Role of ROX Index in the first assessment of COVID-19 patients in the Emergency Department

Abstract Background: In Italy, since the first symptomatic cases of Coronavirus disease 2019 (COVID-19) appeared in late February 2020, 205.463 cases of Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) were reported as of April 30, causing an high rate of hospital admission through the Emergency Department (ED).Objectives: The aim of the study was to evaluate the accuracy of ROX index in predicting hospitalization and mortality in patients with suspected diagnosis of COVID-19 in the ED. Secondary outcomes were to assess the number of readmissions and the variations of ROX index between first and second admission.Methods: This is an observational prospective monocentric study, conducted in the ED of Policlinico Sant’Orsola-Malpighi in Bologna. We enrolled 1371 consecutive patients with suspected COVID-19 and ROX index was calculated in 554 patients. Patients were followed until hospital discharge or death. Results: ROX index value < 25.7 was associated with hospitalization (AUC=0.737, 95%CI 0.696–0.779, p<0.001). ROX index < 22.3 is statistically related with higher 30-days mortality (AUC= 0.764, 95%CI 0.708-0.820, p<0.001). 8 patients were discharged and returned in the ED within the following 7 days, their mean ROX index was 30.3 (6.2; range 21.9-39.4) at the first assessment and 24.6 (5.5; 14.5-29.5) at the second assessment, (p=0.012).Conclusion: ROX index, together with laboratory, imaging and clinical findings, can help discriminate patients suspected for COVID-19 requiring hospital admission, their clinical severity and their mortality risk. Furthermore, it can be useful to better manage these patients in territorial healthcare services, especially in the hypothesis of another pandemic.

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Pathogenic Role of Bacillus Cereus in Wound Infections in the Tropics

Journal of the Royal Society of Medicine ◽

10.1177/014107688708000807 ◽

1987 ◽

Vol 80 (8) ◽

pp. 480-481 ◽

Cited By ~ 5

Author(s):

M S Dryden

Keyword(s):

Bacillus Cereus ◽

Clinical Findings ◽

Costa Rican ◽

High Rate ◽

Wound Infections ◽

Pathogenic Role ◽

Infected Wounds ◽

The Tropics ◽

Nose And Throat

A bacteriological survey was undertaken on clinically infected traumatic wounds amongst a group of young and fit Operation Raleigh members, who were living and working in a remote area of Costa Rican rain forest. All infected wounds were swabbed before treatment and, where possible, at intervals during treatment. Swabs were also obtained from the nose and throat of each patient. All swabs were stored by desiccation in sterile silica gel for culture at a later date. Culture revealed a high rate of isolation of Bacillus cereus from the wounds. The organism was commonly isolated in pure and heavy growth. Contamination by B. cereus was considered and excluded experimentally. Preliminary toxological studies have shown that the majority of the isolates produce a necrotic exotoxin, in keeping with the clinical findings. These results suggest that B. cereus caused significant sepsis in this series of traumatic wounds.

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Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities

Journal of International Medical Research ◽

10.1177/03000605211010638 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110106

Author(s):

Stefan H. Meyering ◽

Chet D. Schrader ◽

Darren Kumar ◽

Yuan Zhou ◽

Naomi Alanis ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Clinical Outcomes ◽

Classification Accuracy ◽

Characteristic Curve ◽

Hospital Readmissions ◽

Day Hospital ◽

Cardiac Events ◽

Heart Score

Objective We aimed to examine the role of the HEART (history, EKG, age, risk factors, and troponin) score in the evaluation of six clinical outcomes among three groups of patients in the emergency department (ED). Methods We performed a retrospective observational study among three ED patient groups including White, Black, and Hispanic patients. ED providers used the HEART score to assess the need for patient hospital admission and for emergent cardiac imaging tests (CITs). HEART scores were measured using classification accuracy rates. Performance accuracies were measured in terms of HEART score in relation to four clinical outcomes (positive findings of CITs, ED returns, hospital readmissions, and 30-day major adverse cardiac events [MACE]). Results A high classification accuracy rate (87%) was found for use of the HEART score to determine hospital admission. HEART scores showed moderate accuracy (area under the receiver operating characteristic curve 0.66–0.78) in predicting results of emergent CITs, 30-day hospital readmissions, and 30-day MACE outcomes. Conclusions Providers adhered to use of the HEART score to determine hospital admission. The HEART score may be associated with emergent CIT findings, 30-day hospital readmissions, and 30-day MACE outcomes, with no differences among White, Black, and Hispanic patient populations.

