Quick Score Research Articles

Lateral clavicle fracture fixation in adolescents using an Endobutton technique

Purpose: The purpose of this study was to assess if the use of the “endobutton” technique via an arthroscopically-assisted approach was associated with good patient reported outcome measures and low complication rates in select adolescent patients with displaced lateral third clavicle fractures. Methods: A retrospective review of displaced lateral third clavicle fractures sustained in adolescents treated operatively using the endobutton technique over a 2 year period was carried out at our institution. Four cases were identified, all sustained while involved in sporting activities and all were treated via an arthroscopically-assisted approach. Results: all 4 patients scored 0 on the Quick DASH assessment score. No hardware required removal and all patients returned to sport at the same level. Conclusions: Displaced lateral clavicle fractures in adolescents can pose a significant challenge in terms of management options. Use of the endobutton technique via an arthroscopic-assisted approach can offer a safe and effective means of treatment with excellent patient reported outcomes and low complications rates. Level of Evidence: 4 Keywords: lateral clavicle; adolescent; arthroscopicassisted

Homoeopathic Management of Breast Fibroadenoma—An Open Label, Single Arm, Observational Trial

Abstract Background Fibroadenoma of breast is the commonest ailment of women with significant morbidity. Available literature revealed that breast tumour recedes by homoeopathic treatment.The present study evaluated the role of homoeopathic treatment on breast fibroadenoma by using ‘Triple assessment criteria’ and to explore the mechanism, whether homoeopathic medicines bring their therapeutic effect by altering the oestrogen and progesterone receptor (ER/PR) status on tumour tissue. Materials and Methods An open label, prospective, single arm, observational study was conducted on 64 female patients having fibroadenoma of breast. Triple assessment criteria were used to explore the effectiveness of homoeopathic treatment on breast fibroadenoma. Individualised homoeopathic medicines were prescribed. The outcome measures were changes in clinical picture, number and size of lump by ultrasonomammography. ER/PR study was performed by immunohistochemistry using quick score analysis. Results Post-treatment response of 23 cases (35.93%) of fibroadenoma revealed disappearance of lump. Partial improvement was noticed in 22 cases (34.37%) with significant reduction in mean size (p < 0.001). Similarly significant reduction in number of lesions was seen in fibroadenoma (p <0.05). Conium maculatum and Phytolacca decandra were found to be the most useful remedies. Quick score value of ER after treatment showed significant reduction (Z = 4.910). Conclusion The study revealed that the therapeutic effects of individualised homoeopathic medicines play significant role in management of fibroadenoma of breast. The results of ER/PR show significant reduction in ER suggesting that homoeopathic medicines have some inhibitory effect on ER.

The association between the quick sequential organ failure assessment score prior to emergency ICU admission and outcomes in adults with suspected infection

Background: Sepsis and septic shock are leading causes of mortality world-wide. In patients outside the intensive care unit (ICU) a rising qSOFA (quick Sequential Organ Failure Assessment) score correlates with mortality risk. We sought to investigate if the duration of a qSOFA score ≥ 2 prior to ICU admission further affects outcomes, namely: ICU mortality, in-hospital mortality and length of ICU stay. Method: A retrospective chart review was performed using the electronic ICU database at a quaternary level hospital in Durban, KwaZulu-Natal, examining entries from 1 January 2008 to 31 December 2017. The review included 235 emergency in-hospital adult admissions with suspected infection, of which 144 had a qSOFA score ≥ 2 prior to ICU admission. Results: There was no significant association between the duration of a qSOFA score ≥ 2 prior to ICU admission and ICU mortality (p = 0.975), in-hospital mortality (p = 0.918) and length of ICU stay until demise (p = 0.848) or discharge (p = 0.624). The qSOFA score was significantly associated with ICU mortality with scores of 0, 1, 2 and 3 resulting in ICU mortality rates of 0%, 22.5%, 53.7% and 84.6% respectively (p < 0.001). Conclusion: The duration of a qSOFA score ≥ 2 prior to emergency ICU admission was not significantly associated with ICU mortality, in-hospital mortality or length of ICU stay in adults with suspected infection.

