Scoring System For Use Research Articles

Development of a novel granulocyte scoring system for use as a predictive/prognostic biomarker in patients with advanced melanoma undergoing treatment with combination immunotherapy.

9551 Background: Despite the implementation of immune checkpoint inhibition (ICI) for patients with metastatic melanoma, there remains an unmet clinical need for predictive/prognostic biomarkers to determine, from outset, which patients will derive benefit. Recent literature has suggested a significant role for granulocyte subsets in the development of resistance to systemic therapies, with an associated role in adaptive immunity. Methods: We sought to establish a novel immunological scoring system to use as a predictive/prognostic biomarker in patients with advanced melanoma being treated with ICI. In this retrospective, single centre study evaluating patients with advanced melanoma treated with combination ipilimumab and nivolumab, progression free survival (PFS) and overall survival (OS) were compared between groups defined by neutrophil, lymphocyte, eosinophil, monocyte and basophil counts. Data from 226 patients was collected at baseline, week 3, week 6, first response scan and at progression. Baseline and week 3 data was the focus of this primary analysis. Kaplan-Meier estimation and Cox regression analysis were performed. Results: Univariate analysis demonstrated that absolute neutrophil, eosinophil and basophil count strongly associates with PFS and OS outcomes at week 3. Combination of these counts into a novel neutrophil to eosinophil + basophil ratio (NEBR, (N/(E+B)) was assessed as a scoring system. High NEBR was associated with poorer PFS and OS at baseline and week 3 with consistently superior predictive/prognostic value than the well-established neutrophil to lymphocyte ratio (NLR). After accounting for covariates including concurrent steroids, infection and LDH, high NEBR remained significantly associated with worse PFS at baseline and poorer PFS and OS at week 3. Conclusions: Our findings highlight NEBR as a novel immunotherapeutic predictive/prognostic biomarker with potential clinical utility that warrants further investigation in patients with advanced melanoma and across other tumour groups. Further validation will be required through independent external datasets. [Table: see text]

72 Bringing Neuropsychology to the Community: Adaptation of a Rey Osterreith Complex Figure Scoring System for Use in Large-Scale Community-Based Clinical Trials

Objective:The Rey Osterreith Complex Figure (ROCF) is a neuropsychological task used to measure visual-motor integration, visual memory, and executive functioning (EF) in autistic youth. The ROCF is a valued clinical tool because it provides an insight into the way an individual approaches and organizes complex visual stimuli. The constructs measured by the ROCF such as planning, organization, and working memory are highly relevant for research in, but the standardized procedures for scoring the ROCF can be challenging to implement in large scale clinical trials due to complex and lengthy scoring rubrics. We present preliminary data on an adaptation to an existing scoring system that provides quantifiable scores, can be implemented with reliability, and reduces scoring time.Participants and Methods:Data was taken from two large-scale clinical trials focusing on EF in autistic youth. All participants completed the ROCF following standard administration guidelines. The research team reviewed commonly used scoring systems and determined that the Boston Qualitative Scoring System (BQSS) was the best fit due to its strengths in measuring EF, the process-related variables generated, and the available normative data. Initially, the BQSS full scoring system was used, which resulted in comprehensive scores but was not feasible due to the time required (approximately 1-1.5 hours per figure for research assistants to complete scoring). Then, the BQSS short form was used, which was successful at solving the timing problem, but resulted in greater subjectivity in the scores impacting the team’s ability to become reliable. Independent reliability could not be calculated for this version because of the large number of discrepancies among scorers which included 2 neuropsychologists and 4 research assistants. A novel checklist was then developed that combined aspects of both scoring systems to help promote objectivity and reliability. In combination with this checklist the team created weekly check in meetings where challenging figures could be brought to discuss. Independent reliability was calculated amongst all research assistant team members (n=4) for the short form and novel checklist. Reliability was calculated based on (1) if the drawing qualified for being brought to the whole team and (2) individual scores on the checklist.Results:Independent reliability was calculated for 10 figures scored utilizing the novel checklist by a team of 4 trained research assistants. All scorers were able to achieve 80% reliability with a high average (80-86%). Study team members reported that scoring took less time taking on average 30-45 minutes per figure.Conclusions:Inter-rater reliability was strong on the checklist the study team created, indicating its potential as a useful adaptation to the BQSS scoring system that reduces time demands, making the tool feasible for use in large-scale clinical research studies with initially positive reliability factors. The checklist was easy to use, required little training and could be completed quickly. Future research should continue to examine the reliability of the checklist and the time it takes to complete. Additionally, the ROCF should be studied more broadly in research and examined as a potential outcome measure for large scale research studies.

Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children.

The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs. Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9-39 months. All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as "clear" (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83). The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.

Accuracy and Reliability of Peripheral Artery Calcium Scoring Systems Using an Intravascular Ultrasound Reference Standard

Peripheral artery calcium scoring systems are commonly used in clinical trials to categorize calcium severity but there are little data on their accuracy and reliability. The purpose of this study was to investigate the accuracy and reliability of these systems. Angiographic, computed tomography angiography, and intravascular ultrasound (IVUS) imaging were obtained from 47 consecutive cases sourced from a prospectively collected database of patients undergoing femoropopliteal artery endovascular intervention. Two independent blinded readers graded calcium severity using the Peripheral Arterial Calcium Scoring System, Peripheral Academic Research Consortium, and Fanelli calcium scoring systems. IVUS maximum arc of calcium and calcium length were compared between severity grades for each scoring system. The diagnostic accuracy of each scoring system for identifying severe calcium was calculated using the reference standard of an IVUS maximum calcium arc ≥180°. Agreement testing was performed between scoring systems and between and within observers for each system. IVUS identified calcium in 85% (42/47) of cases, compared to 68% (32/47) of cases with angiography. There were no differences in IVUS calcium parameters between grades of calcium for any of the scoring systems. Severe calcium was detected by IVUS in 30 cases, in 23 cases by Peripheral Arterial Calcium Scoring System (sensitivity: 73%, specificity: 33%, positive predictive value [PPV]: 83%, negative predictive value [NPV]: 22%), in 12 cases by Peripheral Academic Research Consortium (sensitivity: 42%, specificity: 83%, PPV: 92%, NPV: 25%), and in 10 cases by Fanelli (sensitivity: 39%, specificity: 100%, PPV: 100%, NPV: 27%). Agreement between scoring systems was weak to moderate (range: k=0.55-0.74). Interobserver agreement was weak (k=0.41-0.54) and intraobserver agreement was highly variable ranging from k=0.41 to k=0.92. The poor diagnostic accuracy and weak-to-moderate reliability of calcium scoring systems raise doubts about the use of current calcium scoring systems for use in clinical trials.

Hematological markers and ultrasound 7-joint inflammation score as add-on tools in the assessment of inflammation in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation and joint destruction that eventually induces severe disability. Inflammation is the key determinant and primary underlying mechanism leading to disability and increased mortality in patients with RA. This study aimed to correlate the hematological markers and ultrasound 7-joint inflammation score to disease activity in rheumatoid arthritis patients.ResultsThe current study involved 54 RA patients diagnosed according to the 2010 ACR/EULAR classification criteria for RA and thirty healthy control subjects. There were 48 females (88.9%) and 6 males (11.1%). The age of patients ranged from 32 to 60 years, with a mean of 46.04 ± 5.65 years. Using disease activity score 28-ESR, total white blood cell count and absolute lymphocytic count were significantly lower in RA patients with high disease activity. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume, ESR, and CRP were significantly higher in patients with high disease activity using disease activity score 28 CRP. Also, a statistically significant positive correlation was detected between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and both clinical disease activity scores. Red cell distribution width but not platelet distribution width was significantly higher in RA patients but both parameters had no association or correlation with clinical disease activity scores. Neutrophil-to-lymphocyte ratio was found to have a statistically significant positive correlation with the tenosynovitis score by powered Doppler ultrasound. There were statistically significant positive correlations between disease activity score 28 ESR and CRP and synovitis and tenosynovitis scores by greyscale and powered Doppler ultrasound using the ultrasound 7 score.ConclusionNeutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume could be potential inflammatory markers for follow-up of disease activity in RA patients. The ultrasound 7 score is a simple and practical scoring system for use in the detection of inflammation, even subclinically in RA patients, which may help the physician in his clinical decisions. The combined use of both hematological markers and the ultrasound 7 score may be of great value.

