Multiple Scoring Systems Research Articles

Role for Endoscopic Triage in Acute UGI Bleeding

Multiple scoring systems have been developed to predict outcomes in patients who present with nonvariceal upper gastrointestinal (UGI) bleeding. Some scoring systems use endoscopic appearance of lesions, and others rely only on clinical data, without endoscopy. To evaluate the incremental value of endoscopy, investigators in Los Angeles retrospectively extracted data from the charts of 175 patients who presented to …

Multiple Factor Scoring System for Risk Assessment of Acute Pancreatitis

Background. The initial prognostic classification of a pathologic event has important implications for management, outcome, and resource utilization. A variety of prognostic classification methods have been developed, but none has thus far shown consistent predictive accuracy in individual patients. In an attempt to overcome some of the limitations encountered by earlier workers, we have developed a simplified system for evaluation and prognosis of acute pancreatitis.Materials and methods. We studied retrospectively 306 patients with acute pancreatitis. Nonstandard statistical calculations were used to create risk indices for pancreatitis severity for all 13 variables which were included in a standard chart.Results. The risk assessment rule's correct prediction is 81.32% (sensitivity) and 93.95% (specificity) for severe and mild pancreatitis, respectively. The total accuracy is 90.20%.Conclusion. The results of this nonstandard small retrospective study seem promising. It should remain experimental until larger prospective studies confirm the usefulness of the method.

Dialysis modalities in patients with acute renal failure.

Acute renal failure (ARF) is a syndrome characterizedby a sudden (over several hours to several weeks)deterioration in renal function resulting in the failureof the kidney to excrete nitrogenous waste productsand to maintain fluid and electrolyte homeostasis w1x.Community-acquired ARF occurs in approximately209 patients per 1 million population, and the fre-quency of this syndrome appears to be increasing inhospitalized patients w2x. ARF occurs in approximately20% of patients treated in intensive care units (ICU)and in 4 15% of patients after cardiovascular surgery.Despite advances in the management of critically illpatients and technological advances in renal replace-ment therapy, the mortality of ARF acquired in thehospital and in the ICU is approximately 45–70%,respectively w3–5x. However, the demographics of ARFhave changed over the last decades, with patientsgenerally being older and having a higher severity ofillness based on multiple scoring systems w2x.

Cellular injury score for multiple organ failure severity scoring system.

Cellular Injury Score (CIS) is an index of cellular injury, being calculated from three parameters of intracellular metabolism: arterial ketone body ratio, osmolality gap, and blood lactate. The usefulness of CIS as a severity scoring system for patients with multiple organ failure was prospectively evaluated in 157 consecutive patients with MOF (58 survivors, 99 nonsurvivors). CISs in nonsurvivors were significantly higher compared with those in survivors throughout the clinical courses. CIS was significantly correlated with the number of failing organs and mortality rate. The optimal cutoff point of CIS from receiver operating characteristics curve analysis was 4 for the maximal value during the clinical course. The changes in CIS well reflected the severity of injury in survivors and nonsurvivors who died within 2 weeks. CIS could be a useful index for mortality risk prediction and is potentially applicable as a severity scoring system for individual patients with MOF.

Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation.

We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2- to 4-year followup. The postoperative physical examination and KT-1000 arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1+ result in 17% of patients. Seventy percent of patients had < 3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The Tegner activity level was significantly improved from prereconstruction ratings and similar to preinjury ratings. The mean Lysholm score was 87. The modified Hospital for Special Surgery scores resulted in good or excellent results in 82% of the patients (mean, 87 points). The mean Noyes sports function score was 89, and the reoperation rate for a symptomatic knee flexion contracture was 12%. Ninety-seven percent of patients indicated that they would undergo the procedure again. When compared with this same population at 2 to 4 years, we saw no deterioration in scoring scale results.

A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome PAUL C HEBERT, ALANA J DRUMMOND, JOEL SINGER, ET AL St. Paul's Hospital; University of British Columbia, Vancouver; Vanderbilt University, Nashville, Tennessee

A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome PAUL C HEBERT, ALANA J DRUMMOND, JOEL SINGER, ET AL St. Paul's Hospital; University of British Columbia, Vancouver; Vanderbilt University, Nashville, Tennessee

Assessment of Clinical Competence

Abstract Current approaches to the examination of clinical competence at the undergraduate level are reviewed and differences in the approaches adopted in Australasia, Britain and North America are mentioned. The test methods used in these examinations are discussed critically and their separate strengths and weaknesses highlighted. It is made clear that no single test method is capable of providing a reliable and valid evaluation of the components which constitute clinical competence. Finally, newer approaches which involve multiple methods and profile scoring systems are outlined.