ABSTRACT
Background: Patients with hypotension or shock usually have high mortality rates, and use of traditional physical examination techniques only may be misleading for rapid diagnosis and treating the same. RUSH (Rapid Ultrasound for Shock and Hypotension) protocol is used in patients with undifferentiated shock to improve accurate diagnosis of shock. Methods: A prospective observational study was done from April to June 2022 at emergency department in 100 patients who presented with hypotension. This included patients who had systolic blood pressure (SBP) of <90 mmHg, along with tachypnoea and tachycardia. Patients RUSH examination was performed. The patients were followed up to document their final diagnosis. Results: In our study, the mean age of patients with hypotension was 58.8±8.7 years with male preponderance of 53%. The hypovolemic shock (40%) was found to be the most common subtype of shock. 86% of patients were correctly diagnosed with RUSH study. The sensitivity, specificity, PPV and NPV of RUSH in shock patients was 36.69%, 25.7%, 26.5%, 87.25% respectively and disease prevalence 31.5% and accuracy 68.75%.Cohens Kappa index was 0.5 showed a moderate agreement of the RUSH protocol in diagnosis of causes of shock with the final diagnosis. Conclusion: This study advocates the use of RUSH protocol in patients presenting with undifferentiated hypotension in the emergency department. It narrows the possible differentials of shock and guides the emergency physician to an early initial therapy, thereby improving the final outcome of patient.
ABSTRACT
Objective: Several predictive scoring systems measuring disease severity are used to predict outcomes, typically mortality, of critically ill patients in the intensive care unit (ICU). Two common validated predictive scoring systems include acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment score (mSOFA). To compare performance of APACHE II and mSOFA score in critically ill patients regarding the outcomes in the form of morbidity and mortality in ICU. Methods: This prospective observational clinical study was conducted on 100 patients over 6 months. For each patient, APACHE II score on day of admission and serial mSOFA scores on day 0, 3, 7 and 10 were calculated and compared. Results: The age of the non-survivors was significantly older than survivors was (57.1±11.76 and 54.28±15.16). [In our study we found that the mean length of ICU stay of non-survivors was (5.41±4.81) & survivors(8.63± 4.81) days.] In our study mortality rate was 40%.The APACHE II score with cut-off point of 23 demonstrated a sensitivity rate of 98.33% & specificity rate of 17.5%, accuracy of 66.00%. Serial mSOFA scores with cut-off of 11 on day0, day3, day7 better differentiated survivors from non-survivors with 98.3% sensitivity, 27.5% specificity and 70% accuracy. Conclusion: Both APACHE II and mSOFA scores can help ICU physicians as a significant predictive marker for mortality in critically ill patients. The serial measurement of mSOFA score in the first week is a better mortality predictor tool than APACHE II score in critically ill patients.