scholarly journals Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmanuel Nkonge ◽  
Olivia Kituuka ◽  
William Ocen ◽  
Herbert Ariaka ◽  
Alfred Ogwal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Teaching Hospital ◽  
Adverse Outcomes ◽  
Secondary Peritonitis ◽  
Prolonged Hospital Stay ◽  
Resource Limited ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Prolonged Hospital

Abstract Background SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. A tertiary teaching hospital in Uganda uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However, there are associated delays in decision making given SIRS partial reliance on laboratory parameters which are often not quickly available in a resource limited emergency setting. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool. However, its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in a resource limited setting of a tertiary teaching hospital in a low and middle income country like Uganda. Objective To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis among patients on the adult surgical wards in a tertiary teaching hospital in Uganda. Methods This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the Accident and Emergency unit and the adult surgical wards of a tertiary teaching hospital in Uganda. QSOFA and SIRS scores were generated for each patient, with a score of ≥2 recorded as high risk, while a score of < 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13. Results A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS. Conclusion SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

scholarly journals Comparison of QSOFA and SIRS Scores for the Prediction of Adverse Outcomes of Secondary Peritonitis in a Tertiary Teaching Hospital in Uganda: a Prospective Cohort Study

2021 ◽  
Author(s):  
Emmanuel Nkonge ◽  
Olivia Kituuka ◽  
William Ocen
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Adverse Outcomes ◽  
Secondary Peritonitis ◽  
Mulago Hospital ◽  
Prolonged Hospital Stay ◽  
Prolonged Hospital

Abstract Background: SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. Mulago hospital uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However it’s associated with delays in decision making given its partial reliance on laboratory parameters. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool, however its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in Mulago hospital, Uganda.Objective: To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis in Mulago hospital, Uganda.Methods: This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the A&E, Mulago hospital. QSOFA and SIRS scores were generated for each of the patient, with a score of ≥ 2 recorded as high risk, while a score of ≤ 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13Results: A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS.Conclusion: SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

scholarly journals Needlestick and sharps injuries in an Indonesian tertiary teaching hospital from 2014 to 2017: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041494
Author(s):  
Evy Yunihastuti ◽  
Dewi Mira Ratih ◽  
Matdoan Rifkiah Aisyah ◽  
Ainum Jhariah Hidayah ◽  
Alvina Widhani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Teaching Hospital ◽  
Healthcare Workers ◽  
Medical Doctors ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
The Mean ◽  
Sharps Injury ◽  
Sharps Injuries ◽  
Needlestick And Sharps Injuries

ObjectiveNeedlestick and sharps injuries among healthcare workers (HCWs) pose significant occupational health problems. We aim to provide incidence and other epidemiological aspects of needlestick and sharp injuries (NSSIs) among HCWs in a tertiary teaching hospital in Indonesia, to inform the evaluation of NSSIs prevention programme.MethodsA cohort study was conducted at Cipto Mangunkusumo Hospital in Jakarta. We analysed data of the sharps injury programme at the hospital between January 2014 and December 2017. Incidence of NSSIs was calculated per 1000 person-years (1000-PY).ResultsOver the 4-year period, a total of 286 NSSIs were reported. The mean NSSIs incidence rate for 4 years was 13.3/1000-PY, peaking in 2015 (15.5/1000-PY) then decreasing afterward. Most NSSIs were experienced by nurses (42.7%), but the highest incidence was among midwives (18.9/1000-PY), followed by nurses, medical students and medical doctors (15.2/1000-PY, 12.6/1000-PY and 11.8/1000-PY, respectively). The devices causing the highest proportion of NSSIs were hollow-bore needles (66.8%), followed by suture needles (14.3%) and solid needles (10.8%). 9.4% of NSSIs were related to insulin pen injection. Of all the incidents, 31.3% occurred during surgical procedures, 25.9% during blood collections, 14.3% during administering injection of drugs and 13.3% during waste cleaning.ConclusionIn conclusion, this study showed varied incidences of NSSI among different occupations, with the highest among midwives and nurses. Many unsafe work practices still continue, which is of utmost concern. We suggest opportunities for prevention including training and cultivating safer workplace practices.

scholarly journals Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

2020 ◽  
Author(s):  
Ephraim Teffera Yeheyis ◽  
Seyoum Kassa ◽  
Hiwot Yeshitila ◽  
Abebe Bekele
Keyword(s):  
Blood Pressure ◽  
Esophageal Cancer ◽  
Systolic Blood Pressure ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Postoperative Outcome ◽  
Adverse Outcomes ◽  
Prolonged Hospital Stay ◽  
Intraoperative Hypotension ◽  
Prolonged Hospital

Abstract Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods Prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak and prolonged hospital stay were analyzed as outcome variables Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. Mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 .2 % (n=29) of patients; of these, 7.4% (n=4) had anastomotic leak (OR 1.2, 95% CI 0.26-6.3; p=0.76) , mortality was 5.5% (n=3) (OR 1.44, 95% CI 0.22- 9.3; p =0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34 ).Over all anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9.2% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite out comes of mortality, anastomotic leak and prolonged hospital stay (AOR 1.06 ,95% CI 0.98-1.14; p=0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association either with individual or composite adverse outcomes of mortality, anastomotic leak and prolonged hospital stay.

scholarly journals Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

2020 ◽  
Author(s):  
Ephraim Teffera Yeheyis ◽  
Seyoum Kassa ◽  
Hiwot Yeshitila ◽  
Abebe Bekele
Keyword(s):  
Blood Pressure ◽  
Esophageal Cancer ◽  
Systolic Blood Pressure ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Adverse Outcomes ◽  
Prolonged Hospital Stay ◽  
Intraoperative Hypotension ◽  
The Mean ◽  
Prolonged Hospital

Abstract Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods Prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak and prolonged hospital stay were analyzed as outcome variables Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 % (n=29) of patients. Anastomotic leak occurred in 7% (n=4) (OR 1.2, 95% CI 0.26-6.3; p=0.76) . In-hospital mortality was 5 % (n=3) (OR 1.44, 95% CI 0.22- 9.3; p =0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34 ).The overall anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p=0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 minutes during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.

scholarly journals Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ephraim Teffera Yeheyis ◽  
Seyoum Kassa ◽  
Hiwot Yeshitela ◽  
Abebe Bekele
Keyword(s):  
Blood Pressure ◽  
Esophageal Cancer ◽  
Systolic Blood Pressure ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Adverse Outcomes ◽  
Prolonged Hospital Stay ◽  
Intraoperative Hypotension ◽  
The Mean ◽  
Prolonged Hospital

Abstract Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables. Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26–6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22–9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14–1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98–1.14; p = 0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.

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