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Role of Lung Ultrasound in Predicting Clinical Severity and Fatality in COVID-19 Pneumonia

Journal of Personalized Medicine ◽

10.3390/jpm11080757 ◽

2021 ◽

Vol 11 (8) ◽

pp. 757

Author(s):

Ivan Skopljanac ◽

Mirela Pavicic Ivelja ◽

Ognjen Barcot ◽

Ivan Brdar ◽

Kresimir Dolic ◽

...

Keyword(s):

Hospital Admission ◽

Disease Severity ◽

Predictive Power ◽

Lung Ultrasound ◽

Clinical Severity ◽

Imaging Method ◽

High Flow Nasal Cannula ◽

Severity Of The Disease

Background: Lung ultrasound (LUS) is a useful imaging method for identifying COVID-19 pneumonia. The aim of this study was to explore the role of LUS in predicting the severity of the disease and fatality in patients with COVID-19. Methods: This was a single-center, follow-up study, conducted from 1 November 2020, to 22 March 2021. The LUS protocol was based on the assessment of 14 lung zones with a total score up to 42, which was compared to the disease severity and fatality. Results: A total of 133 patients with COVID-19 pneumonia confirmed by RT-PCR were enrolled, with a median time from hospital admission to lung ultrasound of one day. The LUS score was correlated with clinical severity at hospital admission (Spearman’s rho 0.40, 95% CI 0.24 to 0.53, p < 0.001). Patients with higher LUS scores were experiencing greater disease severity; a high flow nasal cannula had an odds ratio of 1.43 (5% CI 1.17–1.74) in patients with LUS score > 29; the same score also predicted the need for mechanical ventilation (1.25, [1.07–1.48]). An LUS score > 30 (1.41 [1.18–1.68]) and age over 68 (1.26 [1.11–1.43]) were significant predictors of fatality. Conclusions: LUS at hospital admission is shown to have a high predictive power of the severity and fatality of COVID-19 pneumonia.

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Factors associated with clinical severity in Emergency Department patients presenting with symptomatic SARS-CoV-2 infection

10.1101/2020.12.08.20246017 ◽

2020 ◽

Author(s):

Sophia Newton ◽

Benjamin Zollinger ◽

Jincong Freeman ◽

Seamus Moran ◽

Alexandra Helfand ◽

...

Keyword(s):

Emergency Department ◽

Logistic Regression ◽

African American ◽

Hospital Admission ◽

Clinical Severity ◽

General Medical Service ◽

Severe Illness ◽

Insurance Status ◽

Public Insurance ◽

Multivariable Logistic Regression

ABSTRACTObjectiveTo measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic Emergency Department (ED) patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection.MethodsThis study is a retrospective case-series of symptomatic patients presenting to a single ED with laboratory-confirmed SARS-CoV-2 infection from March 12-August 9, 2020. We collected patient-level information regarding demographics, public insurance status (Medicare or Medicaid), comorbidities, level of care, and mortality using a structured chart review. We compared demographics and comorbidities of patients who were (1) able to convalesce at home, (2) required admission to general medical service, (3) required admission to intensive care unit (ICU), or (4) died within 30 days of the index visit. Multivariable logistic regression analyses were performed to report adjusted odds ratios (aOR) and the associated 95% confidence intervals (95% CI) with hospital admission versus ED discharge home.ResultsIn total, 993 patients who presented to the ED with symptoms were included in the analysis with 370 (37.3%) patients requiring hospital admission and 70 (7.1%) patients requiring ICU care. Patients requiring admission were more likely to be Black or African American, to be Hispanic or Latino, or to have public insurance (either Medicaid or Medicare.) On multivariable logistic regression analysis comparing which patients required hospital admission, African-American race (aOR 1.4, 95% CI 0.7-2.8) and Hispanic ethnicity (aOR 1.1, 95% CI 0.5-2.0) were not associated with need for admission but, public insurance (Medicaid: aOR 3.4, 95% CI 2.2-5.4; Medicare: aOR 2.6, 95% CI 1.2-5.3; Medicaid and Medicare: aOR 3.6 95% CI 2.1-6.2) and the presence of hypertension (aOR 1.8, 95% CI 1.2-2.7), diabetes (aOR 1.6, 95% CI 1.1-2.5), obesity (aOR 1.7, 95% CI 1.1-2.5), heart failure (aOR 3.9, 95% CI 1.4-11.2), and hyperlipidemia (aOR 1.8, 95% CI 1.2-2.9) were identified as independent predictors of hospital admission.ConclusionComorbidities and public insurance are predictors of more severe illness for patients with SARS-CoV-2. This study suggests that the disparities in severity seen in COVID-19 among African Americans and Hispanics are likely to be closely related to low socioeconomic status and chronic health conditions and do not reflect an independent predisposition to disease severity.

