scholarly journals Predictive value of Score for Neonatal Acute Physiology and Perinatal Extension II for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia

2017 ◽  
Vol 56 (5) ◽  
pp. 257
Author(s):  
I Gede Ketut Aryana ◽  
I Made Kardana ◽  
I Nyoman Adipura
Keyword(s):  
Intensive Care ◽  
Neonatal Mortality ◽  
Goodness Of Fit ◽  
Assessment Tool ◽  
Area Under The Curve ◽  
Severe Infection ◽  
Scoring Systems ◽  
World Health ◽  
Severe Illness ◽  
Goodness Of Fit Test

Background Neonatal mortality, which is largely caused by severe illness, is the biggest contributor to overall infant mortality. The World Health Organization (WHO) estimated that 4 million neonates die yearly worldwide, often due to severe infection and organ system immaturity. Neonates with severe illness require treatment in the neonatal intensive care unit (NICU), in which a reliable assessment tool for illness severity is needed to guide intensive care requirements and prognosis. Neonatal disease severity scoring systems have been developed, including Score for Neonatal Acute Physiology and Perinatal Extension II  (SNAPPE II), but it has never been validated in our setting.ObjectiveTo study the prognostic value of SNAPPE II as a predictor of neonatal mortality in Sanglah Hospital, Denpasar, Indonesia.Methods This prospective cohort study was conducted in the NICU of Sanglah Hospital, Denpasar from November 2014 to February 2015. All neonates, except those with congenital anomaly, were observed during the first 12 hours of admission and their outcomes upon discharge from the NICU was recorded. We assessed the SNAPPE II cut-off point to predict neonatal mortality. The calibration of SNAPPE II was done using the Hosmer-Lemeshow goodness-of-fit test, and discrimination of SNAPPE II was determined from the receiver-operator characteristic (ROC) curve and area under the curve (AUC) value calculation.ResultsDuring the period of study, 63 children were eligible, but 5 were excluded because of major congenital abnormalities. The SNAPPE II optimum cut-off point of 37 gave a high probability of mortality and the ROC showed an AUC of 0.92 (95%CI 0.85 to 0.99). The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with P = 1.0Conclusion The SNAPPE II  has a good predictive ability for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia.

scholarly journals Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rahmet Guner ◽  
Bircan Kayaaslan ◽  
Imran Hasanoglu ◽  
Adalet Aypak ◽  
Hurrem Bodur ◽  
...  
Keyword(s):  
Intensive Care ◽  
Goodness Of Fit ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Severe Illness ◽  
P Value ◽  
Goodness Of Fit Test ◽  
Logistic Regression Models ◽  
Predictive Parameters

Abstract Background Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. Methods Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer–Lemeshow Goodness-of-fit test, and calibration curve analysis. Results Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902–0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899–0.947). Hosmer–Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). Conclusion We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

scholarly journals A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study

10.2196/14540 ◽  
2019 ◽  
Vol 7 (8) ◽  
pp. e14540 ◽  
Author(s):  
Madison Vanosdoll ◽  
Natalie Ng ◽  
Anthony Ho ◽  
Allison Wallingford ◽  
Shicheng Xu ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Health Workers ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Ease Of Use ◽  
World Health ◽  
Severe Illness ◽  
Home Setting ◽  
Danger Signs ◽  
Neonatal Assessment

Background While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda.

scholarly journals External validation of the European risk assessment tool for cardio metabolic disease in a Middle Eastern population

2020 ◽  
Author(s):  
Samaneh Asgari ◽  
Fatemeh Moosaie ◽  
Davood Khalili ◽  
Fereidoun Azizi ◽  
Farzad Hadaegh
Keyword(s):  
Metabolic Disease ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Goodness Of Fit ◽  
Assessment Tool ◽  
External Validation ◽  
Iranian Population ◽  
Risk Assessment Tool ◽  
Goodness Of Fit Test

