Simple Clinical Scoring System Research Articles

Validation of the NULL-EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out-of-Hospital Cardiac Arrest.

NULL-PLEASE is a simple and accurate clinical scoring system developed in a Western cohort of patients with out-of-hospital cardiac arrest (OHCA). The need for blood test results limits its use in early stages of care. We adapted and validated the NULL-EASE score (without laboratory tests) in an independent, multiethnic Asian cohort of patients with out-of-hospital cardiac arrest. Using the Singapore OHCA registry, we included consecutive adult patients with out-of-hospital cardiac arrest who survived to hospital admission between April 2010 to December 2020. In-hospital mortality was the primary outcome. Logistic regression analyses were performed with STATA MP v18. Of 3274 patients (median age 64, interquartile range 54-75; 67.9% male) included in the study, 2476 (75.6%) had in-hospital mortality. NULL-EASE score was significantly lower in survivors compared with nonsurvivors (median [inter quartile range] 3 [1-4] versus 6 [4-7]; P<0.001) and strongly predictive of mortality (area under receiver operating characteristic, 0.81 [95% CI, 0.79-0.83]). Patients with a score of ≥3 had higher odds of mortality (adjusted odds ratio, 8.11 [95% CI, 6.57-10.00]) when compared with those with lower scores, after adjusting for sex, residential arrest, diabetes, respiratory disease, and stroke. A cutoff value of ≥3 predicted mortality with 92.2% sensitivity, 84.1% positive predictive value, 46.1% specificity, and 65.5% negative predictive value. NULL-EASE score performed better in younger compared with older patients (area under receiver operating characteristic, 0.82 versus 0.77, P=0.008). The NULL-EASE score has good discriminative performance (sensitivity and accuracy) in our multiethnic Asian cohort, but the cutoff of ≥3 falls short of the desired level of specificity for therapeutic decision-making.

Non-pancreatic hyperlipasemia: A puzzling clinical entity.

Increased lipase level is a serological hallmark of the diagnosis of acute pancreatitis (AP) but can be detected in various other diseases associated with lipase leakage due to inflammation of organs surrounding the pancreas or reduced renal clearance and/or hepatic metabolism. This non-pancreatic hyperlipasemia (NPHL) is puzzling for attending physicians during the diagnostic procedure for AP. It would be clinically beneficial to identify the clinical and laboratory variables that hinder the accuracy of lipase diagnosis with the aim of improve it. A more precise description of the NPHL condition could potentially provide prognostic factors for adverse outcomes which is currently lacking. To perform a detailed clinical and laboratory characterization of NPHL in a large prospective patient cohort with an assessment of parameters determining disease outcomes. A Hungarian patient cohort with serum lipase levels at least three times higher than the upper limit of normal (ULN) was prospectively evaluated over 31 months. Patients were identified using daily electronic laboratory reports developed to support an ongoing observational, multicenter, prospective cohort study called the EASY trial (ISRCTN10525246) to establish a simple, easy, and accurate clinical scoring system for early prognostication of AP. Diagnosis of NPHL was established based on ≥ 3 × ULN serum lipase level in the absence of abdominal pain or abdominal imaging results characteristic of pancreatitis. A total of 808 patients [male, n = 420 (52%); median age (IQR): 65 (51-75) years] were diagnosed with ≥ 3 × ULN serum lipase levels. A total of 392 patients had AP, whereas 401 had NPHL with more than 20 different etiologies. Sepsis and acute kidney injury (AKI) were the most prevalent etiologies of NPHL (27.7% and 33.2%, respectively). The best discriminative cut-off value for lipase was ≥ 666 U/L (sensitivity, 71.4%; specificity, 88.8%). The presence of AKI or sepsis negatively affected the diagnostic performance of lipase. NPHL was associated with a higher in-hospital mortality than AP (22.4% vs 5.1%, P < 0.001). In multivariate binary logistic regression, not lipase but increased amylase level (> 244 U/L) and neutrophil-to-lymphocyte ratio (NLR) (> 10.37, OR: 3.71, 95%CI: 2.006-6.863, P < 0.001), decreased albumin level, age, and presence of sepsis were independent risk factors for in-hospital mortality in NPHL. NPHL is a common cause of lipase elevation and is associated with high mortality rates. Increased NLR value was associated with the highest mortality risk. The presence of sepsis/AKI significantly deteriorates the serological differentiation of AP from NPHL.