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Role of Lung Ultrasound in the Management of Patients with Suspected SARS-Cov-2 Infection in the Emergency Department

10.21203/rs.3.rs-471145/v1 ◽

2021 ◽

Author(s):

Andrea Boccatonda ◽

Alice Grignaschi ◽

Antonella Lanotte ◽

Fabrizio Giostra ◽

Cosima Schiavone ◽

...

Keyword(s):

Emergency Department ◽

Lung Ultrasound ◽

Ultrasound Examination ◽

Hospitalization Rate ◽

Clinical Severity ◽

A Value ◽

Ultrasound Study ◽

Increased Risk ◽

Level Method

Abstract Background: the LUS score has been proposed as an optimal scheme for the ultrasound study of the patient with suspected / confirmed COVID-19 pneumonia. The aim of our study was to evaluate the use of lung ultrasound as a diagnostic tool for diagnosing SARS-CoV-2 pneumonia, and to examine the validity of LUS score for the diagnosis of COVID-19 pneumonia, and to correlate with hospitalization rate and 30-days mortality.Material & methods: a retrospective analysis was performed on all patients who were referred to the General Emergency Department of the S. Orsola-Malpighi Hospital from April 2020 to May 2020 for symptoms suspected for SARS-CoV-2 infection. The ultrasound examination was based on a common execution scheme called LUS score, as previously described.Results & Conclusions: LUS score correlates with the degree of clinical severity and respiratory failure (P/F ratio, Delta (A-a), Delta (A-a) increase). COVID-19 patients with a LUS score > 7 require the use of oxygen support; a value > 10 is associated with an increased risk of oro-tracheal intubation. The LUS score presents higher values in hospitalized patients, increasing according to the degree of care intensity. COVID-19 died patients were characterized by a mean LUS score of 11 at presentation to the emergency department. A LUS score value > 7.5 displays a sensitivity of 83% and specificity of 89% against 30-days mortality in COVID-19 patients. Lung ultrasound seems to be an optimal first level method for pneumonia detection in patients with suspected SARS-CoV-2 infection.

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286 Predictors and Outcomes of Older Persons Attending the Emergency Department of a Large Acute Dublin Teaching Hospital

Age and Ageing ◽

10.1093/ageing/afz103.181 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Íde O'Shaughnessy ◽

Robert Briggs ◽

Suzanne Timmons ◽

Conal Cunningham

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Older Persons ◽

Strong Predictor ◽

Roc Curves ◽

High Rate ◽

Clinical Frailty Scale ◽

Manchester Triage System ◽

Index Visit ◽

Frailty Status

Abstract Background An emergency department (ED) visit is often considered a sentinel event for an older person due to elevated risks of deleterious outcomes. This prospective cohort study explored factors associated with disposition post ED index visit and unscheduled 30 day revisit. Methods Consecutive ED attendees aged ≥70 years, and Manchester Triage System 3-5, in a 6-month period, were eligible for inclusion. Participants underwent an interdisciplinary assessment by a Home FIRsT (Frailty Intervention & Response Team) member. Logistic regression analyses were performed to identify factors predictive of admission post ED index visit and unscheduled revisit. Predictive validity of frailty instruments were performed using receiver operating characteristic (ROC) curves Results 1,156 ED attendances were included - 59% were female; median age was 80 years; 66% were discharged home post index visit; 17.8% had an unscheduled ED revisit within 30 days. Age and sex did not predict hospital admission. Hospital admission post ED visit was imperfectly predicted by mild-moderate frailty: Clinical Frailty Scale 5-6 (Odds Ratio (OR) 1.83 (95% CI 1.11 – 3.04), p=0.019); ‘Think Frailty’ 3 (OR 1.75 (95% CI 1.07 – 2.85), p=0.025) and 4 (OR 2.32 (95% CI 1.16 – 4.63), p=0.017). Paradoxically, higher frailty scores were not predictive. Cognitive impairment (4AT 1-3) similarly predicted admission (OR 1.62 (95% 1.16 – 2.27, p=0.005), while delirium (4AT ≥4) was the strongest predictor of admission (OR 5.87 (95% CI 3.17 – 10.88, p<0.001). ROC curves of both frailty scales showed moderate ‘diagnostic accuracy’ for admission, but less so for unscheduled revisits. Conclusion Home FIRsT operationalised the assessment of frailty and delirium in the ED. Delirium is a strong predictor of admission post ED index visit, more than frailty status. Older persons have a high rate of 30-day unscheduled revisits; however, it is difficult to produce models from patient information available at index visit that can reliably predict unscheduled revisits.

