Abstract W P256: Influence of Withdrawal of Care on Spontaneous Intracerebral Hemorrhage Predictive Scales

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Santiago Ortega Gutierrez ◽  
maria angeles aranda calleja ◽  
Pankhil Shah ◽  
Sergio Amaro Delgado ◽  
sachin agarwal ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Medical Records ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Youden Index ◽  
Major Influence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Radiological Criteria ◽  
Ich Score

Background: Various scoring systems combining different predictors have been developed to more accurately predict the short and long-term outcome after ICH. However, these different scoring systems do not take into account the major influence of the primary cause of mortality in ICH, namely the withdrawal of care (WC). We aim to compare the in-hospital mortality prediction performance after accounting for WC of three widely used scoring systems, the original ICH score (oICH), the ICH Grading scale (ICH-GS), and the simplified ICH score (sICH), in a cohort of ICH patients prior to the development of the aforementioned scales. Methods: Retrospective observational single center cohort study of adult patients presenting a confirmed diagnosis of ICH. Admission clinical and radiological criteria were obtained through review of medical records and CT at admission. In-hospital mortality was selected as a primary outcome and obtained from the medical records. In the event of death, groups weredivided into: ICH-direct cause of death (cardiac arrest or brain death) andneurological devastation leading to WC. Scoring systems were calculated in each individual patient. Receiver operating characteristic (ROC) analysis was used to assess the ability of each score to predict in-hospital mortality and the maximum Youden Index was identified to denote each score’s optimal predictive cutoff point for each scale. The area under the curve (AUC) between groups was compared by using the Delong et al method. P< 0.05 was set as statistically significant. Conclusion: Performance of ICH scoring systems accurately predicted in-hospital mortalityeven when WC care is taken into account.

Clinicopathological Features of Remnant Gastric Cancer After Gastrectomy

2021 ◽  
pp. 000313482110562
Author(s):  
Kenichi Iwasaki ◽  
Edward Barroga ◽  
Yota Shimoda ◽  
Masaya Enomoto ◽  
Erika Yamada ◽  
...  
Keyword(s):  
Medical Records ◽  
Tumor Invasion ◽  
Cox Regression ◽  
Remnant Stomach ◽  
Invasion Depth ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
Tumor Invasion Depth

Background Remnant gastric cancer (RGC) encompasses all cancers arising from the remnant stomach. Various studies have reported on RGC and its prognosis, but no consensus on its surgical treatment and postoperative management has been reached. Moreover, the correlation between the clinicopathological characteristics and long-term outcomes of RGC remains unclear. This study investigated the clinicopathological factors associated with the long-term survival of RGC patients. Methods The medical records (March 1993-September 2020) of 104 RGC patients from Tokyo Medical University Hospital database were analyzed. Of these 104 patients, the medical records of 63 patients who underwent surgical curative resection were analyzed using R. Kaplan-Meier plots of cumulative incidence of RGC were made. Differences in survival rates were compared using the log-rank test. Prognostic factors were analyzed using multivariate Cox regression analysis ( P < .05). Results Of the 104 RGC patients, 63 underwent total remnant stomach excision. The median time from the first surgery to the total excision was 10 years. The 5-year survival rate of the 63 RGC patients was .55 ((95% CI); .417-.671). The clinicopathological factors that were significantly associated with the long-term outcome of the RGC patients were tumor diameter (≥3.5 cm), presence or absence of combined resection of multiple organs, tumor invasion (deeper than T2), TNM stage, and postoperative morbidity. The multivariate Cox regression analysis showed that tumor invasion depth was the only independent prognostic factor for RGC patients [HR (95% CI): 5.49 (2.629-11.5), P ≤ .005]. Conclusions Among prognostic factors, tumor invasion depth was the only independent factor affecting RGC’s long-term outcome.

Abstract TP366: National Institutes of Health Stroke Scale (NIHSS) is a Potent Predictor of Outcome in Acute Intracerebral Hemorrhage

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Suzie Kazaryan ◽  
Nerses Sanossian ◽  
David S Liebeskind ◽  
Sidney Starkman ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Strong Predictor ◽  
Final Diagnosis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Acute Cerebral Ischemia ◽  
History Of ◽  
Acute Intracerebral Hemorrhage ◽  
Ich Score

