Full Outline Research Articles

Factors associated with the use of anesthetic drug infusion in patients with status epilepticus and their relation to outcome: a prospective study.

Status epilepticus (SE) is one of the most dreadful neurological emergencies; unfortunately, studies targeting SE are still inadequate. This study aims to identify factors associated with the use of CIVAD in patients presenting with status epilepticus and detect those impact the clinical outcome. A prospective study involving 144 episodes of SE in 144 patients. Patients were categorized according to whether or not they received CIVAD. Subjects underwent clinical assessment, brain imaging, and EEG. The consciousness level was assessed using the Glasgow coma scale (GCS) and the Full outline of responsiveness (FOUR) scale. SE severity score (STESS) and Epidemiology-based mortality score (EMSE) were used as scales for outcome prediction. Continuous IV anesthetic drug infusion was initiated in 36% of patients (+ CIVAD). Such groups showed a significantly worse initial level of consciousness (< 0.001), an unstable course of seizure evolution (0.009), and all of them showed abnormal EEG patterns. A significantly higher number of patients (+ CIVAD) developed complications (< 0.001), had higher outcome prediction scores (< 0.001), and mortality rates (< 0.001) compared to those who did not need CIVAD (-CIVAD). Mortality was associated with acute symptomatic etiology and higher total doses of propofol. Among the study population, mortality among patients who received CIVAD was associated with acute symptomatic SE and prolonged propofol infusion rather than any clinical parameters or predictor scores.

KOMPARASI GLASGOW COMA SCALE (GCS) DAN FULL OUTLINE OF UNRESPONSIVENESS (FOUR) UNTUK MENILAI MORTALITAS PADA PASIEN CEDERA KEPALA DI AREA PERAWATAN KRITIS: LITERATUR REVIEW

Abstrak&#x0D; Latar Belakang: Cedera kepala merupakan penyakit kritis yang membutuhkan perawatan khusus di ruang intermediate care di Rumah Sakit. Pasien cedera kepala bisa mengalami perubahan kondisi yaitu penurunan kesadaran. Perubahan kondisi ini akan mempengaruhi prognosis dan mortalitas pasien, sehingga pada area perawatan kritis membutuhkan skala pengukuran yang tepat diantaranya Glascow Koma Scale (GCS) dan Full Outline of Un Responding (FOUR) untuk menilai tingkat kesadaran. Tujuan: Mengidentifikasi pengukuran tingkat kesadaran menggunakan GCS dan FOUR untuk menilai mortalitas pada pasien cedera kepala di area perawatan kritis. Metode: Penelitian dilakukan dengan metode literature review dengan menelaah sebelas jurnal dari Portal Garuda, EBSCO, PROQUEST, CANGAGE dan DOAJ yang dipublikasikan dari tahun 2010 sampai dengan tahun 2020. Hasil: menunjukkan GCS dan FOUR dapat digunakan dalam memprediksi mortalitas pasien cedera kepala di ruang perawatan kritis. Kesimpulan: GCS dan FOUR merupakan alat ukur yang efektif untuk menilai mortalitas pada pasien cedera kepala, tetapi pada pasien dengan intubasi akan lebih tepat menggunakan FOUR.&#x0D; Kata Kunci: GCS, FOUR, Mortalitas, Cedera Kepala

Forecast of the medical evacuation in patients with the cardiovascular dysfunction. A retrospective study

Introduction. The prognosis for the patients with the cardiovascular dysfunction and the use vasopressors or cardiotonics is always doubtful. Frequently patientʼs unstability and usage of vasoactive drugs increases the risks of incidents and are contraindication for medical evacuation. The results of published studies indicate that the use of these drugs when transporting patients is accompanied by certain risks, and methods for their prediction are not well described. Objectives. Determine prognostic factors and evaluate the results of medical evacuation in patients requiring vasopressor and cardiotonic support. Materials and methods. The retrospective study included 1210 patients from the database of the Tyumenʼs resuscitative-consultative center and the prospective study included 41 patients who were delivered to the Tyumen level III hospitals in 2019. Patients were distributed into 2 groups — survivors and deceased after evacuation. Results. Our study showed the importance of the integral estimation of severity of patients subjected to medical evacuation and the high predictive value of the National Early Warning Score (NEWS) scale and Full Outline of UnResponsiveness (FOUR) at the stages of evacuation. In the next day after delivery, the Acute Physiology And Chronic Health Evaluation (APACHE II) scale demonstrated high prediction accuracy. Despite the risks associated with the development of undesirable situations during transportation (their frequency according to our data was 12.2 %), the evacuation of patients with cardiovascular dysfunction increases the chance of an favorable outcome 2.8 time. Conclusions. Despite the presence of vascular dysfunction, the evacuation of patients in need of vasopressor and cardiotonic support is a life-saving measure that increases the chances of patients for a favorable outcome by 2.82 times.

