scholarly journals “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database

2022 ◽  
Vol 12 ◽  
Author(s):  
Olivier Beauchet ◽  
Liam A. Cooper-Brown ◽  
Joshua Lubov ◽  
Gilles Allali ◽  
Marc Afilalo ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Emergency Room ◽  
Receiver Operating Characteristic ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Neurocognitive Disorders ◽  
Risk Level ◽  
Receiver Operating

Purpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The aim of this study is to examine the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [LR+], negative likelihood ratio [LR-] and area under the receiver operating characteristic curve [AUROC]) of the ER2 high-risk level and its “temporal disorientation” item alone to screen for major neurocognitive disorders in older ED visitors at the JGH.Methods: Based on a cross-sectional design, 999 older adults (age 84.9 ± 5.6, 65.1% female) visiting the ED of the JGH were selected from the ER2 database. ER2 was completed upon the patients' arrival at the ED. The outcomes were ER2's high-risk level, the answer to ER2's temporal disorientation item (present vs. absent), and the diagnosis of major neurocognitive disorders (yes vs. no) which was confirmed when it was present in a letter or other files signed by a physician.Results: The sensitivities of both ER2's high-risk level and temporal disorientation item were high (≥0.91). Specificity, the PPV, LR+, and AROC were higher for the temporal disorientation item compared to ER2's high-risk level, whereas a highest sensitivity, LR-, and NPV were obtained with the ER2 high-risk level. Both area under the receiver operating characteristic curves were high (0.71 for ER2's high-risk level and 0.82 for ER2 temporal disorientation item). The odds ratios (OR) of ER2's high-risk level and of temporal disorientation item for the diagnosis of major neurocognitive disorders were positive and significant with all OR above 18, the highest OR being reported for the temporal disorientation item in the unadjusted model [OR = 26.4 with 95% confidence interval (CI) = 17.7–39.3].Conclusion: Our results suggest that ER2 and especially its temporal disorientation item may be used to screen for major neurocognitive disorders in older ED users.

scholarly journals Age-Adjusted Endothelial Activation and Stress Index for Coronavirus Disease 2019 at Admission Is a Reliable Predictor for 28-Day Mortality in Hospitalized Patients With Coronavirus Disease 2019

2021 ◽  
Vol 8 ◽  
Author(s):  
Felipe Pérez-García ◽  
Rebeca Bailén ◽  
Juan Torres-Macho ◽  
Amanda Fernández-Rodríguez ◽  
Maria Ángeles Jiménez-Sousa ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Receiver Operating Characteristic ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Predictive Performance ◽  
Endothelial Activation ◽  
Stress Index ◽  
Reliable Predictor ◽  
Receiver Operating

Background: Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients.Methods: We performed a retrospective study on COVID-19 patients from two different cohorts [derivation (n = 1,200 patients) and validation (n = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase * creatinine)/thrombocytes] and aEASIX-COVID (EASIX * age), which were log2-transformed for analysis.Results: Log2-EASIX and log2-aEASIX-COVID were independently associated with an increased risk of death in both cohorts (p < 0.001). Log2-aEASIX-COVID showed a good predictive performance for 28-day mortality both in the derivation cohort (area under the receiver-operating characteristic = 0.827) and in the validation cohort (area under the receiver-operating characteristic = 0.820), with better predictive performance than log2-EASIX (p < 0.001). For log2 aEASIX-COVID, patients with low/moderate risk (<6) had a 28-day mortality probability of 5.3% [95% confidence interval (95% CI) = 4–6.5%], high (6–7) of 17.2% (95% CI = 14.7–19.6%), and very high (>7) of 47.6% (95% CI = 44.2–50.9%). The cutoff of log2 aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log2 aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%.Conclusion: Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.

scholarly journals Prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department

2018 ◽  
Vol 25 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Xiaowei Liu ◽  
Tao Ma ◽  
Zhi Liu
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Prognostic Significance ◽  
Urine Concentration ◽  
Paraquat Poisoning ◽  
Independent Risk Factors ◽  
Receiver Operating

