Severity Of Illness Index Research Articles

The value of Tei index for evaluation on chronic heart failure

Objective To explor the value of Tei index for evaluation the cardiac function of patients with chronic heart failure(CHF).Methods Tei index in 60 patients with CHF(CHF group) and 30 normal controls(control group) were evaluated and compared with the levels of NT-ProBNP and the NYHA class,and the sensitivity and specificity of Tei index for CHF diagnosis were appraised.Results (1) Tei index in CHF group was significantly higher than that in control group.When Tei index was more than and equal to 0.45,the sensitivity,specificity,positive predictive value,and negative predictive value of Tei index for diagnosing CHF were 85.6％,90.4％,89.8％ and 78.0％.(2)There was a remarkable positive correlation between Tei and Log NT-ProBNP(r =0.84,P ＜ 0.01).(3)There were significant differences in Tei index among NYHA Ⅱ,Ⅲ,Ⅳ class [(0.47 ± 0.06),(0.56 ± 0.08),(0.64 ±0.13)].Conclusion Tei index can be used to diagnose CHF and evaluate the degree of it. Key words: Echocardiography; Severity of illness index; Heart failure, congestive

Factors Associated With Elevated Plateau Pressure in Patients With Acute Lung Injury Receiving Lower Tidal Volume Ventilation

Lung-protective ventilation with lower tidal volume and lower plateau pressure improves mortality in patients with acute lung injury and acute respiratory distress syndrome. We sought to determine the incidence of elevated plateau pressure in acute lung injury /acute respiratory distress syndrome patients receiving lower tidal volume ventilation and to determine the factors that predict elevated plateau pressure in these patients. We used data from 1398 participants in Acute Respiratory Distress Syndrome Network trials, who received lower tidal volume ventilation (≤ 6.5mL/kg predicted body weight). We considered patients with a plateau pressure greater than 30cm H2O and/or a tidal volume less than 5.5mL/kg predicted body weight on study day 1 to have "elevated plateau pressure." We used logistic regression to identify baseline clinical variables associated with elevated plateau pressure and to develop a model to predict elevated plateau pressure using a subset of 1,188 patients. We validated the model in the 210 patients not used for model development. Medical centers participating in Acute Respiratory Distress Syndrome Network clinical trials. None. Of the 1,398 patients in our study, 288 (20.6%) had elevated plateau pressure on day 1. Severity of illness indices and demographic factors (younger age, greater body mass index, and non-white race) were independently associated with elevated plateau pressure. The multivariable logistic regression model for predicting elevated plateau pressure had an area under the receiving operator characteristic curve of 0.71 for both the developmental and the validation subsets. acute lung injury patients receiving lower tidal volume ventilation often have a plateau pressure that exceeds Acute Respiratory Distress Syndrome Network goals. Race, body mass index, and severity of lung injury are each independently associated with elevated plateau pressure. Selecting a smaller initial tidal volume for non-white patients and patients with higher severity of illness may decrease the incidence of elevated plateau pressure. Prospective studies are needed to evaluate this approach.

Effect of Intravenous High-Dose Selenium Supplementation in Patients with Systemic Inflammatory Response Syndrome: A Pilot Study

