Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis.

2021 ◽  
pp. 1-10
Author(s):  
Nazir Najeeb Kapadia ◽  
Emaduddin Siddiqui
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cross Sectional ◽  
Mild Acute Pancreatitis ◽  
Ranson Score

Abstract Objective: To determine diagnostic accuracy of BISAP in comparison to Ranson scores in predicting mortalities and severities in patients with acute pancreatitis coming to the emergency department. Methods: Cross-sectional study conducted in Department of Emergency Medicine, Aga Khan University Hospital, Stadium road Karachi, Pakistan. 136 patients were selected via non-probability consecutive sampling technique, those who fulfilled the criteria of inclusion. BISAP score was applied in the emergency department (ED) & the patients were followed in ward/intensive care unit where Ranson scores were calculated in the following 48 hours. Both the scores were calculated and compared for the prediction of severity and mortality for each patient. All the obtained data was recorded in Performa. Results: In this study 136 patients, who fulfill the inclusion criteria were selected. On the basis of BISAP and Ranson score; mild acute pancreatitis to moderate acute pancreatitis (MAP to ModAP) was diagnosed in 123 (90.4%) and 119 (87.5) patients and severe AP (SAP) in 13 (9.6%) and 17 (12.5%) patients respectively. Specificity (Sp) 94.62% vs 91.54%, Sensitivity (Sn) 100.0% vs 100.0%, negative predictive value (NPV) 100.0% vs 100.0%, positive predictive value (PPV) 46.15% vs 35.29% and diagnostic accuracy (DA) 94.85% vs 91.91% of BISAP vs Ranson scores respectively. Conclusion: It was concluded from the study that BISAP and Ranson score are very reliable tool for identification of acute pancreatitis patients at higher risk of severity and mortality. BISAP and Ranson score has same sensitivity but BISAP score has higher specificity than Ranson score. Continuous...

Accuracy of Bisap Score to Predict Severe Acute Pancreatitis Keeping Ranson Score as Gold Standard

2021 ◽  
Vol 15 (10) ◽  
pp. 3426-3428
Author(s):  
Muhammad Rehan Khan ◽  
Tayyaba Mushtaq Khan ◽  
Syed Munim Hussain ◽  
Syed Mukarram Hussain
Keyword(s):  
Acute Pancreatitis ◽  
Diagnostic Accuracy ◽  
Severe Acute Pancreatitis ◽  
Gold Standard ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Cross Sectional ◽  
Serum Lipase ◽  
Surgical Department ◽  
Ranson Score

Objective: To ascertain the diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard Study design: Descriptive Cross Sectional study Place and duration of study: Surgical Department, Combined Military Hospital Rawalpindi from January 2017 to July 2017. Methodology: 65 patients having history indicative of acute pancreatitis, serum lipase and serum amylase were measured. Patients with confirmed diagnosis of acute pancreatitis who consented for taking part in the research and achieving the inclusion and exclusion criteria were enrolled for study. Patients were evaluated by adequate history and thorough examination. All patients are investigated for Ranson score and BISAP score and divided into mild and severe pancreatitis on the basis of BISAPS and Ranson scoring. Results: In our study, mean+sd age was 44.92+8.92 years. Frequency of severe acute pancreatitis was 32.3%. Diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard had 80.9% of sensitivity, 81% of specificity, 68% of PPV and 90% of NPV. Conclusion: BISAP score have an excellent accuracy for prediction of severe acute pancreatitis as Ranson score. BISAP score can be used as tool for recognition of severe acute pancreatitis within 24 hours in simple and precise manner. Keywords: Severe acute pancreatitis, Prediction, BISAP score, Ranson score, Accuracy

scholarly journals Discharge against medical advice from the emergency department in a university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feras H. Abuzeyad ◽  
Moonis Farooq ◽  
Salah Farhat Alam ◽  
Mudhaffar Ismael Ibrahim ◽  
Luma Bashmi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Medical Advice ◽  
University Hospital ◽  
High Risk Population ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Level 3 ◽  
Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

