scholarly journals Internal evaluation of risk stratification tool using procalcitonin and clinical risk factors in pediatric febrile neutropenia: the first step in a pilot quality improvement project

2021 ◽  
Author(s):  
Charles Nessle ◽  
Thomas Braun ◽  
Sung Won Choi ◽  
Rajen Mody
Keyword(s):  
Febrile Neutropenia ◽  
Risk Stratification ◽  
Bacterial Infections ◽  
Decision Rules ◽  
Clinical Decision ◽  
Blood Stream ◽  
Low Risk ◽  
Improvement Project ◽  
Internal Evaluation ◽  
Risk Patients

Risk stratification of pediatric febrile neutropenia (FN) is an established concept; the internal evaluation of a validated clinical decision rules (CDR) tool has not been well-described. In this study, restrictive criteria and procalcitonin were added to a recommended CDR for internal evaluation before implementation. Analysis of 577 FN episodes showed good sensitivity and negative predictive value in predicting blood stream infections (87.3%; 95.6%) and intensive care admissions (97.2%; 99.1%). There were no severe adverse events in low-risk patients with low procalcitonin; procalcitonin identified 3 low-risk patients with serious bacterial infections. The modified CDR with procalcitonin may assist in risk stratification.

scholarly journals Management of syncope in the emergency department based on risk stratification

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Matthew James Reed
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Decision Rules ◽  
Clinical Decision ◽  
Outpatient Setting ◽  
Low Risk ◽  
Cardiac Syncope ◽  
Observation Units ◽  
Risk Characteristics ◽  
European Society Of Cardiology

This article, based on the 2018 European Society of Cardiology syncope guidelines, highlights the key features of the management of syncope in the Emergency Department (ED) based on risk stratification. Firstly Transient Loss of Consciousness of a syncopal nature should be established. Secondly the treating clinician should ask whether syncope is the presenting feature of an obvious acute disease; if so, treatment and management should follow the guidelines of the specific complaint. If there is no obvious underlying cause, the treating clinician should assess the risk of a serious outcome aided by a risk stratification approach using history, past medical history, examination and ECG. Patients with low-risk characteristics are more likely to have reflex, situational or orthostatic syncope with generally an excellent prognosis and should likely be able to be discharged from the ED with education. Patients with high-risk characteristics are more likely to have cardiac syncope requiring urgent investigation and likely admission but alternatively may be able to be observed in an Observation or Syncope Unit. Patients with neither high nor low-risk features can probably be safely managed in an outpatient setting; there is evidence that management in an ED observation unit and/or fast track to a syncope clinic is beneficial. Risk stratification scores and clinical decision rules are yet to prove useful. There is little evidence that hospital admission in unexplained syncope is useful and novel organisational approaches such as ED observation units and syncope in- and outpatient units offer safe and effective alternatives to admission.

scholarly journals Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rules

2020 ◽  
Vol 18 ◽  
pp. 100220 ◽  
Author(s):  
Gabrielle M. Haeusler ◽  
Karin A. Thursky ◽  
Monica A. Slavin ◽  
Franz E. Babl ◽  
Richard De Abreu Lourenco ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Risk Stratification ◽  
Decision Rules ◽  
Clinical Decision ◽  
Children With Cancer ◽  
Clinical Decision Rules

Outcomes and Cost of Outpatient or Inpatient Management of 712 Patients With Febrile Neutropenia

2008 ◽  
Vol 26 (4) ◽  
pp. 606-611 ◽  
Author(s):  
Linda S. Elting ◽  
Charles Lu ◽  
Carmelita P. Escalante ◽  
Sharon H. Giordano ◽  
Jonathan C. Trent ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Statistical Tests ◽  
Signs And Symptoms ◽  
Low Risk ◽  
Outpatient Management ◽  
Single Episode ◽  
Risk Patients ◽  
Inpatient Management ◽  
The Mean ◽  
Mean Cost

Purpose We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

scholarly journals Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

Comparison of Wells and YEARS clinical decision rules with D‐dimer for low‐risk pulmonary embolus patients

2019 ◽  
Vol 49 (6) ◽  
pp. 739-744
Author(s):  
Christopher J. McLenachan ◽  
Olivia Chua ◽  
Betty S. H. Chan ◽  
Elia Vecellio ◽  
Angela L. Chiew
Keyword(s):  
Pulmonary Embolus ◽  
Decision Rules ◽  
Clinical Decision ◽  
Low Risk ◽  
Clinical Decision Rules ◽  
D Dimer
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