Point Scoring System Research Articles

Intraobserver and interobserver reliability of mud scoring systems for use in cattle at slaughter

At slaughter plants, live cattle are often scored for mud coverage as mud on hides can impact food safety and drives decisions regarding interventions during processing. Currently, there is no standardized method utilized to assess mud coverage. The aim of this study was to determine the intraobserver and interobserver reliability of 3, 4, and 5 point mud scoring systems. Beef cattle (n = 110) were videotaped during movement to holding pens upon arrival at a commercial slaughter facility. Five scorers were assigned to a 3, 4, or 5 point scoring system (n = 15), reviewed the video and assigned the cattle a mud score. A multi-rater weighted kappa analysis was used to determine intraobserver and interobserver reliability for each system. Although all scorers in the 3 point analysis and one scorer each for the 4 and 5 point analysis demonstrated moderate intraobserver reliability, all interobserver reliability kappas were poor (kappa ≤0.12). Further exploration to develop a suitable system that is repeatable is recommended.

Prospectively assessing risk of acute care utilization for patients with an active cancer diagnosis.

208 Background: Acute care utilization (ACU)--emergency department visits or hospitalizations--is common in patients with cancer. As many as 83% of all patients with cancer visit the emergency department annually; nearly three quarters of patients with advanced cancer are hospitalized in the year after diagnosis. Much of this ACU may be preventable. Identifying patients at risk for ACU using model-based approaches has shown potential for risk stratifying certain patient subgroups. However, a model applicable to any patient with an active cancer diagnosis is needed. We developed a real time clinical prediction model to assess risk for acute care utilization in patients with an active cancer diagnosis. Methods: We completed a retrospective cohort analysis of patients with an active cancer diagnosis (defined as at least one medical oncology encounter in a 12 month period) at one health system. Clinical factors with potential to impact disease progression and ACU were identified through a clinical review. Significant variables were defined by multivariate logistic regression. Risk of ACU was further characterized through the development of a point scoring system to define the upper decile of patients at highest risk. Results: We included 8,246 patient records in the analysis. Seven variables were determined to be statistically significant: An emergency department visit in the last 90 days, chronic obstructive pulmonary disease, congestive heart failure, chronic kidney disease, low hemoglobin, low albumin, and low absolute neutrophil count. The model produced an overall C-statistic of 0.726 Each significant variable was assigned a score of 0 or 1 (with the exception of ED visits, which were given one point for each visit, with three points maximum). Each patient received a total score, resulting from the summation of the individual variable scores. An evaluation of the distribution of points determined that 10% of the patients achieved a score of 2 or higher and contributed to 46% of ACU in the last 90 days. Patients receiving 0 points were defined as low risk (73% of patients contributing to 30% of ED/admissions). Patients receiving 1 point were deemed intermediate risk (17% of patients contributing to 24% of ED/admissions). Conclusions: Risk of acute care utilization for patients with an active cancer diagnosis can be prospectively assessed. This tool is currently integrated into our clinical practice and is updated every 14 days, or any time the chart is accessed. Assessment of efficacy is ongoing.

Derivation and validation of the J-CTO extension score for pre-procedural prediction of major adverse cardiac and cerebrovascular events in patients with chronic total occlusions.

We developed a prediction model of long-term risk after percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) based on pre-procedural clinical information. A total of 4,139 eligible patients, who underwent CTO-PCI at 52 Japanese centers were included. Specifically, 1,909 patients with 1-year data were randomly divided into the derivation (n = 1,273) and validation (n = 636) groups. Major adverse cardiac and cardiovascular event (MACCE) was the primary endpoint, including death, stroke, revascularization, and non-fatal myocardial infarction. We assessed the performance of our model using the area under the receiver operating characteristic curve (AUC) and assigned a simplified point-scoring system. One-hundred-thirty-eight (10.8%) patients experienced MACCE in the derivation cohort with hemodialysis (HD: odds ratio [OR] = 2.55), left ventricular ejection fractions (LVEF) <35% (OR = 2.23), in-stent occlusions (ISO: OR = 2.27), and diabetes mellitus (DM: OR = 1.72). The AUC of the derivation model was 0.650. The model's performance was similar in the validation cohort (AUC, 0.610). When assigned a point for each associated factor (HD = 3, LVEF <35%, ISO = 2, and DM = 1 point), the average predicted versus the observed MACCE probability using the Japan-CTO extension score for the low, moderate, high, and very high risk groups was 8.1% vs. 7.3%, 16.9% vs. 15.9%, 22.0% vs. 26.1%, and 56.2% vs. 44.4%, respectively. This novel risk model may allow for the estimation of long-term risk and be useful in disseminating appropriate revascularization procedures.