목적: 전신염증반응증후군과 패혈증에 빠지면 과도한 산화성 스트레스가 발생한다. 고용량 셀레늄 정맥내 투여가 인체의 염증 조절 작용을 보완하여 일부 전신염증반응증후군 및 패혈증 환자의 예후에 영향을 미친다는 보고가 있어 본 연구에서는 전신염증반응증후군 환자에게 고용량 셀레늄을 정맥내 투여할 경우의 효과에 대해 알아보고자 하였다. 방법: 대상 환자들은 무작위로 셀레늄군 또는 대조군으로 분류하였고, 셀레늄군에 1주일간 매일 셀레늄 800 μg을 30분에 걸쳐 정맥내 일시주사하였고, 대조군에는 생리 식염수를 주사하였다. 급성기 반응물질과 질환 중증도지표가 호전되는 속도를 비교하기 위하여 진찰 및 혈액 검사를 시행하였다. 결과: 2010년 3월부터 2011년 8월까지 경증 전신염증반응 증후군 환자와 중등증 전신염증반응증후군 환자 23명이 등록 되었다. 셀레늄군의 혈청 셀레늄 농도는 시험 0일 9.95 μg/dL에서 시험 7일 18.15 μg/dL로 유의하게 호전되었으나(p=0.005), 대조군의 혈청 셀레늄 농도는 시험 0일에 비해 시험 7일에 유의한 변화가 없었다(p=1.000). 백혈구 수와 SOFA 점수는 셀레늄군에서 시험 0일에 비하여 시험 7일과 시험 14일에 유의한 호전을 보였으나 대조군에서는 시험 7일과 시험 14일 모두 유의한 호전이 없었다. 혈청 CRP 수치는 셀레늄군에서 시험 0일에 비하여 시험 7일과 시험 14일에 유의하게 호전을 보였으나 대조군에서는 시험 7일에는 유의한 호전이 없었고, 시험 14일에 유의한 호전을 보였다. APACHEII (Acute Physiology and Chronic Health Evaluation II) 점수는 셀레늄군과 대조군 모두에서 시험 0일에 비하여 시험 7일과 시험 14일에 유의한 호전을 보였다. 셀레늄 투여와 연관된 특별한 부작용은 관찰되지 않았다. 결론: 경증 전신염증반응증후군 환자와 중등증 전신염증 반응증후군 환자에 고용량 셀레늄 정맥내 일시주사는 일부 급성기 반응물질 및 질환중증도지표를 호전키는 효과가 있다. 그러나 본 연구는 대상자의 수가 적고, 이중 눈가림 방법이 사용되지 않아 편견의 가능성이 있으며, 투약의 효과지표로 급성기 반응물질과 질환중증도지표만을 모니터하였고, 7일 사망률, 28일 사망률 등 예후지표를 보지 않았다는 한계점이 있어 향후 대규모 연구의 필요성을 환기시키는 점에 그 의의가 있다고 판단된다.

Value of serum thyroid hormones in assessing the severity of acute pancreatitis

Objective To explore the value of serum thyroid hormones in assessing the severity of acute pancreatitis early in its course.Methods Fifty-two patients with acute pancreatitis were included in this prospective study.Attacks were classified as severe ( n =32) or mild ( n =20) according to the Atlanta criteria.Serum levels of thyroid hormones,including FT4,FT3,rT3 and TSH,were measured at admission.Each of the thyroid hormone levels was compared between the severe and mild groups,and the relationships of these thyroid hormones with APACHE Ⅱ scores and CT severity grading were analyzed.Effectiveness of thyroid hormone for the prediction of disease severity was evaluated by receiver operating characteristic (ROC) curve analysis.Results Serum FT3 levels were decreased significantly in severe acute pancreatitis compared with those in mild acute pancreatitis (P ＜ 0.01 ) ; whereas no significant difference was noted in the levels of FT4,rT3 and TSH between groups (P ＞ 0.05 ).Serum FT3 levels were negatively correlated with APACHE Ⅱ scores ( r =- 0.687,P ＜ 0.01 ) and CT severity grading ( r =- 0.720,P ＜ 0.01 ).The area under curve of FT3 was 0.875.With an optimum cutoff value of 2.87 pmol/L for FT3,the sensitivity,specificity,positive predictive and negative predictive values for the prediction of severe acute pancreatitis were 75％,95％,93.8％,and 79.2％,respectively.Conclusions Serum FT3 level is an acceptable indicator for early assessment of the severity of acute pancreatitis. Key words: Pancreatitis, Acute necrotizing; T4 thyroid hormones; T3 thyroid hormones; Reverse T3 thyroid hormones; Thyroid-stimulating hormone; Severity of illness index; Diagnosis.

Acute Kidney Injury and Mortality in Hospitalized Patients

Background: The objective of this study was to determine the incidence of acute kidney injury (AKI) and its relation with mortality among hospitalized patients. Methods: Analysis of hospital discharge and laboratory data from an urban academic medical center over a 1-year period. We included hospitalized adult patients receiving two or more serum creatinine (sCr) measurements. We excluded prisoners, psychiatry, labor and delivery, and transferred patients, ‘bedded outpatients’ as well as individuals with a history of kidney transplant or chronic dialysis. We defined AKI as (a) an increase in sCr of ≥0.3 mg/dl; (b) an increase in sCr to ≥150% of baseline, or (c) the initiation of dialysis in a patient with no known history of prior dialysis. We identified factors associated with AKI as well as the relationships between AKI and in-hospital mortality. Results: Among the 19,249 hospitalizations included in the analysis, the incidence of AKI was 22.7%. Older persons, Blacks, and patients with reduced baseline kidney function were more likely to develop AKI (all p < 0.001). Among AKI cases, the most common primary admitting diagnosis groups were circulatory diseases (25.4%) and infection (16.4%). After adjustment for age, sex, race, admitting sCr concentration, and the severity of illness index, AKI was independently associated with in-hospital mortality (adjusted odds ratio 4.43, 95% confidence interval 3.68–5.35). Conclusions: AKI occurred in over 1 of 5 hospitalizations and was associated with a more than fourfold increased likelihood of death. These observations highlight the importance of AKI recognition as well as the association of AKI with mortality in hospitalized patients.

