Cardiopulmonary Monitors and Clinically Significant Events in Critically Ill Children

2011 ◽  
Vol 45 (s1) ◽  
pp. 38-45 ◽  
Author(s):  
Linda B. Talley ◽  
Jeffrey Hooper ◽  
Brian Jacobs ◽  
Cathie Guzzetta ◽  
Robert McCarter ◽  
...  
Keyword(s):  
Critically Ill ◽  
False Positive ◽  
Critically Ill Children ◽  
Predictive Values ◽  
Safety Issues ◽  
Clinical Events ◽  
Significant Events ◽  
Clinically Significant ◽  
Sensitivity Specificity ◽  
Clinical Conditions

Abstract Cardiopulmonary monitors (CPMs) generate false alarm rates ranging from 85%–99% with few of these alarms actually representing serious clinical events. The overabundance of clinically insignificant alarms in hospitals desensitizes the clinician to true-positive alarms and poses significant safety issues. In this IRB-approved externally funded study, we sought to assess the clinical conditions associated with true and false-positive CPM alarms and attempted to define optimal alarm parameters that would reduce false-positive alarm rates (as they relate to clinically significant events) and thus improve overall CPM performance in critically ill children. Prior to the study, clinically significant events (CSEs) were defined and validated. Over a seven-month period in 2009, critically ill children underwent evaluation of CSEs while connected to a CPM. Comparative CPM and CSE data were analyzed with an aim to estimate sensitivity, specificity, and positive and negative predictive values for CSEs. CPM and CSE data were evaluated in 98 critically ill children. Overall, 2,245 high priority alarms were recorded with 68 CSEs noted in 45 observational days. During the course of the study, the team developed a firm understanding of CPM functionality, including the pitfalls associated with aggregation and analysis of CPM alarm data. The inability to capture all levels of CPM alarms represented a significant study challenge. Selective CPM data can be easily queried with standard reporting, however the default settings with this reporting exclude critical information necessary in compiling a coherent study denominator database. Although the association between CPM alarms and CSEs could not be comprehensively evaluated, preliminary analysis reflected poor CPM alarm specificity. This study provided the necessary considerations for the proper design of a future study that improves the positive predictive value of CPM alarms. In addition, this investigation has resulted in improved awareness of CPM alarm parameter settings and associated false-positive alarms. This information has been incorporated into nursing educational programs.

scholarly journals Computer-Aided Diagnosis Improves the Detection of Clinically Significant Prostate Cancer on Multiparametric-MRI: A Multi-Observer Performance Study Involving Inexperienced Readers

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 973
Author(s):  
Valentina Giannini ◽  
Simone Mazzetti ◽  
Giovanni Cappello ◽  
Valeria Maria Doronzio ◽  
Lorenzo Vassallo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computer Aided Diagnosis ◽  
Multiparametric Mri ◽  
Performance Study ◽  
Predictive Values ◽  
Cad System ◽  
Computer Aided ◽  
Clinically Significant ◽  
Sensitivity Specificity ◽  
Aided Diagnosis

Recently, Computer Aided Diagnosis (CAD) systems have been proposed to help radiologists in detecting and characterizing Prostate Cancer (PCa). However, few studies evaluated the performances of these systems in a clinical setting, especially when used by non-experienced readers. The main aim of this study is to assess the diagnostic performance of non-experienced readers when reporting assisted by the likelihood map generated by a CAD system, and to compare the results with the unassisted interpretation. Three resident radiologists were asked to review multiparametric-MRI of patients with and without PCa, both unassisted and assisted by a CAD system. In both reading sessions, residents recorded all positive cases, and sensitivity, specificity, negative and positive predictive values were computed and compared. The dataset comprised 90 patients (45 with at least one clinically significant biopsy-confirmed PCa). Sensitivity significantly increased in the CAD assisted mode for patients with at least one clinically significant lesion (GS > 6) (68.7% vs. 78.1%, p = 0.018). Overall specificity was not statistically different between unassisted and assisted sessions (94.8% vs. 89.6, p = 0.072). The use of the CAD system significantly increases the per-patient sensitivity of inexperienced readers in the detection of clinically significant PCa, without negatively affecting specificity, while significantly reducing overall reporting time.