Abstract Background: High burden of chronic cardio-metabolic disease (CCD) including type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and cardiovascular disease (CVD) have been reported in the Middle East and North Africa region. We aimed to externally validate a Europoid risk assessment tool designed by Alssema et al, including non-laboratory measures, for the prediction of the CCD in the Iranian population. Methods: The predictors included age, body mass index, waist circumference, use of antihypertensive, current smoking, and family history of cardiovascular disease and or diabetes. For external validation of the model in the Tehran lipids and glucose study (TLGS), the Area under the curve (AUC) and the Hosmer-Lemeshow (HL) goodness of fit test were performed for discrimination and calibration, respectively. Results: Among 1310 men and 1960 women aged 28-85 years, 29.5% and 47.4% experienced CCD during the 6 and 9-year follow-up, respectively. The model showed acceptable discrimination, with an AUC of 0.72(95% CI: 0.69-0.75) for men and 0.73(95% CI: 0.71-0.76) for women. The calibration of the model was good for both genders (min HL P=0.5). Considering separate outcomes, AUC was highest for CKD (0.76(95% CI: 0.72-0.79)) and lowest for T2DM (0.65(95% CI: 0.61-0.69)), in men. As for women, AUC was highest for CVD (0.82(95% CI: 0.78-0.86)) and lowest for T2DM (0.69(95% CI: 0.66-0.73)). The 9-year follow-up demonstrated almost similar performances compared to the 6-year follow-up. Conclusion: This model showed acceptable discrimination and good calibration for risk prediction of CCD in short and long-term follow-up in the Iranian population.

Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study

2020 ◽  
Author(s):  
Davide Carino ◽  
Paolo Denti ◽  
Guido Ascione ◽  
Benedetto Del Forno ◽  
Elisabetta Lapenna ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Goodness Of Fit ◽  
Area Under The Curve ◽  
High Volume ◽  
Brier Score ◽  
Calibration Plot ◽  
Valve Repair ◽  
Goodness Of Fit Test ◽  
High Level

Abstract OBJECTIVES The EuroSCORE II is widely used to predict 30-day mortality in patients undergoing open and transcatheter cardiac surgery. The aim of this study is to evaluate the discriminatory ability of the EuroSCORE II in predicting 30-day mortality in a large cohort of patients undergoing surgical mitral valve repair in a high-volume centre. METHODS A retrospective review of our institutional database was carried on to find all patients who underwent mitral valve repair in our department from January 2012 to December 2019. Discrimination of the EuroSCORE II was assessed using receiver operating characteristic curves. The maximum Youden’s Index was employed to define the optimal cut-point. Calibration was assessed by generating calibration plot that visually compares the predicted mortality with the observed mortality. Calibration was also tested with the Hosmer–Lemeshow goodness-of-fit test. Finally, the accuracy of the models was tested calculating the Brier score. RESULTS A total of 2645 patients were identified, and the median EuroSCORE II was 1.3% (0.6–2.0%). In patients with degenerative mitral regurgitation (MR), the EuroSCORE II showed low discrimination (area under the curve 0.68), low accuracy (Brier score 0.27) and low calibration with overestimation of the 30-day mortality. In patients with secondary MR, the EuroSCORE II showed a good overall performance estimating the 30-day mortality with good discrimination (area under the curve 0.88), good accuracy (Brier score 0.003) and good calibration. CONCLUSIONS In patients with degenerative MR operated on in a high-volume centre with a high level of expertise in mitral valve repair, the EuroSCORE II significantly overestimates the 30-day mortality.

scholarly journals Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit

2018 ◽  
Vol 07 (04) ◽  
pp. 201-206 ◽  
Author(s):  
Priyamvada Tyagi ◽  
Mukesh Agrawal ◽  
Milind Tullu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Roc Curve ◽  
Goodness Of Fit ◽  
Pediatric Intensive Care ◽  
Goodness Of Fit Test ◽  
Risk Of Mortality ◽  
Pediatric Index Of Mortality ◽  
Good Calibration

Aims To compare and validate the Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) 2, and PIM 3 scores in a tertiary care pediatric intensive care unit (PICU) (Indian setting). Materials and Methods All consecutively admitted patients in the PICU of a public hospital (excluding those with unstable vital signs or cardiopulmonary resuscitation within 2 hours of admission, cardiopulmonary resuscitation before admission, and discharge or death in less than 24 hours after admission) were included. PRISM III, PIM 2, and PIM 3 scores were calculated. Mortality discrimination for the three scores was calculated using the receiver operating characteristic (ROC) curve, and calibration was performed using the Hosmer–Lemeshow goodness-of-fit test. Results A total of 350 patients were included (male:female = 1.3:1) over the study duration of 18 months (median age: 12 months [interquartile range: 4–60 months]). Nearly half were infants (47.4%). Patients with central nervous system disease were the highest (22.8%) followed by cardiovascular system (20.6%). Mortality rate was 39.4% (138 deaths). The area under the ROC curve for the PRISM III score was 0.667, and goodness-of-fit test showed no significant difference between the observed and expected mortalities in any of these categories (p > 0.5), showing good calibration. Areas under the ROC curve for the PIM 2 and PIM 3 scores were 0.728 and 0.726, respectively. For both the scores, the goodness-of-fit test showed good calibration. Conclusions Although all the three scores demonstrate good calibration, the PIM 2 and PIM 3 scores have an advantage regarding the better discrimination ability, ease of data collection, simplicity of computation, and inherent capacity of not being affected by treatment in PICU.