Background: Although the NIHSS is a well-validated tool in assessing neurological deficit and predicting long-term outcome in acute cerebral ischemia, its utility in ICH has not been extensively studied. As NIHSS is routinely obtained in cases of stroke prior to imaging, it is often available in ICH patients to potentially assist physicians in triage, prognostication, and risk-adjustment. Methods: We analyzed consecutive patients enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial whose final diagnosis was ICH. Trained study nurses performed the NIHSS in the Emergency Department (ED) shortly after arrival and the modified Rankin Scale (mRS) at 90 days. Primary outcomes were disability or death (mRS 3-6) and mortality. Candidate potential predictor variables, including NIHSS, ICH Score, and GCS, those with threshold of p<0.10 were candidate parameters for backward selection logistic regression to determine independent predictors of disability or death and of mortality. Results: Among the 384 ICH patients, age was mean 65 (±13); female 34%; race white 78%, black 10%, Asian 10%; Hispanic ethnicity 33%; and history of hypertension 78%. The ED NIHSS and GCS was performed a median 148 minutes (IQR 121-180) after last known well. Initial NIHSS was median 16 (IQR 9-16), GCS 15 (IQR 10-15), and ICH Score 1(IQR 0-2). NIHSS correlated with ICH Score (r=0.780) and GCS (r=0.860). At 90 days, median mRS was 4 (IQR 2-6), disability or death (mRS 3-6) was present in 70%, and mortality occurred in 26%. In predicting disability or death at 90 days, c statistics were: NIHSS 0.81, ICH Score 0.81, and GCS 0.72. NIHSS≥14 showed 72% sensitivity and 75% specificity. For mortality by 90 days, c statistics were: NIHSS 0.78, ICH Score 0.80, and GCS 0.73. NIHSS≥19 had 80% sensitivity and 70% specificity. On multivariate analysis age (OR 1.07, 95%CI 1.04-2.0) and NIHSS (OR 1.18, 95%CI 1.13-1.23) were independent predictors of disability and death. Conclusions: The initial NIHSS is a strong predictor of disability and death and good predictor of mortality after intracerebral hemorrhage, performing as well as the ICH Score and better than the GCS. Consideration should be given to routine performance and documentation of the NIHSS in ICH patients.

scholarly journals The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan

2019 ◽  
Author(s):  
Mai Thi Ngoc Nguyen ◽  
Nobuyuki Saito ◽  
Yukiko Wagatsuma
Keyword(s):  
Hospital Mortality ◽  
Charlson Comorbidity Index ◽  
Epidemiologic Study ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Comorbidity Index

Abstract Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia.Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70-84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1[1-3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07-1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.

scholarly journals The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan

2019 ◽  
Author(s):  
Mai Thi Ngoc Nguyen ◽  
Nobuyuki Saito ◽  
Yukiko Wagatsuma
Keyword(s):  
Hospital Mortality ◽  
Charlson Comorbidity Index ◽  
Epidemiologic Study ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Comorbidity Index

Abstract Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia.Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70-84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1[1-3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07-1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.

scholarly journals Modified Systemic Inflammation Score Is an Independent Predictor of Long-Term Outcome in Patients Undergoing Surgery for Adenocarcinoma of the Esophagogastric Junction

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianping Xiong ◽  
Wenzhe Kang ◽  
Fuhai Ma ◽  
Hao Liu ◽  
Shuai Ma ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Esophagogastric Junction ◽  
Scoring Systems ◽  
Roc Curve Analysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lymphocyte To Monocyte Ratio ◽  
Adenocarcinoma Of Esophagogastric Junction ◽  
Systemic Inflammation Score ◽  
Inflammation Score

Background: The modified systemic inflammation score (mSIS), which is calculated by a composite score of the lymphocyte-to-monocyte ratio and the albumin content in serum, is identified as the new score to predict the prognosis for various cancers. However, its significance for patients with adenocarcinoma of esophagogastric junction (AEJ), who receive surgery, remains unclear.Methods: This study retrospectively analyzed 317 patients with AEJ receiving surgery between September 2010 and December 2016. The associations between the mSIS and the clinicopathological features, overall survival (OS), as well as relapse-free survival (RFS), were assessed. In addition, the time-dependent receiver operating characteristic (t-ROC) curve analysis was performed for comparing the value of those scoring systems in predicting patient prognosis.Results: Of the 317 cases, 119 were rated as mSIS 0, 123 as mSIS 1, and 75 as mSIS 2. Besides, mSIS was significantly related to age and tumor size. On multivariate analysis, mSIS was identified as a predictor to independently predict OS (p &lt; 0.001) along with RFS (p &lt; 0.001), and a significantly strong correlation was observed at the advanced pTNM stages based on the mSIS system. In the subgroup analysis of adjuvant chemotherapy and surgery alone, mSIS was still the predictor for independently predicting patient OS (p &lt; 0.001) together with RFS (p &lt; 0.001) for the two groups. T-ROC analysis showed that mSIS was more accurate than controlling nutritional status score in predicting OS and RFS.Conclusions: The mSIS can serve as an easy, useful scoring system to independently predict the preoperative survival for AEJ cases undergoing surgery.

scholarly journals The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Mai Thi Ngoc Nguyen ◽  
Nobuyuki Saito ◽  
Yukiko Wagatsuma
Keyword(s):  
Hospital Mortality ◽  
Charlson Comorbidity Index ◽  
Epidemiologic Study ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Comorbidity Index