Hospital-acquired viral infection increases mortality in children with severe viral respiratory infection

To investigate the association of method of acquisition (hospital-acquired vs. community-acquired) and mortality in children with severe viral respiratory infection. Retrospective cohort study. : Pediatric intensive care unit at an urban academic tertiary care children's hospital. All patients aged <18 yrs admitted to our pediatric intensive care unit with laboratory-confirmed respiratory syncytial virus, influenza, parainfluenza, or adenovirus infection between October 2002 and September 2008. We stratified patients by method of viral acquisition and identified those patients with chronic medical conditions associated with an increased risk of complications from viral illness. There were 289 patients admitted to the pediatric intensive care unit with laboratory-confirmed viral respiratory infection during the period of study. Fifty-three patients (18%) had hospital-acquired infection and 117 patients (40%) had chronic medical conditions associated with an increased risk of complications from viral illness. Hospital-acquired infection was associated with increased mortality and length of stay (all p < .001). Adjusting for age, chronic medical conditions, severity of illness index, and catheter-associated bloodstream infections, patients with hospital-acquired infection had a 5.8 (95% confidence interval 2.1-15.6) times greater odds (p = .001) of mortality. Our results suggest that in children with severe viral respiratory infection, hospital acquisition of infection is associated with increased mortality even after adjusting for chronic medical conditions that predispose to an increased risk of complications from viral illness.

182 To Admit or Discharge Congestive Heart Failure Patients: Use of a Severity of Illness Index

182 To Admit or Discharge Congestive Heart Failure Patients: Use of a Severity of Illness Index

Correlation between disease activity and pemphigus-specific antibody subclasses in patients with pemphigus

Objective To assess the correlation between the subclasses of antibodies against desmoglein (Dsg) 1 and Dsg3 and disease activity in patients with pemphigus. Methods Sera were collected from 47 patients with pemphigus, and ELISA was performed to determine the titers and subclasses of antibodies against Dsg1 and Dsg3. The correlation of antibody titers and subclasses with disease activity was assessed.Results Clinical phenotype was associated with antibody profiles in these patients with pemphigus. Of 17 patients with mucocutaneous involvement, 14 (82.4%) had both anti-Dsg3 and anti-Dsg1 antibodies; of 16 patients with cutaneous involvement, 15 (93.7%) had anti-Dsg1 antibody, only 1 (6.3%) developed anti-Dsg3 antibody; of 6 patients with mucosal involvement, all ( 100% ) had only anti-Dsg3 antibody. The serum levels of antibodies against Dsg1 and Dsg3 were increased, but not in parallel with the disease severity in these patients.Moreover, the subclasses of antibodies were correlated with disease severity. IgG4 subclass antibodies against Dsg1 and Dsg3 predominated in patients with pemphigus at active stage, whereas IgG1 subclass in those at remission stage. The serum levels (expressed as absorbance value) of IgG4 and IgG1 subclass antibodies were 1.92 ± 1.21 and 0.60 ± 0.61 respectively, with the ratio of IgG4 to IgG1 more than 1, in patients with antiDsg1 antibodies at active stage, 0.03 ± 0.02 and 0.22 ± 0.11 respectively with the ratio of IgG4 to IgG1 less than 1, in those at remission stage, 2.35 ± 2.17 and 1.84 ± 1.16 respectively with the ratio of IgG4 to IgG1 more than 1 in patients with anti-Dsg3 antibodies at active stage, 0.15 ± 0.16 and 1.05 ± 0.77 respectively with the ratio of IgG4 to IgG1 less than 1 in those at remission stage. Conclusions The subclasses of pemphigus-specific antibodies are closely correlated with the disease severity in patients with pemphigus. The detection of subclasses and titers of anti-Dsg1 and anti-Dsg3 antibodies may aid in the diagnosis of and monitoring of disease severity in pemphigus. Key words: Pemphigus; Autoantibodies; Severity of illness index; Enzyme-linked immunosorbent assay