Predictive Ability of Factors in diagnosing COVID-19: Experiences from Qatar's Primary Care Settings

ObjectiveThe aim of this paper is to establish the predictive ability of demographic and clinical factors in diagnosing Coronavirus Disease 2019 (COVID-19) in Qatar's publicly funded primary care settings. MethodsReverse transcription polymerase chain reaction (rt-PCR) test and COVID-19 screening data (COVID-19 related factors) were extracted from electronic medical records for all individuals who visited a primary health care centre in Qatar between 15th March to 15th June 2020. Data analysis was undertaken to assess the validity of individual factors in predicting a positive rt-PCR test. ResultsFever/history of fever [N= 1471 (54.7%); OR 4.6 (95% CI 4.16 - 5.08)], followed by cough [N=1020 (37.9%); OR 1.82 (95% CI 1.65 - 2)] and headache [N=372 (13.8%); OR 1.45 (95% CI 1.27 - 1.67)] were the most frequently reported clinical symptoms amongst individuals who tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) infection by rt-PCR. Only five factors, fever/history of fever, cough, working/living in an area reporting local transmission, gender and headache (ranked according to predictive power), were found to be statistically significant. Fever/history of fever alone had a specificity of 79.2% and it gradually increased to 99.9% in combination with runny nose, cough, male gender and age ≥ 50. ConclusionsThe study identified predictive ability of factors in diagnosing COVID-19, individually and in combination. It proposes a scoring system for use in publicly funded primary care settings in Qatar without an rt-PCR test, thus enabling early isolation and treatment where necessary. Further similar studies are needed as newer variations of SARS-CoV2 are continuously emerging to ensure its accuracy.

Prognostic Significance of Simple Scoring Systems in the Prediction of Diffuse Peritonitis Morbidity and Mortality

Introduction: Diffuse peritonitis is a serious disease. It is often addressed within urgent management of an unstable patient in shock. The therapy consists of treatment of the source of peritonitis, decontamination of the abdominal cavity, stabilization of the patient and comprehensive resuscitation care in an intensive care unit. A number of scoring systems to determine patient prognosis are available, but most of them require complex input data, making their practical application a substantial problem. Objective: Our aim was to assess simple scoring systems within a cohort, evaluate the level of mortality, morbidity, and duration of hospital stay, followed by a comparison of the acquired data with the literature and determination of an easily implementable scoring system for use in clinical practice. Material and Methods: We evaluated a group of patients with diffuse peritonitis who underwent surgery in the 2015–2019 period. Medical history, surgical findings, and paraclinical examinations were used as the input for four scoring systems commonly used in practice—MPI, qSOFA, ECOG, and ASA. We compared the results between the systems and with the literature. Results: Our cohort included 274 patients diagnosed with diffuse peritonitis. Mortality was 22.6%, morbidity 73.4%, with a 25.2 day average duration of hospital stay. Mortality and morbidity increased with rising MPI and qSOFA, well-established scoring systems, but also with rising ASA and ECOG, similarly to MPI and qSOFA. Conclusions: The utilized scoring systems correlated well with the severity of the condition and with predicted mortality and morbidity as reported in the literature. Simple scoring systems primarily used in other indications (i.e., ASA and ECOG) have a similar predictive value in our cohort as commonly used systems (MPI, qSOFA). We recommend them in routine clinical practice due to their simplicity.

A new scoring system for use in capture–recapture studies for bowhead whales photographed with drones

Effective management of animal populations requires knowledge of life history parameters and estimates of population abundance. One method commonly used to estimate abundance is capture–recapture analyses of photographs. Small, relatively inexpensive, rotary-wing drones have become an effective platform for obtaining high-quality aerial photographs of whales. To conduct capture–recapture analyses the animal needs to be defined as marked or unmarked and the photographs must be of high quality. While a system for scoring quality and markedness has previously been developed for bowhead whales (Balaena mysticetus Linnaeus, 1758) ( Rugh et al. 1998 . Rep. int. Whal. Commn. 48: 501–512), a revised scoring system was needed to incorporate increased information in photographs taken by drones. We present a revised scoring system that enlarges two of the previously defined areas of the whale examined for markings and incorporates smaller markings into the definition of marked whales. We scored 30 whales using the previous criteria and the revised criteria developed in this paper. More whales were identified as marked (23%) and mark scores were higher for 30% of the zones scored using the new system. Increasing the number of marked whales during capture–recapture studies increases the precision of estimated parameters and permits us to make those estimates with smaller samples of photographs.