Study to assess the effectiveness of structured teaching programme on knowledge regarding four score (full outline of unresponsiveness) coma scale among Staff nurses working in intensive care units in selected Hospitals

Study to assess the effectiveness of structured teaching programme on knowledge regarding four score (full outline of unresponsiveness) coma scale among Staff nurses working in intensive care units in selected Hospitals

Faktor-Faktor yang Berhubungan dengan Kejadian Luka Dekubitus Akibat Penggunaan Alat Medis di Ruang PICU

The use of medical devices in patients treated at the Pediatric Intensive Care Unit (PICU) is very high. Patients who are treated in intensive care are also at risk for medical device-related pressure injury (MDRPI). This study aimed to determine the factors associated with the incidence of MRDPI in the Pediatric Intensive Care Unit (PICU) RSUP DR. Wahidin Sudirohusodo Makassar. This study used an observational analytic method with a prospective cohort approach. The Sampling method used a simple random sampling of 76 people. This research was conducted on 8 May - 6 July 2019. The data collection technique used an observation sheet with the research instrument used in the form of the Pediatric Early Warning Scoring System to assess critical conditions, the level of awareness was fully used Full Outline of UnResponsiveness score (FOUR Score). The data were analyzed tested by using the statistical the Chi Square with a confidence level of 95%. All data were analyzed using the SPSS version 21.0 program (SPSS, Inc. Chicago, IL). Factors associated with the MDRPI incidence include critical conditions based on PEWSS (p = 0.002), level of awareness based on the FOUR Score (p = 0.025), number of devices installed (p = 0.015), and fixation techniques (p = 0.025). As for peripheral tissue perfusion (p = 0.268), albumin (p = 0.309), skin moisture (p = 0.888) were not related. Factors associated with the incidence of MDRPI include critical condition, level of awareness, number of devices installed, and fixation techniques. It’s recommended to make preventive efforts.

PREDICTORS OF EARLY NEUROLOGICAL DETERIORATION IN PATIENTS WITH ACUTE SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HAEMORHAGE

This study was designed in order to improve diagnostic approaches in acute period of spontaneous intracerebral haemorrhage based on the elaboration of prognostic criteria for detecting early neurological deterioration under the conservative treatment. This prospective study included 339 patients having the first intracerebral haemorrhage. Clinical neurological examinations were carried out over the course of acute period of the disease by using Full Outline of UnResponsiveness scale and National Institute of Health Stroke Scale. The volume of intracerebral and secondary intraventricular haemorrhage, presence and severity of midline shift were detected by neurovisualizing techniques. Early neurological deterioration was chosen as a cumulative endpoint. We considered the signs of deterioration under the therapy during the first 24 – 48 hours following the admission to the hospital: decrease in Full Outline of UnResponsiveness scale score ≥2; increase in the National Institute of Health Stroke Scale score ≥4; lethal outcome. Logistic regressive analysis and ROC-analysis were used for elaboration of the prognostic criteria. Results. Neurological deterioration under the conservative therapy for 24 – 48 hours since the hospitalization was detected in 29,2-33,6% of cases. Multiple logistic regression analysis showed that initial degree of midline shift and volume of secondary intraventricular haemorrhage are the most informative parameters for evaluating risk of early neurological deterioration in patients with hemorrhagic stroke, who received the conservative therapy.&#x0D; The volume of secondary intraventricular hemorrhage &gt;13,5 ml (sensitivity 70,5-72,7%, specificity 80,8-82,8%) and mean value of septum pellucidum and pineal gland shift &gt;4,5 mm (sensitivity 60,6-60,7%, specificity 85,8-89,2%) were the predictors for early neurological deterioration. The above-mentioned predictors were integrated into the mathematical models for early neurological deterioration prognosis during 24 hours (AUC (95% CІ) = 0,85 (0,81-0,89), р˂0,0001) and 48 hours since the hospital admission (AUC (95% CІ) = 0,87 (0,83-0,90), р˂0,0001). Conclusions. The informative neurovisualization criteria for early neurological deterioration in patients with spontaneous supratentorial intracerebral haemorrhage were elaborated. They include the integrated degree of midline shift and the volume of secondary intraventricular hemorrhage. These criteria enable to determine the individual cumulative risk of unfavorable outcomes of acute period of the disease under the conservative therapy following 24 – 48 hours since the hospitalization with the accuracy of 81,7-82,9%.