Validation of Nine Different Prognostic Grading Indexes for Radiosurgery of Brain Metastases in Breast Cancer Patients and Development of an All-Encompassing Prognostic Tool.

Purpose: Several prognostic indexes for overall survival (OS) after radiotherapy of brain metastases in breast cancer patients exist but are mainly validated for whole-brain radiotherapy or not specifically for breast cancer patients. To date, no such index provides information beyond mere OS.Methods: We retrospectively analyzed 95 breast cancer patients treated with stereotactic radiosurgery for 203 brain metastases. The Kaplan–Meier method with log-rank test was used to assess OS, local control (LC), distant cranial control (DCC), and extracranial control (EC). Cox regression was applied to detect prognostic outcome factors. A point scoring system was designed to stratify patients based on outcome. Nine established prognostic indexes were analyzed using the concordance index (c-index).Results: Two out of nine analyzed prognostic indexes for OS showed a significant c-index, the breast graded prognostic assessment (bGPA; 0.631; 95% CI, 0.514–0.748; p = 0.037) and the modified bGPA (mod-bGPA; 0.662; 95% CI, 0.547–0.777; p = 0.010). Significant results from multivariate analysis (Karnofsky Performance Score, Her2/neu receptor status, extracranial control) were used to generate a new point system: the breast cancer stereotactic radiotherapy score (bSRS), which discriminated three significantly different prognostic groups, for LC, DCC, EC, and OS, respectively. However, the c-index was only significant for OS (0.689; 95% CI, 0.577–0.802; p = 0.003).Conclusions: The new bSRS score was superior to the bGPA and mod-bGPA scores for prognosis of OS. The bSRS is easy to use and the first tool, which might also provide outcome assessment beyond mere OS. Future studies need to validate these findings.

Development of the point scoring system of medical parameters for HIV severity monitoring and modeling in numerical terms

The article considers the possibility of using a point scoring system of medical parameters for HIV severity monitoring and modeling in numerical terms. There were investigated the features of the use of medical parameters in the form of a point scoring system as well as the possibility of applying a numerical model for determining the HIV severity when tuberculosis is joined. To solve the problem, it was developed a step-by-step algorithm for applying the point scoring system. Conclusions were drawn. The possibility to predict in numerical terms the outcome of the disease (in particular the AIDS progression) using the number of systematically collected medical parameters in HIV carriers is of great interest. The information system development allows to determine the most important properties of the process and to separate its non-essential characteristics. Often the information system and modeling allow us to formulate new hypotheses and gain new knowledge about the object, those which were not available during the research.

A study on outcome of combined cuboid/cuneiform osteotomy for correction of residual forefoot adduction deformity in idiopathic clubfoot

Introduction: Recurrence is by definition the development of one or more of the original deformities (equinus, varus, adductus and cavus) after the full correction of the clubfoot is obtained. Adduction of the forefoot is the most common residual deformity in clubfoot associated with supination of the foot [Tarraf and Carroll]. Under correction at the time of initial surgery, medial displacement of the anterior part of calcaneum and navicular bones around the talus were considered to be some of the causative factors. Aims & objectives: To analyse the effectiveness of the combined cuboid /cuneiform osteotomy for correction of residual forefoot adduction deformity in idiopathic clubfoot. To study the improvement in forefoot flexibility, gait and overall functional outcome. To study the advantage of this procedure over other techniques of osteotomy. Materials and methods: 16 cases (feet) in 11 children, who presented to our institution (Government Rajaji Hospital, Madurai) between November 2010 and November 2012 with residual forefoot adduction deformity. Children were followed up for a period 2 years. Ethical committee approval was obtained for the procedure. The mean age at the time of surgery was 6.5 years (range 3- 10 years). There were 7 boys (10 feet), 4 girls (6 feet). The right foot in 9 children and left foot in 7. Results: Results according to point scoring system: (modified Bensahel et al.) approved by the International clubfoot study group. Of the 16 feet treated, 8 feet (50%) had excellent results, 5 feet (32%) good, 2 feet (12%) fair and 1 foot (6%) poor results. Conclusion: The combination of a shortening osteotomy of the cuboid and elongation of the cuneiform was first described by Mc hale and Lenhart. The combined osteotomy is a safe procedure and allows satisfactory correction of the residual forefoot adduction deformity and achieving a straight plantigrade foot.

Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. In conjunction with advice from internal and external reviewers and expert consultants in the field, this update is based on a systematic review of the literature centred on the following: the Population (P), Intervention (I), Comparator (C) and Outcomes (O) framework; the use of the SIGN guideline/Cochrane review system; and the 21 point scoring system advocated by IWGDF/EWMA. This has resulted in 13 recommendations. The recommendation on sharp debridement and the selection of dressings remain unchanged from the last recommendations published in 2016. The recommendation to consider negative pressure wound therapy in post-surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non-healing ischaemic ulcers also remains unchanged. Recommendations against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide, nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means also remain. New recommendations include consideration of the use of sucrose-octasulfate impregnated dressings in difficult to heal neuro-ischaemic ulcers and consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal, in both cases when used in addition to best standard of care. A further new recommendation is the consideration of topical placental derived products when used in addition to best standard of care.

Validation of the GED-C point-scoring system in true Gaucher disease patients

Validation of the GED-C point-scoring system in true Gaucher disease patients

Identification and weighting of kidney allocation criteria: a novel multi-expert fuzzy method

BackgroundKidney allocation is a multi-criteria and complex decision-making problem, which should also consider ethical issues in addition to the medical aspects. Leading countries in this field use a point scoring system to allocate kidneys. Hence, the purpose of this study is to identify and weight the kidney allocation criteria considering the balance between utility and equity.MethodsTo do this, a new fuzzy hybrid approach is proposed, which consists of two steps: In the first step, Fuzzy Delphi Method (FDM) is used to identify the effective criteria in the kidney allocation algorithm. In the second step, Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP) is employed to determine the weight of the criteria.ResultsThe results showed that the highest weight belongs to “Medical emergency” criterion and the lowest weight to “5 HLA mismatches”, which is similar to Euro-transplant kidney allocation system (ETKAS). The developed method is evaluated in two steps. First, the proposed model is implemented using a real case study from the Iranian Kidney Allocation System. It was shown that the proposed model has the potential to improve allocation outcome. Second, the proposed model’s superiority to the current model is approved by the experts using the results display in the profile matrix. Finally, sensitivity analysis is performed to check the robustness of the proposed model.ConclusionsThis paper contributes to the kidney allocation literature by doing the following: (a) developing a comprehensive framework for identification and weightings of criteria for kidney allocation, (b) using, for the first time, the IF-AHP technique to consider hesitancy of decision makers and uncertainty in organ allocation, and (c) proposing an appropriate framework for the countries that intend to improve or modify their organ allocation system.

56. The development of a predictive scoring system for discharge to a facility following posterior spinal fusion for adult spinal deformity

BACKGROUND CONTEXT Discharge to a rehabilitation or skilled nursing facility following elective surgical treatment of adult spinal deformity is common. However, this practice carries a number of disadvantages, including an increased cost of care to the patient and the health care system, and the potential for increased risk of postoperative complications. Uncertainty regarding a patient's discharge plan may also prolong the initial hospitalization, further contributing to the cost of care. As bundled-care payment systems become increasingly common, the cost associated with discharge to a facility may adversely affect the reimbursement of inpatient surgical fees. Given the many variables involved in the care of patients with adult spinal deformity, determining which patients will require discharge to a facility vs home has remained a challenge for interdisciplinary care teams. PURPOSE The aim of this study was to develop a risk stratification system by identifying risk factors for discharge to a facility following surgery for patients with adult spinal deformity. STUDY DESIGN/SETTING Retrospective prognostic study. PATIENT SAMPLE Consecutive patients who underwent elective posterior spinal fusion for adult deformity at a single academic institution from 2008 to 2014 were identified. Patients were excluded from analysis if they were under 18 years old, had a prior thoracolumbar surgery, or deceased during the hospitalization. OUTCOME MEASURES The primary outcome measure analyzed was discharge to a facility. Patient factors analyzed included age, sex, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) score, BMI, smoking status, and history of prior spine surgery. Surgical/hospitalization factors analyzed included number of fusion levels, number of single column osteotomies, presence of a three column osteotomy, operative duration, and length of hospital stay. METHODS To determine risk factors for discharge to a facility, a stepwise multivariate logistic regression was used, which initially included all preoperative variables and sequentially excluded nonsignificant variables until only those with p RESULTS A total of 208 patients were included, and 98 (47.12%) were discharged to a facility. Backwards stepwise multivariate logistic regression found the following risk factors for discharge to a facility: age (p=0.032), ASA score of three or more (p=0.032), and presence of a three column osteotomy (p 85% with 12 or more total points. CONCLUSIONS A point-scoring system for predicting discharge to facility after posterior spinal fusion for adult spinal deformity was developed. Age, ASA score of three or more, and three-column osteotomy were the primary factors that influenced this outcome. These findings may help interdisciplinary care teams to streamline discharge planning, reduce overall costs, and improve the quality of care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Extubation Readiness in Critically Ill Stroke Patients.