Diagnostic Accuracy of HRCT Chest in Detection of Covid-19 Infection Taking PCR as Gold Standard

2021 ◽  
Vol 15 (6) ◽  
pp. 1679-1681
Author(s):  
Afaque Ali ◽  
Majid Shaikh ◽  
Ahsanullah . ◽  
Adeel Ahmed ◽  
Abid Ali Sahito ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Gold Standard ◽  
Cross Sectional Study ◽  
Radiology Department ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Head Of Department

Objective: To determine the diagnostic accuracy of High-resolution computed tomography (HRCT) chest in detection of covid-19 infection taking PCR as gold standard. Study Design: Cross-sectional study Setting: Radiology department of Tabba Hospital, Karachi. Duration: From March 2019 to September 2020 Material and Methods: All the clinically suspected patients of covid-19, of any age, both genders and those referred to radiology for High-resolution computed tomography (HRCT) chest to detect the covid-19 infection were included. After two days, patients’ PCR reports were collected from the ward, after taking informed consent and permission from head of department. The diagnostic accuracy of HRCT was established with respect to sensitivity, PPV, NPV, and specificity by taking PCR as gold standard. All the information was collected via study proforma. Results: Total 70 patients suspected for COVID-19 were studied, and the patients’ mean age was 58.23±9.52 years. Males were in majority 54(77.1%). As per HRCT findings, COVID-19 infection was positive in 46 patients, however, 48 patients were detected positive for COVID-19 infection as per PCR findings. In the detection of COVID-19 infection, HRCT chest showed sensitivity of 91%, specificity of 90%, PPV of 83%, NPV of 84% and diagnostic accuracy of 94%; by taking PCR as gold standard. Conclusion: High-resolution computed tomography (HRCT) is a reliable diagnostic approach in promptly detecting the COVID-19; with 91% sensitivity, 90% specificity, 83% positive predictive value, 84% negative predictive value and 94% diagnostic accuracy. Keywords: Accuracy, HRCT, COVID-19

scholarly journals Comparison of Venous and Capillary Sampling in Oral Glucose Testing for the Diagnosis of Gestational Diabetes Mellitus: A Diagnostic Accuracy Cross-Sectional Study Using Accu-Chek Inform II

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1011
Author(s):  
Sofia Nevander ◽  
Eva Landberg ◽  
Marie Blomberg ◽  
Bertil Ekman ◽  
Caroline Lilliecreutz
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Oral Glucose ◽  
Sectional Study ◽  
Cross Sectional ◽  
Capillary Sampling

Gestational diabetes mellitus (GDM) is a common complication with negative impacts on mother and child. The primary aim of this study was to examine whether plasma glucose cutoffs for GDM diagnosis based on venous sampling can be replaced by cutoffs based on capillary sampling. A prospective cross-sectional study was performed at an antenatal care clinic including 175 pregnant women undergoing an oral glucose tolerance test (OGTT). Duplicate samples were collected by capillary and venous puncture while fasting and 1 h and 2 h after an OGTT. Both samples were analyzed on Accu-Chek Inform II. The cutoffs for a GDM diagnosis using capillary samples were corrected from 5.1 to 5.3 mmol/L for the fasting sample, from 10.0 to 11.1 mmol/L for the 1 h sample, and from 8.5 to 9.4 mmol/L for the 2-h sample using half of the dataset. Applying these cutoffs to the remaining dataset resulted in a sensitivity, specificity, and accuracy of 85.0%, 95.0%, and 90.3%, respectively, with a positive predictive value (PPV) of 83%, an negative predictive value (NPV) of 96%, and a positive negative likelihood ratio (LHR) of 16.4 using capillary sampling for the GDM diagnosis at fasting and 2-h after. Corrected cutoffs and capillary samples can be used for the diagnosis of GDM with maintained diagnostic accuracy using Accu-Chek Inform II.

scholarly journals ACCURACY OF THE UPPER LIP BITE TEST;

