scholarly journals Predicting Mortality in Adult Patients With Sepsis in the Emergency Department by Using Combinations of Biomarkers and Clinical Scoring Systems: A Systematic Review.

2021 ◽  
Author(s):  
Kirby Tong-Minh ◽  
Iris Welten ◽  
Henrik Endeman ◽  
Tjebbe Hagenaars ◽  
Christian Ramakers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Scoring System ◽  
Early Stage ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Prognostic Accuracy ◽  
Multiple Biomarkers ◽  
Clinical Scoring

Abstract IntroductionSepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED.MethodsWe performed a systematic search using MEDLINE, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the prognostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. ResultsWe included 18 articles in which a total of 35 combinations of biomarkers and clinical scoring systems were studied, of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality. ConclusionThe combination of PCT, IL-6, lactate and the SAPS-2 score had the highest AUC on 1-month mortality in patients with sepsis in the ED. The studies we found in this review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis.

scholarly journals Predicting mortality in patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review.

2020 ◽  
Author(s):  
Kirby Tong-Minh ◽  
Iris Welten ◽  
Henrik Endeman ◽  
Tjebbe Hagenaars ◽  
Christian Ramakers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Early Stage ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Multiple Biomarkers ◽  
Clinical Scoring

Abstract Introduction Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED.Methods We performed a systematic search using MEDLINE, PubMed, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the diagnostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. Results We found 18 articles in this systematic review. In these 18 articles, a total of 35 combinations of biomarkers and clinical scoring systems were studied of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality. Conclusion In this systematic review, the combination of PCT, IL-6, lactate and the SAPS-2 score had the highest AUC on 1-month mortality in patients with sepsis in the ED. The studies we found in this review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis.

scholarly journals Predicting mortality in adult patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirby Tong-Minh ◽  
Iris Welten ◽  
Henrik Endeman ◽  
Tjebbe Hagenaars ◽  
Christian Ramakers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Scoring System ◽  
Early Stage ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Prognostic Accuracy ◽  
Clinical Scoring ◽  
Qsofa Score

Abstract Background Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED. Methods We performed a systematic search using MEDLINE, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the prognostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. We did not define biomarker cut-off values in advance. Results We included 18 articles in which a total of 35 combinations of biomarkers and clinical scoring systems were studied, of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality. Conclusion The studies we found in this systematic review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis. Future studies should focus on clinical scoring systems which require a limited amount of clinical parameters, such as the qSOFA score in combination with a biomarker that is already routinely available in the ED.

scholarly journals Prognostic Accuracy of SOFA Score and qSOFA as a predictor of mortality among sepsis patients presenting to Emergency Department in one of a tertiary Hospital in Kathmandu, Nepal

2020 ◽  
Vol 22 (1-2) ◽  
pp. 18-21
Author(s):  
Sameer Thapa ◽  
AR Upreti ◽  
R Bajracharya ◽  
BK Lingden
Keyword(s):  
Emergency Department ◽  
Sofa Score ◽  
Scoring Systems ◽  
Tertiary Hospital ◽  
Common Source ◽  
Prognostic Accuracy ◽  
Source Of Infection ◽  
Clinical Scoring ◽  
Qsofa Score ◽  
Sepsis And Septic Shock

There are many clinical scoring systems that measure the severity in sepsis and septic shock. Therefore, our study aims to calculate prognostic accuracy of commonly used scoring system SOFA and qSOFA in emergency department as a predictor of mortality among sepsis patients.This was prospective observational study conducted in an emergency department for a period of seven months. 156 patients were studied and descriptive statistical analysis was done. The most common source of infection was respiratory. A positive and moderate correlation was seen between initial SOFA score and qSOFA score. The AUC of SOFA score and qSOFA for predicting the mortality were 0.978 and 0.886 with sensitivity of 96.9% and specificty of 57% for SOFA and sensitivity of 96.9% and specificity of 76.1% for qSOFA.SOFA and qSOFA both proved to be similar as a simple prognostic tool with discriminatory capacity in predicting prognosis in septic patient presenting to emergency department.