Association between HBA1C and NIHSS score in stroke

Diabetes Mellitus is a very common metabolic disorder and it is an independent risk factor for stroke and is associated with 2 to 6 fold increased risk compared with non-diabetic subjects and worsens survival of patients with acute stroke. Glucose intolerance or even fasting hyperglycemia may follow an acute vascular event, and ensuing physical inactivity and poor food intake may lead to continued glucose intolerance. Glucose intolerance in a stroke patient may or may not reflect glycemia prior to the event. Measurement of HbA1C rather than glucose as an indicator of prior glycemia offers a new perspective. Hence this study is to find out association between HbA1c levels with NIHSS score in stroke. To find out association between HbA1c levels with NIHSS score in stroke. This a cross sectional descriptive study. In this study well controlled Diabetes has moderate stroke severity, fairly controlled Diabetes has moderate to severe stroke severity and poorly controlled Diabetes has severe stroke. It is observed that severity of the presenting complaints worsened from well controlled Diabetes to poorly controlled Diabetes. The NIHSS score correlates with the HbA1C, with increase in severity of the stroke from well controlled Diabetes to poorly controlled Diabetes. Severity of the score increases as the infarct size increases. Poorly controlled Diabetes has more severe stroke as per NIHSS score with large sized infarcts. Stroke is a medical emergency and can cause permanent neurological damage, complications and death. National Institutes of Health Stroke Scale (NIHSS) is a well-validated, reliable scoring system for use specifically with stroke patients. The National Institutes of Health Stroke Scale (NIHSS) can be used as a standard measurement instrument by physicians to evaluate the severity of a patient and outcome.

Reliability of a beef cattle locomotion scoring system for use in clinical practice

BackgroundLocomotion (lameness) scoring has been used and studied in the dairy industry; however, to the authors’ knowledge, there are no studies assessing the reliability of locomotion scoring systems when used...

Intact Tails as a Welfare Indicator in Finishing Pigs? Scoring of Tail Lesions and Defining Intact Tails in Undocked Pigs at the Abattoir.

Tail biting lesions are a potential measure of on-farm animal welfare, as a large range of stressors increase the risk for tail biting outbreaks. Further, tail biting is a major challenge, as lesions due to tail biting decrease animal welfare and health, as well as production efficiency and carcass quality. The aim of this study was to suggest a tail scoring system for use at slaughterhouses processing undocked pigs, and to link tail lesion scores to meat inspection data. A further aim was to suggest a definition for an intact enough tail. To validate the suggested scoring system we assessed tails before and after scalding and compared results to pathological examinations. In total, 14,433 tails were scored, and 117 tails were collected for pathological examination. After scalding, 49.2% of all tails were scored as fully intact. Of tails with lesions 2.5% were scored as having major acute wounds (>2 cm), while 11.6% had minor acute wounds (<2 cm), and 36.7% healed lesions. Intact tails were on average 31.5 cm (SD 2.5 cm) long. Lesion scored at the slaughter-line agreed well with the pathological assessment. Tail lesions were associated with several meat inspection findings: tails with more severe lesions and of shorter length increased the risk for meat inspection findings to a higher degree. A detailed lesion scoring method helps to identify carcasses at risk for condemnations, as well as being a potential method for on-farm welfare estimation. We suggest that a system for scoring tail lesions in undocked pigs should utilize a combination of scoring of the lesion and measuring the tail length. As bite marks or bruises on an otherwise intact tail were not a concern for meat hygiene, we suggest the definition of an intact enough tail could allow the inclusion of tails with these mild changes. Meat inspection findings in carcasses with tails scored as healed, but with no fresh lesions, and with more than 75% of the average intact length remaining were rather similar to those of fully intact tails. Based on these findings we suggest that a tail of this length, and with no visible fresh lesions could also be considered intact enough.

A prospective study of effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: Peritonitis is defined as inflammation of the peritoneal cavity, caused by a number of etiologic agents including bacteria, fungi, viruses, chemical irritants, and foreign bodies. The Mannheim peritonitis index (MPI) is one of the simple scoring systems in use that allows the surgeon to easily determine outcome risk. Aims and objective: To estimate outcome of patients with perforation peritonitis. To evaluate effect of MPI score in identification of high risk cases.Methods: A prospective study was conducted in 100 patients with peritonitis due to hollow viscous perforation at surgical unit of tertiary care unit. The duration of study was 2 years. All the data was recorded. Written informed consent was obtained and data was analyzed using appropriate analysis strategy.Results: In this study, total 100 patients enrolled, out of which 54 % patients were in the age group &lt;50 years and 46% patients were in the age group &gt;50 years. Mortality was higher among patients with age group more than 50 years (21%) and in female patients (37.93%). 18 patients had organ failure. 87 patients had preoperative duration was &gt;24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was &lt;21 while 25 (25%) patients total score was 21-29 and it was &gt;29 in 23 (23%) patients. Mortality was higher among patients with MPI Score more than 29 (95.65%).Conclusions: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death. This study differs in one adverse outcome variables, non-colonic origin of sepsis, we advocate need for further studies on Mannheim peritonitis index to include colonic origin of sepsis.