2012 ◽  
Vol 20 (01) ◽  
pp. 132-138
Author(s):  
MUHAMMAD ATIF ◽  
MUHAMMAD ABDULLAH ◽  
MUHAMMAD JAVAD YOUSAF ◽  
Khalid Buland
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

scholarly journals Factors affecting prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252044
Author(s):  
Doaa Mahmoud Khalil ◽  
Elmorsy Elmorsy ◽  
Ahmed Arafa ◽  
Hesham Ahmed Nafady ◽  
Lamiaa Saleh
Keyword(s):  
Emergency Department ◽  
Time Delay ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Consciousness Level ◽  
Injured Patients ◽  
Prehospital Time

Purpose This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt. Materials and methods In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury. Results The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26–11.68), 3.49 (2.22–5.48), and 0.56 (0.32–0.96), respectively. Conclusion The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level.

scholarly journals Risk factors for mortality among inpatients with smear positive pulmonary tuberculosis

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Sidra Hameed ◽  
Faisal Faiyaz Zuberi ◽  
Sagheer Hussain ◽  
Syed Khalid Ali
Keyword(s):  
Risk Factors ◽  
Pulmonary Tuberculosis ◽  
Demographic Data ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Smoking History ◽  
Cross Sectional ◽  
Creative Commons ◽  
Smear Positive Pulmonary Tuberculosis

Objective: To evaluate risk factors having significant effect on mortality of smear positive Pulmonary Tuberculosis (PTB) inpatients. Methods: A descriptive cross-sectional study was conducted at Ojha Institute of Chest Diseases, Dow University Hospital Ojha Campus, Karachi. One hundred and seventy (170) inpatients of smear positive PTB confirmed by Acid Fast Bacilli (AFB) smear, aged between 13-80 years were enrolled by using consecutive sampling technique while patients with drug resistant Tuberculosis (TB) and extra pulmonary TB were excluded from the study. Selected patients were interviewed for collecting demographic data and risk factor data by using a standard questionnaire. Results: Out of 170 PTB inpatients, mortality was observed in 23 (13.5%) patients among which male patients were 12 (52.2%), and female were 11 (47.8%). Mortality was significantly associated with increasing age (p=0.003), socioeconomic status (p=0.019), anemia (p=0.03), Chronic Liver Disease (CLD) (p=0.005), Diabetes Mellitus (DM) (p=0.001), Human Immunodeficiency Virus (HIV) (p=0.007), Hypertension (HTN) (p=0.006), recurrent TB (p=0.001), and smoking (p=0.001). Conclusion: Increasing age, poverty, smoking history, and presence of comorbidities like DM, CLD, HIV, hypertension, and anemia are associated with higher mortality in smear positive PTB cases. doi: https://doi.org/10.12669/pjms.35.5.919 How to cite this:Hameed S, Zuberi FF, Hussain S, Ali SK. Risk factors for mortality among inpatients with smear positive pulmonary tuberculosis. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.919 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparison between qualitative and quantitative measurement of strength deficit in shoulder flexors of young females: a cross- sectional study

2021 ◽  
Vol 71 (11) ◽  
pp. 2559-2562
Author(s):  
Saadia Perwaiz ◽  
Muhammad Waqar Afzal ◽  
Ghulam Fatima
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Manual Muscle Testing ◽  
Primary Analysis ◽  
Cross Sectional ◽  
Young Females ◽  
Muscle Testing

Objective: To compare accuracy of manual muscle testing in detection of strength differences across grade 4 and 5 at different percentage deficits of dynamometric mean in shoulder flexors of young females.  Methods: Cross sectional research design, conducting primary analysis of strength of shoulder flexors measured through manual muscle testing and hand-held dynamometer. Three hundred young healthy females without any ailment of upper extremity or generalized health problem were selected from University of South Asia and Association of Fatima Jinnah Old Graduates, Lahore. Non-probability convenient sampling technique was used. The age group selected was 18-39 years. The strength of shoulder flexors measured through manual muscle testing and hand-held dynamometer was main outcome measure. Results: The overall diagnostic accuracy of manual muscle testing showed better results at 10% dynamometric measures. It was 63.33%(95% CI: 57.74%, 68.59%) in non-dominant shoulder flexors and 61.67% (95% CI: 56.05%, 66.99%) in dominant shoulder flexors. The positive predictive value (PPV) and specificity of manual muscle testing was better at 10% strength deficit in comparison with dynamometric measures, whereas negative predictive value (NPV) and sensitivity was better at 20% strength deficit. Contrasting association was found between positive predictive value (PPV) and sensitivity, negative predictive value and specificity.  Conclusion: The subjective area of grade 4 and 5 showed better, although not ideal, diagnostic worth at 10% deficit of dynamometric measures in shoulder flexors. Further exploration through study of contrasting trends between PPV and sensitivity by subgroup analysis is required. Continuous...