Clinical investigation of the utility of a pair of coagulation-fibrinolysis markers for definite diagnosis of sepsis-induced disseminated intravascular coagulation: A single-center, diagnostic, prospective, observational study

BackgroundDisseminated intravascular coagulation (DIC) often occurs with sepsis. A scoring system has been used for the diagnosis of DIC, but the system included at least 4 parameters. The purpose of this study was to propose a simple set of DIC criteria with coagulation-fibrinolysis markers (CFMs). MethodsPatients with ≥2 signs of systemic inflammatory response syndrome and a quick Sequential Organ Failure Assessment score ≥ 2 points were investigated. All blood samples were collected on Days 0, 1, 3, and 7. Cutoff values of CFMs were calculated by receiver operating curve analysis. Positive predictive values (PPVs) and negative predictive values (NPVs) for the Japanese Association for Acute Medicine (JAAM) DIC criteria were evaluated by pairing the markers. Differences were analyzed by the Mann–Whitney U test, Kruskal-Wallis test, and the log-rank test. ResultsA total of 107 patients were enrolled. The cutoff values of soluble fibrin (SF), protein C (PC), and plasminogen activator inhibitor (PAI)-1 were 48 μg/mL, 42%, and 71 ng/mL according to the International Society of Thrombosis and Hemostasis DIC criteria. The PPV of the severe SFxPC group was 100% for the JAAM DIC criteria, excluding Day 0. ConclusionCutoff values of SF over 48 μg/mL and PC <42% could almost definitely identify JAAM DIC.

Fast Track Triage for COVID-19 Based on a Population Study: The SODA Score

Background: Healthcare systems are under prominent stress due to the COVID-19 pandemic. A fast and simple triage is mandatory to screen patients who will benefit from early hospitalization, from those that can be managed as outpatients. There is a lack of all-comers scores, and no score has been proposed for western-world population. Aims: To develop a fast-track risk score valid for every COVID-19 patient at diagnosis. Methods: Single-center, retrospective study based on all the inhabitants of a healthcare area. Logistic regression was used to identify simple and wide-available risk factors for adverse events (death, intensive care admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke). Results: Of the total healthcare area population, 447.979 inhabitants, 965 patients (0.22%), were diagnosed with COVID-19. A total of 124 patients (12.85%) experienced adverse events. The novel SODA score (based on sex, peripheral O2 saturation, presence of diabetes, and age) demonstrated good accuracy for adverse events prediction (area under ROC curve 0.858, CI: 0.82-0.98). A cut-off value of 5 points, high-risk patients (PPV 58.8% for adverse events). Conclusions: This quick and easy score allows fast-track triage at the moment of diagnosis for COVID-19 using four simple variables: age, sex, SpO2, and diabetes. SODA score could improve preventive measures taken at diagnosis in high-risk patients and also relieve resources by identifying very low-risk patients. Funding Statement: None. Declaration of Interests: The authors declare that there is no conflict of interest regarding the publication of this article. Ethics Approval Statement: This study complied with the edicts of the 1975 Declaration of Helsinki and was approved by the institutional ethics of the institution.

Corneal Microstructural Changes by Confocal Microscopy in Vernal Keratoconjunctivitis Patients Treated with Topical Cyclosporine

ABSTRACT Purpose: To compare corneal morphologic changes in vernal keratoconjunctivitis (VKC) patients before and after treatment with topical cyclosporin (CsA). Methods: 23 VKC patients and 40 healthy subjects as controls were considered. All patients were treated with 1%CsA during their active phase. The impact of treatment on quality of life was evaluated administering the QUICK questionnaire. Both eyes were evaluated using the in vivo confocal microscopy (IVCM) before treatment (T0), at the end of treatment in Autumn (T1) and at the recurrence of symptoms in the next season (T2). Results: All VKC patients improved their QUICK scores after CsA treatment. IVCM highlighted corneal microstructural changes at the level of epithelium, sub-basal nerve plexus and stroma in patients affected by VKC and allowed to follow their evolution after topical treatment with CsA. Conclusions: IVCM is a valuable tool to evaluate the dynamic corneal changes in VKC before and after treatment with CsA.

Predictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil. A Prospective Multicenter Study.