Abstract Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia. Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70–84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1 [1–3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07–1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.

scholarly journals Objective Scoring Evaluation and Uroflowmetry Assessment of Two-Stage Hypospadias Repair: Single Center Experience

2013 ◽  
Vol 12 (2) ◽  
pp. 133-139
Author(s):  
Naser S Hussein ◽  
Shapiee B Samat ◽  
Mohd Abdullah ◽  
Mohd N Gohar
Keyword(s):  
Medical Science ◽  
Scoring Systems ◽  
Hypospadias Repair ◽  
Two Stage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Urethral Plate ◽  
Non Invasive ◽  
Single Center Experience

Background: Hypospadias is a common congenital anomaly affecting the penis, two-stage repair becoming more interesting in era of tubularized –incised urethral plate (TIP). Functional outcome of hypospadias repair either single or two stage is as important as cosmetic outcome. In contemporary series , structured scoring systems (Hypospadias Objective Scoring Evaluation-HOSE and Pediatric Penile Perception Scoring -PPPS), evaluation of photographs and uroflowmetry, were used to assess results of hypospadias repair. Objectives: We have assessed outcomes of two-stage hypospadias repair using Hypospadias Objective Scoring Evaluation(HOSE) and uroflowmetry. Material and Methods: Over a period of eight years, from January 1997 to December 2004, One hundred and twenty six hypospadias patients were treated, ninety of them had two-stage repair and36 single-stage repairs. The HOSE questionnaire and uroflowmetry were obtained to evaluate the long term outcome of two –stage hypospadias repair. Results: The age at time of assessment ranged from 8 to 23 year-old, with mean follow up of 39.78months. Thrifty five patients had proximal hypospadias and 20 had distal varieties of hypospadias. Operations performed were 37 Bracka?s and 18 Byar?s procedures. Of the 55 patients had complete two stage hypospadias repair and agree to participate in the study , Nineteen patients had acceptable HOSE and 36 had non-acceptable score. Uroflow rates of 43 subjects were below the fifth centile in three patients ,equivocal (between 5th and 25th centile ) in four patients and above 25th centile in 36 subjects. Conclusion: Two –stage repair is a suitable technique for all types of hypospadias with versatile outcomes. HOSE and uroflowmetry are simple, easy, non invasive and non expensive tools to assess long term outcomes objectively. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 Page 133-139 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14940

scholarly journals Short and long-term outcome following surgical stabilization of tarsocrural instability in dogs

2016 ◽  
Vol 29 (02) ◽  
pp. 142-148 ◽  
Author(s):  
Lee Beever ◽  
Elvin Kulendra ◽  
Richard Meeson
Keyword(s):  
External Fixator ◽  
Medical Records ◽  
Brief Pain Inventory ◽  
Subsequent Removal ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Major Complications ◽  
Short And Long Term ◽  
Internal Fracture

SummaryObjectives: To evaluate the outcome and complications following surgical stabilization of canine tarsocrural luxations.Methods: Medical records of dogs which were surgically treated for tarsocrural joint instability between February 2007 and June 2014 were reviewed. Surgical technique, complications and long-term outcome (via questionnaire and Canine Brief Pain Inventory) were assessed.Results: Twenty-four dogs (26 joints) were included. All injuries were traumatic. All joints had associated fractures; malleolar in 21/26 limbs (13/26 medial). Eight joints had internal fracture fixation and transarticular external skeletal fixator, six had external fixator alone, four had prosthetic ligaments with external fixator, and four had prosthetic ligaments with external coaptation. Two joints had pantarsal arthrodesis and two primary ligament repair. Complications occurred in 24/26 limbs giving 45 distinct complications; 16 were minor, 29 major, and 31 complications were external fixator associated. Prosthetic ligaments were significantly associated with major complications (p = 0.017); five out of eight required subsequent removal between 105–1006 days. Cost was significantly associated with major complications (p = 0.017) and soft tissue wounds (p = 0.03). Long-term lameness was seen in nine of 14 dogs. There was no association between pain severity (p = 0.3) and pain interference scores (p = 0.198) when comparing stabilization methods.Clinical significance: Complications are common; however many are external fixator related. Prosthetic ligaments are significantly associated with major complications. Regardless of technique, a degree of ongoing lameness is likely.

scholarly journals The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan

2019 ◽  
Author(s):  
Mai Thi Ngoc Nguyen ◽  
Nobuyuki Saito ◽  
Yukiko Wagatsuma
Keyword(s):  
Hospital Mortality ◽  
Charlson Comorbidity Index ◽  
Epidemiologic Study ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Comorbidity Index

Abstract Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia.Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70-84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1[1-3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07-1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.

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