Можливості клініко-нейровізуалізаційної верифікації прогнозу перебігу гострого періоду спонтанного супратенторіального внутрішньомозкового крововиливу на тлі консервативної терапії

The aim of the study – to improve the diagnostic measures in patients with spontaneous supratentorial intracerebral hemorrhage through elaboration of the prognostic criteria for the early neurological deterioration on the ground of comparative analysis of clinical scales that evaluate the severity of patient’s condition. Materials and methods. Prospective, cohort investigation of 339 patients (mean age 64,8±0,6 years) in acute period of spontaneous supratentorial intracerebral hemorrhage was done. The diagnosis was made on the ground of clinical, neurovisualization examination. Initial patient’s condition severity was estimated by using the National Institute of Health Stroke Scale (NIHSS), Full Outline of UnResponsiveness (FOUR) Scale, Glasgow Coma Scale, original Intracerebral Hemorrhage Scale (oICH), modified Intracerebral Hemorrhage Scales (mICH-A, mICH-B), Intracerebral Hemorrhage Grading Scale (ICH-GS), Intracerebral Hemorrhage Functional Outcome Scale (ICH-FOS). The early neurological deterioration was used as a cumulative end-point. It was detected as onset of one or some events from the following during 24 hours from the admission on the ground of conservative therapy: 1) decrease of FOUR score ≥2; 2) increase of NIHSS score ≥4; 3) lethal outcome. Logistic regression and ROC-analysis were used for prognostic criteria elaboration. Results. Clinical neurological deterioration during 24 hours from admission was revealed in 99 (29,2%) patients. On the ground of univariate logistic regression analysis it was detected that the risk of early neurological deterioration in patients with spontaneous supratentorial intracerebral hemorrhage on the ground of conservative therapy is evaluated as the following summary score: oICH (OR (95% CІ) = 2,71 (2,07–3,55), р˂0,0001), mICH-A (OR (95% CІ) = 1,70 (1,50–1,93), р˂0,0001), mICH-B (OR (95% CІ) = 1,81 (1,57–2,09), р˂0,0001), ICH-GS (OR (95% CІ) = 1,91 (1,59–2,29), р˂0,0001) and ICH-FOS (OR (95% CI) = 1,40 (1,28–1,54), р˂0,0001). It was detected that mICH-A and mICH-B scales differ with higher AUC values compared with oICH, ICH-GS and ICH-FOS concerning early neurological deterioration prediction in patients with spontaneous supratentorial intracerebral hemorrhage. Conclusions. Early neurological deterioration predictors in patients with spontaneous supratentorial intracerebral hemorrhage during 24 hours from the admission are the mICH-A score &gt;4 (sensitivity = 71,7%, specificity = 78,8%) and mICH-B score &gt;2 (sensitivity = 82,8%, specificity = 63,8%)

Brain Injury in Critical Illness and a Note on the Virus

Brain Injury in Critical Illness and a Note on the Virus

General Approach to the Poisoned Patient

Poisoning and ingestions constitute an increasing amount of morbidity and mortality nationwide. According to the American Association of Poison Control Centers (AAPCC), 2.2 million exposures were reported in 2013, and ingestions are currently the leading cause of injury-related death in the United States. Exposures include intentional overdose or suicide attempts, accidental overdose in drug abusers or children, and work-related injuries or acts of terrorism. According to the AAPCC, 50% of exposures are in children less than 5 years old and 80% of exposures are unintentional. When it comes to the unstable undifferentiated and possibly poisoned patient, one must take a stepwise approach similar to that for any critically ill patient, This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of poisoning. Figures show The Full Outline of Unresponsiveness (FOUR) scale, a patient with methemoglobinemia, a hand with scaling due to mercury poisoning, an electrocardiogram with examples of QT prolongation and QRS widening, and an electrocardiogram of bidirectional ventricular tachycardia, pathognomonic of digitalis glycoside poisoning. Tables list a stepwise approach to a potentially poisoned patient, a general approach to the poisoned patient, heart rate, toxidromes, anticholinergic toxidrome, cholinergic toxidrome, Glasgow Coma Scale, toxins and associated odors, electrocardiogram findings, causes of anion-gap metabolic acidosis, and antidotes. This review contains 5 highly rendered figures, 13 tables, and 23 references Key words: Poison ingestion, Accidental poisoning, Toxidrome, Accidental overdose

