scholarly journals Validation of the Full Outline of Unresponsiveness score coma scale in patients clinically suspected to have acute stroke in the emergency department

2017 ◽  
Vol 24 (5) ◽  
pp. 230-236 ◽  
Author(s):  
Tommy Kwok Ping Lee ◽  
Abdul Karim Bin Kitchell ◽  
Axel Yuet Chung Siu ◽  
Ngan Kwan Chen
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Interrater Reliability ◽  
Coma Scale ◽  
Point Increase

Introduction: The Full Outline of Unresponsiveness score coma scale is a recently introduced coma scale. The objectives of this study were to assess the interrater reliability of the Full Outline of Unresponsiveness score coma scale when physicians and nurses in the emergency department apply the Full Outline of Unresponsiveness score on patients clinically suspected to have acute stroke and to look for any association between Full Outline of Unresponsiveness score coma scale and in-hospital mortality. Methods: Prospective study of 105 patients clinically suspected to have acute stroke recruited in an emergency department in a 4-month period. The Full Outline of Unresponsiveness score coma scale and Glasgow Coma Scale of each patient were assessed by one doctor and one nurse independently. The interrater reliability between physicians and nurses using the Full Outline of Unresponsiveness score and Glasgow Coma Scale score was assessed. The association between the Full Outline of Unresponsiveness score coma scale and in-hospital mortality was analysed using logistic regression, controlled for age, sex and diagnosis. Results: Full Outline of Unresponsiveness score had a good interrater reliability when applied to patients suspected to have acute stroke (kappa = 0.742, 95% confidence interval = 0.626–0.858). This was comparable to Glasgow Coma Scale score with a kappa = 0.796 (95% confidence interval = 0.694–0.898). For every 1-point increase in Full Outline of Unresponsiveness score coma scale, a reduction in in-hospital mortality was observed with an odds ratio of 0.76 (95% confidence interval = 0.63–0.91, p = 0.003), controlled for age, sex and diagnosis. Conclusion: The Full Outline of Unresponsiveness score may be a tool that can be used by emergency department doctors and nurses in assessing clinical stroke patients.

scholarly journals How to interpret urine toxicology tests

2019 ◽  
Vol 105 (2) ◽  
pp. 84-88 ◽  
Author(s):  
Emma M Dyer ◽  
Sormeh Salehian
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Social Services ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale ◽  
Urine Toxicology ◽  
The Family ◽  
Rule Out

A 13-year-old girl presents to the emergency department for the second time with an unresponsive episode. She has a GCS (Glasgow Coma Scale) score of 11 on arrival and all other observations are normal. The story is unclear, but there are ongoing safeguarding concerns and the family are known to social services. All investigations are normal. After a period of observation on the ward, her GCS returns to normal and she appears well. Both on the first presentation and this presentation ingestion of a toxin was suspected. However, this was denied by the patient and urine toxicology screen was negative. Does this rule out toxin ingestion? Will this change your management?

RESEARCH IN SERUM COPEPTIN CONCENTRATION IN THE ACUTE STROKE PATIENTS

2017 ◽  
pp. 156-163
Author(s):  
Thanh Cong Nguyen ◽  
Thi Bich Thuan Le ◽  
Chuyen Le ◽  
Thi Minh Phuong Phan
Keyword(s):  
Ischemic Stroke ◽  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Stroke Patients ◽  
Nihss Score ◽  
Coma Scale

Objectives: To determine serum Copeptin concentration and correlation between serum Copeptin concentration with some major predictors of acute stroke patients (ischemic stroke and intracerebral hemorrhage). Subjects and Methods: Cross-sectional descriptive study with 72 patients (40 acute ischemic stroke patients and 32 intracerebral hemorrhage patients at Hue University Hospital. Data processing method is according to usual medical statistics and SPSS 20.0. Results: 1. The serum Copeptin concentration in the patients with acute stroke: - The serum Copeptin concentration in the patients with acute ischemic stroke was 11.28 ± 5.2 pmol/L (admission) and 8.81 ± 4.94 pmol/L (after 7 days). - The serum Copeptin concentration in the patients with acute intracerebral hemorrhage was 9.17 ± 7.97 pmol/L (admission) and 7.14 ± 6.62 pmol/L (after 7 days). - The serum Copeptin concentration in the patients with acute stroke at admission and after 7 days there was not statistically significant difference between female and male (p > 0.05). 2. The correlation between serum Copeptin concentration and severity of acute stroke patients: - The serum Copeptin concentration correlated positively with size of injury (ischemic stroke: r = 0.743; p< 0.001 and intracerebral hemorrhage: r = 0.502; p= 0.003). - The serum Copeptin concentration in the acute stroke patients correlated positively with NIHSS score at admission (ischemic stroke: r = 0.657, p < 0.001 and intracerebral hemorrhage: r = 0.408, p = 0.021). - The serum Copeptin concentration in the acute stroke patients correlated positively with NIHSS score after 7 days (ischemic stroke: r = 0.486, p < 0.001 and intracerebral hemorrhage: r = 0.359, p = 0.044). - The serum Copeptin concentration in the acute stroke patients correlated negatively with Glasgow Coma Scale score at admission (ischemic stroke: r = - 0.564, p < 0.001 and intracerebral hemorrhage: r = - 0.466, p = 0.007).The serum Copeptin concentration in the acute stroke patients correlated negatively with Glasgow Coma Scale score after 7 days (ischemic stroke: r = - 0.499, p < 0.001 and intracerebral hemorrhage: r = - 0.38, p = 0.032). Conclusions: There was correlation between serum Copeptin concentration with severity of acute stroke patients. Key words: Copeptin, acute stroke, ischemic stroke, intracerebral hemorrhage

Predicting Pneumonia in Acute Stroke Patients Using the Glasgow Coma Scale Score

2017 ◽  
Vol 27 (8) ◽  
pp. 522
Author(s):  
Malinee Neelamegam ◽  
Sharad Malavade ◽  
Irene Looi ◽  
Zariah Abdul Aziz ◽  
Norsima Nafizah Sidek
Keyword(s):  
Glasgow Coma Scale ◽  
Acute Stroke ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Stroke Patients ◽  
Coma Scale

scholarly journals Expert-Performed Endotracheal Intubation-Related Complications in Trauma Patients: Incidence, Possible Risk Factors, and Outcomes in the Prehospital Setting and Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yuko Ono ◽  
Takeyasu Kakamu ◽  
Hiroaki Kikuchi ◽  
Yusuke Mori ◽  
Yui Watanabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Trauma Patients ◽  
Coma Scale ◽  
Injured Patients

The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients.

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