Quick Score Research Articles

Effects of a High Dose of Vitamin C along with Thiamine in Critically-ill Patients with Septic Shock: A Preliminary Study

Septic shock may occur in critically ill patients and despite antimicrobial treatment, it is associated with a high mortality rate. It is reasonable to look for new treatment modalities that might improve outcome. This is a randomized, double-blind control trial aiming at critically-ill septic patients in a tertiary hospital. Patients with quick sofa score of 2 and with organ dysfunction were included in this study. The intervention group received high doses of vitamin C at a dose of 50 mg/kg/four times daily along with thiamine at a dose of 200 mg/ twice daily) and the control group received normal saline for four days. The dose of vasopressors, procalcitonin and lactate clearance, and mean sequential organ failure assessment (SOFA) score were examined in the two groups. Patients were followed for 28 days. One hundred patients were allocated into two equal groups, and there was no difference between the two groups regarding baseline characteristics. Mean lactate concentration, SOFA score, days of antimicrobial therapy, and mortality at 28 days were similar between them. However, the mean procalcitonin concentration, and mean vasopressor treatment hours were significantly lower in the intervention group (p<0.05). Although Days of ICU stay were lower in the intervention group, It did not reach statistical significance. The results of this study showed that treatment with high dose vitamin C Reduces the vasopressor requirement without any effects on other parameters. Further studies with larger sample size are required for more generalizable results.

Accuracy of Quick Sequential Organ Failure Assessment Score to Predict Sepsis Mortality in 121 Studies Including 1,716,017 Individuals: A Systematic Review and Meta-Analysis.

We searched multiple electronic databases including MEDLINE, the Cochrane Library, Embase, Web of Science, and Google Scholar (up to March 1, 2019) that evaluated quick Sequential Organ Failure Assessment score, systemic inflammatory response syndrome, or both (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42018103327). Studies were included if the outcome was mortality, organ dysfunction, admission to ICU, ventilatory support, or prolonged ICU stay and if prediction performance was reported as either area under the curve, odds ratio, sensitivity, or specificity. The criterion validity of the quick Sequential Organ Failure Assessment score and systemic inflammatory response syndrome criteria were assessed by measuring its predictive validity for primary (mortality) and secondary outcomes in pooled metrics as mentioned. The data were analyzed using random effects model, and heterogeneity was explored using prespecified subgroups analyses. We screened 1,340 studies, of which 121 studies (including data for 1,716,017 individuals) were analyzed. For mortality prediction, the pooled area under the curve was higher for quick Sequential Organ Failure Assessment score (0.702; 95% CI, 0.685-0.718; I 2 = 99.41%; p < 0.001) than for systemic inflammatory response syndrome (0.607; 95% CI, 0.589-0.624; I 2 = 96.49%; p < 0.001). Quick Sequential Organ Failure Assessment score consistently outperformed systemic inflammatory response syndrome across all subgroup analyses (area under the curve of quick Sequential Organ Failure Assessment vs. area under the curve of systemic inflammatory response syndrome p < 0.001), including patient populations (emergency department vs ICU), study design (retrospective vs prospective), and countries (developed vs resource-limited). Quick Sequential Organ Failure Assessment score was more specific (specificity, 74.58%; 95% CI, 73.55-75.61%) than systemic inflammatory response syndrome (specificity, 35.24%; 95% CI, 22.80-47.69%) but less sensitive (56.39%; 95% CI, 50.52-62.27%) than systemic inflammatory response syndrome (78.84%; 95% CI, 74.48-83.19%). Overall, quick Sequential Organ Failure Assessment score outperforms systemic inflammatory response syndrome in predicting sepsis outcome, but quick Sequential Organ Failure Assessment score has relative strengths/weaknesses (more specific but less sensitive) compared with systemic inflammatory response syndrome.