Full Outline of Unresponsiveness Score and Brainstem Sign Score Application to Predict Mortality of Patients with Severe Head Injuries at Gambiran Public Hospital of Kediri

There are many factors and variables that influence the prognosis in patients with severe head injuries make determining the prognosis for patients with severe head injuries become difficult. There are two parameters that can predict the prognosis of severe head injury patients with optimal full outline of unresponsiveness score (FOUR score) and brainstem sign score (BSS). FOUR scores can provide a wealth of information about the scale of neurological signs that are quick and easy used for unconcious patients. BSS is an assessment to predict the death of a person permanently to determine whether there is a physiological function that is not function normally. The aimed of this study was to determine ratio of FOUR score and BSS in determining the prognosis of patients with severe head injury at RSUD Gambiran Kediri. The type of study was cross sectional approach. The sampling technique used consecutive sampling technique and obtained a sample of 60 people. The data was analyzed by using chi-square test for comparison of FOUR score and BSS in determining the prognosis of severe head injury patient at RSUD Gambiran Kediri. Based on the results of study by chi-square test showed that p FOUR score = p BSS = 0,004, which meant the FOUR score and BSS was determined the prognosis of patients with severe traumatic head injury at RSUD Gambiran Kediri. The study showed that there was no difference between the FOUR score and BSS in determining the prognosis of severe head injury patient at RSUD Gambiran Kediri but FOUR score could be used in incubated or ventilated patients. Based on the results of this study, it is advisable to use scoring method more easily and according to the condition of the patient is with the installed ventilator or non ventilator.

Abstract PO-269: Documentation methods for vulvar pain: Implications for detection of vulvar cancer, a cancer with known disparities

Abstract Introduction. Vulvar pain can be a symptom of vulvar cancer, which is frequently detected at late stage for elderly women, and has racial disparities. Better documentation, detection, and monitoring of vulvar pain, may eventually lead to early detection of vulvar cancer to reduce age and racial disparities in this cancer. Unfortunately, typical body outline drawings for measuring pain location do not allow documentation of the specific details of vulvar pain. Our study purpose was to compare two measures of pain location for patients with another vulvar pain condition, vulvodynia. Methodology. Using baseline data from an ongoing randomized clinical trial conducted in Chicago, 62 women with vulvodynia marked their pain on a genital specific outline and 59 of those also marked their pain on a full body outline. The women’s ages ranged from 20-62 years (31.8±9.4 years). Their education levels were high school (10%), some college (9%), bachelors degree (43%), and advanced leveled education (38%). 11% were Asian, 7% were Black, 74% were White, and 9% were other race. They completed PAINReportIt, an electronic version of the McGill Pain Questionnaire, which allowed women to mark the region of their pain and describe their pain intensity. ImageJ software was used to isolate and analyze the surface area included within the markings on a full body outline with a total of 48 segments and on a genital area outline with a total of 22 segments. Descriptive statistics and Pearson’s correlation were used to analyze the number of segments marked and the number of pixels marked on each segment of both outlines. Results. As a context for women’s pain experience, the average pain intensity was 3.9±2.6. On the full body outline, 41 women marked the genital area only contrary to 18 women who marked both the genital area and elsewhere. On the full body outline, 24/48 segments were marked and the most frequent were segments near the vulvar region: left anterior thigh (n=59), right anterior thigh (n=54), left lumbar/iliac region (n=49), and right lumbar/iliac region (n=47). Some women also marked regions in the gluteal and posterior thigh region: left gluteal region (n=13), right gluteal region (n=9), and left hamstrings (n=10). On the genital specific outline, 22/22 body areas were marked. The most frequent vulvar specific areas marked were: vestibular fossa (n=51), left labia minora (n= 52)and vagina (n=55). There was a moderate correlation (r=.43, p=.001) between the body surface area marked on the full-body outline and the body surface area marked on the genital area outline. Conclusion. Study findings support the validity of the body surface area as a measure of pain location using either outline. The genital area outline provides more specific information about pain in the vulvar region, and implications for its use have the potential to eliminate disparities of vulvar cancer through the improved detection and monitoring of vulvar pain. Citation Format: Guettchina Telisnor, Rishabh Garg, Yingwei Yao, Judith Schlaeger, Diana J. Wilkie. Documentation methods for vulvar pain: Implications for detection of vulvar cancer, a cancer with known disparities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-269.

