam, and anticipated resource need, to categorize patients into numerical or color categories to represent level of acuity. The studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. The stroke triage tools were designed to promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Stroke triage literature evaluates tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools sought to identify patients that require immediate transport to trauma centers with emergency surgery capability. The studies on trauma triage evaluate prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge.ConclusionsThe published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools, without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial RegistrationNot applicable.

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