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

scholarly journals A Study of the Diagnostic Accuracy of an Existing Multivariable Test to Predict Shoulder Dystocia

2019 ◽  
Vol 09 (03) ◽  
pp. e262-e267
Author(s):  
Henry Alexander Easley ◽  
Todd Michael Beste
Keyword(s):  
Diagnostic Accuracy ◽  
Prediction Model ◽  
Study Design ◽  
False Positive ◽  
False Positive Rate ◽  
Shoulder Dystocia ◽  
The Other ◽  
Predictive Values ◽  
Positive Rate ◽  
Sensitivity Specificity

Objectives To evaluate the diagnostic accuracy of a multivariable prediction model, the Shoulder Screen (Perigen, Inc.), and compare it with the American College of Obstetricians and Gynecologists (ACOG) guidelines to prevent harm from shoulder dystocia. Study Design The model was applied to two groups of 199 patients each who delivered during a 4-year period. One group experienced shoulder dystocia and the other group delivered without shoulder dystocia. The model's accuracy was analyzed. The performance of the model was compared with the ACOG guideline. Results The sensitivity, specificity, positive, and negative predictive values of the model were 23.1, 99.5, 97.9, and 56.4%, respectively. The sensitivity of the ACOG guideline was 10.1%. The false-positive rate of the model was 0.5%. The accuracy of the model was 61.3%. Conclusion A multivariable prediction model can predict shoulder dystocia and is more accurate than ACOG guidelines.

High Resolution Magnetic Resonance Imaging of Resected Plaque

1997 ◽  
Vol 3 (S2) ◽  
pp. 309-310
Author(s):  
D. Saloner
Keyword(s):  
Atherosclerotic Plaque ◽  
Carotid Bifurcation ◽  
Surgical Removal ◽  
Strongly Correlated ◽  
Clinical Events ◽  
Significant Events ◽  
Diseased Vessel ◽  
Clinically Significant ◽  
Substantial Interest

Atherosclerotic plaque at the carotid bifurcation is strongly correlated with the incidence of clinically significant events, such as transient ischemie attacks or stroke. Large multi-center trials have demonstrated that surgical removal of the atheroma is more effective in reducing these clinical events than is medical treatment alone. Patients are selected for surgery from an assessment of the severity of disease at the carotid bifurcation. The measure of disease severity is conventionally taken to be the degree of narrowing of the diseased vessel compared to a normal segment of vessel. However, using this criterion alone, many patients receive endarterectomy surgery who would probably not have progressed to other neurological events, while others are excluded who do progress to neurological events. For this reason, there is substantial interest in methods that could evaluate the composition of the atherosclerotic plaque in vivo, with the hope that this information would improve the predictive power of pre-surgical imaging of the diseased vessel.

Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis

2016 ◽  
Vol 33 (12) ◽  
pp. 656-662
Author(s):  
Joy Mammen ◽  
Jui Choudhuri ◽  
Joshua Paul ◽  
Thomas Isaiah Sudarsan ◽  
T. Josephine ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Donors ◽  
Area Under The Curve ◽  
Standard Test ◽  
Suspected Sepsis ◽  
Predictive Values ◽  
Reactive Protein ◽  
Sensitivity Specificity