Rationale: Although proposed as a clinical prompt to sepsis based on predictive validity for mortality, the Quick Sepsis-related Organ Failure Assessment (qSOFA) score is often used as a screening tool, which requires high sensitivity.Objectives: To assess the predictive accuracy of qSOFA for mortality in Brazil, focusing on sensitivity.Methods: We prospectively collected data from two cohorts of emergency department and ward patients. Cohort 1 included patients with suspected infection but without organ dysfunction or sepsis (22 hospitals: 3 public and 19 private). Cohort 2 included patients with sepsis (54 hospitals: 24 public and 28 private). The primary outcome was in-hospital mortality. The predictive accuracy of qSOFA was examined considering only the worst values before the suspicion of infection or sepsis.Measurements and Main Results: Cohort 1 contained 5,460 patients (mortality rate, 14.0%; 95% confidence interval [CI], 13.1–15.0), among whom 78.3% had a qSOFA score less than or equal to 1 (mortality rate, 8.3%; 95% CI, 7.5–9.1). The sensitivity of a qSOFA score greater than or equal to 2 for predicting mortality was 53.9% and the 95% CI was 50.3 to 57.5. The sensitivity was higher for a qSOFA greater than or equal to 1 (84.9%; 95% CI, 82.1–87.3), a qSOFA score greater than or equal to 1 or lactate greater than 2 mmol/L (91.3%; 95% CI, 89.0–93.2), and systemic inflammatory response syndrome plus organ dysfunction (68.7%; 95% CI, 65.2–71.9). Cohort 2 contained 4,711 patients, among whom 62.3% had a qSOFA score less than or equal to 1 (mortality rate, 17.3%; 95% CI, 15.9–18.7), whereas in public hospitals the mortality rate was 39.3% (95% CI, 35.5–43.3).Conclusions: A qSOFA score greater than or equal to 2 has low sensitivity for predicting death in patients with suspected infection in a developing country. Using a qSOFA score greater than or equal to 2 as a screening tool for sepsis may miss patients who ultimately die. Using a qSOFA score greater than or equal to 1 or adding lactate to a qSOFA score greater than or equal to 1 may improve sensitivity.Clinical trial registered with www.clinicaltrials.gov (NCT03158493).

Usefulness of the Geriatric Nutritional Risk Index to predict the severity of cholecystitis among older patients in the emergency department

We sought to investigate whether the Geriatric Nutritional Risk Index is associated with systemic organ dysfunction among older patients who present with cholecystitis to the emergency department. This was an observational retrospective study among consecutive older patients with cholecystitis in the emergency department from 2012 to 2018. We collected baseline characteristics and laboratory data, and re-categorized the Geriatric Nutritional Risk Index into three risk groups. We carried out univariate and multivariate analyses to identify factors associated with systemic organ dysfunction. Logistic regression was used for statistical analysis. A total of 303 patients were included in this study. The median age of participants was 74 years (interquartile range 68-79 years). The overall proportion of systemic organ dysfunction was 26.4%. The Geriatric Nutritional Risk Index was stratified as: ≥98 (n = 183, systemic organ dysfunction 15.3%), 87 to <98 (n = 90, systemic organ dysfunction 38.9%) and <87 (n = 30, systemic organ dysfunction 56.7%). Multivariate analysis using a logistic regression model showed that age, respiratory rate, temperature, geriatric nutritional risk index and quick Sepsis-related Organ Failure Assessment score in the emergency department were independently associated with systemic organ dysfunction in patients with cholecystitis. The Geriatric Nutritional Risk Index was recognized as an independent factor associated with systemic organ dysfunction in older patients in the emergency department who presented with cholecystitis. This index might be helpful in screening patient risk and deciding whether to carry out further tests. Geriatr Gerontol Int 2020; 20: 455-460.

Adesão ao protocolo de sepse em um serviço de emergência relacionado à taxa de mortalidade intra-hospitalar

Objetivo: Avaliar a adesão dos profissionais de saúde ao protocolo de tratamento da sepse em um serviço de emergência, e os índices de mortalidade antes e após a implementação do protocolo gerenciado neste serviço. Métodos: Estudo de coorte retrospectivo comparativo, com abordagem quantitativa, realizado em um Hospital de uma cidade do estado do Rio Grande do Sul (RS). A coleta de dedos correu nos meses de julho a agosto de 2018. Foram coletados os dados referentes aos períodos: (a) antes da implementação do protocolo de sepse (maio a outubro de 2016); (b) após a implementação deste protocolo de sepse (maio a outubro de 2017). Para organização dos dados foi utilizado o programa Microsoft Excel versão 2016. Resultados: Houve predomínio do sexo feminino (60,0%). A média de idade foi de 75,2 ± 16,4 anos. Na classificação de risco, 49,4% dos pacientes foram triados com o escore quick sequential organ failure assessment score (qSOFA) positivo. Quanto à antibioticoterapia intravenosa, 54,1% dos pacientes iniciaram esse tratamento antes de completar 60 minutos de atendimento. Conclusão: Concluímos que houve uma boa adesão dos profissionais de saúde ao protocolo de sepse instituido no serviço de emergência. Melhores desfechos foram demonstrados, especialmente quanto às taxas de mortalidade que diminuiram consideravelmente após a implemetação do protocolo de sepse.

