Emergency Room Patients Research Articles

Association Between Positive Troponin and Fear of Earthquakes: A Retrospective Study.

Introduction The association between natural disasters and cardiovascular events has been well-established. However, the impact of earthquakes on cardiac health, and the role of fear in this association, remains unclear. This study aims to examine the association between positive troponin levels, indicating cardiac ischemia, and fear of earthquakes among Emergency Roompatients at a referral center in Beirut, Lebanon. Materials and methods This is a retrospective study conducted on patients who presented to the Emergency Room with suspected cardiac symptoms and were ordered a troponin level after the Kahramanmaras earthquakethat occurred on the sixth of February 2023 and affected many neighboring countries, including Lebanon. A control group was taken from the same period in 2022 (January-February) and from the period prior to theearthquake (January up to 6 February 2023). Patients were divided into three groups: the first group (group 1) comprised patients who presented during January and February 2022 (period 1). The second group (group 2) included patients who presented from January up to the sixth of February 2023, when the Kahramanmaras earthquake occurred (period 2). The third group (group 3) consisted of patients who presented after the earthquake until the end of February 2023 (period 3). Patients who consented to participate in the study were sent a questionnaire to assess their Fear of Earthquake Scale (FES), chief complaints, date of presentation to the Emergency Room, past medical history, and other socio-demographic data. Results Our study involved 1410 participants, with 782 belonging to group 1, 470 to group 2, and 158 to group 3. The mean age was 62.96 ± 17.87 for the total population and 63.9 ± 18.49 for patients of group 3. The number of positive troponin results was higher during period 3 (62% of participants) in comparison to period 2 and 1 (22.1% and 28.5% of participantsrespectively) (p<0.001).Positive troponin was significantly more common among patients who are non-smokers (53%, p-value <0.001), with a negative family history of premature cardiac diseases (93.9%, p-value <0.05), previously healthy (46.9%, p-value <0.001) and presenting to the Emergency Room for dyspnea or palpitations (17.3% each, p-value <0.001). In addition, patients who tested positive for troponin had a higher mean FES(27.89 ± 1.23 versus 20.47 ± 6.02) and a higher mean age (71.07 ± 14.33 versus 52.25 ± 18.69) in comparison to those who tested negative for troponin (p-value <0.05). Conclusion This study suggests that fear of earthquakes maybe associated with cardiac ischemia, as indicated by positive troponin levels. Healthcare providers should be aware of the potential impact of natural disasters on cardiovascular health and take measures to address patients' fears and concerns.

5-Years of Thrombolytic Treatment Experience

Objective: Thrombolytic therapy has a vital role in saving both life and vital functions in emergency room patients. Our aim in our study is to reveal the thrombolytic practice experience of a 3rd level hospital in a long period of 5 years.&#x0D; Methods: Adult patients who applied to the emergency department between 2017-2022 and were given thrombolytic therapy were selected. Demographic information, risk factors, laboratory and radiological parameters, diagnoses and thrombolytic use of the patients were examined.&#x0D; Results: 56 patients were included in the study. Survival in patients with comorbidity was lower than in patients without comorbidity (p=0.0036). Survival of patients with a history of cerebrovascular occlusion was lower than those without (p=0.01). There was no statistically significant difference in survival between patients who received coagulation therapy in their history and patients (p&gt;0.05). Survival analysis was performed according to the diagnosis of the patients in the emergency department. There was no statistical significance in terms of survival among patients with different diagnosis types (p=0.098). No statistically significant difference was found in the survival analysis for different application sites of thrombolytic therapy as emergency room, clinical service and intensive care unit (p=0.85). It was observed that doctors started thrombolytic practice as of 2017, and the number of applications increased over the years.&#x0D; Conclusion: The favorable outcomes thrombolytic therapy have led an increase in the number of thrombolytic therapy conducted by ED clinicians while it was also seen that there was a reduction in morbidity and mortality over time.