The role of cholinergic pathway lesions in vascular cognitive impairment

Objective To investigate the relationship between white matter lesions (WML) within the cholinergic pathway and vascular cognitive impairment.Method Middle-aged and elderly stroke patients underwent brain MRI examination and Montreal Cognitive Assessment (MoCA).Cholinergic Pathways Hyperintensities Scale (CHIPS) scores and the overall WML burden by Schelten on fluidattenuated inversion recovery MRI images were determined and compared with MoCA scores.Spearman partial rank correlation coefficients and standardized regression coefficients were calculated.Results Thirty four patients were included ( mean age ( 62.2 ± 8.8 ) years, 45-82 years).MoCA scores negatively correlated with WML burdens by Schelten scores ( β = - 0.357, P = 0.042) and CHIPS scores ( β =-0.382,P=0.026).CHIPS scores were negatively associated with visuospatial and executive function (r = - 0.290, P = 0.048 ), naming function ( r = - 0.486, P = 0.002 ), attention ( r = - 0.311, P =0.037) and abstraction ( r = - 0.344, P = 0.023).Schelten scores were negatively associated with naming function (r = - 0.492, P = 0.002), attention ( r = - 0.364, P = 0.017) and abstraction ( r = - 0.390,P=0.011).Conclusion WML lesions within the cholinergic pathyway play a possible role in vascular cognitive impairment especially in visuospatial and executive function. Key words: Cholinergic fibers; Neurol pathways; Brain ischemia; Stroke; Congnitive disorders; Severity of illness index

Study on severity, status of awareness and therapy regarding urinary incontinence in elderly people from rural areas in Jixian county, Tianjin

To understand the prevalence of urinary incontinence (UI) and its severity in rural elderly people, as well as to investigate the awareness on UI in the elderly and health-care service seeking behavior. A cross-sectional study was carried out in two townships of Jixian county, Tianjin. A total of 743 people aged 60 years and over were selected under cluster sampling method. All the information was collected with a standardized structured questionnaire by face-to-face interview. Prevalence, severity, the awareness on UI in the elderly and their utilization of health-care service for its diagnosis and treatment were analyzed. Prevalence of UI was 33.38% among people aged 60 years and over in two townships of Jixian, higher in females than in males (43.15% vs. 22.75%, χ(2) = 34.70, P < 0.0001). The prevalence rates of UI in 60- age group, 65- age group, 70- age group, 75- age group, 80- age group, 85 - 95 age group were 28.64%, 32.12%, 34.08%, 35.45%, 47.76%, 30.00%, respectively, and increased with age (for trend χ(2) = 2.19, P = 0.029). Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were mild, while mixed urinary incontinence (MUI) were mainly moderate. The differences of severity of SUI, UUI, MUI between men and women did not show statistical significance (all P > 0.05). In 743 elderly people, more than half of the respondents had never heard of UI (50.20%, 373/743) and only 170(22.88%) elderly people considered UI as a disease. 630 (84.79%) and 665 (89.50%) elderly people in our research group did not know that such condition was curable and preventable. In 248 elderly people with UI, only 12 (4.84%) of them ever seeking community health-care services in the health-care centers or hospitals. For the ones who did visit the centers, the purpose was only to seek for drug treatment. Prevalence of UI appeared to be high among the elderly people in rural areas of Jixian county. Most of the elderly people were lack of knowledge about UI that hindered them from seeking for diagnosis and treatment in the clinics, plus the treatment program for UI was not standardized. Knowledge on UI and health care seeking behavior should be popularized and strengthened among elderly people living in the rural areas.

Monitoring healing of pressure ulcers: a review of assessment instruments for use in the spinal cord unit

Review. To identify the pressure ulcer healing assessment instrument that is the best choice for use in spinal cord injury rehabilitation. Articles were retrieved from PubMed. Inclusion criteria were written in English, published up to December 2008 and describing instruments evaluated in more than one study. Search terms were pressure ulcer, wound healing, severity of illness index, reproducibility of results, sensitivity and specificity. Articles describing pressure ulcer staging scales and articles not describing clinimetric properties of an instrument were excluded. Validity, reliability, responsiveness and feasibility for routine clinical use were described of all instruments evaluated in two or more studies. Eleven instruments were described. Clinimetric information was incomplete for all instruments. Clinimetric information was most complete and promising for two instruments: 'ruler length and width' and the 'Sessing' scale. The ruler method showed good intra-rater and inter-rater reliability and good concurrent validity. The 'Sessing' scale has a moderate concurrent validity but was not tested for its responsiveness. Further study of the clinimetric properties of pressure ulcer assessment instruments is necessary before the best instrument can be selected.