Objective: To assess the prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department. Methods: Patients with acute paraquat poisoning admitted to the emergency department were recruited. Survivors and non-survivors were compared with regard to urinary paraquat concentration. The urinary level predictive of mortality was assessed by receiver operating characteristic curve. Risk factors of mortality were evaluated by regression analysis. Results: The overall mortality rate was 70.9% over the 28-day follow-up period. There was a significant difference in the urine paraquat concentrations recorded on admission between non-surviving and surviving patients ( p = 0.022). Receiver operating characteristic curve analysis revealed that the area under the curve when applied to receiver operating characteristic of the admission urine paraquat concentrations for predicting mortality was 0.854 with a cut-off value of 34.5 µg/mL. The dose of paraquat ingested, arterial lactate, and urine concentration were independent risk factors predicting 28-day mortality. The time interval between ingestion and hemoperfusion, arterial lactate, and urine concentration of paraquat were independent risk factors predicting acute kidney injury, while the partial pressure of carbon dioxide (PaCO2) and urine concentration of paraquat were independent risk factors predicting acute lung injury. Conclusion: The urine concentrations of paraquat on admission at emergency department demonstrated predictive ability for the prognosis of patients with acute paraquat poisoning.

scholarly journals Development, implementation, and prospective validation of a model to predict 60-day end-of-life in hospitalized adults upon admission at three sites

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Vincent J. Major ◽  
Yindalon Aphinyanaphongs
Keyword(s):  
Positive Predictive Value ◽  
Receiver Operating Characteristic ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Medical Center ◽  
Academic Medical Center ◽  
Model Performance ◽  
Risk Of Death ◽  
Temporal Validation ◽  
Receiver Operating

Abstract Background Automated systems that use machine learning to estimate a patient’s risk of death are being developed to influence care. There remains sparse transparent reporting of model generalizability in different subpopulations especially for implemented systems. Methods A prognostic study included adult admissions at a multi-site, academic medical center between 2015 and 2017. A predictive model for all-cause mortality (including initiation of hospice care) within 60 days of admission was developed. Model generalizability is assessed in temporal validation in the context of potential demographic bias. A subsequent prospective cohort study was conducted at the same sites between October 2018 and June 2019. Model performance during prospective validation was quantified with areas under the receiver operating characteristic and precision recall curves stratified by site. Prospective results include timeliness, positive predictive value, and the number of actionable predictions. Results Three years of development data included 128,941 inpatient admissions (94,733 unique patients) across sites where patients are mostly white (61%) and female (60%) and 4.2% led to death within 60 days. A random forest model incorporating 9614 predictors produced areas under the receiver operating characteristic and precision recall curves of 87.2 (95% CI, 86.1–88.2) and 28.0 (95% CI, 25.0–31.0) in temporal validation. Performance marginally diverges within sites as the patient mix shifts from development to validation (patients of one site increases from 10 to 38%). Applied prospectively for nine months, 41,728 predictions were generated in real-time (median [IQR], 1.3 [0.9, 32] minutes). An operating criterion of 75% positive predictive value identified 104 predictions at very high risk (0.25%) where 65% (50 from 77 well-timed predictions) led to death within 60 days. Conclusion Temporal validation demonstrates good model discrimination for 60-day mortality. Slight performance variations are observed across demographic subpopulations. The model was implemented prospectively and successfully produced meaningful estimates of risk within minutes of admission.

scholarly journals Systematic Review with Meta-Analysis: Fecal Calprotectin as a Surrogate Marker for Predicting Relapse in Adults with Ulcerative Colitis

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jiajia Li ◽  
Xiaojing Zhao ◽  
Xueting Li ◽  
Meijiao Lu ◽  
Hongjie Zhang
Keyword(s):  
Ulcerative Colitis ◽  
Receiver Operating Characteristic ◽  
Likelihood Ratio ◽  
Odds Ratio ◽  
Operating Characteristic ◽  
Diagnostic Odds Ratio ◽  
Fecal Calprotectin ◽  
Clinical Relapse ◽  
Sensitivity Specificity ◽  
Receiver Operating

The clinical course of ulcerative colitis (UC) is featured by remission and relapse, which remains unpredictable. Recent studies revealed that fecal calprotectin (FC) could predict clinical relapse for UC patients in remission, which has not yet been well accepted. To detect the predictive value of FC for clinical relapse in adult UC patients based on updated literature, we carried out a comprehensive electronic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify all eligible studies. Diagnostic accuracy including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic (AUROC) was calculated using a random effects model. Heterogeneity across studies was assessed by the I2 metric. Sources of heterogeneity were detected using subgroup analysis. Metaregression was used to test potential factors correlated to DOR. Publication bias was assessed using Deek’s funnel plots. In our study, 14 articles enrolling a total of 1110 participants were finally included, and all articles underwent a quality assessment. Pooled sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.75 (95% CI: 0.70–0.79), 0.77 (95% CI: 0.74–0.80), 3.45 (95% CI: 2.31–5.14), and 0.37 (95% CI: 0.28–0.49) respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.82, and the diagnostic odds ratio was 10.54 (95% CI: 6.16–18.02). Our study suggested that FC is useful in predicting clinical relapse for adult UC patients in remission as a simple and noninvasive marker.