Utility of quick sepsis-related organ failure assessment (qSOFA) score to predict outcomes in out-of-ICU patients with suspected infections.

Background:Referral of sepsis patients at the level of primary care is often delayed due to the lack of an assessment tool which effectively predicts sepsis. The quick Sepsis-related Organ Failure Assessment score (qSOFA) can be used in such scenarios to improve patient outcomes.Aim:To assess the prognostic accuracy of qSOFA score in predicting adverse outcomes in patients with suspected infections and to compare it with the SIRS (Systemic Inflammatory Response Syndrome) and the SOFA (Sequential Organ failure Assessment Score).Methods:This study included 180 participants admitted in the emergency wards of the Department of Medicine, over a period of one year with suspected infection. The primary outcome was the combined outcome of mortality and/or ICU stay of more than three days. Secondary outcomes were the duration of ICU stay, duration of inotrope use, and duration of mechanical ventilation.Statistical Analysis:Descriptive statistics using SPSS version 19.0 was applied in the study.Results:Of the 180 participants, 54 had a qSOFA score of 2 at admission, 52 participants had an SIRS score of 2. The qSOFA score had the highest AUC for both mortality and the combined outcome of mortality and prolonged ICU stay (0.740 and 0.835, respectively). For a combined outcome of mortality and ICU stay >3 days, the qSOFA score had a sensitivity of 75% and a specificity of 82%. The positive likelihood ratio was 4.17.Conclusion:In a primary care setting, the qSOFA score of more than 2 can be used reliably to refer patients for admission and intensive care as they are likely to need longer hospital stay and can have worse outcomes.

Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection.

ObjectiveThe quick sequential organ failure assessment (qSOFA) score, which includes mentation, systolic blood pressure, and respiratory rate, was developed to identify serious sepsis in out-of-hospital or emergency department (ED) settings. We evaluated the ability of the qSOFA score to predict poor outcome in South Korean ED patients with suspected infection.MethodsThe qSOFA score was calculated for adult ED patients with suspected infection. Patients who received intravenous or oral antibiotics in the ED were considered to have infection. In-hospital mortality rate, admission rate, intensive care unit (ICU) admission rate, length of hospital stay (LOS), and lactate levels were compared between the qSOFA score groups. Receiver operating characteristic curves and area under the receiver operating characteristic curve values for in-hospital mortality were calculated according to qSOFA cut-off points and lactate levels.ResultsOf 2,698 patients, in-hospital mortality occurred in 134 (5.0%). The mortality rate increased with increasing qSOFA score (2.2%, 6.4%, 17.5%, and 42.4% for qSOFA scores 0, 1, 2, and 3, respectively, P<0.001). The admission rate, ICU admission rate, LOS, and lactate level also increased with increasing qSOFA score (all P<0.001). The area under the receiver operating characteristic curve values for predicting in-hospital mortality associated with qSOFA score, lactate ≥2 mmol/L, and lactate ≥4 mmol/L were 0.719 (95% confidence interval [CI], 0.670 to 0.768), 0.657 (95% CI, 0.603 to 0.710), and 0.632 (95% CI, 0.571 to 0.693), respectively.ConclusionPatients with a higher qSOFA score had higher admission, ICU admission, and in-hospital mortality rates, longer LOS, and higher lactate level. The qSOFA score showed better performance for predicting poor outcome than lactate level.

The discrimination of quick Paediatric Early Warning Scores in the pre-hospital setting.