Measures of disease severity and life quality in patients with psoriasis

Psoriasis is a common and chronic disease in dermatological clinical settings. Dermatologists often estimate the impact of the disease on patients by their intuition. Accurate measurement of psoriasis disability is essential for the development of treatment strategy and evaluation of its efficacy. This paper describes several measures of psoriasis severity which involve the rating of symptom (such as psoriasis area and severity index (PASI), psoriasis global assessment (PGA) and lattice system physician's global assessment (LS-PGA)) and health-associated life quality (including general health questionnaires, dermatology specific questionnaires, disease specific questionnaires), as well as the criteria for definition of severe psoriasis. Key words: Psoriasis; Quality of life; Severity of illness index

Tei index for right ventricular function monitoring in pregnant women complicated with cardiac disease and pulmonary hypertension

To investigate clinical value of Tei index used for monitoring right ventricular (RV) function in pregnant women complicating cardiac disease accompanying pulmonary hypertension (PH) and the influence on left ventricular (LV) function due to overload pressure of RV. Fifty-eight pregnant women complicating cardiac disease (including 32 cases with congenital heart disease, 14 cases with rheumatic heart disease and 8 cases with arrhythmia) were enrolled in this study, among 26 cases coexisted with pulmonary hypertension. According to the pressure of PH, those patients were divided into three groups: 11 cases in mild group [30 - 49 mm Hg (1 mm Hg = 0.133 kPa)], 9 cases in moderate group (50 - 79 mm Hg) and 6 cases in severe group (>or= 80 mm Hg). In the mean time, 15 healthy pregnant women were matched as control. Tei index were measured for LV and RV respectively. (1) The isovolumetric relaxation time [IRT, (93 +/- 52) ms] and isovolumetric contraction time [ICT, (66 +/- 41) ms] of RV in PH group were significantly higher than normal controls [(39 +/- 19) ms in IRT and (38 +/- 20) ms in ICT] and the other patients without PH group [(59 +/- 12) ms in IRT and (43 +/- 19) ms in ICT, P < 0.01, P < 0.05; P < 0.05, P < 0.05]; however, ejection time (ET) was (239 +/- 46) ms significantly shortened in PH group (P < 0.05, P < 0.01) when compared with (250 +/- 41) ms in patients without PH and (299 +/- 38) ms in normal controls. Tei index in PH group were 0.72 +/- 0.49, which were significantly higher than 0.38 +/- 0.12 in normal controls and 0.43 +/- 0.16 in patients without PH (P < 0.01, P < 0.05). (2) The IRT [(99 +/- 27) ms] and ICT [(71 +/- 40) ms] of LV in PH group were significantly higher than in normal controls [(88 +/- 20) ms, (50 +/- 24) ms] (P < 0.01, P < 0.01). ET of LV in PH group [(202 +/- 26) ms] were significantly shortened that (290 +/- 21) ms in normal controls and (220 +/- 36) ms in patients without PH (P < 0.01, P < 0.05). Tei index of LV in PH group were significantly higher than 0.43 +/- 0.15 in normal controls and 0.58 +/- 0.21 in patients without PH (P < 0.01, P < 0.05). (3) Positive correlation between Tei index of RV and pressure of pulmonary artery were observed (r = 0.84, P < 0.01). (4) Tei index of RV in severe PH were significantly higher than mild PH (0.75 +/- 0.43 vs. 0.68 +/- 0.35, P < 0.01) and moderate PH (0.75 +/- 0.43 vs. 0.71 +/- 0.14, P < 0.05). (1) The Tei index is a novel efficient Doppler index in assessing RV function of pregnant women complicating cardiac disease accompanying PH. And the fluctuation of Tei index might reflect seriousness of the disease. (2) The overload pressure of RV pressure due to PH has significant influence on LV function.