84 Development of a Risk Prediction Model and Comparison with Clinical Severity Scores in Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S54-S55
Author(s):  
Dohern Kym
Keyword(s):  
Prediction Model ◽  
Goodness Of Fit ◽  
Scoring Systems ◽  
Clinical Severity ◽  
Brier Score ◽  
P Value ◽  
Burn Patients ◽  
Goodness Of Fit Test ◽  
Prediction Of Mortality ◽  
Severity Scores

Abstract Introduction The purpose of this study was to develop a new prediction model to reflect the risk of mortality and severity of disease and to evaluate the ability of the developed model to predict mortality among adult burn patients. Methods This study included 2009 patients aged more than 18 years who were admitted to the intensive care unit (ICU) within 24 hours after a burn. We divided the patients into two groups; those admitted from January 2007 to December 2013 were included in the derivation group and those admitted from January 2014 to September 2017 were included in the validation group. Shrinkage methods with 10-folds cross-validation were performed to identify variables and limit overfitting of the model. The discrimination was analyzed using the area under the curve (AUC) of the receiver operating characteristic curve. The Brier score, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were also calculated. The calibration was analyzed using the Hosmer-Lemeshow goodness-of-fit test (HL test). The clinical usefulness was evaluated using a decision-curve analysis. Results The new prediction model showed good calibration with the HL test (χ2=8.785, p=0.361); the highest AUC and the lowest Brier score were 0.943 and 0.068, respectively. The NRI and IDI were 0.124 (p-value = 0.003) and 0.079 (p-value < 0.001) when compared with FLAMES, respectively. Conclusions This model reflects the current risk factors of mortality among adult burn patients. Furthermore, it was a highly discriminatory and well-calibrated model for the prediction of mortality in this cohort. Applicability of Research to Practice There are many severity scoring systems widely used in the ICU to predict outcomes and characterize the severity of the disease. All of these scoring systems have been developed for the mixed population in the ICU. Their accuracy among subgroups, such as burn patients, is questionable and therefore, burn-specific scoring systems are required for accurate prediction.

Predictive Validity of the Cubbin-Jackson and Braden Skin Risk Tools in Critical Care Patients: A Multisite Project

2021 ◽  
Vol 30 (2) ◽  
pp. 140-144
Author(s):  
Jill M. Delawder ◽  
Samantha L. Leontie ◽  
Ralitsa S. Maduro ◽  
Merri K. Morgan ◽  
Kathie S. Zimbro
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Assessment Tool ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Braden Scale ◽  
Skin Integrity

Background Patients in intensive care units are 5 times more likely to have skin integrity issues develop than patients in other units. Identifying the most appropriate assessment tool may be critical to preventing pressure injuries in intensive care patients. Objectives To validate the Cubbin-Jackson skin risk assessment in the critical care setting and to compare the predictive accuracy of the Cubbin-Jackson and Braden scales for the same patients. Methods In 5 intensive care units, the Cubbin-Jackson and Braden assessments were completed by different clinicians within 61 minutes of each other for 4137 patients between October 2017 and March 2018. Bivariate correlations and the Fisher exact test were used to check for associations between the scores. Results The Cubbin-Jackson and Braden scores were significantly and positively correlated (r = 0.80, P < .001). Both tools were significant predictors of skin changes and identified as “at risk” 100% of the patients who had a change in skin integrity occur. The specificity was 18.4% for the Cubbin-Jackson scale and 27.9% for the Braden scale, and the area under the curve was 0.75 (P < .001) for the Cubbin-Jackson scale and 0.76 (P < .001) for the Braden scale. These findings show acceptable construct validity for both scales. Conclusions The predictive validities of the Cubbin-Jackson and Braden scales are similar, but both are sub-optimal because of poor specificity and positive predictive value. Change in practice may not be warranted, because there are no differences between the 2 scales of practical benefit to bedside nurses.