Abstract 3131: Novel multi-gene classifier for prediction of relapse-free survival after FU-based adjuvant chemotherapy for stage III colon cancer: A biomarker study of the ACTS-C trial, a randomized controlled study

Abstract Background &amp; Purpose: The ACTS-CC trial is a phase III study that have demonstrated the efficacy of S-1 as adjuvant chemotherapy for stage III colon cancer by evaluating its non-inferiority to UFT/LV. As an additional study, gene expression analysis of 5-FU metabolizing enzymes and folate metabolizing enzymes was performed prospectively to identify predictive and/or prognostic biomarkers. We analyzed the correlation between these gene expression levels and relapse free survival (RFS), and then constructed the scoring system to predict the efficacy of each regimen. Methods: Among 1535 patients enrolled in the trial, total RNA was extracted from 798 formalin-fixed, paraffin-embedded specimens. Gene expression levels of 11 enzymes (TS, DPD, TP, OPRT, FPGS, GGH, DHFR, MTHFR, MTHFD, FOLRA, GART) related to 5-FU and folic acid metabolism were analyzed by quantitative real-time reverse transcription - TaqMan PCR. Impact of the mRNA expression level of each gene on RFS was investigated. A multivariate Cox regression with elastic net penalization was employed using treatment-by-gene interaction terms extracted by Tian’s transformation (Tian L, et al.; J Am Stat Assoc. 109, 2014). To evaluate the predictive accuracy of this scoring system method, a double 10-fold cross-validation was performed to stratify all patients based on the cross-validated score. Finally, the prediction algorithm was applied to the entire cohort data to build the scoring system for use in future patients. Results: FPGS and GGH significantly correlated with RFS (HR; 1.289 [95%CI; 1.054-1.577], p= 0.014 and HR; 0.908 [95%CI; 0.832-0.991], p= 0.031) and TP seemed to correlate with RFS (HR; 0.906 [95%CI; 0.816-1.007], p= 0.068). In the S-1 treated group, TP and FPGS significantly impacted on RFS (HR; 0.853 [95%CI; 0.731-0.995], p= 0.043 and HR; 1.591 [95%CI; 1.212-2.089], p&amp;lt; 0.001). In the UFT/LV treated group, there was no significant correlation between the gene expression levels of 5-FU/ folate metabolizing enzymes and RFS. In the cross-validation analysis with the penalized Cox regression scoring method, it was demonstrated that a third part of patients with the lowest cross-validated scores had improved RFS by receiving S-1 treatment. The final scoring system developed using the entire patient cohort was composed of TS, TP, and FPGS. Conclusions: Gene expression level of FPGS, GGH and TP were correlated with the prognosis of stage III colon cancer. The predicting scoring system using the gene expression level of TS, TP and FPGS seemed to be useful for the selection of oral fluoropyrimidine. S-1 might be effective for patients with the low-score colon cancers. Citation Format: Toshiaki Ishikawa, Kenta Murotani, Megumi Ishiguro, Eiji Nakatani, Hiroyuki Uetake, Shigeyuki Matsui, Kenichi Sugihara. Novel multi-gene classifier for prediction of relapse-free survival after FU-based adjuvant chemotherapy for stage III colon cancer: A biomarker study of the ACTS-C trial, a randomized controlled study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3131.