TATA KELOLA REKAM MEDIS BERBASIS TEKNOLOGI INFORMASI DALAM MONITORING KUNJUNGAN PASIEN IGD DENGAN MENGGUNAKAN METODE AGILE

This study aims to simplify and expedite the processing of patient data, as well as the preparation of reports for officers. In addition, it aims to design an information system for emergency room patient visits to process patient data more quickly and effectively. This study employs a qualitative method with a descriptive approach. Data collection techniques include observation, interviews, and supplemented by literature study. The development method follows agile principles. The problems identified in this study are as follows: There is no information system for emergency patient visits, and the patient visit data for emergency departments are still being recorded using Microsoft Excel. With the implementation of this information system, officers can process patient data quickly and easily, as the computerized system is more organized and better integrated than before.

Artificial intelligence-based opportunistic detection of coronary artery stenosis on aortic computed tomography angiography in emergency department patients with acute chest pain.

To evaluate a deep-learning model (DLM) for detecting coronary stenoses in emergency room patients with acute chest pain (ACP) explored with electrocardiogram-gated aortic computed tomography angiography (CTA) to rule out aortic dissection. This retrospective study included 217 emergency room patients (41% female, mean age 67.2 years) presenting with ACP and evaluated by aortic CTA at our institution. Computed tomography angiography was assessed by two readers, who rated the coronary arteries as 1 (no stenosis), 2 (<50% stenosis), or 3 (≥50% stenosis). Computed tomography angiography was categorized as high quality (HQ), if all three main coronary arteries were analysable and low quality (LQ) otherwise. Curvilinear coronary images were rated by a DLM using the same system. Per-patient and per-vessel analyses were conducted. One hundred and twenty-one patients had HQ and 96 LQ CTA. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of the DLM in patients with high-quality image for detecting ≥50% stenoses were 100, 62, 59, 100, and 75% at the patient level and 98, 79, 57, 99, and 84% at the vessel level, respectively. Sensitivity was lower (79%) for detecting ≥50% stenoses at the vessel level in patients with low-quality image. Diagnostic accuracy was 84% in both groups. All 12 patients with acute coronary syndrome (ACS) and stenoses by invasive coronary angiography (ICA) were rated 3 by the DLM. A DLM demonstrated high NPV for significant coronary artery stenosis in patients with ACP. All patients with ACS and stenoses by ICA were identified by the DLM.

Hubungan Waktu Tunggu Dan Length Of Stay (LOS) Dengan Kepuasan Pasien

The Emergency Department is one of the most important units of a hospital that serves as a place to handle emergencies at the main gate. Emergency room services are a type of quality care in a timely manner. Triage is a type of assessment that is precise, fast, and responsive with the time possible in utilizing human resources, facilities, and equipment efficiently. In the Emergency Department length of stay and waiting time can see clinical performance and density levels. Length of stay in the emergency department can see clinical workload and overcrowding levels. This study uses correlation analytic research procedures using a cross-sectional approach which aims to determine the relationship between waiting for time and length of stay and patient satisfaction in the Emergency Department of RSU. Royal Prima Marelan. The population in this study amounted to 72 respondents. The sampling technique was saturated sampling, so the sample was 72 people. The results of the study obtained 52 respondents (72.3%) were satisfied with the waiting time and Length of Stay in the Emergency Room of the Royal Prima Marelan Hospital. The results of the Chi-Square statistical test obtained p-value = 0,157 (p &lt;0.05) so that the Alternative Hypothesis (Ha) can be accepted which means that there is no relationship between waiting for time and Length of Stay and satisfaction of emergency room patients.