Continuous EEG in ICU: Not a Luxury After All.

Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness and No Recent Seizure: A Multicenter Randomized Clinical Trial Rossetti AO, Schindler K, Sutter R, Rüegg S, Zubler F, Novy J, Oddo M, Warpelin-Decrausaz L, Alvarez V. JAMA Neurol. 2020;77(10):1-8. doi:10.1001/jamaneurol.2020.2264Importance:In critically ill patients with altered consciousness, continuous electroencephalogram (cEEG) improves seizure detection but is resource-consuming compared with routine EEG (rEEG). It is also uncertain whether cEEG has an effect on outcome.Objective:To assess whether cEEG is associated with reduced mortality compared with rEEG.Design, Setting, and Participants:The pragmatic multicenter Continuous EEG Randomized Trial in Adults was conducted between 2017 and 2018, with follow-up of 6 months. Outcomes were assessed by interviewers blinded to interventions. The study took place at 4 tertiary hospitals in Switzerland (intensive and intermediate care units). Depending on investigators’ availability, we pragmatically recruited critically ill adults having Glasgow Coma Scale scores of 11 or less or Full Outline of Responsiveness score of 12 or less, without recent seizures or status epilepticus. They had cerebral (eg, brain trauma, cardiac arrest, hemorrhage, or stroke) or noncerebral conditions (eg, toxic-metabolic or unknown etiology), and EEG was requested as part of standard care. An independent physician provided emergency informed consent.Interventions:Participants were randomized 1:1 to cEEG for 30 to 48 hours versus 2 rEEGs (20 minutes each), interpreted according to standardized American Clinical Neurophysiology Society guidelines.Main Outcomes and Measures:Mortality at 6 months represented the primary outcome. Secondary outcomes included interictal and ictal features detection and change in therapy.Results:We analyzed 364 (33% women; mean [SD] age, 63 [15] years) patients. At 6 months, mortality was 89 of 182 in those with cEEG and 88 of 182 in those with rEEG (adjusted relative risk [RR]: 1.02; 95% CI: 0.83-1.26; P = .85). Exploratory comparisons within subgroups stratifying patients according to age, premorbid disability, comorbidities on admission, deeper consciousness reduction, and underlying diagnoses revealed no significant effect modification. Continuous EEG was associated with increased detection of interictal features and seizures (adjusted RR: 1.26; 95% CI: 1.08-1.15; P = .004 and 3.37; 95% CI: 1.63-7.00; P = .001, respectively) and more frequent adaptations in anti-seizure therapy (RR: 1.84; 95% CI: 1.12-3.00; P = .01).Conclusions and Relevance:This pragmatic trial shows that in critically ill adults with impaired consciousness and no recent seizure, cEEG leads to increased seizure detection and modification of anti-seizure treatment but is not related to improved outcome compared with repeated rEEG. Pending larger studies, rEEG may represent a valid alternative to cEEG in centers with limited resources.

Value of amplitude-integrated EEG combined with Full Outline of Unresponsiveness in evaluating the prognosis of children with disturbance of consciousness

Objective To study the value of amplitude-integrated EEG (aEEG), Full Outline of Unresponsiveness (FOUR), and Glasgow Coma Scale (GCS) in evaluating the prognosis of children with disturbance of consciousness in the pediatric intensive care unit (PICU). Methods A total of 164 children with disturbance of consciousness who were admitted to the PICU of Children's Hospital Affiliated to Soochow University were enrolled as subjects. According to prognosis, they were divided into a poor prognosis group with 111 children and a good prognosis group with 53 children. The results of aEEG monitoring, FOUR score, and GCS score on days 1 and 5 of admission were collected. The association between evaluation methods and prognosis was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of aEEG, FOUR, and GCS in predicting prognosis. Results The children with no improvement or abnormal aggravation of aEEG on day 5 tended to have a poor prognosis. The results of aEEG was positively correlated with prognosis (r=0.689, P 0.05), while aEEG combined with FOUR had an AUC of 0.945, which was significantly larger than that of each index alone (P Conclusions Both aEEG and FOUR can be used as effective tools to predict the prognosis of children with disturbance of consciousness, and a combination of aEEG and FOUR can improve the predictive value.