scholarly journals Comparação da Aplicação da EER Hema-Obs a 250 Gestações da Consulta de Hematologia-Obstetrícia do Centro Hospitalar São João, Portugal Versus EER Galit Sarig a 90 Gestações no Rambam Health Care Campus, Israel

2015 ◽  
Vol 28 (2) ◽  
pp. 189
Author(s):  
Ana Salselas ◽  
Inês Pestana ◽  
Francisco Bischoff ◽  
Mariana Guimarães ◽  
Joaquim Aguiar Andrade
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Pregnant Women ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Risk Groups ◽  
Low Risk ◽  
Very High ◽  
Receiver Operating

<strong>Introduction:</strong> Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used.<br /><strong>Purposes:</strong> The aim of this study was to validate a Risk Stratification Scale and thromboprophylaxis protocol by means of comparing it with a similar scale, developed and published by Sarig.<br /><strong>Material and Methods:</strong> We have compared: The distribution, by risk groups, obtained through the application of the two scales on pregnant women followed at Centro Hospitalar São João, Porto, Portugal, consultation; the sensibility and specificity for each one of the scales (DeLong scale, applied to Receiver Operating Characteristic) curves; the outcomes in pregnancies followed in Hospital São João, Porto, Portugal<br /><strong>Results:</strong> According to our Hema-Obs risk stratification scale, 29% were allocated to low-risk, 47% to high-risk and 24% to very-high-risk groups. According to Galit Sarig risk stratification scale, 24% were considered low-risk, 53% moderate, 16% high-risk and 7% as very high-risk group. In our study we observed 9% of spontaneous abortions, in comparison with 18% in the Galit Sarig cohort. From the application of Receiver Operating Characteristic curve to both risk stratification scales, the results of the calculated areas were 58,8% to our Hema-Obs risk stratification scale and 38,7% to Galit Sarig risk stratification scale, with a Delong test significancie of p = 0.0006.<br /><strong>Conclusions:</strong> We concluded that Hema-Obs risk stratification scale is an effective support for clinical monitoring of therapeutic strategies.

scholarly journals Skor Prediksi Kematian Pneumonia pada Anak Usia di Bawah Lima Tahun

Sari Pediatri ◽  
2017 ◽  
Vol 18 (3) ◽  
pp. 214
Author(s):  
Ambarsari Latumahina ◽  
Rina Triasih ◽  
Kristia Hermawan
Keyword(s):  
Receiver Operating Characteristic ◽  
Likelihood Ratio ◽  
Operating Characteristic ◽  
Receiver Operating

Latar belakang. Pneumonia merupakan penyebab utama kematian pada anak usia di bawah lima tahun di negara berkembang. Pengembangan sistem skor yang sederhana untuk memprediksi kematian pada pneumonia dapat meningkatkan kualitas pelayanan dan menurunkan angka kematian anak akibat pneumonia.Tujuan. Menyusun skor prediksi kematian pada anak dengan pneumonia.Metode. Penelitian kohort retrospektif pada anak (umur 2 bulan sampai 5 tahun) yang dirawat di RSUP Dr. Sardjito dengan pneumonia sejak Januari 2009 sampai Desember 2014. Anak dengan rekam medis tidak lengkap atau dengan infeksi HIV dieksklusi. Digunakan metode Spiegelhalter Knill-Jones untuk penyusunan skor kematian. Prediktor kematian dengan likelihood ratio (LHR) ≤0,5 atau ≥2 dimasukkan dalam sistem skor. Cut off point dari skor total ditentukan dengan kurva receiver operating characteristic (ROC).Hasil. Di antara 225 anak yang memenuhi kriteria, 42 (18,7%) meninggal. Prediktor kematian yang memenuhi kriteria LHR adalah usia <6 bulan (LHR 2,05), takikardia (LHR 2,11), saturasi oksigen (SpO2) <92% (LHR 2,54), anemia (LHR 0,38) dan leukositosis (LHR 2,04). Skor prediksi kematian terdiri atas usia (skor=5 bila usia <6 bulan dan 0 bila >6 bulan); frekuensi nadi skor=6 bila takikardia dan -8 bila normal); saturasi oksigen (skor=3 bila SpO2 <92% dan 0 bila SpO2 >92%); hemoglobin (skor=4 bila anemia dan -6 bila normal), leukosit (skor=3 bila leukosit dan 0 bila normal). Total skor >3 Mempunyai sensitivitas dan spesifitas terbaik, yaitu 85,7% dan 72,1%.Kesimpulan. Skor prediksi kematian pneumonia >3 dapat digunakan untuk memprediksi kematian pada anak dengan pneumonia.