scholarly journals 458. Diagnostic Accuracy and Management of Suspected Moderate to Severe Cellulitis Referred to an Infectious Diseases Outpatient Parenteral Antibiotic Clinic: A Prospective Cross-Sectional Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S225-S225
Author(s):  
Jolanta Piszczek ◽  
Eric Partlow ◽  
Shay-Anne Daniels ◽  
Milena Semproni ◽  
Wayne Ghesquiere
Keyword(s):  
Emergency Department ◽  
Infectious Diseases ◽  
Diagnostic Accuracy ◽  
Cross Sectional Study ◽  
High Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Parenteral Antibiotic ◽  
Intravenous Antibiotics ◽  
The Impact

Abstract Background Moderate to severe cellulitis is a common reason for presentation to the emergency department and administration of intravenous antibiotics. Misdiagnosis of cellulitis occurs frequently as the disease can masquerade as a wide variety of noninfectious and infectious problems. There are currently no studies evaluating the impact of infectious diseases physicians on the diagnostic accuracy and management of cellulitis referred to an outpatient parenteral antibiotic clinic from the emergency department. The objective of this study was to quantify the prevalence of misdiagnosed moderate to severe cellulitis through an evaluation by an infectious diseases specialist, characterize the alternative diagnoses, and assess variables associated with misdiagnosis. Methods A prospective cross-sectional study of adults referred from emergency departments with presumed moderate to severe cellulitis to an outpatient parenteral antibiotic clinic staffed by infectious diseases specialists. Results 301 consecutive patients with presumed cellulitis were evaluated over a 6-month period. A concurring diagnosis of cellulitis was found in 170 patients (56.5%), for a misdiagnosis rate of 43.5% (131/301). Table 1 summarizes the alternative diagnoses. Infectious conditions other than cellulitis were the most common (63/301; 20.9%), with abscess being present in 23 (7.6%) of patients. Fifty-two of 301 (17.3%) of the diagnoses were noninfectious and 16/301 (5.3%) patients had a dual diagnosis where minor cellulitis was present, but secondary to another, predomintating condition. The presence of stasis dermatitis (OR 6.62, P = 0.013) and a history of physical trauma (OR 1.76, P = 0.046) were associated with a misdiagnosis. 31.9% (107/335) of antibiotic regimens prescribed by emergency physicians were inappropriate or sub-optimal compared with 7.9% (22/280) of those ordered by infectious disease doctors. Conclusion Moderate to severe cellulitis was incorrectly diagnosed in nearly half of the patients referred for intravenous antibiotics and resulted in a high rate of unstewardly antimicrobial use. Infectious diseases physicians at an outpatient antibiotic clinic improved the diagnostic accuracy and management of this complicated condition. Disclosures All authors: No reported disclosures.

scholarly journals Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department

2020 ◽  
Vol 33 (4) ◽  
pp. 267-273
Author(s):  
Natalia F. Pascual Gómez ◽  
Iván Monge Lobo ◽  
Inmaculada Granero Cremades ◽  
Angels Figuerola Tejerina ◽  
Fernando Ramasco Rueda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mortality Risk ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Clinical Severity ◽  
Sectional Study ◽  
Blood Cell Count ◽  
Cross Sectional ◽  
Predictors Of Mortality ◽  
Multivariate Study

Objective. Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. Method. Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. Results. A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). Conclusions. Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

Sign in / Sign up

Export Citation Format

Share Document