The Braden Scale for Predicting the Outcome and Prognosis of Pressure Injuries in Older Inpatients: A Multicenter, Retrospective Cohort Study

2021 ◽  
Vol 33 (5) ◽  
pp. 127-135
Author(s):  
Yi-Ping Song ◽  
Man-Li Zha ◽  
Hong-Wu Shen ◽  
Yang Li ◽  
Lin Du ◽  
...  
Keyword(s):  
Respiratory Diseases ◽  
Goodness Of Fit ◽  
Operating Characteristic ◽  
Healing Rate ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Goodness Of Fit Test ◽  
Braden Scale ◽  
Older Inpatients ◽  
Digestive System Diseases

Introduction. The Braden scale is used to assess the risk of patients with pressure injuries (PIs), but there are limitations to the prediction of PI healing. There is a lack of tools for evaluating PI healing and outcome in clinical practice. Objective. The purpose of this study was to examine the ability of the Braden scale to predict the outcome and prognosis of PIs in older patients. Materials and Methods. Outcome indicator was the wound healing rate of patients with PIs at discharge. The receiver operating characteristic (ROC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination and calibration. Results. Completed data were available for 309 patients, 181 of whom (58.6%) were male. The Braden scale had poor discrimination to predict the outcome and prognosis of PIs with an area under the curve (AUC) of 0.63 (95% CI, 0.56–0.70; P = .01). Subgroup analyses showed the Braden scale had low diagnostic value for patients aged over 90 years (AUCROC = 0.56; 95% CI, 0.17–0.96; P = .738), patients with respiratory diseases (AUCROC = 0.51; 95% CI, 0.37–0.65; P = .908), and digestive system diseases (AUCROC = 0.59; 95% CI, 0.42–0.75; P = .342). The level of calibration ability by Hosmer-Lemeshow goodness-of-fit test was acceptable, defined as P >.200 (χ2 = 6.59; P = .473). In patients aged more than 90 years (χ2 = 4.88; P = .431) and female patients (χ2 = 7.03; P = .425), the Braden scale was also fitting. It was not suitable for patients with respiratory diseases (χ2 = 11.35; P = .078). Conclusions. The Braden scale had low discrimination for predicting the outcome and prognosis of PIs in older inpatients. The development of a new tool is needed to predict healing in patients with preexisting PIs.

Practised sedation in mechanically ventilated patients: A survey of nurses’ perceptions

2020 ◽  
Vol 40 (2) ◽  
pp. 105-112
Author(s):  
Vivian Nystrøm ◽  
Brita Fosser Olsen ◽  
Idunn Brekke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Assessment Tool ◽  
Scoring Systems ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Nurses Perceptions ◽  
Light Sedation

Recent clinical practice guidelines recommend analgosedation in intensive care unit patients, where the patients' pain first is relieved, followed by sedatives only on indication. The aims of the present study was to examine sedation practice today, to evaluate the degree to which there is a difference in sedation practice between units, and to investigate the associations between nurses' demographic characteristics and their perception of sedation practice. A cross sectional survey was conducted to the nurses in three intensive care units in Norway. The results indicated that light sedation was implemented in the three intensive care unit studied. Continuous infusion of propofol and dexmedetomidine were used most frequently, and continuous infusion of midazolam was used occasionally. However, the sedation practices varied significantly between the units. Subjective scoring systems, physician's prescriptions, and prescription follow-up were reported to be most frequently used as guidelines and directives, and Richmond Agitation–Sedation Scale was reported to be the most frequently used sedation assessment tool.

Validity of the Framingham Risk Model Applied to Japanese Men

2002 ◽  
Vol 41 (03) ◽  
pp. 213-215 ◽  
Author(s):  
H. Sugimori ◽  
K. Yoshida ◽  
M. Suka
Keyword(s):  
Goodness Of Fit ◽  
Risk Model ◽  
Area Under The Curve ◽  
Health Examination ◽  
Characteristic Analysis ◽  
Goodness Of Fit Test ◽  
Japanese Men ◽  
Discriminatory Accuracy ◽  
Framingham Risk ◽  
Chd Risk

Summary Objectives: To examine whether the Framingham Risk Model can appropriately predict coronary heart disease (CHD) events detected by electrocardiography (ECG) in Japanese men. Methods: Using the annual health examination database of a Japanese company 5611 male workers, between the ages of 30 to 59, who were free of cardiovascular disease, were followed up to observe the occurrence of CHD events detected by ECG over a period of five to seven years. The probability of CHD was calculated for each individual from the equations of the Framingham risk model (with total cholesterol). Results: The incidence of CHD increased with the estimated CHD risk. The Hosmer-Lemeshow goodness of fit test showed an adequate fit of the risk model to the data of the study subjects. In the receiver operating characteristic analysis, the area under the curve reached 0.67 which indicated an acceptable discriminatory accuracy of the risk model. Conclusions: The Framingham risk model provides useful information on future CHD events in Japanese men.

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