In-office wide-awake hand surgery versus traditional surgery in the operating room: a comparison of clinical outcomes and healthcare costs at an academic institution

Background: Our study compared clinical outcomes and healthcare costs of A1 pulley release performed wide-awake in an office setting to A1 pulley release performed in an operating room with monitored anesthesia care (MAC) at a United States academic institution. Methods: A retrospective chart review was performed on consecutive patients who underwent single-digit A1 pulley release wide-awake in an office setting or in an ambulatory surgical center with MAC. Clinical outcomes were assessed using the modified Disabilities Arm Shoulder and Hand (DASH) scores and a telephone questionnaire. Hospital financial records were reviewed for all patients and the summation of professional fee, anesthesiology fee, and hospital fee was calculated to determine healthcare cost. Financial comparisons were stratified by insurance carriers. Results: There were 76 patients with complete records: 43 wide-awake, 33 traditional. Both groups had significant improvement in postoperative quick DASH scores. When asked about subsequent surgery, 100% of wide-awake patients and 68% of traditional patients reported they would prefer to be wide-awake. Eighty percent of wide-awake patients said the procedure was less painful or comparable to a procedure at the dentist. Eighty-four percent of wide-awake patients said their experience was better than they expected, compared to 23% of traditional patients. The traditional group had significantly higher total healthcare costs ($2148.62 vs. $607.65), a more than 250% increase in healthcare spending. Professional reimbursement was significantly higher in the wide-awake group ($607.65 vs. $298.83). Conclusions: A1 pulley release performed with patients wide-awake in an office setting led to higher patient satisfaction, decreased healthcare spending and higher physician reimbursement than when performed in an operating room with sedation.

Predictives of Poor Outcomes after Volar Plating an Unstable Distal Radius Fracture; A Retrospective Clinical Analysis

Aim: We aimed to evaluate the functional and radiological outcomes and complications after an unstable distal radius fracture that was treated with a volar locked plate in adults and to find out the predictive factors of poor outcomes. Patients and Method: 91 patients (55 male / 36 female) that were operated for distal radius fractures with a volar locked plate between May 2006 and August 2016 were included in this retrospective study. All fractures were classified by AO classification system. Mayo Wrist score and Quick DASH-T measure were used to quantify the functional and Steawart scores for radiological outcomes. Varying factors were evaluated for predicting the poor radiological and functional outcomes. Results: Mean age of the patients was 46.9 years (23-72 min-max) and mean follow-up was 29.6 months (12-39 min-max) in this study. Mean union time was 7.3 weeks (6-11 min-max) for all patients. Mean Quick DASH-T score was 7.1 (0-65.9) and mean Mayo Wrist score was 85.8 (55-100) at the follow-up. There were 10 patients with various complications as; 8 patients had wound infections and 2 patients had hypertrophic scars. The strongest predictive factors of poor outcomes were the type of fracture and wound complications. Conclusion: Volar locked plates are useful for treatment of displaced unstable distal radius fractures with acceptable complication rate and any attempt should be considered to avoid wound complications.

Automated language essay scoring systems: a literature review.

BackgroundWriting composition is a significant factor for measuring test-takers’ ability in any language exam. However, the assessment (scoring) of these writing compositions or essays is a very challenging process in terms of reliability and time. The need for objective and quick scores has raised the need for a computer system that can automatically grade essay questions targeting specific prompts. Automated Essay Scoring (AES) systems are used to overcome the challenges of scoring writing tasks by using Natural Language Processing (NLP) and machine learning techniques. The purpose of this paper is to review the literature for the AES systems used for grading the essay questions.MethodologyWe have reviewed the existing literature using Google Scholar, EBSCO and ERIC to search for the terms “AES”, “Automated Essay Scoring”, “Automated Essay Grading”, or “Automatic Essay” for essays written in English language. Two categories have been identified: handcrafted features and automatically featured AES systems. The systems of the former category are closely bonded to the quality of the designed features. On the other hand, the systems of the latter category are based on the automatic learning of the features and relations between an essay and its score without any handcrafted features. We reviewed the systems of the two categories in terms of system primary focus, technique(s) used in the system, the need for training data, instructional application (feedback system), and the correlation between e-scores and human scores. The paper includes three main sections. First, we present a structured literature review of the available Handcrafted Features AES systems. Second, we present a structured literature review of the available Automatic Featuring AES systems. Finally, we draw a set of discussions and conclusions.ResultsAES models have been found to utilize a broad range of manually-tuned shallow and deep linguistic features. AES systems have many strengths in reducing labor-intensive marking activities, ensuring a consistent application of scoring criteria, and ensuring the objectivity of scoring. Although many techniques have been implemented to improve the AES systems, three primary challenges have been identified. The challenges are lacking of the sense of the rater as a person, the potential that the systems can be deceived into giving a lower or higher score to an essay than it deserves, and the limited ability to assess the creativity of the ideas and propositions and evaluate their practicality. Many techniques have only been used to address the first two challenges.