Background: The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. Methodology: In this prospective study, VCS parameters, procalcitonin, and C-reactive protein (CRP) were assessed in patients with proven sepsis (cases) and 2 control groups (intensive care unit [ICU] patients without sepsis and healthy blood donors). The diagnostic property of each test was explored by calculating sensitivity, specificity, negative and positive predictive values, and area under the curve (AUC). Results: The study included 65 patients with sepsis, 58 nonseptic ICU controls, and 98 blood donors. Procalcitonin and CRP were not significantly different ( P > .06) between patients with sepsis and nonseptic patients. Mean (95% confidence interval [CI]) neutrophil volume (MNV) was significantly higher ( P < .001) in patients with sepsis (165.5; 95%CI 161.6-169.4) than in nonseptic (157.3; 95%CI 154.6-160.1) patients and donors (148.9; 95%CI 147.9-150). A similar pattern was seen with mean monocyte volume (MMoV). Neutrophil and monocyte conductivity and scatter parameters were variably associated. The AUC was highest for MMoV (0.74) and lowest for CRP (0.62). Among all parameters, MNV and MMoV had the highest specificity of 85% and 80%, respectively. Conclusion: In critically ill patients with suspected sepsis, VCS parameters may help strengthen the diagnostic probability of sepsis. Future studies may explore the role of serial monitoring of VCS to track response to antimicrobial therapy.

scholarly journals The natural history of asymptomatic central venous catheter–related thrombosis in critically ill children

Blood ◽  
2019 ◽  
Vol 133 (8) ◽  
pp. 857-866 ◽  
Author(s):  
Sophie Jones ◽  
Warwick Butt ◽  
Paul Monagle ◽  
Timothy Cain ◽  
Fiona Newall
Keyword(s):  
Natural History ◽  
Central Venous Catheter ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Postthrombotic Syndrome ◽  
Central Venous ◽  
History Of ◽  
Clinically Significant

Abstract Asymptomatic central venous catheter (CVC)–related thrombosis in children varies in incidence from 5% to 69%. The rate of acute and long-term complications, such as postthrombotic syndrome (PTS), from asymptomatic CVC-related thrombosis is unknown. This article reports the outcomes of a prospective study of 189 children in pediatric intensive care that aimed to determine the frequency of asymptomatic CVC-related thrombosis during hospital admission, and the incidence of residual CVC-related thrombosis and clinically significant PTS 2 years later. Risk factors associated with CVC-related thrombosis were also identified. This study is distinct from previous work as children identified to have asymptomatic CVC-related thrombosis were not treated (clinical team kept blinded) and the entire cohort was followed for 2 years to determine the natural history of asymptomatic thrombosis. Ultrasounds of 146 children determined a 21.9% incidence of acute CVC-related thrombosis. Two children were symptomatic. No radiological thrombosis extension or clinical embolization occurred in the 126 children assessed at follow-up. Using 2 recognized PTS scales, clinically significant PTS was reported in 2 children (1 symptomatic, 1 asymptomatic CVC-related thrombosis), however, neither had functional impairment. Cardiac arrest was a risk factor for CVC-related thrombosis during admission and femoral CVC placement was predictive of residual thrombosis 2 years later. This study challenges the notion that critically ill children with asymptomatic CVC-related thrombosis require anticoagulant treatment, as the results demonstrate that the incidence of acute or long-term complications is low. A larger confirmatory study of nontreatment of CVC-related thrombosis in critically ill children is justified.

scholarly journals Bleeding in Critically Ill Children—Review of Literature, Knowledge Gaps, and Suggestions for Future Investigation

2021 ◽  
Vol 9 ◽  
Author(s):  
Adi Avniel Aran ◽  
Oliver Karam ◽  
Marianne E. Nellis
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Current Knowledge ◽  
Critically Ill Children ◽  
Future Research ◽  
Published Data ◽  
Review Of Literature ◽  
Knowledge Gaps ◽  
Clinically Significant

Clinically significant bleeding complicates up to 20% of admissions to the intensive care unit in adults and is associated with severe physiologic derangements, requirement for significant interventions and worse outcome. There is a paucity of published data on bleeding in critically ill children. In this manuscript, we will provide an overview of the epidemiology and characteristics of bleeding in critically ill children, address the association between bleeding and clinical outcomes, describe the current definitions of bleeding and their respective limitations, and finally provide an overview of current knowledge gaps and suggested areas for future research.

scholarly journals Antenatal Umbilical Coiling Index and Newborn Outcomes: Cohort Study