Standardization of Full Outline of Unresponsiveness Scale to Assess the Level of Consciousness of the Patients Hospitalized in the Intensive Care Unit in Iran

Standardization of Full Outline of Unresponsiveness Scale to Assess the Level of Consciousness of the Patients Hospitalized in the Intensive Care Unit in Iran

FOUR Score sebagai Alternatif dalam Menilai Derajat Keparahan dan Memprediksi Mortalitas pada Pasien Cedera Otak Traumatik yang Diintubasi

The ideal consciousness scoring scale must be linear, reliable, valid, and user-friendly. There is a need to develop and validate a scale to quickly evaluate the level of consciousness, the severity of the disease, and the prognosis of morbidity and mortality. Glasgow Coma Scale (GCS) is the most commonly used tool to assess the level of consciousness and is considered the gold standard. However, GCS has several limitations, such as inability to evaluate verbal components in intubated patients. To overcome these challenges, researchers developed the Full Outline of UnResponsiveness (FOUR) score. FOUR scores is a clinical grading scale to assess the altered state of consciousness. FOUR scores is simpler and able to provide better information, especially in intubated-traumatic brain injury (TBI) patients. Some studies showed that GCS and FOUR scores have the high predictive value in predicting not only the mortality of trauma patients but also the outcome of discharged patients. A multicentre study showed that FOUR scores and GCS do not differ in predicting inpatient mortality. This study suggested that the FOUR scores could be a better diagnostic tool for assessing brainstem reflexes and breathing patterns. Unfortunately, some studies have found conflicting results between GCS and FOUR scores in predicting patient outcomes. These contradictions suggest the need to conduct more studies. Therefore, this literature review will compare GCS and FOUR scores in predicting mortality of TBI patients.

Mid-Air Haptic Rendering of 2D Geometric Shapes With a Dynamic Tactile Pointer.

An important challenge that affects ultrasonic mid-air haptics, in contrast to physical touch, is that we lose certain exploratory procedures such as contour following. This makes the task of perceiving geometric properties and shape identification more difficult. Meanwhile, the growing interest in mid-air haptics and their application to various new areas requires an improved understanding of how we perceive specific haptic stimuli, such as icons and control dials in mid-air. We address this challenge by investigating static and dynamic methods of displaying 2D geometric shapes in mid-air. We display a circle, a square, and a triangle, in either a static or dynamic condition, using ultrasonic mid-air haptics. In the static condition, the shapes are presented as a full outline in mid-air, while in the dynamic condition, a tactile pointer is moved around the perimeter of the shapes. We measure participants' accuracy and confidence of identifying shapes in two controlled experiments ( n1 = 34, n2 = 25). Results reveal that in the dynamic condition people recognise shapes significantly more accurately, and with higher confidence. We also find that representing polygons as a set of individually drawn haptic strokes, with a short pause at the corners, drastically enhances shape recognition accuracy. Our research supports the design of mid-air haptic user interfaces in application scenarios such as in-car interactions or assistive technology in education.

Early neurological deterioration prediction in patients with hemorrhagic hemispheric stroke on the ground of quantitative evaluation of secondary interventricular hemorrhage severity

The early neurological deterioration criteria in patients with hemorrhagic hemispheric stroke (HHS) were elaborated on the ground of quantitative evaluation of secondary interventricular hemorrhage (IVH) severity. The prospective study with 339 patient’s involvement with the participation of patients with an average age (64.8±0.6) years old with spontaneous (hypertensive) supratentorial intracerebral hemorrhage. The diagnosis was made by brain computed tomography with quantitative evaluation of secondary intraventricular hemorrhage severity by using Graeb, Leroux and Intraventricular Hemorrhage (IVH). Early neurological deterioration (END) was taken as a combined clinical end-point. END was detected as one of the following criteria onset: reduction of the summary score according to Full Outline of UnResponsiveness coma scale &gt; 2; increasing of the summary score on National Institute of Health Stroke Scale &gt; 4; lethal outcome. Statistic processing of the results was made with the use of Mann-Whitney criteria and ROC-analysis. Combined clinical end-point was registered in 29.2 % cases. It was detected that patients with END are characterized with higher values of summary score according to Graeb (7 [4–8] vs 0 [0–4], p&lt;0.0001), Leroux (9 [5–12] vs 0 [0–5], p&lt;0.0001) and IVH scales (17 [13–20] vs 0 [0–12], p&lt;0.0001). While the mentioned scales do not differ in diagnostic informativeness when individual END detection prognosis in patients with HHS (AUC is 0.80-0.81). Summary score according to Graeb &gt; 5 (Se = 68.7%, Sp = 82.9%), Leroux &gt; 4 (Se = 76.8%, Sp = 74.6%) and IVH &gt; 13 (Se =72.7%, Sp = 80.8%) scales are predictors of END in patients with HHS. It was detected that in case of FOUR score &lt; 13, volume of intracerebral hemorrhage &gt; 40 ml and midline shift &gt; 5 mm, positive predictive value of these criteria exceeds 90%, while in general cohort – does not reach 65%. The threshold values of summary score in Graeb, Leroux and IVH scales are the informative criteria of END prognosis in patients with HHS. Keywords: hemorrhagic stroke, intraventricular hemorrhage, early neurological deterioration, prognosis.