Diagnosis accuracy of quick sequential organ failure assessment score for adult sepsis patient with soft tissue infection

To assess the diagnosis accuracy of the quick sequential organ failure assessment (qSOFA) score for adult sepsis patient with soft tissue infection, and to assess the prognostic accuracy of the qSOFA score for septic shock. A retrospective study was conducted. The patients with soft tissue infection admitted to the general surgery department of Beijing Hospital and the burns and plastic surgery department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled. Patients were divided into the sepsis group and the non-sepsis group according to whether sepsis occurred within 48 hours after diagnosis of infection. The baseline data, prognosis, and qSOFA, the change of sequential organ failure assessment (ΔSOFA), systemic inflammatory response syndrome (SIRS) scores were compared between the two groups, and the receiver operating characteristic (ROC) curves were also drawn to assess the diagnosis accuracy of the qSOFA and SIRS scores for adult sepsis patients with soft tissue infection and to assess the prognostic accuracy of the qSOFA, ΔSOFA and SIRS scores for septic shock of these patients. 192 patients were included in the study. Sepsis occurred in 79 patients (41.1%) within 48 hours after diagnosis of infection. Septic shock occurred in 28 patients (14.6%) during 28-day hospitalization and 6 patients (3.1%) died. Compared with non-sepsis group, more proportion of necrotizing fasciitis, septic shock and patients received mechanical ventilation (21.5% vs. 4.4%, 31.6% vs. 2.7%, 16.5% vs. 4.4%, all P < 0.01), with higher mortality (7.6% vs. 0%, P = 0.003) in sepsis group. ROC curve analysis showed that when the cut-off value of qSOFA ≥ 2, the sensitivity, specificity, positive predictive value, negative predictive value and area under ROC curve (AUC) were 48.1%, 92.0%, 80.8%, 71.7% and 0.824 [95% confidence interval (95%CI) = 0.764-0.884, P < 0.01] respectively for diagnosis of sepsis caused by soft tissue infection. When the cut-off value of SIRS score ≥ 3, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 89.8%, 48.6%, 55.0%, 87.3% and 0.721 (95%CI = 0.677-0.765, P < 0.01) respectively for diagnosis of sepsis caused by soft tissue infection. All scores of qSOFA ≥ 2, ΔSOFA ≥ 2 and SIRS score ≥ 3 could be used to predict septic shock (all P < 0.01). The AUC of ΔSOFA, qSOFA and SIRS scores were 0.767 (95%CI = 0.665-0.869), 0.840 (95%CI = 0.757-0.923) and 0.716 (95%CI = 0.596-0.835) respectively. qSOFA ≥ 2 can be used as a rapid sepsis screening tool for adult patients with soft tissue infection. It is suggested that qSOFA or SIRS scores can be used to predict septic shock of adult patients with soft tissue infection initially.

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection.

Evaluate the accuracy of the quick Sequential Organ Failure Assessment tool to predict mortality across increasing levels of comorbidity burden. Retrospective observational cohort study. Twelve acute care hospitals in the Southeastern United States. A total of 52,187 patients with suspected infection presenting to the Emergency Department between January 2014 and September 2017. None. The primary outcome was hospital mortality. We used electronic health record data to calculate quick Sequential Organ Failure Assessment risk scores from vital signs and laboratory values documented during the first 24 hours. We calculated Charlson Comorbidity Index scores to quantify comorbidity burden. We constructed logistic regression models to evaluate differences in the performance of quick Sequential Organ Failure Assessment greater than or equal to 2 to predict hospital mortality in patients with no documented (Charlson Comorbidity Index = 0), low (Charlson Comorbidity Index = 1-2), moderate (Charlson Comorbidity Index = 3-4), or high (Charlson Comorbidity Index ≥ 5) comorbidity burden. Among the cohort, 2,030 patients died in the hospital (4%). No comorbidities were documented for 5,038 patients (10%), 9,235 patients (18%) had low comorbidity burden, 12,649 patients (24%) had moderate comorbidity burden, and 25,265 patients (48%) had high comorbidity burden. Overall model discrimination for quick Sequential Organ Failure Assessment greater than or equal to 2 was the area under the receiver operating characteristic curve of 0.71 (95% CI, 0.69-0.72). A model including both quick Sequential Organ Failure Assessment and Charlson Comorbidity Index had improved discrimination compared with Charlson Comorbidity Index alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.76-0.78 vs area under the curve, 0.61; 95% CI, 0.59-0.62). Discrimination was highest among patients with no documented comorbidities (quick Sequential Organ Failure Assessment area under the receiver operating characteristic curve, 0.84; 95% CI; 0.79-0.89) and lowest among high comorbidity patients (quick Sequential Organ Failure Assessment area under the receiver operating characteristic curve, 0.67; 95% CI, 0.65-0.68). The strength of association between quick Sequential Organ Failure Assessment and mortality ranged from 30.5-fold increased likelihood in patients with no comorbidities to 4.7-fold increased likelihood in patients with high comorbidity. The accuracy of quick Sequential Organ Failure Assessment to predict hospital mortality diminishes with increasing comorbidity burden. Patients with comorbidities may have baseline abnormalities in quick Sequential Organ Failure Assessment variables that reduce predictive accuracy. Additional research is needed to better understand quick Sequential Organ Failure Assessment performance across different comorbid conditions with modification that incorporates the context of changes to baseline variables.