Background and Purpose- Predicting safe extubation represents a clinical challenge in acute stroke patients. Classical respiratory weaning criteria have not proven reliable. Concerning the paramount relevance of postextubation dysphagia in this population, criteria related to airway safety seem to perform better, but diagnostic standards are lacking. We compare clinical and instrumental swallowing examination tools to assess extubation readiness and propose a simple Determine Extubation Failure in Severe Stroke score for decision making. Methods- Data of 133 orally intubated acute stroke patients were prospectively collected in this observational study. Classical extubation criteria, a modified semiquantitative airway score, and an oral motor function score were assessed before extubation. A 3-ounce water swallow test and validated 6-point fiberoptic endoscopic dysphagia severity scoring were performed thereafter. Association of demographic and clinical parameters with extubation failure (EF) was investigated. Independent predictors of EF were translated into a point scoring system. Ideal cutoff values were determined by receiver operator characteristics analyses. Results- Patients with EF (24.1% after 24±43 hours) performed worse in all swallowing assessments (P<0.001). Fiberoptic endoscopic dysphagia severity scoring was the only independent predictor of EF (adjusted odds ratio, 4.2; P<0.007) with optimal cutoff ≥5 (sensitivity 84.6% and specificity 76.5%). Restricting regression analysis to parameters collected before extubation, a 4-item Determine Extubation Failure in Severe Stroke score (duration of ventilation, the examination of oral motor function, infratentorial lesion, and stroke severity) was derived. The score demonstrated excellent discrimination (area under the curve 0.89; 95% CI, 0.83-0.95) and calibration (Nagelkerkes R2=0.54) with an ideal cutoff ≥4 (sensitivity: 81.3% and specificity: 78.2%). Conclusions- Risk of EF is strongly correlated with postextubation dysphagia severity in stroke. Fiberoptic endoscopic examination of swallowing best predicts necessity of reintubation but requires a trial of extubation. The Determine Extubation Failure In Severe Stroke score is based on easy to collect clinical data and may guide extubation decision making in critically ill stroke patients.

Early prediction of treatment failure in severe community-acquired pneumonia: The PRoFeSs score

PurposeTo identify a single/panel of biomarkers and to provide a point score that, after 48 h of treatment, could early predict treatment failure at fifth day of Intensive Care Unit (ICU) stay in severe community-acquired pneumonia (SCAP) patients. Materials and methodsSingle-center, prospective cohort study of 107 ICU patients with SCAP. Primary outcome included death or absence of improvement in Sequential Organ Failure Assessment score by ≥2 points within 5 days of treatment. Biomarkers were evaluated within 12 h of first antibiotic dose (D1) and 48 h after the first assessment (D3). ResultsA model based on Charlson's score and a panel of biomarkers (procalcitonin on D1 and D3, B-natriuretic peptide on D1, D-dimer and lactate on D3) had good discrimination for primary outcome in both derivation (AUC 0.82) and validation (AUC 0.76) samples and was well calibrated (X2 = 0.98; df = 1; p = .32). A point score system (PRoFeSs score) built on the estimates of regression coefficients presented good discrimination (AUC 0.81; 95% Confidence Interval 0.72–0.89) for primary outcome. ConclusionsIn SCAP, a combination of biomarkers measured at admission and 48 h later may early predict treatment failure. PRoFeSs score may recognize patients with poor short-term prognosis.

Inter-Session Reliability of the Tennis Serve and Influence of the Laboratory Context.