A Simple Clinical Scoring System to Determine the Risk of Pancreatic Cancer in the General Population.

This study aimed to develop and validate a simple scoring system to determine the high-risk group for pancreatic cancer (PC) in the asymptomatic general population. The scoring system was developed using data from PC cases and randomly selected non-PC cases undergoing annual medical checkups between 2008 and 2013. The performance of this score was validated for participants with medical checkups between 2014 and 2016. In the development set, 45 PC cases were diagnosed and 450 non-PC cases were identified. Multivariate analysis showed three changes in clinical data from 1 year before diagnosis as independent risk factors: ΔHbA1c ≥ 0.3%, ΔBMI ≤ -0.5, and ΔLDL ≤ -20 mg/dL. A simple scoring system, incorporating variables and abdominal ultrasound findings, was developed. In the validation set, 36 PC cases were diagnosed over a 3-year period from 32,877 participants. The AUROC curve of the scoring system was 0.925 (95%CI 0.877-0.973). The positive score of early-stage PC cases, including Stage 0 and I cases, was significantly higher than that of non-PC cases (80% vs. 6%, p = 0.001). The simple scoring system effectively narrows down high-risk PC cases in the general population and provides a reasonable approach for early detection of PC.

A simple and efficient clinical prediction scoring system to identify malignant pleural effusion.

Early diagnosis of malignant pleural effusion (MPE) is of great significance. Current prediction models are not simple enough to be widely used in heavy clinical work. We aimed to develop a simple and efficient clinical prediction scoring system to distinguish MPE from benign pleural effusion (BPE). This retrospective study involved patients with MPE or BPE who were admitted in West China Hospital from December 2010 to September 2016. Patients were divided into training, testing, and validation set. Prediction model was developed from training set and modified to a scoring system. The diagnostic efficacy and clinical benefits of the scoring system were estimated in all three sets. Finally, 598 cases of MPE and 1094 cases of BPE were included. Serum neuron-specific enolase, serum cytokeratin 19 fragment (CYFRA21-1), pleural carcinoembryonic antigen (CEA), and ratio of pleural CEA to serum CEA were selected to establish the prediction models in training set, which were modified to the scoring system with scores of 6, 8, 10, and 9 points, respectively. Patients with scores >12 points have high MPE risk while ⩽12 points have low MPE risk. The scoring system has a high predictive value and good clinical benefits to differentiate MPE from BPE or lung-specific MPE from BPE. This study developed a simple clinical prediction scoring system and was proven to have good clinical benefits, and it may help clinicians to separate MPE from BPE.

Early diagnosis of caesarean scar pregnancy by ultrasound - a novel, simple and rapid clinical classification scoring system.

In the recent years, with the increase in the caesarean section rate, the incidence of caesarean scar pregnancy (CSP) has shown a significant upwards trend. We propose a novel, simple and rapid clinical and ultrasound (US) classification scoring system to assist in the early diagnosis of CSP. A total of 385 patients with CSP were included in the study. All patients were given a comprehensive score, iincluding clinical data (whether HCG is consistent with gestational age and vaginal bleeding) and US findings (linea a and b, gestational sac morphology, the presence of primitive cardiac tube beat, and color Doppler aspect). The scores were analysed by ROC curve analysis, and sensitivity and specificity were calculated. A score of 4 has a specificity of 91.7% and a sensitivity of 95.6% in diagnose CSP. The area under the ROC curve was 0.973. This scoring system may be a reliable tool for the early diagnosis of CSP and has the characteristics of being simple and rapid. For patients with a total score of ≥4 points, CSP is suggested, and early clinical treatment can be carried out, while patients with a score of less than 4 points can temporarily retain pregnancy and be closely followed up.