Association of Coronary Anatomical Complexity With Clinical Outcomes After Percutaneous or Surgical Revascularization in the Veterans Affairs Clinical Assessment Reporting and Tracking Program

Anatomical scoring systems for coronary artery disease, such as the SYNTAX (Synergy Between Percutaneous Coronary Intervention [PCI] With Taxus and Cardiac Surgery) score, are well established tools for understanding patient risk. However, they are cumbersome to compute manually for large data sets, limiting their use across broad and varied cohorts. To adapt an anatomical scoring system for use with registry data, allowing facile and automatic calculation of scores and association with clinical outcomes among patients undergoing percutaneous or surgical revascularization. This cross-sectional observational cohort study involved procedures performed in all cardiac catheterization laboratories in the largest integrated health care system in the United States, the Veterans Affairs (VA) Healthcare System. Patients undergoing coronary angiography in the VA Healthcare System followed by percutaneous or surgical revascularization within 90 days were observed and data were analyzed from January 1, 2010, through September 30, 2017. An anatomical scoring system for coronary artery disease complexity before revascularization was simplified and adapted to data from the VA Clinical Assessment, Reporting, and Tracking Program. The adjusted association between quantified anatomical complexity and major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and repeat revascularization, was assessed for patients undergoing percutaneous or surgical revascularization. A total of 50 226 patients (49 359 men [98.3%]; mean [SD] age, 66 [9] years) underwent revascularization during the study period, with 34 322 undergoing PCI and 15 904 undergoing coronary artery bypass grafting (CABG). After adjustment, the highest tertile of anatomical complexity was associated with increased hazard of MACCEs (adjusted hazard ratio [HR], 2.12; 95% CI, 2.01-2.23). In contrast, the highest tertile of anatomical complexity among patients undergoing CABG was not independently associated with overall MACCEs (adjusted HR, 1.04; 95% CI, 0.92-1.17), and only repeat revascularization was associated with increasing complexity (adjusted HR, 1.34; 95% CI, 1.06-1.70) in this subgroup. These findings suggest that an automatically computed score assessing anatomical complexity can be used to assess longitudinal risk for patients undergoing revascularization. This simplified scoring system appears to be an alternative tool for understanding longitudinal risk across large data sets.

Risk Factors and Preoperative Risk Scoring System for Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage.

ObjectiveShunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration. MethodsWe reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge. ResultsIn the multivariate analysis, acute HCP (bicaudate index of ≥0.2) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843–16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044–16.169; p=0.043), and an age of ≥50 years (OR, 3.938; 95% CI, 1.375–11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0–3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750–0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847–0.943). ConclusionOur results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.

AB052. 115. “Trinity CP Score” objective, reliable and efficient scoring system for use in clinical setting for standardisation of chronic pancreatitis

Background: Chronic pancreatitis (CP) is a chronic inflammatory disease of pancreas resulting in irreversible morphological changes in pancreas along with pain and could also result in exocrine and endocrine dysfunction and even complete loss of functionality. Severity of condition is usually measured subjectively by clinicians using their clinical impression into mild, moderate and severe. There are multiple scoring systems present at current time but are not widely used either due to complexity of score which makes it impractical to be used in outpatient setting, e.g., Manchester, ABC and M-ANNHEIM or they are using parameters recorded subjectively which make them un-reliable and nonreproducible. So, we devised a scoring system which is practical and reliable.

Validation of Bisap Scoring System in Predicting the Severity of Acute Pancreatitis according to the Latest Atlanta Classification

Acute pancreatitis (AP) is an inflammatory condition of the pancreas with a clinical course hat varies from mild to severe, leading to activation of pancreatic enzyme and causing selfdigestion of the pancreas. The overall mortality rate of AP is 2–5%, but the mortality of severe acute pancreatitis (SAP) may range upto 20–30%. So it is important to assess the disease severity in a timely and accurate manner There are variety of score systems such as Ransom’s criteria[1], Acute Physiology and Chronic Health Evaluation (APACHE) II [2] and Computed Tomography Severity Index (CTSI). But these systems have their own distinct pros and cons. A new mortality based prognostic scoring system for use in acute pancreatitis has been derived and validated which was named the Bedside Index of Severity in Acute Pancreatitis (BISAP). The 5­point BISAP score system incorporates the variables: Blood urea nitrogen level &gt;25 mg/dl, Impaired mental status, Systemic inflammatory response syndrome (SIRS), and age &gt; 60years, and presence of pleural effusion. Thus the BISAP score represents a simple way to identify patients at risk of increased mortality and the development of intermediate markers of severity within 24h of presentation.

Long-Term Nursing Home Entry: A Prognostic Model for Older Adults with a Family or Unpaid Caregiver.