To meet the demand of a player’s entourage (e.g., coaches and medical staff), it is important for the biomechanics specialist to perform repeatable measures. To the best of our knowledge, to date, it has not been demonstrated whether similar results are obtained between two sessions of testing or between laboratory and field sport kinematic protocols with regard to the tennis serve. This study had two primary aims. First, the inter-session repeatability of biomechanical variables of a tennis serve was evaluated. Second, the differences between laboratory and field evaluations were studied. Thirteen national tennis players (ITN 3) performed the same 28 markers’ set laboratory test twice two weeks apart, and other thirteen national players (ITN 3) performed two 4 markers’ set tests both in the laboratory and on an official tennis court one week apart. A 3D motion system was used to measure lower-limb, pelvis, trunk, dominant arm and racket kinematics. A force plate was used to evaluate kinetics of legs’ drive in the laboratory. A personal method based on a point scoring system was developed to evaluate the ball landing location accuracy. We observed that the majority of the studied variables were acceptable for excellent relative reliability for the inter-session analysis. We also showed that the impact of the laboratory versus field context on the player’s serve was limited

Stratification Risk Analysis in Bridging Patients to Lung Transplant on ECMO: The STABLE Recipient Risk Score

Purpose No recipient risk index for in-hospital mortality of patients bridged to lung transplantation (LTP) using ECMOhas been clinically validated. We queried the UNOS database to generate a novel quantitative recipient risk score. Methods Since 2004 a total of 783 patients in the US were bridged to LTP using ECMO. Patients Results 6 pretransplant recipient specific variables were translated into a 26 point scoring system (Table 1). Derivation and validation cohort scores ranged between 0-22 and 0-24, with ROC areas under the curve of 71% and 75%, respectively (Figure 1A, 1B). In both derivation (Figure 1C) and validation (Figure 1D) cohort, each STABLE point increased the odds of in-hospital mortality by 22% (OR 1.22 [1.14-1.31, p Conclusion The STABLE score is a novel and validated tool for recipient risk stratification of patients on ECMO bridge to LTP. High predictive power of in-hospital mortality may aid clinical decision making and organ allocation.

Comparative Study of Oral Clonidine and Midazolam as Premedication in Pediatric Patients Undergoing Tonsillectomy

Background and Aim: Anxiety and fear of operation, injections, physicians, operation theatre environment and parental separation are all traumatizing experiences in children. The aim of the study was to compare the effects of oral midazolam and oral clonidine as premedication in children undergoing tonsillectomy .The preoperative sedation, anxiolytic, acceptance of mask for induction of anaesthesia, intravenous cannulation and post-operative recoverywere assessed in both groups. Methods: Aprospective randomized double blinded study of 100 patients of age group 4 -12 yrs undergoing tonsillectomy under general anaesthesia were selected. They were divided into 2 groups of 50 patients each. Group A (oral clonidine) received 4 mcg/kg 90 minutes before induction. Group B (oral midazolam) received 0.5 mg/kg 90 minutes before induction. The sedation and anxiety score was noted at the time of parental separation. The reaction to IV cannulation was assessed by sedation and anxiety scoring at the same time all of them were taken under GA with controlled ventilation. The Mask acceptance was graded by 5 point scoring system .Grade 3,4 and 5 are satisfactory.They were monitored throughout the surgery for any complications. Post operative status was assessed by Modified Objective Pain score. Results: The sedation score and anxiety score at venipuncture was better with clonidine group with statistical significance (p&lt; 0.000 and&lt;0.003). The mask acceptance was better with clonidine group with statistical significance (p &lt;0.000).Postoperative score was also better with clonidine group with statistical significance of p value &lt;0.000. Conclusion: We concluded that oral clonidine and midazolam can be used as better premedicants to produce optimal sedation and emotional state.Clonidine 4 μg / kg has been shown to be a more effective premedication for children undergoing elective tonsillectomy than midazolam 0.5mg/kg

Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed

BackgroundChina launched a 3-year rectification scheme for the clinical use of antibiotics in 2011, and a specific scheme for carbapenem use in 2017. The aim of this study was to investigate the effects of government policies on carbapenem use, and their correlation with carbapenem-resistant Pseudomonas aeruginosa (CRPA).MethodsThe study was divided into four stages: preintervention (2010), antimicrobial programme (2011–2013), post-antimicrobial programme (2014–2016) and carbapenem programme (2017). A point-score system was proposed for evaluating the rationality of carbapenem use, and evaluated based on the indications, microbial culture, single dose, interval, and duration. Any prescription without a global score of 10 points was judged as irrational. The trend was analyzed by regression analysis, and Spearman correlation analysis was used for testing the correlation.FindingsThe rate of rational use of carbapenems was 29.7% in 2010, and increased by 55.5, 45.2, and 51.5% during the subsequent three stages. The rationality declined slightly during the post-antimicrobial programme (2014–2016) while the consumption of carbapenems was markedly increased. These two parameters improved slightly in 2017. Moreover, the prevalence of CRPA was significantly negatively correlated with the rate of rational carbapenem use (Coefficient = − 0.553, P < 0.05), and not with the consumption of carbapenems (P > 0.05).ConclusionsThe rational application of carbapenems was related to government policies in this study, with irrational carbapenem use possibly related to the development of CRPA. The current point-score system could be a useful tool for performing assessments.

Hindsight bias critically impacts on clinicians’ assessment of care quality in retrospective case note review

Objective. To determine whether hindsight bias impacts on retrospective case note review using a five point scoring system based on modern clinical governance toolkits. Design. Survey. Setting. Clinicians of varying grades invited to complete a short internet survey. Participants. Ninety three clinicians were invited to complete an anonymous survey in which they reviewed three case vignettes for the purposes of a fictional clinical governance meeting. For each vignette, participants were randomised to an outcome in which the patient made a full recovery or alternatively died shortly after discharge. Main outcome measure. Participants submit scores from 1 to 5 to indicate the quality of care provided to patients prior to their discharge. These scores were compared to determine whether judgements about the quality of antecedent care were biased by the description of a patient death. Results. In two out of three case vignettes clinicians exhibited marked hindsight bias. In a case of a patient with a swollen leg, identical antecedent care was scored as poor by participants when the patient died the next day, but good when the patient recovered (p<0.00001). In a case of headache, care was scored as poor when the patient died but adequate when the patient made a full recovery (p=0.0003). A third case of chest pain did not exhibit hindsight bias. Seniority of clinician had no impact on the tendency to exhibit hindsight bias when reviewing case notes. Conclusion. In some cases, clinicians are markedly more critical of identical healthcare when a patient dies compared to when a patient survives. Hindsight bias while reviewing care when a patient survives might prevent identification of learning arising from errors. Additionally, we predict hindsight bias combined with a legal duty of candour will cause families to be informed that patients died because of healthcare error when this is not a fact.

Electrocardiography versus Echocardiography for assessment of left ventricular hypertrophy in ischemic heart disease patients with and without cardiovascular risk factors

Background: it is well documented that left ventricular hypertrophy (LVH) detected by 12-lead electrocardiography or echocardiography is a major risk factor for cardiovascular morbidity and mortality in cohorts ranging from the general population to those with established cardiovascular disease, including coronary artery disease (CAD). Objectives: aims of this study were to detect prevalence of LVH in CAD patients by standard echocardiography by measuring LVM indexed to body surface area and to test the sensitivity and specificity of new ECG criteria, Peugero-Lo Prosti criteria, for detection of left ventricular hypertrophy and comparing it with other ECG criteria to diagnose LVH. Patients and Methods: This observational cross sectional study was conducted at El-Hussein University Hospital and Minia Health Insurance Hospital during the period from July 2016 to June 2017, the study involved 230 patients of either sex, and referred for Echocardiography department to perform 2D transthoracic echocardiography. Results: In our study, we founded that firstly, the echo-LVH is prevalent in CAD patient (41.5%) regardless the presence of other cardiovascular risk factors. Moreover, our results showed that, the prevalence of echo-LVH is significantly higher in patients with CAD and hypertension, than in patients with CAD only (54% Vs. 32%). Secondly, the Peguero-Lo Prosti criteria has a higher sensitivity (61.4%) for detecting LVH among the patients with CAD than Sokolow-Lyon criteria (26.5%), Cornell voltage criteria (32.5%) and Romhilt Estes point score (41%) considering LVMI by echocardiography as reference standard. Conclusion: the prevalence of echocardiographic LVH in CAD patient is high regardless the presence of other cardiovascular risk factors. Overall the present study shows that, Peguero-Lo Presti criteria has higher sensitivity and specificity in the ECG diagnosis of LVH compared to Sokolow-Lyon criteria, Cornell voltage criteria and Romhilt-Estes point score system considering LV mass index by 2D Echocardiography as reference standard.