Characteristic and Management Of Oro-Maxillofacial Trauma in Emergency Department of Oral and Maxillofacial Surgery During Covid-19 Pandemic: Retrospective Crosssectional Study

AbstractIntroduction: Oromaxillofacial traumas comprise injuries to the face, jaws, or both that are largely caused by physical forces, foreign bodies, or burns; they include injury to any of the bony structures, skin, and soft tissues around the face. Maxillofacial trauma is related to human activity or mobility, so traffic accidents are the highest cause. During the Covid-19 pandemic, human activity was mostly at home with movement restrictions. This paper aims to describe the types of characteristics and management of oromaxillofacial traumas during covid-19 pandemic at the emergency room RSUP Dr.Hasan Sadikin Bandung Hospital.Methods: A cross-sectional study was conducted to evaluate every maxillofacial trauma in patients treated by the oral surgeon in the emergency room at RSUP Dr.Hasan Sadikin Bandung Hospital. Maxillofacial trauma incidence records were taken directly from case reports department of oral and maxillofacial surgery emergency room patients from January 2020-December 2021. The variables considered were: patient age, gender, etiologies, sites, classifications, and management of the trauma. All the information found is then integrated into a table to be analyzed epidemiologically. Result: 177 maxillofacial trauma patients were registered in the department of oral and maxillofacial surgery report. It was found that the gender ratio, female to male, is equal to 2.3: 7.6. The 18-36 age group accounted for the largest subgroup in both sexes. Motorcycle accidents accounted for as much as 80.22% of the etiology of the most common traumas. While dentoalveolar (28.22%) was the most common site of the fracture, followed by the mandible (23.31%). Injuries around the mouth make up the most portion (62.15%) regarding the area that is directly impacted by the injuries, followed by injuries to the face (18.64%) and injuries to the mouth and nose combined (6.21%). Among the 177 patients mentioned above, 10.17% were hospitalized.Conclusion: It can be concluded from this cross-sectional study that traffic accidents, mainly motorcycle crashes, are the primary cause of traumas, with males being more prone to accidents. Meanwhile, the dentoalveolar fracture was the most common site of fracture. For this reason, we might be better prepared with all the resources necessary to diagnose and treat patients with oromaxillofacial traumas in the future.

Validity of using serum D-dimer titer in prefatory to computed Tomography pulmonary angiography scans in the early identification of pulmonary embolism amid emergency room patients: a single-center retrospective observational study

Background and aim Pulmonary embolism emerges when a thrombus forms in the veins or right heart and travels to the pulmonary arteries. The study aims to ascertain the robustness of D-dimer testing for PE compared with CTPA and identify the threshold values to support its use. Patients and methods The positivity threshold for D-dimer was above 250 ng/ml. CTPA was performed after performing blood sampling. Patients were managed in the ICU with anticoagulants by parenteral use. The most commonly used items were heparin, either unfractionated (UFH) or low-molecular-weight heparin (LMWH). Results Twenty-four patients of the total number of cases were positive for CTPA, while four patients were negative for PE by CTPA. Embolism was detected in the anterior, posterior, medial, and lateral basal segmental branches of the right lung, the lateral, posterior, and anterior basal segmental branches of the left lung, and the posterior segmental branch of the left lung. The D-dimer test and CTPA both provided similarly accurate PE diagnoses with no significant differences between them. There were 28 patients in total, three of those patients had D-dimer levels below the cutoff value of 250 ng/ml, whereas the remaining 25 had D-dimer levels over the diagnostic threshold. Those with a positive CTPA diagnosis of PE had greater levels of D dimers than those with a negative CTPA diagnosis of PE. Conclusion D-dimer levels can help in guiding the option of CTPA and the initiation of treatment for patients with suspected PE.