A scoring system based on fusion genes to predict treatment outcomes of the non-acute promyelocytic leukemia pediatric acute myeloid leukemia

BackgroundFusion genes are considered to be one of the major drivers behind cancer initiation and progression. Meanwhile, non-acute promyelocytic leukemia (APL) pediatric patients with acute myeloid leukemia (AML) in children had limited treatment efficacy. Hence, we developed and validated a simple clinical scoring system for predicting outcomes in non-APL pediatric patients with AML.MethodA total of 184 non-APL pediatric patients with AML who were admitted to our hospital and an independent dataset (318 patients) from the TARGET database were included. Least absolute shrinkage and selection operation (LASSO) and Cox regression analysis were used to identify prognostic factors. Then, a nomogram score was developed to predict the 1, 3, and 5 years overall survival (OS) based on their clinical characteristics and fusion genes. The accuracy of the nomogram score was determined by calibration curves and receiver operating characteristic (ROC) curves. Additionally, an internal verification cohort was used to assess its applicability.ResultsBased on Cox and LASSO regression analyses, a nomogram score was constructed using clinical characteristics and OS-related fusion genes (CBFβ::MYH11, RUNX1::RUNX1T1, KMT2A::ELL, and KMT2A::MLLT10), yielded good calibration and concordance for predicting OS of non-APL pediatric patients with AML. Furthermore, patients with higher scores exhibited worse outcomes. The nomogram score also demonstrated good discrimination and calibration in the whole cohort and internal validation. Furthermore, artificial neural networks demonstrated that this nomogram score exhibits good predictive performance.ConclusionOur model based on the fusion gene is a prognostic biomarker for non-APL pediatric patients with AML. The nomogram score can provide personalized prognosis prediction, thereby benefiting clinical decision-making.

Validation of the Fatty Liver Index for identifying non-alcoholic fatty liver disease in a Kenyan population.

Fatty Liver Index (FLI) is a simple clinical scoring system estimating non-alcoholic fatty liver disease (NAFLD). It is validated in European-descent and Asian populations, but not in sub-Saharan Africans. The aim of this study is to evaluate the validity of the FLI for predicting NAFLD in a population from Kenya. Participants were recruited from a community-based study conducted in Kenya. NAFLD was diagnosed using hepatic ultrasonography. Clinical, anthropometrical, biochemical and lifestyle data were obtained. The accuracy and cut-off point of the FLI to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis. A total of 640 participants (94 with NAFLD) were included. Mean age was 37.4 ± 0.4 years and 58.7% were women. Mean body mass index (BMI) was 22.3 ± 0.2 kg/m2 and waist circumference (WC) 79.1 ± 0.4 cm. A total of 15 (2.3%) participants were diagnosed with type 2 diabetes and 65 (10.2%) with obesity (BMI ≥ 30 kg/m2 ). AUROC of FLI for predicting NAFLD was 0.80 (95% CI 0.74-0.85), which was significantly higher compared to individual components gamma-glutamyl transferase and triglycerides (p < 0.05), but not compared to anthropometric parameters BMI (AUROC of 0.83, 95% CI 0.79-0.88) and WC (AUROC of 0.81, 95% CI 0.76-0.87). FLI is a simple valid scoring system to use in rural and urban Kenyan adults. However, this index might not be superior to BMI or WC to predict NAFLD, and those measurements might therefore be more appropriate in limited settings.

The BAND score: a simple upfront predictive model for futile recanalization to guide patient selection for endovascular thrombectomy during acute ischemic stroke triage (P8-5.004)