Electrocardiography versus Echocardiography for assessment of left ventricular hypertrophy in ischemic heart disease patients with and without cardiovascular risk factors

Background: it is well documented that left ventricular hypertrophy (LVH) detected by 12-lead electrocardiography or echocardiography is a major risk factor for cardiovascular morbidity and mortality in cohorts ranging from the general population to those with established cardiovascular disease, including coronary artery disease (CAD). Objectives: aims of this study were to detect prevalence of LVH in CAD patients by standard echocardiography by measuring LVM indexed to body surface area and to test the sensitivity and specificity of new ECG criteria, Peugero-Lo Prosti criteria, for detection of left ventricular hypertrophy and comparing it with other ECG criteria to diagnose LVH. Patients and Methods: This observational cross sectional study was conducted at El-Hussein University Hospital and Minia Health Insurance Hospital during the period from July 2016 to June 2017, the study involved 230 patients of either sex, and referred for Echocardiography department to perform 2D transthoracic echocardiography. Results: In our study, we founded that firstly, the echo-LVH is prevalent in CAD patient (41.5%) regardless the presence of other cardiovascular risk factors. Moreover, our results showed that, the prevalence of echo-LVH is significantly higher in patients with CAD and hypertension, than in patients with CAD only (54% Vs. 32%). Secondly, the Peguero-Lo Prosti criteria has a higher sensitivity (61.4%) for detecting LVH among the patients with CAD than Sokolow-Lyon criteria (26.5%), Cornell voltage criteria (32.5%) and Romhilt Estes point score (41%) considering LVMI by echocardiography as reference standard. Conclusion: the prevalence of echocardiographic LVH in CAD patient is high regardless the presence of other cardiovascular risk factors. Overall the present study shows that, Peguero-Lo Presti criteria has higher sensitivity and specificity in the ECG diagnosis of LVH compared to Sokolow-Lyon criteria, Cornell voltage criteria and Romhilt-Estes point score system considering LV mass index by 2D Echocardiography as reference standard.

Predicting the Risk of Readmission From Dehydration After Ileostomy Formation: The Dehydration Readmission After Ileostomy Prediction Score

All-cause readmission rates in patients undergoing ileostomy formation are as high as 20% to 30%. Dehydration is a leading cause. No predictive model for dehydration readmission has been described. The purpose of this study was to develop and validate the Dehydration Readmission After Ileostomy Prediction scoring system to predict the risk of readmission for dehydration after ileostomy formation. Patients who underwent ileostomy formation were identified using the American College of Surgeons National Surgical Quality Improvement Program data set (2012-2015). Predictors for dehydration were identified using multivariable logistic regression analysis and translated into a point scoring system based on corresponding β-coefficients using 2012-2014 data (derivation). Model discrimination was assessed with receiver operating characteristic curves using 2015 data (validation). This study used the American College of Surgeons National Surgical Quality Improvement Program. A total of 8064 (derivation) and 3467 patients (validation) were included from the American College of Surgeons National Surgical Quality Improvement Program. Dehydration readmission within 30 days of operation was measured. A total of 8064 patients were in the derivation sample, with 2.9% (20.1% overall) readmitted for dehydration. Twenty-five variables were queried, and 7 predictors were identified with points assigned: ASA class III (4 points), female sex (5 points), IPAA (4 points), age ≥65 years (5 points), shortened length of stay (5 points), ASA class I to II with IBD (7 points), and hypertension (9 points). A 39-point, 5-tier risk category scoring system was developed. The model performed well in derivation (area under curve = 0.71) and validation samples (area under curve = 0.74) and passed the Hosmer-Lemeshow goodness-of-fit test. Limitations of this study pertained to those of the American College of Surgeons National Surgical Quality Improvement Program, including a lack of generalizability, lack of ileostomy-specific variables, and inability to capture multiple readmission International Classification of Diseases, 9/10 edition, codes. The Dehydration Readmission After Ileostomy Prediction score is a validated scoring system that identifies patients at risk for dehydration readmission after ileostomy formation. It is a specific approach to optimize patient factors, implement interventions, and prevent readmissions. See Video Abstract at http://links.lww.com/DCR/A746.