Improving reproducibility of geospatial conference papers – lessons learned from a first implementation of reproducibility reviews

In an attempt to increase the reproducibility of contributions to a long-running and established geospatial conference series, the 23rd AGILE Conference on Geographic Information Science 2020 (https://agile-online.org/conference-2020) for the first time provided guidelines on preparing reproducible papers (Nüst et al., 2020) and appointed a reproducibility committee to evaluate computational workflows of accepted papers ( https://www.agile-giscience-series.net/review_process.html). Here, the committee’s members report on the lessons learned from reviewing 23 accepted full papers and outline future plans for the conference series. In summary, six submissions were partially reproduced by reproducibility reviewers, whose reports are published openly on OSF ( https://osf.io/6k5fh/). These papers are promoted with badges on the proceedings’ website (https://agile-giss.copernicus.org/articles/1/index.html).&#x0D; Compared to previous years’ submissions (cf. Nüst et al. 2018), the guidelines and increased community awareness markedly improved reproducibility. However, the reproduction attempts also revealed problems, most importantly insufficient documentation. This was partly mitigated by the non-blind reproducibility review, conducted after paper acceptance, where interaction between reviewers and authors can provide the input and attention needed to increase reproducibility. However, the reviews also showed that anonymisation and public repositories, when properly documented, can enable a successful reproduction without interaction, as was the case with one manuscript. Individual and organisational challenges due to the COVID-19 pandemic and the conference’s eventual cancellation increased the teething problems. Nevertheless, also under normal circumstances, future iterations will have to reduce the reviewer’s efforts to be sustainable, ideally by more readily executable workflows and a larger reproducibility committee.&#x0D; Furthermore, we discuss changes to the reproducibility review process and their challenges. Reproducibility reports could be made available to “regular” reviewers, or the reports could be considered equally for acceptance/rejection decisions. Insufficient information or invalid arguments for not disclosing material could then lead to a submission being rejected or not being sent out to peer review. Further organisational improvements are a publication of reviewers’ activities in public databases, making the guidelines mandatory, and collecting data on used tools/repositories, spent efforts, and communications.&#x0D; Finally, we summarise the revision of the guidelines, including their new section for reproducibility reviewers, and the status of the initiative “Reproducible Publications at AGILE Conferences” (https://reproducible-agile.github.io/initiative/), which we connect to related undertakings such as CODECHECK (Eglen et al., 2019). The AGILE Conference’s experiences may help other communities to transition towards more open and reproducible research publications.