<h3>Objective:</h3> To develop a clinical scoring system for upfront prediction of poor post-endovascular thrombectomy (EVT) outcomes during the acute stroke triage process. <h3>Background:</h3> Futile recanalization (FR) is an unfavorable outcome following successful EVT for acute ischemic stroke patients. There is currently no clinical scoring system that can accurately predict FR. <h3>Design/Methods:</h3> Consecutive EVT patients for anterior circulation large vessel occlusion strokes were identified from 2016 to 2021 at a Comprehensive Stroke Center, and clinical information was recorded. FR was defined as a 90-day modified Rankin Scale (mRS) of 4 or greater despite achieving modified thrombolysis in cerebral infarction (mTICI) score 2b or greater. Multivariable regression analyses were used to identify independent risk factors for FR, and a scoring system was constructed. <h3>Results:</h3> 619 patients were identified, and 483 patients with successful recanalization and available 90-day follow-up data were analyzed. Overall, FR was observed in 46.5% of patients. From a randomly selected training cohort (n=357), individual risk factors for FR were identified and used to construct the 10-point BAND score: baseline disability (1 point: baseline mRS ≥ 2), age (1 point: 60–69 years, 2 points: 70–79 years, 3 points: 80–84 years, 4 points: 85 years or older), NIHSS (2 points: 13–17, 3 points: 18–22, and 4 points: 23 or higher), and delay from last known normal (1 point: ≥6 hours). The BAND score achieved good predictability of FR with an area under the receiver-operating characteristic curve of 0.80 in our training cohort and 0.78 in our validation cohort. 88.2% of the total and 90.2% of patients 80 years or older with BAND ≥7 had a 90-day mRS of 4 or greater despite successful EVT recanalization. <h3>Conclusions:</h3> The BAND score is a simple clinical scoring system for prediction of FR, and it has potential to serve as a valuable triage tool for physicians in a real-world setting. <b>Disclosure:</b> Mr. Chen has received research support from National Institues of Health. Dr. Colasurdo has nothing to disclose. Dr. Phipps has nothing to disclose. The institution of Dr. Miller has received research support from Medtronic. The institution of Dr. Miller has received research support from Cerenovus, DePuy Synthes Products, Inc.. The institution of Dr. Miller has received research support from InSightec. The institution of Dr. Miller has received research support from Microvention. The institution of Dr. Miller has received research support from Microvention. The institution of Dr. Miller has received research support from InSightec. The institution of Dr. Miller has received research support from MicroVention. The institution of Dr. Miller has received research support from InSightec. The institution of Dr. Miller has received research support from Vesalio. Jacob Cherian has nothing to disclose. Dr. Marino Granados has nothing to disclose. Dr. Cronin has nothing to disclose. Dr. Wozniak has nothing to disclose. Dheeraj Gandhi has nothing to disclose. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar &amp; Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS. Gaurav Jindal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Penumbra.

A Novel Simple Clinical Scoring System to Guide the Utilization of Urodynamic Studies in Women with Overactive Bladder Symptoms: A retrospective Observational study

A Novel Simple Clinical Scoring System to Guide the Utilization of Urodynamic Studies in Women with Overactive Bladder Symptoms: A retrospective Observational study

A Scoring System Based on Laboratory Parameters and Clinical Features to Predict Unfavorable Treatment Outcomes in Multidrug- and Rifampicin-Resistant Tuberculosis Patients.

The growth of antibiotic resistance to Mycobacterium TB represents a major barrier to the goal of "Ending the global TB epidemics". This study aimed to develop and validate a simple clinical scoring system to predict the unfavorable treatment outcomes (UTO) in multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) patients. A total of 333 MDR/RR-TB patients were recruited retrospectively. The clinical, radiological and laboratory features were gathered and selected by lasso regression. These variables with area under the receiver operating characteristic curve (AUC)>0.6 were subsequently submitted to multivariate logistic analysis. The binomial logistic model was used for establishing a scoring system based on the nomogram at the training set (N = 241). Then, another independent set was used to validate the scoring system (N = 92). The new scoring system consists of age (8 points), education level (10 points), bronchiectasis (4 points), red blood cell distribution width-coefficient of variation (RDW-CV) (7 points), international normalized ratio (INR) (7 points), albumin to globulin ratio (AGR) (5 points), and C-reactive protein to prealbumin ratio (CPR) (6 points). The scoring system identifying UTO has a discriminatory power of 0.887 (95% CI=0.835-0.939) in the training set, and 0.805 (95% CI=0.714-0.896) in the validation set. In addition, the scoring system is used exclusively to predict the death of MDR/RR-TB and has shown excellent performance in both training and validation sets, with AUC of 0.930 (95% CI=0.872-0.989) and 0.872 (95% CI=0.778-0.967), respectively. This novel scoring system based on seven accessible predictors has exhibited good predictive performance in predicting UTO, especially in predicting death risk.

Evaluation of Boey scoring in predicting morbidity and mortality in peptic ulcer perforation peritonitis

Among abdominal emergencies, perforations of peptic ulcer are third most common in frequency, after acute appendicitis and acute intestinal obstruction. The prevalence of peptic ulcer disease ranges from 5 to 15% in the western population. Perforation being the most dreaded complication, occurring in about 2–10% of peptic ulcer cases. Inspite of better understanding of the disease, effective resuscitation and prompt surgery under modern anaesthesia techniques, there is still high mortality and morbidity in perforated peptic ulcer with mortality rate ranging from 5% to 15%. Prompt recognition of the condition and early surgery are very important to reduce the mortality. In our study, we stratified the patients with perforated peptic ulcer peritonitis according to Boey score and found a significant relationship between increasing Boey score with higher rates of post-operative morbidity and mortality. The study also demonstrated that using a simple clinical scoring system in surgical emergency room proves critical to reduce the chances of morbidity and mortality among patients with perforated peptic ulcer peritonitis.