Early variation of quick sequential organ failure assessment score to predict in-hospital mortality in emergency department patients with suspected infection.

The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA = qSOFA at 3 h-qSOFA at inclusion). This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days. Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA < 0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA = 0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34-0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09-0.22, P < 0.001). In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.

The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown.

External validation of the quick Sequential Organ Failure Assessment score for mortality and bacteraemia risk evaluation in Japanese patients undergoing haemodialysis: a retrospective multicentre cohort study

ObjectivesWe aimed to examine the validity of the quick Sequential Organ Failure Assessment (qSOFA) score for mortality and bacteraemia risk assessment in Japanese haemodialysis patients.DesignThis is a retrospective multicentre cohort...

Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician.

The initial management of the hematology patient in a critical state is crucial and poses a great challenge both for the hematologist and the intensive care unit (ICU) physician. After years of clinical practice, there is still a delay in the proper recognition and treatment of critical situations, which leads to late admission to the ICU. There is a much-needed systematic ABC (Airway, Breathing, Circulation) approach for the patients being treated on the wards as well as in the high dependency units because the underlying hematological disorder, as well as disease-related complications, have an increasing frequency. Focusing on score-based decision-making on the wards (Modified Early Warning Score (MEWS), together with Quick Sofa score), active sepsis screening with inflammation markers (C-reactive protein, procalcitonin, and presepsin), and assessment of microcirculation, organ perfusion, and oxygen supply by using paraclinical parameters from the ICU setting (lactate, central venous oxygen saturation (ScVO2), and venous-to-arterial carbon dioxide difference), hematologists can manage the immediate critical patient and improve the overall outcome.

Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection.

We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups—those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.

Combining procalcitonin with the qSOFA and sepsis mortality prediction

To investigate whether procalcitonin (PCT) can improve the performance of quick sequential organ failure assessment (SOFA) score in predicting sepsis mortality, we conducted a retrospective multicenter cohort study with independent validation in a prospectively collected cohort in 3 tertiary medical centers. Patients with presumed sepsis were included. Serum PCT levels were measured at admission. Quick SOFA score and systemic inflammatory response syndrome (SIRS) criteria were calculated for each patient. PCT levels were assigned into 0, 1, and 2 points for a serum level of <0.25, 0.25 to 2, and >2 ng/mL, and added to the quick sepsis-related organ failure assessment (qSOFA) score. The incremental value of PCT to qSOFA was then evaluated by logistic regression, receiver-operating characteristic (ROC) curve, and reclassification analysis.In all, 1318 patients with presumed severe infection were enrolled with a 30-day mortality of 13.5%. Serum level of PCT showed a high correlation with qSOFA score and 30-day inhospital mortality. The area under the ROC curve was 0.56 for SIRS criteria, 0.67 for qSOFA score, and 0.73 for qSOFA_PCT in predicting 30-day mortality. The risk prediction improvement was reflected by a net reclassification improvement of 35% (17%-52%). Incorporation of PCT into the qSOFA model could raise the sensitivity to 86.5% (95% confidence interval 80.6%-91.2%). In the validation cohort, qSOFA_PCT greatly improved the sensitivity to 90.9%.A simple modification of qSOFA score by adding the ordinal scale of PCT value to qSOFA could greatly improve the suboptimal sensitivity problem of qSOFA and may serve as a quick screening tool for early identification of sepsis.