Consultations During COVID: Effects of a Pandemic on Neurosurgical Care

COVID-19 has impacted Neurosurgical care around the world. But reports describing patient admission trends during the pandemic have provided limited time frames and diagnoses. The purpose of this paper was to analyze the impact of COVID-19 on Neurosurgical care provided to our Emergency Department during the outbreak. Patient admission data were collected based on a list of 35 ICD-10 codes, which were placed into one of four categories: head and spine trauma ("Trauma"), head and spine infection ("Infection"), degenerative spine ("Degenerative") and subarachnoid hemorrhage / brain tumor ("Control"). Emergency room consultations to the Neurosurgery Department were collected from March 2018 to March 2022, representing 2 years before COVID and 2 years of pandemic. We hypothesized that Control cases would remain stable throughout the two time periods while Trauma, and Infection would decrease. Because of widespread clinic restrictions we postulated Degenerative (spine) cases presenting to the ER would increase. During the first two years of the COVID pandemic, Neurosurgical Trauma and Degenerative ER patients decreased compared to pre-pandemic levels, while Cranial and Spinal infections increased, and continued to do so during the pandemic period studied. Brain tumors and sub-arachnoid hemorrhages ('control' cases) did not change in a significant way throughout the four-year analysis. The COVID pandemic significantly altered the demographics of our Neurosurgical Emergency Room patient population and continues to do so.

Characteristics of suicidal emergency room patients before and during the COVID-19 pandemic in Japan.

Owing to the stress caused by the behavioral restrictions and lifestyle changes during the COVID-19 pandemic, suicide rates have increased in Japan, especially among young people. This study aimed to identify the differences in the characteristics of patients hospitalized for suicide attempts in the emergency room, requiring inpatient care before and during the pandemic over 2 years. This study was a retrospective analysis. Data were collected from the electronic medical records. A descriptive survey was conducted to examine changes in the pattern of suicide attempts during the COVID-19 outbreak. Two-sample independent t-tests, Chi-square tests, and Fisher's exact test were used for data analysis. Two hundred one patients were included. No significant differences were found in the number of patients hospitalized for suicide attempts, average age, or sex ratio before and during the pandemic periods. Acute drug intoxication and overmedication in patients increased significantly during the pandemic. The self-inflicted means of injury with high fatality rates were similar during the two periods. The rate of physical complications significantly increased during the pandemic, while the proportion of unemployed individuals significantly decreased. Despite studies predicting an increase in suicides based on past statistics of young people and of women, no significant changes were observed in this survey of the Hanshin-Awaji region, including Kobe. This may have been owing to the effect of suicide prevention measures and mental health measures implemented by the Japanese government after an increase in suicides and after past natural disasters.

Prevalence and predictors of outcomes among ESRD patients with COVID-19

Background End-stage renal disease patients on hemodialysis (ESRD) patients are at high risk for contracting COVID-19. In this propensity matched cohort study, we examined the prevalence of COVID-19 in emergency room (ER) patients and examined whether clinical outcomes varied by ESRD status.MethodsPatients who visited George Washington University Hospital ER from April 2020 to April 2021 were reviewed for COVID-19 and ESRD status. Among COVID-positive ER patients, the propensity for ESRD was calculated using a logistic regression model to create a propensity-matched sample of ESRD vs non-ESRD COVID-19 patients. A multivariable model examined whether ESRD was an independent predictor of death and other outcomes in COVID-19 patients.ResultsAmong the 27,106 ER patients, 2689 of whom were COVID-positive (9.9%). The odds of testing positive for COVID-19 were 0.97 ([95% CI: 0.78–1.20], p = 0.76) in ESRD vs non-ESRD patients after adjusting for age, sex, and race. There were 2414 COVID-positive individuals with non-missing data, of which 98 were ESRD patients. In this COVID-positive sample, ESRD patients experienced a higher incidence of stroke, sepsis, and pneumonia than non-ESRD individuals. Significant independent predictors of death included age, race, sex, insurance status, and diabetes mellitus. Those with no insurance had odds of death that was 212% higher than those with private insurance (3.124 [1.695–5.759], p < 0.001). ESRD status was not an independent predictor of death (1.215 [0.623–2.370], p = 0.57). After propensity-matching in the COVID-positive patients, there were 95 ESRD patients matched with 283 non-ESRD individuals. In this sample, insurance status continued to be an independent predictor of mortality, while ESRD status was not. ESRD patients were more likely to have lactic acidosis (36% vs 15%) and length of hospital stay ≥ 7 days (48% vs 31%), but no increase in odds for any studied adverse outcomes.ConclusionsIn ER patients, ESRD status was not associated with higher odds for testing positive for COVID-19. Among ER patients who were COVID positive, ESRD was not associated with mortality. However, insurance status had a strong and independent association with death among ER patients with COVID-19.