New Scoring System for Predicting the Risk of Surgical Site Infections Following Stoma Reversal

BackgroundSurgical site infections (SSI) are one of the most frequent complications following stoma reversal (SR-SSI) and lead to multiple problems such as decreased mobility of the patients or increased hospital costs. Several risk factors for SR-SSI have been reported, but there are no risk scoring systems for predicting SR-SSI. The current study aimed to analyze the risk factors for SR-SSI and develop a scoring system. Materials and methodsMultivariate analysis of risk factors for SR-SSI was performed in patients who underwent elective SR and were followed-up during the first month after surgery. A logistic regression model was used to identify risk factors and construct a predictive score. ResultsOf the 182 patients, 53 (29.1%) developed SSI. In multivariate analysis, three variables as preoperative risk factors were associated with increased SR-SSI incidence: subcutaneous fat thickness (≥ 20 mm) (odds ratio [OR]: 8.46 [95% confidence interval (CI): 3.45–20.7], P <0.001), period from stoma creation (≤ 20 weeks) (OR: 2.88 [95% CI: 1.14–7.28], P = 0.025), and SSI after the primary operation (OR: 3.06 [95% CI: 1.19–7.90], P = 0.021). Each of these variables contributed 2,1, and 1 points to the risk score, respectively. The SR-SSI rate was 2.9%, 20.3%, 34.2%, 54.5%, and 81.8% for the scores of 0,1,2,3, and 4 points, respectively. The area under the receiver operating characteristic curve was 0.773 (95% CI: 0.703–0.844). ConclusionsA simple clinical scoring system based on three preoperative variables may be useful in predicting the risk of SR-SSI.

Efficacy of BISAP score versus Ranson’s score to determine the severity index of acute pancreatitis

Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multiorgan failure posing a significant therapeutic challenge for the health care providers. Bedside index of severity in acute pancreatitis (BISAP) is a scoring system that would precisely predict severity as early as within the first 24 hours of the course of acute pancreatitis. This study aims to compare BISAP and Ranson’s score to establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: All 84 cases admitted at HSK Hospital and SNMC, Bagalkot and diagnosed as acute pancreatitis were included in this study, from January 2019 to June 2020. Clinical evaluation in the form of detailed history, per abdominal, systemic examination and laboratory investigations, both BISAP and Ranson’s score were applied and compared, based upon data obtained at admission, within 24 hours and at 48 hours of hospitalization.Results: Out of 84 cases with a male to female ratio of 16:1, majority belonged to age group 31-40 years (42%) and most common etiological factor being alcohol consumption (74%); 19% patients had severe acute pancreatitis and 68% patients had length of hospital stay less than a week. Major organ failure and pancreatic necrosis, severity of BISAP and Ranson’s score were found to be significantly correlated, (p&lt;0.001); mortality was found to be 1.2%.Conclusions: Compared to Ranson’s score, BISAP score is equally effective in finding out the frequency of severity and predicting mortality in patients with acute pancreatitis .The values in BISAP score are instantaneous with no time delay.

TOPRSS: a simple clinical score to predict outcome and mortality in paediatric emergency department

Background: To validate the clinical scoring system TOPRSS for the severity of the illness to prioritize care and predict outcomes in the emergency department.Methods: This prospective hospital-based observational study in 100 children for three months carried out. Cases&lt;1-month age or&gt;14 years excluded. Demographics data, provisional diagnosis, hemodynamics, seizures, and other clinical parameters were recorded on predesigned proforma at the time of admission. Final outcome of the patient, either discharge or death, was considered as the primary variable.Results: Out of 100 children, 92 were discharged and 8 deaths were recorded. Of the six variables, oxygen saturation and sensorium were found to be significantly associated with mortality. Logistic regression found that variables such as oxygen saturation and sensorium were strongly associated with mortality with a highly significant p value of 1% and variables such as pulse rate and seizures were also associated with mortality with a significant P value of 5%.Conclusions: For triage in pediatric emergency, a patient with two or more abnormal variables should be evaluated to facilitate admission as they have a potential risk of death. TOPRSS score being a simple clinical scoring system which does not require any expertise can applied at all levels of health care to identify critically ill patient referral to higher centre especially in regions of resource poor environment.