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The role of perfusion index and plethysmography variability index for predicting dehydration severity in patients with acute gastroenteritis

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919889488 ◽

2019 ◽

pp. 102490791988948

Author(s):

Emine Emektar ◽

Seda Dagar ◽

Hüseyin Uzunosmanoğlu ◽

Gülşah Çıkrıkçı Işık ◽

Şeref Kerem Çorbacıoğlu ◽

...

Keyword(s):

Emergency Department ◽

Acute Gastroenteritis ◽

Clinical Syndrome ◽

Perfusion Index ◽

Fluid Replacement ◽

Severe Dehydration ◽

Cross Sectional ◽

Variability Index ◽

Index Value

Background: Acute gastroenteritis is a clinical syndrome that may cause severe dehydration in affected individuals and a reason of mortality and morbidity in all age groups. Measurement of perfusion index and plethysmography variability index may provide emergency physicians valuable information about hemodynamics of the patient. Objectives: Our study aimed to investigate the role of perfusion index and plethysmography variability index measurement at admission for estimating dehydration severity and determiningthe possible change in those parameters after fluid replacement among patients presenting to emergency department with acute gastroenteritis. Methods: This was a prospective cross-sectional study. Patients diagnosed with acute gastroenteritis at the emergency department were consecutively enrolled. The two groups were defined according to the severity of dehydration: mild and moderate/severe dehydration groups. The values of perfusion index and plethysmography variability index of all patients were measured. Results: A total of 180 patients were included in the study. As compared with the mild dehydration group, moderate/severe dehydration group had a significantly lower perfusion index value and significantly higher plethysmography variability index value on admission (p < 0.001 for both comparisons). Among moderate/severe dehydration patients, perfusion index value significantly increased and plethysmography variability index significantly decreased after treatment (p < 0.001). There was a significant positive correlation between osmolarity and plethysmography variability index (r = 0.298; p = 0.007) and a significant negative correlation between osmolality and perfusion index (r = −0.259; p = 0.019) in the patients with moderate/severe dehydration. Conclusion: The study show that perfusion index and plethysmography variability index may be useful for determining the severity of dehydration in acute gastroenteritis and may be use for assessing the response to fluid replacement especially in patients with severe dehydration at emergency department.

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Prognostic Role of Serum Procalcitonin Measurement in Adult Patients Admitted to the Emergency Department with Fever

Antibiotics ◽

10.3390/antibiotics10070788 ◽

2021 ◽

Vol 10 (7) ◽

pp. 788

Author(s):

Marcello Covino ◽

Alberto Manno ◽

Giuseppe De Matteis ◽

Eleonora Taddei ◽

Luigi Carbone ◽

...

Keyword(s):

Emergency Department ◽

Final Diagnosis ◽

Cross Sectional Study ◽

Clinical Findings ◽

Adult Patients ◽

Hospital Death ◽

Study Cohort ◽

Prognostic Role ◽

Cross Sectional

Background and Objectives. Fever is one of the most common presenting complaints in the Emergency Department (ED). This study aimed at evaluating the prognostic role of serum Procalcitonin (PCT) measurement among adult patients admitted to the ED with fever. Materials and Methods. This is a retrospective cross-sectional study including all consecutive patients admitted to ED with fever and subsequently hospitalized in a period of six-year (January 2014 to December 2019). Inclusion criteria were age > 18 years, fever (T ≥ 38 °C) or chills within 24 h from presentation to the ED as the main symptom, and availability of a PCT determination obtained <24 h since ED access. The primary endpoint was overall in-hospital mortality. Results. Overall, 6595 patients were included in the study cohort (3734 males, 55.6%), with a median age of 71 [58–81] years. Among these, based on clinical findings and quick sequential organ failure assessment (qSOFA), 422 were considered septic (36.2% deceased), and 6173 patients non-septic (16.2% deceased). After correction for baseline covariates, a PCT > 0.5 ng/mL was an independent risk factor for all-cause in-hospital death in both groups (HR 1.77 [1.27–2.48], and 1.80 [1.59–2.59], respectively). Conclusions. Among adult patients admitted with fever, the PCT assessment in ED could have reduced prognostic power for patients with a high suspicion of sepsis. On the other hand, it could be useful for sepsis rule-out for patients at low risk. In these latter patients, the prognostic role of PCT is higher for those with a final diagnosis of bloodstream infection.