Impact of a qSOFA-based triage procedure on antibiotic timing in ED patients with sepsis: A prospective interventional study

BackgroundIt has not been investigated whether the quick sepsis-related organ failure assessment score (qSOFA), a new bedside tool for early sepsis detection, may help accelerating antibiotic initiation in ED patients with sepsis. MethodsIn this prospective pre/post quasi-experimental single-ED study, patients admitted with a suspected bacterial infection were managed using standard triage procedures only (baseline) or in association with qSOFA (intervention, with prioritization of patients with a qSOFA ≥ 2). ResultsA total of 151/328 (46.0%) and 185/350 (52.8%) patients with definite bacterial infection met the criteria for sepsis in the baseline and intervention periods, respectively. The sensitivity and specificity of a qSOFA ≥ 2 for sepsis prediction were 17.3% (95% confidence interval [CI], 13.6%–21.7%) and 98.8% (95% CI, 97.0%–99.5%). Eleven (7.3%) and 28 (13.5%) patients with sepsis in the baseline and intervention periods received a first antibiotic dose within one hour following triage (primary endpoint, absolute difference 6.2%, 95% CI [−0.5%, 12.7%], P = 0.08). The proportions of patients with sepsis receiving a first antibiotic dose within three hours following triage (39.7% [50/151] versus 36.8% [68/185], absolute difference − 2.9%, 95% CI [−13.3%, 7.3%], P = 0.65), requiring ICU admission, or dying in the hospital were similar in both periods. The median ED occupation rate at triage was 104.3% (interquartile range [IQR], 80.4%–128.3%), with a median number of 157 ED visits per day (IQR, 147–169). ConclusionsA qSOFA-based triage procedure does not improve antibiotic timing and outcomes in patients with sepsis admitted to a high-volume ED. The qSOFA value at triage was poorly sensitive for early sepsis detection.Trial registration (ClinicalTrials.gov): NCT03299894.

LO52: Classification versus prediction of mortality using the Systemic Inflammatory Response score and quick Sepsis-related Organ Failure Assessment scores in patients with infection

Introduction: Despite their widespread use, measures of classification accuracy (i.e. sensitivity and specificity) have several limitations that conceals relevant information and may bias decision-making. Assessing the predictive ability of clinical tools instead may provide more useful prognostic information to support decision-making, particularly in an Emergency setting. We sought to contrast classification accuracy versus predictive ability of the Systemic Inflammatory Response Syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA) Sepsis scores for determining mortality risk among patients with infection transported by paramedics. Methods: A one-year cohort of patients with infections transported to the Emergency Department by paramedics was linked to in-hospital administrative databases. Hospital mortality was determined for each patient at the time of discharge. We calculated sensitivity and specificity of SIRS and qSOFA for classifying hospital mortality across different score thresholds, and estimated discrimination (assessed using the C statistic) and calibration (assessed visually) of prediction. Prediction models for hospital mortality were constructed using the aggregated SIRS or qSOFA scores for each patient as a predictor, while accounting for clustering by institution and adjusting for differences in patient age and sex. Predicted and observed risk were plotted to assess calibration and change in risk across levels of each score. Results: A total of 10,409 patients with infection who were transported by paramedics were successfully linked, with an overall mortality rate of 9.2%. The median SIRS score among non-survivors was 2, while the median qSOFA score was 1. SIRS score had higher sensitivity estimates than qSOFA for classifying hospital mortality at all thresholds (0.11 – 0.83 vs. 0.08 – 0.80), but the qSOFA score had better discrimination (C statistic 0.76 vs. 0.71) and calibration. The risk of hospital mortality predicted by the SIRS score ranged from 6.6-24% across score values, whereas the risk predicted by the qSOFA score ranged from 8.6-53%. Conclusion: Assessing the SIRS and qSOFA scores predictive ability reveals that the qSOFA score provides more information to clinicians about a patient's mortality risk despite having worse sensitivity. This study highlights important limitations of classification accuracy for diagnostic test studies and supports a shift toward assessing predictive ability instead. Character count 2490

P082: Predictive ability of the quick Sepsis-related Organ Failure Assessment score among patients with infection transported by paramedics: a Bayesian analysis