The use of a special clinical score and platelet count for assessment of severity and outcome of children with acute lower respiratory tract infection

IntroductionLower respiratory tract infections (LRTIs) are a major threat to the health of children worldwide and are exacerbated by global environmental problems. In the developing countries where nutrition remains poor, LRTIs are the most common cause of death in children. However, although the incidence of LRTI in developed countries is as low as 3–4%, its incidence in developing countries ranges between 20 and 30%. Up to 13% of in-patient deaths in pediatric wards are due to LRTI.Patients and methodsThis is a prospective study conducted in Assiut University Children Hospital during the period from November 2017 to February 2018. A total of 100 infants and children aged 1 month to 2 years old were included in the study. The patients were classified into two categories: severe pneumonia and very severe pneumonia or very severe disease according to the presence or absence of general danger signs reported by WHO 2014. All cases were subjected to Temperature, Oxygen saturation, Pulse rate, Respiratory rate, Sensorium loss and Seizures (TOPRS) clinical score, platelet count, and chest radiography.ResultsOverall, 69% of cases were males and 31% of cases were females; 49% of cases were aged 1–6 months, 31% of cases were aged 6–12 months, and 20% of cases were aged 12–24 months; and 73% of cases were discharged, whereas 27% of cases died in the hospital.ConclusionA special clinical scoring system called TOPRS score is developed. It is a simple clinical scoring system that depends on physical variables only (temperature, oxygen saturation, pulse rate, respiratory rate, sensorium, and seizures), and it can be used mainly to improve the triage in the emergency room to detect the severity of cases presented and to initiate appropriate emergency treatment in time. It is also helpful to predict outcome of the selected cases. Thrombocytopenia is a good indicator for poor outcome of cases of LRTI, being more powerful than thrombocytosis.

Predicting difficult spinal anesthesia: development of a neuraxial block assessment score.

Spinal anesthesia is a commonly performed procedure with unpredictable difficulty. The objective of this study was to predict a difficult lumbar spinal anesthesia with clinical elements that are easy to collect. A questionnaire-based, observational study named NBA, conducted from February 2018 to June 2018. The questions regarded clinical elements and the eventual spinal anesthesia difficulty encountered. A total of 427 questionnaires were filled by the operators. The clinical elements were selected upon literature search and have been integrated with new ones. All the answers were recorded from the anesthesiologist performing the procedure. The NBA Score was derived from a total number of 427 questionnaires. Among them, 26 patients had "previous history of difficult spinal anesthesia;" 277 had "spinous processes not visible;" 83 had "spinous processes not palpable;" 77 had "spinal deformities" and 28 had "previous spinal surgery" in the puncture area; 138 patients received lumbar spinal anesthesia in lateral position. There were 328 (76.8%) single puncture successes. Seventy-nine (18.5%) patients required more than one skin puncture to obtain a successful spinal anesthesia. 20 (4.7%) required an alternative anesthesia technique (general anesthesia). Multivariate analysis indicated that each element is a risk factors for difficult spinal anesthesia, except for previous spinal surgery. The combination of more than one element increased the chance of a second skin puncture of more than 50%. This work proposes a simple clinical scoring system predicting the probability of a difficult spinal anesthesia.

Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

Early Achievable Severity (EASY) index for simple and accurate expedite risk stratification in acute pancreatitis.

Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality. The assessment of severity is crucial in the management of the disease. Current methods of risk stratification in AP have a limited value, as they provide little additional information thus delaying appropriate patient care. Early recognition of severe disease may prevent serious adverse events and improve patient management as well as overall clinical outcome. The EASY trial is an observational, multicenter, prospective cohort study for establishing a simple, easy and accurate clinical scoring system for early prognostication of AP. Evaluation of simple attainable potential prognostic parameters obtained at admission (or not later than 6-12 hours afterwards) from patients diagnosed with AP will be performed to assess their potential correlation with the disease severity. The selected parameters that show the strongest correlation with severe disease course will be further utilized as potential early severity prognostic markers for prospective new patient stratification. Comparison of patients' clinical course with the obtained results of early risk stratification may validate the utilized parameters as prognostic markers. The trial has been (i) discussed and (ii) accepted in a distinguished international scientific meeting, (ii) receiving the relevant ethical approval (TÜKEB: 30595-1/2014/EKU), (ii) registered at the ISRCTN registry which is a primary clinical trial registry recognized by WHO (Trial registration number: ISRCTN10525246). The EASY trial is designed to develop a simple and accurate clinical scoring system that can stratify patients with AP during the first 6-12 hours of hospitalization according to their risk for severe disease course.