Relationship between volume, angle and extent index in non-traumatic avascular osteonecrosis on the femoral head

Objective To explore the relationship between the osteonecrotic volume (lesion size), angle and the index of necrotic extent on the femoral head. Methods Fifty-one hips in 39 patients with non-traumatic avascular osteonecrosis on the femoral head were divided into 12 equal segments from the head to the neck junction (a turning point of the spherical curve of the head) with whole hip displacement, each with 30 degrees on a coronal plane of weight-bearing surface. The osteonecrotic angle of the arc of each necrotic segment from the center of the femoral head was measured at the point of one- to 12-o'clock on imaging of two dimensional reconstruction of computerized tomography (CT) scans and anteroposterior and lateral radiographs. Necrotic volume on each segment of the femoral head was calculated with fluid displacement method. The index of osteonecrotic extent on the femoral head was calculated using direct anatomical measurements. Results Osteoneerotic volume on the femoral head at the point of 12- to one-o'clock on coronal plane was (74. 5 ± 7.4)% of the sphere equivalent of the whole femoral head, which was positively correlated to its necrotic angle [ (41.9±8. 3) degrees] at the point of one-o'clock on the plane, with a coefficient of correlation of 0. 843, and that at the point of one- to two-o'clock on the plane was (73.7 ±0. 4) %, which was positively correlated to its necrotic angle [ (41.9 ± 1.8) degrees] at the point of two-o'clock, with a coefficient of correlation of 0. 543. Osteonecrotic volume on the point of 11- to 12-o'cleck was (83.6±8.6)%, and the necrotic angle at the point of 12-o'clock was (44. 9±3.9) degrees, which were positively correlated each other, with a coefficient of correlation of 0. 701 (P <0. 01 ). Osteonecrotic volume on the femoral head was positively correlated to its necrotic angle , modified index of necrotic extent, index of necrotic extent and Kerboul conjugated necrotic angle, with coefficients of correlation of 0. 798, 0. 701, 0. 377 and 0. 398 ( P < 0. 01 ), respectively, at the point of one o' clock. Conclusions Measurements of osteonecrotic volume was positively correlated to the index of necrotic extent and necrotic angle on the femoral head, respectively. Necrotic angle on the plane at 30-degree of the trochanter on the femoral head can well reflect its necrotic volume. Key words: Femur head necrosis; Tomography, X-ray; Severity of illness index

Comparison of three different organ failure assessment score systems in predicting outcome of severe sepsis

To compare multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA) and the logistic organ dysfunction score (LODS) in predicting hospital mortality in severe sepsis. Four hundred and three patients admitted to the ICU from December 2004 to November 2007 with a diagnosis of severe sepsis were enrolled in this study. Their MODS, SOFA, LODS and Acute Physiology and Chronic Health Evaluation (APACHE) II at admission and the highest score during hospitalization were respectively recorded and collected in regard to mortality. The discrimination of three multiple organ dysfunction score systems were assessed by the areas under the receiver operating characteristic curves (AUC). The AUC of admission scores was 0.811 for LODS, 0.787 for SOFA, 0.725 for MODS, and 0.770 for APACHE II in predicting hospital mortality. All maximum scores had better power of discrimination than the admission scores (P < 0.01). The power of discrimination of LODS and SOFA were better than the MODS, either the admission or the highest, respectively (P < 0.01). However, no significant difference was observed between the LODS and the SOFA regarding mortality prediction (P > 0.05). The AUC value for the APACHE II score was much lower compared to LODS (P < 0.01). However, there was no difference in AUC value among APACHE II, SOFA and MODS (P > 0.05). LODS, SOFA and MODS show a good discrimination power, while maximum LODS is of the highest discrimination power to predict the outcome of patient with severe sepsis.