To comprehensively examine factors associated with long-term nursing home (NH) entry from 6 domains of older adult and family caregiver risk from nationally representative surveys and develop a prognostic model and a simple scoring system for use in risk stratification. Retrospective observational study. National Long-Term Care Surveys 1999 and 2004 and National Health and Aging Trends Study 2011 and linked caregiver surveys. Community-living older adults receiving help with self-care disability and their primary family or unpaid caregiver (N=2,676). Prediction of long-term NH entry (>100 days or ending in death) by 24 months follow up, ascertained from Minimum Data Set assessments and dates of death from Medicare enrollment files. Risk factors were measured from survey responses. In total, 16.1% of older adults entered a NH. Our final model and risk scoring system includes 7 independent risk factors: older adult age (1 point/5 years), living alone (5 points), dementia (3 points), 3 or more of 6 self-care activities (2 points), caregiver age (45-64: 1 point, 65-74: 2 points, ≥75: 4 points), caregiver help with money management (2 points), and caregiver report of moderate (2 points) or high (4 points) strain. Using this model, participants were assigned to risk quintiles. Long-term NH entry was 7.0% in the lowest quintile (0-6 points), 20.4% in the middle 3 quintiles (7-14 points), and 30.9% in the highest quintile (15-22 points). The model was well calibrated and demonstrated moderate discrimination (c-statistic=0.670 in the original data, c-statistic=0.647 in bootstrapped samples, c-statistic=0.652 using the point-scoring system). We developed a prognostic model and simple scoring system that may be used to stratify risk of long-term NH entry of community-living older adults. Our model may be useful for population health and policy applications.

Reliability of a New Symptom Score in a Titrated Quantitative Conjunctival Provocation Test Supported by an Objective Photodocumentation

Background: Allergen provocation tests are useful methods for proving the clinical relevance of an allergen-specific sensitization. Among these methods, the conjunctival provocation test (CPT) represents an easy-to-use tool. However, its readout parameters have not yet been internationally standardized or validated. Photodocumentation has been shown as a good option for objectifying a CPT reaction, supporting the local investigator assessment. Based on test-retest reliability of the score and an objective digital photoanalysis of the conjunctival redness, this study aimed to prove the reproducibility of a new CPT scoring system for use in clinical trials (ClinicalTrials.gov identifier: NCT02690740). Methods: A titrated quantitative CPT was conducted outside of the pollen season in a final cohort of 23 adult patients with birch or grass pollen-induced allergic rhinoconjunctivitis. Conjunctival symptoms were analyzed using a standardized symptom score. Conjunctival redness was also evaluated by an external observer and correlated with a digital photoanalysis using MATLAB software. Results: A test-retest correlation of 0.6 (p < 0.01) was found for the symptom score results. Likewise, a correlation of 0.65 (p < 0.01) was observed in the digital photoanalysis. The total symptom score showed a decrease in the mean value of 0.48 score points in the retest. Conclusions: This study reveals both a valuable test-retest correlation of the proposed score as well as a good correlation of eye redness with the (objective) photodocumentation. Based on our results, we can recommend the use of this scoring system as a valuable clinical protocol for future clinical trials.

Development of a Pain Scoring System for Use in Sheep Surgically Implanted with Ventricular Assist Devices

ABSTRACTPurpose/Aim: In prey species, such as sheep, clinical signs of postoperative pain can manifest in subtle ways or may be concealed entirely. Previous publications describing pain assessment in ruminants focus on lameness and flock behavior, often in a farm environment. These indicators of pain may be difficult to assess in sheep housed in biomedical research settings. We have developed a novel pain scoring system for sheep undergoing thoracotomy for implantation of ventricular assist devices that are permanently housed in modified stanchions. Materials and Methods: The pain scoring system includes ruminant-specific behavioral signs of pain in addition to objective measurements that can be readily evaluated in a biomedical research setting. A numerical score is generated by the evaluator for each category. A decision tree is utilized to help guide further action following the generation of a cumulative score by the evaluator. A total score of 0–2 requires no intervention, 3–9 requires the consideration of additional analgesic administration, and a pain score ≥ 10 warrants the consideration of additional multimodal analgesia. Results: A novel pain scoring system and decision tree specifically designed for sheep undergoing thoracotomy in a biomedical research environment was developed and successfully utilized. Out of 102 postoperative pain scores measured, 86 scores were <2. There were 17/102 postoperative pain scores ≥3, which typically resulted in the administration of supplemental rescue analgesia in the immediate postoperative period. Conclusions: A novel pain scoring system was developed and utilized in a biomedical research environment for evaluating postoperative pain in sheep undergoing thoracotomy for implantation of a ventricular assist device. Further studies are necessary to validate the reliability of this novel pain scoring system.