Abstract P282: A Simple Clinical Scoring System Using Readily Available Clinical Measures for Prediction of Non-alcoholic Fatty Liver Disease: Evidence From the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Many patients have risk factors for non-alcoholic fatty liver disease (NAFLD), the leading cause of liver disease in the US. Screening all patients with risk factors for NAFLD using ultrasound or computed tomography (CT) is not always possible. We present a practical scoring tool for predicting presence of NAFLD based on common anthropometric measurements, clinical parameters and patient characteristics. Methods: We used cross-sectional data from 6,194 white, African American, Hispanic, and Chinese American participants from the Multi-Ethnic Study of Atherosclerosis, ages 45-85 years. Liver fat attenuation was measured by CT scans ( &lt; 40 Hounsfield units identifies hepatic steatosis). We selected risk factors that are routinely available in clinical practice. We used random forest-derived variable importance to select 9 final predictors among 18 candidates. These were used to develop a logistic regression-based score predicting occurrence of NAFLD in a random 2/3 derivation subset of the sample. Calibration and discrimination performance was assessed in the remaining 1/3 validation sample using goodness of fit measures, area under the receiver operating characteristic curve (AUC) and Brier scores. Results: NAFLD prevalence was 6.2% in the overall sample (n=6,194). The table shows the 9 predictors with beta coefficients, OR (95% CI) and points. Using the point-based system, the derivation set achieved an AUC of 0.84 (95% CI, 0.84 to 0.86), and the validation set an AUC of 0.81 (0.78 to 0.85). The Hosmer-Lemeshow goodness-of-fit test had a p=0.15, and the Brier score was 0.06 for the validation set, indicating that our validation model was well calibrated with acceptable prediction performance. At &gt; 27 points, sensitivity was 83%, specificity 66% and Youden’s index was 0.49. Conclusions: Our NAFLD point system is a simple but highly predictive score system that can allow clinicians to identify individuals at high risk of NAFLD. Future studies should evaluate prediction performance in an external dataset.

A Prospective study of BISAP score in Acute Pancreatitis.

Background: Acute pancreatitis is defined as an inflammatory process of the pancreas with possible peri pancreatic tissue and multi-organ involvement inducing Multi-Organ Dysfunction Syndrome (MODS) with an increased mortality rate.The underlying mechanism of injury in pancreatitis is thought to be premature activation of pancreatic enzymes within the pancreas, leading to a process of auto digestion. Due to the risk of rapid deterioration in severe acute pancreatitis, the assessment of severity becomes crucial to a clinician. Multiple risk stratification tools for acute pancreatitis have been developed, but their clinical usefulness is limited. In Ranson's criteria and modified Glasgow score there are multiple parameters, of which some of them are not available in majority of hospitals in India. In addition, both are assessed after 48hrs, thereby missing potentially valuable early therapeutic window. The APACHE II score (Acute Physiology and Chronic Health Evaluation) is the most widely used prediction system currently, but it requires the collection of large number of parameters some of which may not be relevant to prognosis. APACHE II was originally developed as an intensive care instrument. For this purpose, a simple and accurate clinical scoring system that is, Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system was developed. This scoring system is used for stratifying patients according to their risk of mortality and is able to identify patientsat increased risk of mortality prior to the onset of organ failure. More over the data for BISAP score is collected within the first 24hrs of hospitalization. The ability tostratify patients early in their course is a major step in improving future management strategies in acute pancreatitis. Methods: A prospective study was done in cases of acute pancreatitis with the effectiveness of Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system is used for stratifying patients according to their risk of mortality and is able to identify patients at increased risk of mortality prior to the onset of organ failure Results: A total of 50 cases were taken and the Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system was calculated in assessing mortality and intermediate markers of severity in acute pancreatitis in 24 hours of presentation. It is observed that individuals with BISAP score ≥3 were 4.5 times more likely to develop organ failure and 6 times more likely to develop pancreatic necrosis, than those with BISAP score