Paramedic Determinations of Medical Necessity: A Meta-Analysis

Introduction. Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport. Methods. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library databases were searched using Cochrane Prehospital and Emergency Care Field search terms combined with the Medical Subject Headings (MeSH) terms “triage”; “utilization review”; “health services misuse”; “severity of illness index,” and “trauma severity indices.” Two reviewers independently evaluated each title to identify relevant studies; each abstract then underwent independent review to identify studies requiring full appraisal. Inclusion criteria were original research; emergency responses; determinations of medical necessity by U.S. paramedics; and a reference standard comparison. The primary outcome measure of interest was the negative predictive value (NPV) of paramedic determinations. For studies reporting sufficient data, agreement between paramedic and reference standard determinations was measured using kappa; sensitivity, specificity, and positive predictive value (PPV) were also calculated. Results. From 9,752 identified titles, 214 abstracts were evaluated, with 61 studies selected for full review. Five studies met the inclusion criteria (interrater reliability, kappa = 0.75). Reference standards included physician opinion (n = 3), hospital admission (n = 1), and a composite of physician opinion and patient clinical circumstances (n = 1). The NPV ranged from 0.610 to 0.997. Results lacked homogeneity across studies; meta-analysis using a random-effects model produced an aggregate NPV of 0.912 (95% confidence interval: 0.707–0.978). Only two studies reported complete 2 × 2 data: kappa was 0.105 and 0.427; sensitivity was 0.992 and 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823. Conclusion. The results of the few studies evaluating U.S. paramedic determinations of medical necessity for ambulance transport vary considerably, and only two studies report complete data. The aggregate NPV of the paramedic determinations is 0.91, with a lower confidence limit of 0.71. These data do not support the practice of paramedics' determining whether patients require ambulance transport. These findings have implications for EMS systems, emergency departments, and third-party payers.

Tumor Necrosis Factor-a In Emergency Department Patients with Systemic Inflammation as a Predictor of Severity and Outcome of Sepsis

Aim of the study was to determine whether the TNF-a levels, proximal inflammatory mediator, in septic patients presenting to the emergency department (ED) and admitted to the intensive care unit (ICU) are associated with progression to severe sepsis, septic shock or death. Material and methods. A retrospective observational study was performed on a sample of one hundred adult subjects presenting to the ED with systemic inflammatory response syndrome of 2 etiologies: presumed (and later confirmed in the ICU and/or operating room) severe acute pancreatitis or generalized peritonitis. Blood TNF-a samples measurements were taken shortly after ED admission. TNF-a was measured by commercial ELISA test in plasma. Results. Mean values of TNF-a on admission (day zero, in ED) were 191,5-fold lower in group with septic shock compared to severe sepsis group and were 63-fold higher in survivors (p&lt;0.01). The area under the curve (AUC) for the TNF-a plots for severity of clinical status was 0.813 and for outcome 0.834. Patients with TNF-a levels lower than 7.95 pg/mL had a 3.2-fold higher probability of septic shock development than those with higher values, at the cutoff level sensitivity was 83,9% and specificity 72,5%. Patients with TNF-a levels higher than 10.5 pg/mL had a 4.8-fold higher probability to survive than those with lower values, at the cutoff level sensitivity was 83,0% and specificity 77,4%. Conclusion: Decreasing in TNF-a concentration leads to the septic shock development and fatal outcome. TNF-a is very good predictor of sepsis severity and outcome. Key words: sepsis, tumor necrosis factor-alpha, emergency medical services, survival rate, severity of illness index.

Functional outcome of children treated in intensive care unit

Outcome of patients is determined not only by severity of illness index, but also by the impact of patients' preadmission comorbid status. Therefore, we aimed at evaluating the outcome of patients treated in a pediatric intensive care unit, with special focus on the group of children with chronic diseases. Data were obtained prospectively and outcome was assessed according to the Pediatric Overall Performance Category scale for 449 patients in a pediatric intensive care unit of the Split University Hospital. Functional performance was assessed as the preadmission score and the discharge score in patients with neurodevelopmental disabilities, patients with other chronic diseases, and those without chronic disease. The discharge functional status was significantly dependent on the preadmission functional status and on predicted mortality. Children with neurodevelopmental disabilities had the significantly worse baseline score and the significantly smaller deterioration of functional morbidity at discharge compared to children with no chronic disease and children with other chronic diseases. The Pediatric Overall Performance Category scale has proved its applicability in a small intensive care unit, with a heterogeneous population of patients. It should therefore be considered for regular evaluation of health care quality, as a simple and accurate tool. As opposed to other patients, functional status of children with neurodevelopmental disabilities was markedly influenced by their comorbidity. Their preadmission status was worse than the status of other children, and hence could not significantly deteriorate at discharge.

Severity of Illness Index in and Therapy for Adult Community-acquired Pneumonia

Severity of Illness Index in and Therapy for Adult Community-acquired Pneumonia

A Severity of Illness Index and Health-Related Quality of Life for Teens with Congenital Heart Disease

A Severity of Illness Index and Health-Related Quality of Life for Teens with Congenital Heart Disease