scholarly journals Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

2020 ◽  
Author(s):  
Joseph Miller ◽  
Yiyang Wu ◽  
Rawan Safa ◽  
Georgiana Marusca ◽  
Sandeep Bhatti ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Observational Study ◽  
Validation Cohort ◽  
Scoring Systems ◽  
Retrospective Observational Study ◽  
Mortality And Morbidity ◽  
Derivation Cohort ◽  
C Statistic ◽  
Prediction Of Mortality ◽  
Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

scholarly journals Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

2020 ◽  
Author(s):  
Joseph Miller ◽  
MD ◽  
Rawan Safa ◽  
Georgiana Marusca ◽  
BS Sandeep Bhatti ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Observational Study ◽  
Validation Cohort ◽  
Scoring Systems ◽  
Retrospective Observational Study ◽  
Mortality And Morbidity ◽  
Derivation Cohort ◽  
C Statistic ◽  
Prediction Of Mortality ◽  
Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

scholarly journals Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph Miller ◽  
Yiyang Wu ◽  
Rawan Safa ◽  
Georgiana Marusca ◽  
Sandeep Bhatti ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Observational Study ◽  
Primary Outcome ◽  
Validation Cohort ◽  
Scoring Systems ◽  
Retrospective Observational Study ◽  
Mortality And Morbidity ◽  
Derivation Cohort ◽  
C Statistic ◽  
Prediction Of Mortality

Abstract Background Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes. Results The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8–10.8) for 1 point, 12.0 (95% CI 4.9–29.4) for 2 points, and 41.7 (95% CI 15.8–110.1) for 3 points (c-statistic = 0.77). Conclusion An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.

scholarly journals Association between cognitive quotient test score and hippocampal volume: a novel, rapid application-based screening tool

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wataru Kasai ◽  
Tadahiro Goto ◽  
Yuki Aoyama ◽  
Kenji Sato
Keyword(s):  
Correlation Coefficient ◽  
Validation Cohort ◽  
Brain Mri ◽  
Scoring Systems ◽  
Simple Calculation ◽  
Hippocampal Volume ◽  
Primary Outcome Measure ◽  
Test Model ◽  
Moderate Correlation ◽  
Derivation Cohort

Abstract We aimed to develop a brief, preclinical test to screen the reduced hippocampal volume that is a marker of early dementia [Cognitive Quotient (CQ) test]. We performed an observational study of adult subjects who underwent brain MRI in seven institutions from February 2018 to May 2019. The CQ test consists of five components: (1) digits forward, (2) digits backward, (3) Stroop test, (4) simple calculation, and (5) mental rotation. The primary outcome measure was hippocampal volume. We separated the data into derivation (n = 322) and validation cohorts (n = 96). In the derivation cohort, we built two scoring systems using the results of CQ test (model 1 and 2). In the validation cohort, we validated the correlation of the scoring systems with hippocampal volume. In the derivation cohort, there was a moderate correlation between the scoring systems and hippocampal volume [e.g., correlation coefficient = 0.62 in model 1 (95% CI 0.44–0.75)]. Likewise, in the validation cohort, there was a moderate correlation between the scoring systems and hippocampal volume [e.g., correlation coefficient = 0.54 in model 2 (95% CI 0.38–0.67)]. In this analysis of 418 participants, the score of newly developed CQ test was correlated with hippocampal volume.

scholarly journals Development and external validation of new nomograms by adding ECG changes (ST depression or tall T wave) and age to conventional scoring systems to improve the predictive capacity in patients with subarachnoid haemorrhage: a retrospective, observational study in Korea

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024007 ◽  
Author(s):  
Ju young Hong ◽  
Je Sung You ◽  
Min Joung Kim ◽  
Hye Sun Lee ◽  
Yoo Seok Park ◽  
...  
Keyword(s):  
Observational Study ◽  
Subarachnoid Haemorrhage ◽  
Characteristic Curve ◽  
External Validation ◽  
Scoring Systems ◽  
Retrospective Observational Study ◽  
World Federation ◽  
Ecg Changes ◽  
T Wave ◽  
St Depression

ObjectivesTo develop new nomograms by adding ECG changes (ST depression or tall T wave) and age to three conventional scoring systems, namely, World Federation of Neurosurgical Societies (WFNS) scale, Hunt and Hess (HH) system and Fisher scale, that can predict prognosis in patients with subarachnoid haemorrhage (SAH) using our preliminary research results and to perform external validation of the three new nomograms.DesignRetrospective, observational studySettingEmergency departments (ED) of two university-affiliated tertiary hospital between January 2009 and March 2015.ParticipantsAdult patients with SAH were enrolled. Exclusion criteria were age <19 years, no baseline ECG, cardiac arrest on arrival, traumatic SAH, referral from other hospital and referral to other hospitals from the ED.Primary outcome measuresThe 6 month prognosis was assessed using the Glasgow Outcome Scale (GOS). We defined a poor outcome as a GOS score of 1, 2 or 3.ResultsA total of 202 patients were included for analysis. From the preliminary study, age, ECG changes (ST depression or tall T wave), and three conventional scoring systems were selected to predict prognosis in patients with SAH using multi-variable logistic regression. We developed simplified nomograms using these variables. Discrimination of the developed nomograms including WFNS scale, HH system and Fisher scale was superior to those of WFNS scale, HH system and Fisher scale (0.912 vs 0.813; p<0.001, 0.913 vs 0.826; p<0.001, and 0.885 vs 0.746; p<0.001, respectively). The calibration plots showed excellent agreement. In the external validation, the discrimination of the newly developed nomograms incorporating the three scoring systems was also good, with an area under the receiver-operating characteristic curve value of 0.809, 0.812 and 0.772, respectively.ConclusionsWe developed and externally validated new nomograms using only three independent variables. Our new nomograms were superior to the WFNS scale, HH systems, and Fisher scale in predicting prognosis and are readily available.