137. FOUR score over GCS score in critically ill patients in the Emergency Department and the Critical Care Department.

Introduction: The Glasgow Coma Score, published by Graham Teasdale and Bryan J Jennett, which has been under use for over 4 decades proved to be a reliable and easy method of assessing a patient with neurological deficit of any cause by assessing the eye(4),verbal response(5) and motor response(6), however it had certain shortcomings like not being able to assess the verbal part of a patient who is been intubated. On the other hand The Full Outline of Unresponsiveness(FOUR)score developed by Dr. Eelco F.M. Wijdicks at Mayo clinic is even a more simple scale to assess the higher neurological function of any patient presenting to the hospital, which uses a scale ranging from 0-16,with an assessment of four domains such as eye responses, motor responses, brainstem reflexes and breathing pattern, each domain having a score ranging from 0-4, making it easier to assess a patient who is critically ill as the verbal component is replaced by the brainstem reflexes and respiratory patterns. Methodology: This is a prospective study on 106 patients both in the Intensive Care Unit and the Emergency Department, in which each patient who is critically ill is taken up and tested accordingly in a 1:1 ratio as both the patient is checked using the standard GCS scoring and the new FOUR Score respectively dating from 2016 January to 2018 January in PRS Hospital. PRS hospital is a 300- bedded NABH accredited multispecialty hospital with multiple specialized Intensive Care Units such as Neonatal ICU, Neurosurgical ICU, Cardiac ICU, Critical Care ICU, and a fully functional Emergency Department with Standard Triaging system and Trauma Care. All patients >18 years of age who is critically ill presenting to the ER & ICU were assessed with GCS & FOUR score and later MRS was analyzed during the time of discharge. INCLUSION CRITERIA Patients aged 18 or more Patient who are intubated Patients with traumatic brain injury Patients with altered sensorium EXCLUSION CRITERIA Patients who are medically paralyzed/sedated Patients with hearing or visual impairments Patients with degenerative brain disease or mental retardation Patients with seizures within the last 1 hour Results: In a total of 106 patients; FOUR score proved to have a strong positive correlation (P<0.001, chi square 106.573) in predicting the level of disabilities when assessed with the modified Rankin score. It was seen that an excellent FOUR score predicts mild level of disabilities in 98.3%, while a moderate FOUR score predicted severe impairment at discharge in 38.10%. As for the correlation between Rankin score and GCS, 45.7% patients registered severe score in both Rankin and GCS & 85.7% patients registered mild scores in both scoring system, which shows unanimous nature of both the scales but both the scales have false positives and negatives with a significantly low chi square value of 29.284. Thus giving FOUR score an upper hand in predicting the outcomes as well as providing a much bigger spectrum of classification of critically ill patients in comparison to GCS. Conclusion: The FOUR score proved to have a higher degree of predictability of disability when assessed with the modified Rankin scale score in comparison to GCS in assessing the neurological status of critically ill patients.

Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness and No Recent Seizure

In critically ill patients with altered consciousness, continuous electroencephalogram (cEEG) improves seizure detection, but is resource-consuming compared with routine EEG (rEEG). It is also uncertain whether cEEG has an effect on outcome. To assess whether cEEG is associated with reduced mortality compared with rEEG. The pragmatic multicenter Continuous EEG Randomized Trial in Adults (CERTA) was conducted between 2017 and 2018, with follow-up of 6 months. Outcomes were assessed by interviewers blinded to interventions.The study took place at 4 tertiary hospitals in Switzerland (intensive and intermediate care units). Depending on investigators' availability, we pragmatically recruited critically ill adults having Glasgow Coma Scale scores of 11 or less or Full Outline of Responsiveness score of 12 or less, without recent seizures or status epilepticus. They had cerebral (eg, brain trauma, cardiac arrest, hemorrhage, or stroke) or noncerebral conditions (eg, toxic-metabolic or unknown etiology), and EEG was requested as part of standard care. An independent physician provided emergency informed consent. Participants were randomized 1:1 to cEEG for 30 to 48 hours vs 2 rEEGs (20 minutes each), interpreted according to standardized American Clinical Neurophysiology Society guidelines. Mortality at 6 months represented the primary outcome. Secondary outcomes included interictal and ictal features detection and change in therapy. We analyzed 364 patients (33% women; mean [SD] age, 63 [15] years). At 6 months, mortality was 89 of 182 in those with cEEG and 88 of 182 in those with rEEG (adjusted relative risk [RR], 1.02; 95% CI, 0.83-1.26; P = .85). Exploratory comparisons within subgroups stratifying patients according to age, premorbid disability, comorbidities on admission, deeper consciousness reduction, and underlying diagnoses revealed no significant effect modification. Continuous EEG was associated with increased detection of interictal features and seizures (adjusted RR, 1.26; 95% CI, 1.08-1.15; P = .004 and 3.37; 95% CI, 1.63-7.00; P = .001, respectively) and more frequent adaptations in antiseizure therapy (RR, 1.84; 95% CI, 1.12-3.00; P = .01). This pragmatic trial shows that in critically ill adults with impaired consciousness and no recent seizure, cEEG leads to increased seizure detection and modification of antiseizure treatment but is not related to improved outcome compared with repeated rEEG. Pending larger studies, rEEG may represent a valid alternative to cEEG in centers with limited resources. ClinicalTrials.gov Identifier: NCT03129438.