2017 ◽  
Vol 7 ◽  
pp. 21
Author(s):  
Josephine Mwikali Ndolo ◽  
Sudhir Vinayak ◽  
Micah Ominde Silaba ◽  
William Stones
Keyword(s):  
Preterm Birth ◽  
Predictive Value ◽  
Predictive Values ◽  
Newborn Outcomes ◽  
Pregnancy And Birth Outcomes ◽  
Umbilical Coiling Index ◽  
Clinically Significant ◽  
Sensitivity Specificity ◽  
Pregnancy And Birth ◽  
Singleton Pregnancies

Objectives: We aimed to test the predictive value of antenatal umbilical coiling index (aUCI) among a prospectively recruited cohort of antenatal women. Methods: Women with singleton pregnancies were recruited at their second-trimester scan. Images of the umbilical cord were used to calculate the aUCI. Pregnancy and birth outcomes were recorded and statistical associations between aUCI and small for gestational age (SGA) using international standard birth weight centiles and preterm birth were investigated (n = 430). Results: aUCI results were consistent with the literature and showed good reproducibility between observers. Abnormal aUCI was not associated with SGA, but there was a statistical association with preterm birth (odds ratio 3.3 (95% confidence interval 1.4–7.7, P = 0.003). The sensitivity, specificity, and positive and negative predictive values for preterm birth were 47.6%, 76.9%, 9.6%, and 96.6%, respectively. Conclusions: The coiling index is unlikely to be useful in clinical practice as a screening tool for preterm birth owing to limited predictive value. We exclude a statistically or clinically significant association between abnormal coiling and SGA.

scholarly journals A Retrospective Analysis of Thromboembolic Phenomena in Mechanically Ventilated Patients with COVID-19

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Fahad Faqihi ◽  
Abdulrahman Alharthy ◽  
Abdullah Balhamar ◽  
Nasir Nasim ◽  
Khaled Alanezi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Laboratory Data ◽  
Anticoagulation Therapy ◽  
Predictive Values ◽  
Mechanically Ventilated ◽  
Vein Thrombosis ◽  
Icu Length Of Stay ◽  
Hemorrhagic Events ◽  
Sensitivity Specificity ◽  
Deep Vein

Background. Recent studies have shown an increased prevalence of thromboembolic disease in critically ill patients with the novel SARS-CoV-2 disease (COVID-19). However, the use of enhanced anticoagulation therapy in these patients remains controversial. Objectives. To determine the incidence of thromboembolic phenomena (TEP) and hemorrhagic events (HEs) in intensive care unit (ICU) COVID-19 patients. Methods. One hundred and sixty ICU patients with COVID-19 were enrolled. Clinical examination results, laboratory data, and imaging studies (computed tomography/Doppler ultrasound scans) for these patients were retrospectively collected and analyzed. Outcome measures including days on mechanical ventilation, ICU length of stay, and day-28 mortality were recorded. Results. Sixty patients (37.5%) developed TEP including thirty patients with deep vein thrombosis, 55 patients with pulmonary embolism, and 7 patients with arterial thromboembolism. Cardiac arrhythmias, lymphocytopenia, and increased D-dimers were more frequently observed in the TEP group compared to the non-TEP group of patients (all p < 0.05 ). The sensitivity, specificity, and positive and negative predictive values of a cutoff D-dimer level of 3.0 μg/mL for predicting PE were 74.5%, 95.1%, 86.8%, and 91.9%, respectively. Thirteen patients experienced HEs, which were more frequently observed in the TEP group ( p < 0.05 ). Twenty-eight-day mortality was higher in the TEP group (60%) compared to the non-TEP group (30%) of patients ( p = 0.02 ). Conclusions. The rates of TEP and HEs in mechanically ventilated critically ill COVID-19 patients were 37. 5% and 8.1%. Twenty-eight-day mortality was higher in the TEP group (60%) compared to the non-TEP group (30%) of patients.

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