In our previous study, a Paediatric Early Warning Score could be calculated for only one-fifth of 102,993 children transported by ambulance to hospital, as components other than supplemental oxygen were not reliably measured: respiratory rate 90,358 (88%); Glasgow Coma Score 83,648 (81%); heart rate 83,330 (81%); time to capillary reperfusion 81,685 (79%); oxygen saturation 71,372 (69%); temperature 60,402 (59%); systolic blood pressure 37,088 (36%). We tested 12 abbreviated scores with 3-5 components. The discrimination of these 12 scores for the primary outcome (30-day mortality or admission to paediatric intensive care), as measured by the area under the receiving operator characteristic curve, ranged from 0.69 to 0.80. Scores could be calculated for at most 74,508 (72%) children when heart rate, conscious level and respiratory rate were measured, with or without supplemental oxygen: the discrimination of these two versions was 0.75 and 0.77, respectively. Optimal threshold scores of 3 and 2 for these two abbreviated versions discriminated an outcome rate of 2-3% in about one third of children from the other children who had<1% rate of outcome.

Performance of Pediatric SOFA, Quick PELOD and Quick SOFA Scores in Predicting Outcome of Sepsis in Pediatric ICU

Performance of Pediatric SOFA, Quick PELOD and Quick SOFA Scores in Predicting Outcome of Sepsis in Pediatric ICU

Thrombo-inflammatory prognostic score improves qSOFA for risk stratification in patients with sepsis: a retrospective cohort study.

Background Both the thrombo-inflammatory prognostic score (TIPS) and the quick sequential (sepsis-related) organ failure assessment (qSOFA) are quick prognostic scores for sepsis during the early phase, while either of two scores has limited prognostic value for sepsis patients. This study aimed to evaluate whether TIPS adds more information of sepsis risk stratification for qSOFA. Methods This was a retrospective cohort study of patients with sepsis in the emergency department (ED). We performed a receiver-operating characteristic curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision-curve analysis (DCA) analyses to investigate whether TIPS can improve qSOFA for risk prediction in patients with sepsis. The primary endpoint was mortality and the secondary endpoints were mechanical ventilation and admission to the intensive care unit (ICU) during the 28-day follow-up. Results We identified 821 patients with sepsis. We randomly assigned the patients' data to a derivation group (n = 498; n = 112 died during the 28-days follow-up) or to a validation group (n = 323; n = 61). The addition of TIPS to qSOFA (T-qSOFA) improved the area under the curve (AUC) from 0.724 to 0.824 (p < 0.001) for predicting 28-day mortality. The discrimination improvement was confirmed by an IDI of 0.092 (p < 0.001). Addition of TIPS to the qSOFA resulted in a NRI of 0.247 (p < 0.001). The DCA showed that the net benefit of T-qSOFA was higher than that of TIPS or qSOFA for any threshold probabilities. Conclusions The prognostic value of qSOFA for patients with sepsis was enhanced by adding the TIPS score on admission for risk prediction in patients with sepsis during early phases in the ED.

Androgen receptor expression in preputial dartos tissue correlates with physiological androgen exposure in congenital malformations of the penis and in controls

The androgen receptor (AR) plays an important role in the development of male genitalia, and impaired androgen signalling has been hypothesised to underlie congenital penile malformations (CPM) such as hypospadias. Previous studies exploring the role of AR expression in the development of CPM have yielded conflicting results. To assess AR expression in human foreskin of boys/men born with hypospadias, buried penis versus controls. Foreskin samples of 428 boys and men undergoing primary penile surgery (198 controls, 197 hypospadias, and 33 buried penis) were collected between October 2013 and July 2018. AR staining was performed in all samples and semi-quantitatively scored by two researchers independently, using a modified quick score (mQuicks) that assesses the proportion and intensity of AR staining in smooth muscle fibres. The interobserver variability of the mQuicks had a high level of agreement for the total score, as well as for the subscores. Two phases of high AR expression were observed in all groups, the first following the postnatal gonadotropin surge (i.e., mini-puberty) and the second in (pre-) puberty. No differences in AR expression were found in hypospadias or buried penis cases as compared to controls matched for age at time of surgery. This study describes the physiological evolution in AR expression in the human foreskin of boys with CPM and explains the cause of the previously reported, conflicting results. Despite the very large cohort, the limitations of this study are the low number of cases younger than sixmonthsat the time of surgery and the lack of Tanner stages to correlate with the mQuicks in adolescents. The mQuicks is a straightforward and informative tool to semi-quantitatively assess AR expression in the dartos tissue. In this study, AR expression in human foreskin shows a bimodal distribution in boys with CMP and controls, following physiological androgen exposure. No statistically significant difference in AR expression could be found between both groups. Whether other local mechanisms are affected by these physiological changes is currently unclear. However, strict age-matching should be considered when exploring the mechanisms underlying disturbed penile and urethral development in CMP.