The incidence and prevalence of recurrent corneal erosion syndrome in London, UK.

Recurrent corneal erosion syndrome (RCES) is caused by repeated episodes of corneal epithelial breakdown due to improper adherence of the corneal epithelium to the underlying basement membrane. The most common aetiologies are corneal dystrophy or previous superficial ocular trauma. The incidence and prevalence of the condition is currently unknown. This study aimed to determine the incidence and prevalence of RCES within the London population over a 5-year period in order to better inform clinicians and evaluate how this condition affects ophthalmic service provision. A retrospective cohort study over a 5-year period reviewed 487,690 emergency room patient attendances at Moorfields Eye Hospital (MEH) London between 1 January 2015 and 31 December 2019. MEH caters for a local population comprising of around ten regional clinical commissioning groups (CCGs). The data for this study were collected using OpenEyesTM electronic medical records including demographics and comorbidities. The CCGs encompass 41% (3,689,000) of London's total 8,980,000 inhabitants. Using these data the crude incidence and prevalence rates of disease were estimated with results reported per 100,000 population. Out of 330,684 patients, 3623 patients were given a new diagnosis of RCES by the emergency ophthalmology services, and from these, 1056 patients attended outpatient follow-up. The crude annual incidence of RCES was estimated at 25.4 per 100,000, with a crude prevalence rate of 0.96%. There was no statistical difference in annual incidence across the 5-year period. The period prevalence of 0.96% shows that RCES is not uncommon. There was also a stable annual incidence over the 5-year period, showing no changing trend over the study period. However, identifying the true incidence and period prevalence is a challenging task, as minor cases may heal prior to examination by an ophthalmologist. It is highly likely that RCES is underdiagnosed and therefore underreported.

Lived Experience of Caring for Dying Muslim Patients in Emergency Room: A Phenomenological Study.

Death is a natural part of life, which mostly occurs in the ER. This study described the meaning of nurses' lived experience of caring for critical and dying patients in the ERs. In this qualitative study, 13 nurses who was purposefully selected. Data were collected using in-depth individual interviews. Data analysis used van Manen's hermeneutic phenomenological approach. The experiences of caring for the dying patient were divided into two parts: experiences in patients with acute and chronic problems. In patients with acute problems, four themes were extracted: fight to the death, no time for palliative and spiritual care, lacking support for the family, no privacy for peaceful death. In patients with acute problems, four themes were extracted: Facilitating a peaceful death, Allocating time for palliative and spiritual care, support for the family, Attention to privacy. Therefore, attention should be paid to the fields of care and its inadequacies.

JACEP open annual report 2022.

JACEP open annual report 2022.

Management of Acute Poisonous Cases in the Emergency Department

Instances of acute poisoning are a major cause for concern regarding the state of the health of the general population. This article was written with the purpose of conducting a literature review on acute poisoning cases and the treatment that is given to patients in emergency rooms. This was the motivation behind the writing of this article. It was decided that a variety of search engines, including Google, Google Scholar, Science Direct, and PubMed, would be investigated. Acute poisoning cases are a problem that is significantly more widespread than we had previously estimated, as the findings of this study have shown. When everything is taken into consideration, the medical personnel working in the emergency department ought to be adequately prepared to treat and manage severe cases of poisoning. In addition, there needs to be legislation in place that identifies substances that are toxic.

Physical Assault in the Psychiatry Emergency Room.

