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.
ABSTRACT
Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.