Introduction: The quick Sepsis-related Organ Failure Assessment (qSOFA) score was developed to provide clinicians with a quick assessment for patients with latent organ failure possibly consistent with sepsis at high-risk for mortality. With the clinical heterogeneity of patients presenting with sepsis, a Bayesian validation approach may provide a better understanding of its clinical utility. This study used a Bayesian analysis to assess the prediction of hospital mortality by the qSOFA score among patients with infection transported by paramedics. Methods: A one-year cohort of adult patients transported by paramedics in a large, provincial EMS system was linked to Emergency Department (ED) and hospital administrative databases, then restricted to those patients with an ED diagnosed infection. A Bayesian binomial regression model was constructed using Hamiltonian Markov-Chain Monte-Carlo sampling, normal priors for each parameter, the calculated score, age and sex as the predictors, and hospital mortality as the outcome. Discrimination was assessed using posterior predictions to calculate a “Bayesian” C statistic, and calibration was assessed with calibration plots of the observed and predicted probability distributions. The independent predictive ability of each measure was tested by including each component measure (respiratory rate, Glasgow Coma Scale, and systolic blood pressure) as continuous predictors in a second model. Results: A total of 9,920 patients with ED diagnosed infection were included. 264 (2.7%) patients were admitted directly to the ICU, and 955 (9.6%) patients died in-hospital. As independent predictors, the probability of mortality increased as each measure became more extreme, with the Glasgow Coma Scale predicting the greatest change in mortality risk from a high to low score; however, no dramatic change in the probability supporting a single decision threshold was seen for any measure. For the calculated score, the C statistic for predicting mortality was 0.728. The calibration curve had no overlap of predictions, with a probability of 0.5 (50% credible interval 0.47-0.53) for patients with a qSOFA score of 3. Conclusion: Although no single decision threshold was identified for each component measure, a calculated qSOFA score provides good prediction of mortality for patients with ED diagnosed infection. When validating clinical prediction scores, a Bayesian approach may be used to assess probabilities of interest for clinicians to support better clinical decision making. Character count 2494

Evaluation of prognostic value of MEDS, MEWS, and CURB-65 criteria and sepsis I and sepsis III criteria in patients with community-acquired infection in emergency department

Background: Early and effective treatment of patients with sepsis requires early recognition in emergency department and understanding the severity of the disease. Many studies have been conducted for this purpose, and many of scoring systems have been developed that provide early recognition of these patients and show their severity. Objectives: The aim of this study is to evaluate the efficacy of the scoring systems used to determine the mortality of patients with infections admitted in emergency department. Methods: In all, 400 patients who admitted to Uludağ University Hospital Emergency Department were prospectively included in this study. In addition to Systemic Inflammatory Response Syndrome score, Quick SOFA score, Mortality in Emergency Department Sepsis score, Modified Early Warning Score, and Charlson Comorbidity Index score in all patients, CURB-65 score was calculated in the patients diagnosed with pneumonia. It has been aimed to determine the power of these scores’ predictive mortality rates and their superiority to each other. Results: It was found that Mortality in Emergency Department Sepsis score and Quick SOFA score could be used with similar efficacy (respectively p = 0.761 and p = 0.073) in determining early mortality in emergency department (5th and 14th days) and that MEDS score was more effective (p &lt; 0.001) in predicting the 28th-day mortality. While these recommendations were valid in patients diagnosed with pneumonia, it was determined that CURB-65 score could also be used to estimate 5th-, 14th-, and 28th-day mortalities (respectively, for the 5th day, p = 0.894 and p = 0.256; for the 14th day, p = 0.425 and p = 0.098; and for the 28th day, p = 0.095 and p = 0.158). The power of Systemic Inflammatory Response Syndrome score, previously used to identify sepsis, in predicting mortality was detected to be lower. Conclusion: Mortality in Emergency Department Sepsis score and Quick SOFA score could be used with similar efficacy in determining early mortality in emergency department. However, if you want to predict 28th-day mortality rate, it can be better to use Mortality in Emergency Department Sepsis score or CURB-65 (in patients diagnosed with pneumonia).

Clinical Case Report of a Novel use of Quick Mood Score to Evaluate Ayurvedic Shirodhara Treatment

Clinical Case Report of a Novel use of Quick Mood Score to Evaluate Ayurvedic Shirodhara Treatment

Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review.

ObjectiveTo test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients.MethodsPatients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar’s test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value.ResultsAmong the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score <2. The sensitivity of a qSOFA score ≥2 was 61.9%, which was significantly lower than the sensitivity of SIRS ≥2 (82.7%, P<0.001) and SOFA ≥2 (99.1%, P<0.001). The specificity, positive predictive value, and negative predictive value of a qSOFA score ≥2 for 28-day mortality were 58.1%, 32.9%, and 82.2%, respectively.ConclusionThe current clinical criteria of the qSOFA are less sensitive than the SIRS assessment and SOFA to predict 28-day mortality in ED patients with sepsis.