Previous studies of physical assaults in hospitals focused primarily on inpatient psychiatric units, leaving unanswered questions about the extent to which findings generalize to psychiatric emergency rooms. Assault incident reports and electronic medical records from one psychiatric emergency room and two inpatient psychiatric units were reviewed. Qualitative methods were used to identify precipitants. Quantitative methods were used to describe characteristics of each event, as well as demographic and symptom profiles associated with incidents. During the five-year study period, there were 60 incidents in the psychiatric emergency room and 124 incidents on the inpatient units. Precipitating factors, incident severity, means of assault, and interventions were similar in both settings. Among patients in the psychiatric emergency room, a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder with manic symptoms (Adjusted Odds Ratio (AOR) 27.86) and presenting with thoughts to harm others (AOR 10.94) were associated with an increased likelihood of having an assault incident report. Similarities between assaults in the psychiatric emergency room and inpatient psychiatric units suggest that the broader literature from inpatient psychiatry can be generalized to the psychiatric emergency room setting, although some differences exist. Reprinted from J Am Acad Psychiatry Law 2020; 48:484-495, with permission from The American Academy of Psychiatry and the Law. Copyright © 2020.

Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population.

Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

Knowledge of Basic Life support in Post Graduate Residents in two Teaching Hospitals

Background: Cardiopulmonary resuscitation (CPR) knowledge and training among junior doctors is very important as the junior doctor is mostly the first one to attend the patients in emergency room. Unfortunately, they don’t have enough knowledge. Healthcare professionals need to have hands-on practice regularly in order to retain the BLS skills. Aim: To determine the frequency of adequate knowledge of basic life support among Post graduate residents. Method:A Descriptive, Cross-sectional study was conducted from November 2017 to May 2018 in the Children’s Hospital Lahoreand from June 2022to August 2022 in Government Kot Khawaja Saeed Teaching Hospital, Lahore. A total of 96doctors of all 4 years of postgraduate training program of either genderwere included. A questionnaire was prepared. It included demographic data and BLS knowledge assessment. It was distributed to participants who met the inclusion criteria. It did not contain the name of the participant and confidentiality was maintained. Questionnaire was collected back after the completion and knowledge score was noted as described in questionnaire. Score &gt;8 was taken as adequate knowledge. Results: Mean age was 28.76 ± 2.29 years. Out of 96 participants, 70 were from Children Hospital and 26 from Govt. Kot Khawaja Saeed Teaching Hospital KEMU, 50(52.08%) were males and 46(47.92%) were females. The male to female ratio is 1.1:1. Mean time duration since BLS course attended was 9.12±4.54 months. Mean score was 11.78±3.98. This study has shown frequency of adequate knowledge of basic life support among pediatric residents in 57(59.38%) participants and remaining 39(40.62%) participants showed no adequate knowledge. Conclusion: It is concluded that frequency of adequate knowledge of basic life support among postgraduate residents is good. Keywords: Basic life support (BLS), Pediatric Advanced Life Support, residents, adequate knowledge.

Urinary Tract Infection and Antibiotic Sensitivity to Culture Most Commonly to Nitrofurantoin and Fosfomycin

Objective: To document susceptibility to Fosfomycin and nitrofurantoin among uropathogens isolated from the OPD and Emergency Room of PAEC General Hospital Islamabad. Material and Methods: The duration of this study was from March 2019 to July 2019, bacteria isolated from urine samples of OPD and emergency room patients suffering from pyuria were evaluated for susceptibility to antibiotic drugs such as nitrofurantoin and Fosfomycin. The medical records of the patients were obtained from hospital record and reviewed for uropathogens and other antimicrobial susceptibilities. The UTIs patients were categorized as complicated and uncomplicated UTIs. Results: This research study enrolled a total of 297 UTI patients with positive urine cultures. Complicated UTIs and uncomplicated UTIs were found in 228 and 69 patients respectively. The Escherichia coli (E. coli) (70.1%) and Klebsiella pneumoniae (15.5%) was the most common pathogens. The susceptibility of E. coli and K. pneumoniae to Fosfomycin and nitrofurantoin was high. Conclusion: The uropathogens in PACE general Hospital Islamabad have higher susceptibilities to antibiotics Fosfomycin than to nitrofurantoin. Keywords: Susceptibility, Urinary Tract Infection, Fosfomycin, Nitrofurantoin, Uropathogens.