scholarly journals Comparison of Mortality Risk Models in Patients with Postcardiac Arrest Cardiogenic Shock and Percutaneous Mechanical Circulatory Support

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Georgios Chatzis ◽  
Birgit Markus ◽  
Styliani Syntila ◽  
Christian Waechter ◽  
Ulrich Luesebrink ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Circulatory Support ◽  
Saps Ii ◽  
Prognostic Accuracy ◽  
Va Ecmo

Background. Although scoring systems are widely used to predict outcomes in postcardiac arrest cardiogenic shock (CS) after out-of-hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI), data concerning the accuracy of these scores to predict mortality of patients treated with Impella in this setting are lacking. Thus, we aimed to evaluate as well as to compare the prognostic accuracy of acute physiology and chronic health II (APACHE II), simplified acute physiology score II (SAPS II), sepsis-related organ failure assessment (SOFA), the intra-aortic balloon pump (IABP), CardShock, the prediction of cardiogenic shock outcome for AMI patients salvaged by VA-ECMO (ENCOURAGE), and the survival after venoarterial extracorporeal membrane oxygenation (SAVE) score in patients with OHCA refractory CS due to an AMI treated with Impella 2.5 or CP. Methods. Retrospective study of 65 consecutive Impella 2.5 and 32 CP patients treated in our cardiac arrest center from September 2015 until June 2020. Results. Overall survival to discharge was 44.3%. The expected mortality according to scores was SOFA 70%, SAPS II 90%, IABP shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 50%, and SAVE score 70% in the 2.5 group; SOFA 70%, SAPS II 85%, IABP shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 75%, and SAVE score 70% in the CP group. The ENCOURAGE score was the most effective predictive model of mortality outcome presenting a moderate area under the curve (AUC) of 0.79, followed by the CardShock, APACHE II, IABP, and SAPS score. These derived an AUC between 0.71 and 0.78. The SOFA and the SAVE scores failed to predict the outcome in this particular setting of refractory CS after OHCA due to an AMI. Conclusion. The available intensive care and newly developed CS scores offered only a moderate prognostic accuracy for outcomes in OHCA patients with refractory CS due to an AMI treated with Impella. A new score is needed in order to guide the therapy in these patients.

scholarly journals Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophia Marie-Therese Schmitz ◽  
Andreas Kroh ◽  
Tom Florian Ulmer ◽  
Julia Andruszkow ◽  
Tom Luedde ◽  
...  
Keyword(s):  
Scoring System ◽  
High Sensitivity ◽  
Scoring Systems ◽  
Obese Patients ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Nafld Fibrosis Score ◽  
Histologic Evaluation ◽  
Clinical Scoring ◽  
Nas Score

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients. Methods In a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score. Results APRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC = 0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score. Conclusions APRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.

scholarly journals Clinical scoring system may improve yield of head CT of non-trauma emergency department patients

2015 ◽  
Vol 22 (5) ◽  
pp. 511-516 ◽  
Author(s):  
Christopher Bent ◽  
Paul S. Lee ◽  
Peter Y. Shen ◽  
Heejung Bang ◽  
Mathew Bobinski
Keyword(s):  
Emergency Department ◽  
Scoring System ◽  
Head Ct ◽  
Clinical Scoring ◽  
Emergency Department Patients

scholarly journals Pediatric Observational Priority Score and Early Warning Scoring System to Predict Admission Status in Pediatric Patients in Haji Adam Malik General Hospital

2021 ◽  
Vol 9 (T3) ◽  
pp. 244-248
Author(s):  
Linda Wati ◽  
Ririe Fachrina Malisie ◽  
Juliandi Harahap
Keyword(s):  
Emergency Department ◽  
General Hospital ◽  
Scoring System ◽  
Pediatric Patients ◽  
Scoring Systems ◽  
Diagnostic Value ◽  
Emergency Rooms ◽  
Priority Score ◽  
Admission Status ◽  
Diagnostic Values