scholarly journals Diagnostic Accuracy of Non-invasive Laboratory-Based Fibrosis Scores in Predicting the Presence of Esophageal Varices in Liver Cirrhosis

2020 ◽  
Vol 9 (2) ◽  
pp. 54-59
Author(s):  
Rajesh Pandey ◽  
Rahul Pathak ◽  
Arun Gnawali ◽  
Prem Krishna Khadga ◽  
Sashi Sharma ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Receiver Operating Characteristic ◽  
Esophageal Varices ◽  
Operating Characteristic ◽  
Cutoff Value ◽  
Non Invasive ◽  
Apri Score ◽  
Receiver Operating

Introduction: Non-invasive assessment of esophageal varices (EVs) may reduce endoscopic burden and cost. This study aimed to evaluate the diagnostic accuracy of non-invasive fibrosis scores (AAR, APRI, FIB-4, King and Lok scores) for the prediction of varices in liver cirrhosis. Methods: This prospective study included 100 liver cirrhosis patients who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and Lok scores were assessed. The receiver operating characteristic curves (ROC) were plotted to measure and compare the performance of each score for predicting EVs and to obtain the corresponding optimal prediction value. Results: Of the 100 patients, 70 were males and 30 were females with a mean age of 54.05±11.58 years. Esophageal varices were found in 77 patients out of which 58.44% were high-risk varices. Platelet count and non-invasive fibrosis scores APRI, FIB-4, Lok and King were able to discriminate patients with and without varices. Using area under receiver operating characteristic curve (AUROC), these scores were found to have low to moderate diagnostic accuracy for the presence of EVs and high-risk EVs, where the APRI score had the highest AUROC (0.77 and 0.70) respectively. At a cutoff value > 1.4, APRI score had 90.9% sensitivity, 60.9% specificity and 84 % diagnostic accuracy in predicting the presence of varices, while it had 84.4% sensitivity, 45.5% specificity and 63% diagnostic accuracy in predicting the presence of highrisk varices, at a cutoff value > 2.02. Conclusion: APRI, AAR, FIB-4, King, and Lok scores had low to moderate diagnostic accuracy in predicting the presence of varices in liver cirrhosis. The APRI score can help select a patient for the endoscopy but cannot replace endoscopy for esophageal varices screening.

scholarly journals 215 Assessment of the Diagnostic Sensitivity and Specificity of Pain Biomarkers in Cattle Using Receiver Operating Characteristic Curves

2020 ◽  
Vol 98 (Supplement_3) ◽  
pp. 7-8
Author(s):  
Miriam S Martin ◽  
Michael Kleinhenz ◽  
Karen Schwartzkopf-Genswein ◽  
Johann Coetzee
Keyword(s):  
Diagnostic Accuracy ◽  
Receiver Operating Characteristic ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Diagnostic Sensitivity ◽  
Diagnostic Sensitivity And Specificity ◽  
Good Diagnostic Accuracy ◽  
Receiver Operating

Abstract Biomarkers are commonly used to assess pain and analgesic drug efficacy in livestock. However, the diagnostic sensitivity and specificity of these biomarkers for different pain conditions over time have not been described. Receiver operating characteristic (ROC) curves are graphical plots that illustrate the diagnostic ability of a test as its discrimination threshold is varied. The objective of this analysis was to use area under the curve (AUC) values derived from ROC analysis to assess the predictive value of pain biomarkers at specific timepoints. The biomarkers included in the analysis were blood cortisol, salivary cortisol, hair cortisol, infrared thermography (IRT), mechanical nociceptive threshold (MNT), substance P, and outcomes from a pressure/force measurement system and visual analog scale. A total sample size of 7,992 biomarker outcomes were collected from 6 pain studies involving pain associated with castration, dehorning, lameness, and surgery were included in the analysis. Each study consisted of three treatments; pain, no pain, and analgesia. All statistics were performed using statistical software (JMP Pro 14.0, SAS Institute, Inc., Cary, NC). Results comparing analgesia verses pain yielded good diagnostic accuracy (AUC &gt; 0.7; 95% CI: 0.40 to 0.99) for blood cortisol (timepoints 1.5, 2, and 6 hours); IRT (timepoints 6, 8, 12, and 72 hours); and MNT (timepoints 6, 25, and 49 hours). These results indicate that ROC analysis can be a useful indicator of the predictive value of pain biomarkers and certain timepoints seem to yield good diagnostic accuracy while many do not.

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