Infrared image method for possible COVID-19 detection through febrile and subfebrile people screening

This study proposed an infrared image-based method for febrile and subfebrile people screening to comply with the society need for alternative, quick response, and effective methods for COVID-19 contagious people screening. The methodology consisted of: (i) Developing a method based on facial infrared imaging for possible COVID-19 early detection in people with and without fever (subfebrile state); (ii) Using 1206 emergency room (ER) patients to develop an algorithm for general application of the method, and (iii) Testing the method and algorithm effectiveness in 2558 cases (RT-qPCR tested for COVID-19) from 227,261 workers evaluations in five different countries. Artificial intelligence was used through a convolutional neural network (CNN) to develop the algorithm that took facial infrared images as input and classified the tested individuals in three groups: fever (high risk), subfebrile (medium risk), and no fever (low risk). The results showed that suspicious and confirmed COVID-19 (+) cases characterized by temperatures below the 37.5 °C fever threshold were identified. Also, average forehead and eye temperatures greater than 37.5 °C were not enough to detect fever similarly to the proposed CNN algorithm. Most RT-qPCR confirmed COVID-19 (+) cases found in the 2558 cases sample (17 cases/89.5%) belonged to the CNN selected subfebrile group. The COVID-19 (+) main risk factor was to be in the subfebrile group, in comparison to age, diabetes, high blood pressure, smoking and others. In sum, the proposed method was shown to be a potentially important new tool for COVID-19 (+) people screening for air travel and public places in general.

Deep phenotyping of oxidative stress in emergency room patients reveals homoarginine as a novel predictor of sepsis severity, length of hospital stay, and length of intensive care unit stay.

We aimed to determine primary markers of oxidative stress (OS) in ED patients which predict hospital length of stay (LoS), intensive care unit (ICU) LoS, and sepsis severity. This prospective, single center observational study was conducted in adult patients recruited from the ED who were diagnosed with either sepsis, infection without sepsis, or non-infectious, age-matched controls. 290 patients were admitted to the hospital and 24 patients had direct admission to the ICU. A panel of 269 OS and related metabolic markers were profiled for each cohort. Clinical outcomes were direct ICU admission, hospital LoS, ICU LoS, and post-hoc, adjudicated sepsis severity scoring. Bonferroni correction was used for pairwise comparisons. Principal component regression was used for dimensionality reduction and selection of plasma metabolites associated with sepsis. Multivariable negative binomial regression was applied to predict admission, hospital, and ICU LoS. Homoarginine (hArg) was the top discriminator of sepsis severity [sepsis vs. control: ROC-AUC = 0.86 (95% CI 0.81-0.91)], [sepsis vs. infection: ROC-AUC = 0.73 (95% CI 0.68-0.78)]. The 25th percentile of hArg [odds ratio (OR) = 8.57 (95% CI 1.05-70.06)] was associated with hospital LoS [IRR = 2.54 (95% CI 1.83-3.52)] and ICU LOS [IRR = 18.73 (95% CI 4.32-81.27)]. In prediction of outcomes, hArg had superior performance compared to arginine (Arg) [hArg ROC-AUC = 0.77 (95% CI 0.67-0.88) vs. Arg ROC-AUC = 0.66 (95% CI 0.55-0.78)], and dimethylarginines [SDMA ROC-AUC 0.68 (95% CI 0.55-0.79) and ADMA ROC-AUC = 0.68 (95% CI 0.56-0.79)]. Ratio of hArg and Arg/NO metabolic markers and creatinine clearance provided modest improvements in clinical prediction. Homoarginine is associated with sepsis severity and predicts hospital and ICU LoS, making it a useful biomarker in guiding treatment decisions for ED patients.