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One-Year Readmission and Emergency Department Presentation After an Epilepsy-Related Admission in People with Intellectual Disability: A Registry-Linkage Study

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1498 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Peiwen Liao

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Hospital Admissions ◽

Healthcare Services ◽

Linkage Study ◽

Adjusted Incidence Rate ◽

One Year ◽

Service Data ◽

Patients With Epilepsy ◽

The Impact

IntroductionIntellectual disability (ID) is a neurodevelopmental condition that affects approximately 1-2% of the population, and epilepsy is a common comorbidity in people with ID. Although hospital admission for epilepsy is also common, little is known about the impact of ID on healthcare use following an epilepsy admission. Objectives and ApproachUsing linked administrative health datasets that included hospital admissions and disability service data, we aimed to examine whether the presence of ID led to greater or lesser use of healthcare services following an epilepsy admission, as represented by all-cause unplanned readmissions and emergency department (ED) presentations. Comparing the rate of readmissions and ED presentations within 30, 90 and 365 days of the first epilepsy admission during the study period, the effect of ID was assessed using Poisson regression. ResultsA total of 18,987 patients had an epilepsy admission between 2005 and 2014, and of these, 3,256 (17.1%) had ID. Compared to patients without ID, patients with ID had a higher risk of unplanned readmissions within each follow-up period (adjusted incidence rate ratio (IRR) with 95% CI: 30 days: 1.48 (1.34, 1.65); 90 days: 1.42 (1.31, 1.54); 365 days: 1.49 (1.40, 1.59)). Differences were also found in the reasons for readmission, including more readmissions for neurological disorders. Similarly, the ED presentation risk was elevated in patients with ID (adjusted IRR: 30 days: 1.34 (1.23, 1.46); 90 days: 1.33 (1.24, 1.42); 365 days: 1.38 (1.30, 1.46)). Conclusion / ImplicationsIn patients with epilepsy, the presence of ID appears to increase the chance of a readmission or ED presentation following a hospital admission for epilepsy, with the reasons for readmission also potentially different. This suggests the potential for improvements in post-admission screening and management.

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Clinical Profiles in Renal Patients with COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm9082665 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2665 ◽

Cited By ~ 2

Author(s):

María Dolores Arenas ◽

Marta Crespo ◽

María José Pérez-Sáez ◽

Silvia Collado ◽

Dolores Redondo-Pachón ◽

...

Keyword(s):

Emergency Department ◽

Mechanical Ventilation ◽

Hospital Admission ◽

Kidney Transplant ◽

Invasive Mechanical Ventilation ◽

Clinical Severity ◽

Maintenance Hemodialysis ◽

Rt Pcr ◽

Non Invasive ◽

Clinical Profiles

The COVID-19 pandemic has led to frequent referrals to the emergency department on suspicion of this infection in maintenance hemodialysis (MHD) and kidney transplant (KT) patients. We aimed to describe their clinical features comparing confirmed and suspected non-confirmed COVID-19 cases during the Spanish epidemic peak. Confirmed COVID-19 ((+)COVID-19) corresponds to patient with positive RT-PCR SARS-CoV-2 assay. Non-confirmed COVID-19 ((−)COVID-19) corresponds to patients with negative RT-PCR. COVID-19 was suspected in 61 patients (40/803 KT (4.9%), 21/220 MHD (9.5%)). Prevalence of (+)COVID-19 was 3.2% in KT and 3.6% in MHD patients. Thirty-four (26 KT and 8 MHD) were (+)COVID-19 and 27 (14 KT and 13 MHD) (−)COVID-19. In comparison with (−)COVID-19 patients, (+)COVID-19 showed higher frequency of typical viral symptoms (cough, dyspnea, asthenia and myalgias), pneumonia (88.2% vs. 14.3%) and LDH and CRP while lower phosphate levels, need of hospital admission (100% vs. 63%), use of non-invasive mechanical ventilation (36% vs. 11%) and mortality (38% vs. 0%) (p < 0.001). Time from symptoms onset to admission was longer in patients who finally died than in survivors (8.5 vs. 3.8, p = 0.007). In KT and MHD patients, (+)COVID-19 shows more clinical severity than suspected non-confirmed cases. Prompt RT-PCR is mandatory to confirm COVID-19 diagnosis.

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