Abstract 164: Outcome Prediction After Endovascular Reperfusion Therapy For Acute Ischemic Stroke: The SNARL Score

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Kevin N Sheth ◽  
John B Terry ◽  
Raul G Nogueira ◽  
Anat Horev ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Outcome Prediction ◽  
Validation Cohort ◽  
Reperfusion Therapy ◽  
Anterior Circulation ◽  
Derivation Cohort ◽  
Good Outcome ◽  
C Statistic ◽  
Pre Treatment

Background: Tools to predict outcome after endovascular reperfusion therapy (ERT) for acute ischemic stroke (AIS) have previously included only pre-treatment variables. We sought to derive and validate an outcome prediction score based on readily available pre-treatment and treatment factors. Methods: The derivation cohort consisted of 516 patients with anterior circulation AIS from 9 centers from September 2009-July 2011. The validation cohort consisted of 110 patients with anterior circulation AIS from the Penumbra Pivotal Trial. Multivariable logistic regression identified predictors of good outcome, defined as a modified Rankin Score (mRS) of < 2, in the derivation sample; model beta coefficients were used to assign point scores. Discrimination was tested using C-statistics. We then validated the score in the Penumbra cohort and performed calibration (predicted versus observed good outcome) in both cohorts. Results: Good outcome at 3 months was noted in 189 (36.8%) patients in the derivation cohort. The independent predictors of good outcome were A ge (2 pts: <60; 1 pt: 60-79; 0 pts: >79), N IHSS score (4 pts: 0-10; 2 pts: 11-20; 0 pts: > 20), L ocation of clot (2 pts: M2; 1 pt: M1; 0 pts: ICA), R ecanalization (5 pts: TICI 2 or 3), and S ymptomatic hemorrhage (2 pts: none, HT1-2, or PH1; 0 pts: PH2). The outcome (SNARL) score demonstrated good discrimination in the derivation cohort (C-statistic 0.78, 95% CI 0.72-0.78) and validation cohort (C-statistic 0.74, 95% CI 0.64-0.84). There was excellent calibration in each cohort (Figure). Conclusions: The SNARL score is a validated tool to determine the probability of functional recovery among AIS treated with endovascular reperfusion strategies. Unlike previous scores that did not include treatment factors such as successful recanalization or hemorrhagic complications, our score can be applied to patients after treatment and may provide guidance to physicians, patients, and families about expected functional outcome.

P2699Comparison of fractional myocardial mass, a vessel-specific myocardial mass-at-risk, with coronary angiographic scoring systems for predicting myocardial ischemia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-Y Kim ◽  
J.-H Choi ◽  
J.-H Doh ◽  
H.-S Lim ◽  
E.-S Shin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Predictive Value ◽  
Validation Cohort ◽  
Invasive Coronary Angiography ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Myocardial Mass ◽  
Derivation Cohort ◽  
Non Invasive

Abstract Aims The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia. Methods In this multicenter registry, 411 patients who underwent coronary computed tomography angiography (CCTA) were followed by invasive coronary angiography and FFR measurement. CCTA–derived %FMM with diameter stenosis ≥70% (%FMM-70) or ≥50% (%FMM-50) were compared with 9 angiographic scores (APPROACH, Duke Jeopardy, BARI, CASS, SYNTAX, Jenkins, BCIS-1, Leaman, Modified Duke) and were tested regarding their performance for predicting FFR ≤0.80. Predictive performance of %FMM or angiographic scores for FFR ≤0.80 established in derivation cohort (N=250) and tested in validation cohort (N=161). Results The performance of %FMM-70 and %FMM-50 were similar to most angiographic scores (%FMM-70, c-statistics=0.76; %FMM-50, 0.71; angiographic scores, 0.68–0.79). The frequency of FFR ≤0.80 increased consistently according to %FMM-70, %FMM-50, and all angiographic scores (p<0.001, all). The optimal cutoff of %FMM-50 and %FMM-70 for FFR ≤0.80 were ≥34.5% and ≥9.8%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of %FMM-50 were 83%, 56%, 73%, 70%, 72%, and of %FMM-70 were 72%, 78%, 75%, 75%, and 75% using these cutoffs. Validation cohort showed consistent results. Conclusion %FMM correlated well with angiographic scores and had a potential to be used as a non-invasive alternative to the angiographic scores. The integration of the severity of stenosis and the amount of subtended myocardium may improve the detection of clinically significant coronary artery stenosis.

scholarly journals The Waterlow score for risk assessment in surgical patients

2013 ◽  
Vol 95 (1) ◽  
pp. 52-56 ◽  
Author(s):  
CC Thorn ◽  
M Smith ◽  
O Aziz ◽  
TC Holme
Keyword(s):  
Area Under The Curve ◽  
Scoring Systems ◽  
Outcome Data ◽  
Surgical Patients ◽  
Morbidity Rate ◽  
Inpatient Mortality ◽  
Characteristic Analysis ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality ◽  
Operative Severity Score

Introduction Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort. Methods A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). Results The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80–0.85) and for morbidity it was 0.72 (0.69–0.76). The ASA grade achieved a similar level of discrimination. Conclusions The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.

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