The quick sepsis-related organ failure score has limited value for predicting adverse outcomes in sepsis patients with liver cirrhosis.

Background/AimsThe quick Sepsis-related Organ Failure Assessment (qSOFA) is a newly developed risk stratification tool, which has been presented along with a new sepsis definition, to classify infected patients outside of the intensive care unit (ICU). We evaluated the clinical usefulness of qSOFA for predicting adverse outcomes in sepsis patients with liver cirrhosis.MethodsWe performed a retrospective cohort study to assess the utility of qSOFA in sepsis patients with liver cirrhosis for whom medical emergency teams (METs) were activated in general wards at an academic tertiary care hospital between March 2008 and December 2015. qSOFA, Systemic inflammatory response syndrome (SIRS), modified early warning score (MEWS), and sequential (sepsis- related) organ failure assessment (SOFA) scores were calculated according to data at MET activation.ResultsOf 188 patients, 69 (36.7%) had a qSOFA score of 0 or 1 point and 119 (63.3%) had ≥ 2 points. The areas under the receiver operating characteristic curve (AUROC) for ICU transfer on the SOFA (AUROC, 0.691; 95% confidence interval [CI], 0.615 to 0.767) or MEWS (AUROC, 0.663; 95% CI, 0.586 to 0.739) were significantly higher compared to those for qSOFA (AUROC, 0.589; 95% CI, 0.507 to 0.671) or SIRS (AUROC, 0.533; 95% CI, 0.451 to 0.616).ConclusionsOur findings suggest that qSOFA score may have limited utility in predicting adverse outcomes in sepsis patients with liver cirrhosis at MET activation. Either MEWS or another screening tool is needed for detecting early sepsis in these patients.

520. The Clinical Profile and Outcomes of Patients given Intravenous Colistin for Multidrug-Resistant Gram-negative Infections in a Philippine Tertiary Hospital

BackgroundColistimethate sodium (colistin) is used to treat multi-drug-resistant Gram-negative infections. We describe the profile and outcomes of patients given colistin in a tertiary level government hospital.MethodsWe performed a retrospective cross-sectional study of patients from the Philippine General Hospital given intravenous colistin between January 2015 to June 2018. Adult patients who received colistin for at least 24 hours and not on dialysis were included. Clinical success was defined as a composite of hemodynamic stability, stable quick Sequential Organ Failure Assessment score (qSOFA), and microbiological cure. Overall in-hospital mortality was recorded.ResultsWe included 250 patients during the study period. The median age was 55 (19–91) years, 55.6% (139/250) were male, and 49.2% (123/250) were admitted in the intensive care unit (ICU). 77.2% (193/250) had at least one comorbidity, with solid-organ malignancy (27.6%, 69/250) being the most common. Most patients had at least one invasive device, commonly a nasogastric tube (64.4%, 161/250) or mechanical ventilator (63.2%, 150/250). There was an increase in Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, qSOFA, and septic shock from baseline to 24 hours prior to colistin use (Table 1). The most common site of infection was the respiratory tract (90.8%, 227/250). Majority of patients (78.8%, 197/250) had Acinetobacter baumannii infection of which 79.9% were extensively drug-resistant (XDR), susceptible only to colistin and amikacin or minocycline. Colistin was given for a mean of 12 (2- 43) days, concomitant with meropenem in 96.4% (241/250). Most patients received piperacillin–tazobactam (59%, 142/250) and/or meropenem (58%, 138/250) within the same admission. Nephrotoxicity (30.8%, 77/250) was the most frequent adverse effect (Table 2). Renal replacement therapy was needed in 6% (15/250) patients. Clinical success was seen in 61.2% (153/250) patients and overall mortality was 41.6% (104/250).ConclusionColistin was frequently used in combination with a carbapenem for treatment of XDR-related respiratory infection or septic shock. Nephrotoxicity was a common adverse effect. The clinical success rate was modest and overall mortality was high. Disclosures All authors: No reported disclosures.