Background: Doctors must be able to quickly and accurately assess clinical condition of patients, especially in the emergency rooms. An easy scoring system but producing meaningful clinical conclusions is the reason for creating various scoring systems. Includes a scoring system for predicting the admission status of patients. Aim: To determine the diagnostic value of POPS and EWSS to predicting admission status of pediatric patients in the emergency department. Methods: Diagnostic tests for POPS and EWSS were done to predict the admission status of pediatric patients in the emergency department of Haji Adam Malik general hospital from May to October 2020. Subjects aged 1 month to 18 years were excluded if they left the emergency department prior to assessment, had trauma cases, died, inpatients due to social indications, and patients who came only to continue therapy were also excluded. POPS and EWSS assessments were carried out by the researcher and the admission status of the patients were determined by the doctor in charge in the emergency department. Results: There were 119 children meeting the inclusion and exclusion criteria. POPS score ≥3 had sensitivity 82.65%, specificity 85.71%, and AUC 0.88 (p <0.001). EWSS score ≥2 had sensitivity 83.67%, specificity 71.43%, and AUC 0.83 (p <0.001). Conclusion: POPS and EWSS had good diagnostic values in predicting the admission status of pediatric patients in the emergency department. POPS has a slightly higher diagnostic value than EWSS.

scholarly journals Does Rheumatoid Arthritis Really Improve During Pregnancy? A Systematic Review and Metaanalysis

2018 ◽  
Vol 46 (3) ◽  
pp. 245-250 ◽  
Author(s):  
Hannah Jethwa ◽  
Suzanne Lam ◽  
Colette Smith ◽  
Ian Giles
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Health Professional ◽  
Disease Activity ◽  
Prospective Studies ◽  
Scoring System ◽  
Scoring Systems ◽  
Final Analysis ◽  
Inclusion Criteria ◽  
In Pregnancy

Objective.We performed a systematic review and metaanalysis to assess rheumatoid arthritis (RA) disease activity during pregnancy using objective disease activity scoring systems.Methods.A systematic review of PubMed, EMBASE/Medline, Cochrane, and LactMed databases was performed. Our inclusion criteria for analysis were prospective studies, more than 5 patients per study, and data on RA using an objective scoring system conducted by a clinician/health professional.Results.Ten studies were eligible for final analysis, which included 237 patients, of which prepartum data were available for 204 patients. Postpartum disease activity was recorded in 135 pregnancies.Conclusion.Disease activity improved in 60% of patients with RA in pregnancy and flared in 46.7% postpartum.

Sore throat in adults – does the introduction of a clinical scoring system improve the management of these patients in a secondary care setting?

2005 ◽  
Vol 119 (7) ◽  
pp. 550-555 ◽  
Author(s):  
S L Woolley ◽  
J M Bernstein ◽  
J A Davidson ◽  
D R K Smith
Keyword(s):  
Emergency Department ◽  
Sore Throat ◽  
Scoring System ◽  
Antibiotic Prescription ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Number Of Patients ◽  
Clinical Scoring ◽  
System 2 ◽  
New Guidelines

Objective: To audit sore throat management in adults, introduce proforma-based guidelines and to reaudit clinical practice.Setting: Adult emergency department of an inner city teaching hospital.Methods: A literature search was carried out to identify relevant guidelines. In stage one, patients presenting to the emergency department with sore throat were identified retrospectively from the emergency department attendance register. Proformas were completed retrospectively. In stage two, new guidelines were introduced and staff educated about the guidelines. In stage three, patients presenting with sore throat were identified at triage and proformas were completed at time of consultation.Outcome Measures: (1) appropriate clinical assessment of the likelihood of bacterial infection using the clinical scoring system, (2) appropriateness of antibiotic prescription, (3) recommendation of supportive treatments to patients.Results: Introduction of a clinical scoring system reduced the inappropriate prescribing of antibiotics from 44 per cent to 11 per cent. Correct antibiotic prescription rose from 60 per cent to 100 per cent. Although the variety of advice given about supportive treatment increased, the actual number of patients receiving documented supportive advice fell from 67.8 per cent in stage one to 58 per cent in stage three.Conclusion: The introduction of clinically based guidelines for the diagnosis and management of sore throat in adults can reduce inappropriate antibiotic prescribing.

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