Performance of a quick sofa-65 score as a rapid sepsis screening tool during initial emergency department assessment: A propensity score matching study

PurposeWe sought to elucidate the performance of a Quick Sequential Organ Function Assessment-65 (qSOFA-65) score in recognizing sepsis and to compare the qSOFA-65 score to systemic inflammatory response syndrome (SIRS) and qSOFA scores. MethodsWe performed a matched case-control study using propensity score matching. The number of patients meeting qSOFA-65, qSOFA, and SIRS positive criteria were calculated between the sepsis and non-sepsis groups. We compared the diagnostic performance of the three scoring systems in predicting sepsis. ResultsA total of 2441 patients were included in the study. In propensity matched cohorts, the percentage of patients who met qSOFA-65, qSOFA, and SIRS positive criteria were 46.7%, 14.3%, and 55.6%, respectively. The sensitivity and specificity scores for the qSOFA-65, qSOFA, and SIRS positive criteria for sepsis were 0.66 and 0.73, 0.28 and 0.97, and 0.66 and 0.55, respectively. The AUC value of qSOFA-65 positive criteria in predicting sepsis was significantly higher than that of qSOFA and SIRS positive criteria (adjusted AUC 0.688 vs. 0.630 vs. 0.596, respectively). ConclusionsWe found that qSOFA-65 was more likely to identify patients with sepsis on the initial ED visit relative to qSOFA or SIRS. This may have quality improvement implications in predicting sepsis.

Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis.

Sepsis can be caused by malaria infection, but little is known about the utility of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) and SOFA score in malaria. We conducted a prospective observational study from March 2013 to February 2017 to examine adults admitted with community-acquired infection in a tertiary-care hospital in Ubon Ratchathani, Northeast Thailand (Ubon-sepsis). Subjects were classified as having sepsis if they had a modified SOFA score ≥2 within 24 hours of admission. Serum was stored and later tested for malaria parasites using a nested PCR assay. Presence of severe malaria was defined using modified World Health Organization criteria. Of 4,989 patients enrolled, 153 patients (3%) were PCR positive for either Plasmodium falciparum (74 [48%]), P. vivax (69 [45%]), or both organisms (10 [7%]). Of 153 malaria patients, 80 were severe malaria patients presenting with sepsis, 70 were non-severe malaria patients presenting with sepsis, and three were non-severe malaria patients presenting without sepsis. The modified SOFA score (median 5; IQR 4–6; range 1–18) was strongly correlated with malaria severity determined by the number of World Health Organization severity criteria satisfied by the patient (Spearman’s rho = 0.61, p<0.001). Of 80 severe malaria patients, 2 (2.5%), 11 (14%), 62 (77.5%) and 5 (6%), presented with qSOFA scores of 0, 1, 2 and 3, respectively. Twenty eight-day mortality was 1.3% (2/153). In conclusion, qSOFA and SOFA can serve as markers of disease severity in adults with malarial sepsis. Patients presenting with a qSOFA score of 1 may also require careful evaluation for sepsis; including diagnosis of cause of infection, initiation of medical intervention, and consideration for referral as appropriate.

Prognostic value of prehospital quick sequential organ failure assessment score among patients with suspected infection.

After the third international consensus on sepsis released its new definitions, the prognostic value of quick sequential organ failure assessment (qSOFA) score has been confirmed in the emergency department. However, its validity in the prehospital setting remains unknown. The objective of the study was to assess its accuracy for prehospital patients cared by emergency physician-staffed ambulances (services mobiles d'urgence et de réanimation SMUR). This was a prospective observational multicenter cohort study (N = 6). All consecutive patients with prehospital clinical suspicion of infection by the emergency physician of the SMUR emergency medical service were included. Components of qSOFA were collected, and the patients were followed until hospital discharge. The primary end point was in-hospital mortality, censored at 28 days. Secondary end points included ICU admission longer than 72 h and a composite of 'death or ICU stay more than 72 h'. We screened 342 patients and included 332 in the analysis. Their mean age was 73 years, 159 (48%) were women, and the most common site of infection was respiratory (73% of cases). qSOFA was at least 2 in 133 (40%) patients. The overall in-hospital mortality was 27%: 41% in patients with qSOFA of at least 2 versus 18% for qSOFA less than 2 (absolute difference 23%; 95% confidence interval: 13-33%, P < 0.001). The overall discrimination for qSOFA was poor, with an area under the receiver operating characteristic curve of 0.69 (95% confidence interval: 0.62-0.74). In this large multicenter study, prehospital qSOFA presents a strong association with mortality in infected patient, though with poor prognostic performances in our severely ill sample.