Development of a risk prediction score for acute kidney injury in critically-ill septic Filipino patients admitted in perpetual succour hospital

Introduction@#Acute kidney injury (AKI) is a lethal complication of critical illness characterized by the rapid loss of the kidney's excretory function encountered in 50% of intensive care unit (ICU) admissions. Its impact on the outcome of critically ill patients makes AKI a significant cause of morbidity and mortality.@*Objectives@#To develop and validate an acute kidney injury risk prediction score based on routinely available variables and common laboratories of admitted critically-ill septic Filipino patients.@*Methods@#This is a prospective cohort study conducted in a tertiary hospital in Cebu from February to September 2020. The data of 2545 patients were identified by chart review but only 607 patients with a quick Sepsis Organ Failure Assessment Score (qSOFA) score of >2 were included in the pre-screening. After stratified sampling, a total of 198 septic ICU patients were enrolled. Demographic profile, laboratory results and outcome data were collated. Variables were screened then stepwise forward elimination was done to identify the significant predictors. An AKI risk score model was developed with binomial regression analysis by identifying independent prognostic factors. The diagnostic ability of the model was determined by the Area under the Receiver Operating Characteristics (AuROC).@*Results@#AKI developed in 155 (78%) patients. The significant predictors for Acute Kidney Injury were age, hypertension, atherosclerotic cardiovascular disease, weight, white blood count, creatinine, and BUN. An AKI prediction model with a cut off score of 161.9 was made with a fair diagnostic ability for predicting AKI at 0.79 based on AuROC.@*Conclusion@#The developed risk prediction tool using routinely available variables is found to be fairly accurate to predict the development of AKI among critically ill septic patients.

Effect of modified Shengxian Decoction on extravascular lung water index and lung injury prediction score of patients with acute respiratory distress syndrome caused by sepsis / 国际中医中药杂志

Objective:To observe the effect of modified Shengxian Decoction on extravascular lung water index (EVLWI) and lung injury prediction score (LIPS) in patients with acute respiratory distress syndrome (ARDS) caused by sepsis.Methods:Prospective cohort study. A total of 200 patients with ARDS caused by sepsis who were hospitalized in Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2019 to May 2021 were selected and divided into the observation group and control group by random number table method, with 100 in each group. The patients in the control group were given rountin western medicine treatment according to the guidelines, and the patients in the observation group were treated with modified Shengxian Decoction on the basis of the treatment in the control group. Both groups were treated for 7 days as a course of treatment. The PH value, oxygen volume index (FiO 2), oxygen partial pressure (PaO 2), arterial carbon dioxide partial pressure (PaCO 2) of the two groups before and after treatment, calculate the oxygenation index (PaO 2/FiO 2) were observed and compared. The C-reactive protein (hs-CRP), interleukin-6 (IL-6) levels were observed by ELISA, the procalcitonin (PCT) levels was detected by double antibody sandwich immunoluminescence method. The APACHE Ⅱ score and LIPS score, EVLWI and cardiac index (CI) of the two groups were observed and compared. The mechanical ventilation time and ICU hospitalization time of the two groups were compared. Results:After treatment, the PaCO 2 level [(37.15 ± 5.42) mmHg vs. (38.24 ± 3.24) mmHg, t=2.03] of the observation group was significantly lower than that of the control group, and the oxygenation index (292.34 ± 78.91 vs. 236.54 ± 70.58, t=5.27) was significantly higher than that of the control group ( P<0.05). After treatment, the levels of hs-CRP [(35.21 ± 6.73) mg/L vs. (48.97 ± 8.52) mg/L, t=12.67], IL-6 [(40.57 ± 8.51) ng/L vs. (47.61 ± 9.97) ng/L, t=5.37] and PCT [(0.75 ± 0.21) μg/L vs. (1.14 ± 0.38) μg/L, t=8.98] in the observation group were significantly lower than those in the control group ( P<0.01). After treatment, the APACHE Ⅱscore (11.14 ± 0.54 vs. 14.67 ± 0.89, t=33.91], LIPS score (2.21 ± 0.73 vs. 4.59 ± 0.88, t=20.82), and EVLWI [(6.19 ± 0.42) ml/kg vs. (8.24 ± 0.78) ml/kg, t=23.14) of the observation group were significantly lower than those in the control group, and the CI level [(4.49 ± 1.27) L/(min?m 2) vs. (3.61 ± 0.88) L/(min?m 2), t=5.70] was significantly higher than that of the control group ( P<0.01). The mechanical ventilation time and ICU stay in the observation group were shorter than those in the control group ( t=3.66, 5.74, P<0.01). Conclusion:The modified Shengxian Decoction can reduce the level of inflammation indexes in patients with ARDS caused by sepsis, reduce EVLWI and LIPS scores, improve blood gas analysis indexes, and shorten the time of mechanical ventilation and ICU hospitalization.

Predictors and prediction scores of shunt-dependent hydrocephalus in patients with aneurismal subarachnoid hemorrhage / 国际脑血管病杂志

Shunt-dependent hydrocephalus (SDHC) is a common and serious complication of aneurismal subarachnoid hemorrhage (aSAH). The incidence of SDHC after aSAH was 9%-36%, and it is associated with the poor outcome of patients. This article reviews the predictors and prediction scores of SDHC after aSAH.

Establishment and verification of LIPS score combined with APACHE Ⅱ score and oxygenation index to predict the occurrence model of ARDS / 中华危重病急救医学

Objective:To construct and verify the occurrence model of acute respiratory distress syndrome (ARDS) using lung injury prediction score (LIPS) combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and oxygenation index (PaO 2/FiO 2). Methods:Using a prospective cohort study method, 244 patients with complete medical records who were admitted to the intensive care unit (ICU) of Peking University Third Hospital from December 2020 to July 2022 were selected as research objects according to the inclusion and exclusion criteria. They were divided into training set (173 cases) and validation set (71 cases). Patients' gender, age, body mass index (BMI), various causes (shock, sepsis, craniocerebral injury, pulmonary contusion, multiple trauma, aspiration, pneumonia, acute abdomen, hypoproteinemia, acidosis, major surgery, etc.), underlying diseases (diabetes, malignant tumor, cerebrovascular disease, liver disease, kidney disease) and laboratory test indicators were collected. According to the above data, the LIPS score, APACHE Ⅱ score, sequential organ failure assessment (SOFA) and PaO 2/FiO 2, etc within 24 hours after admission to the ICU were calculated. Univariate analysis was used to screen the influencing factors for the occurrence of ARDS, and the factors with P < 0.2 were included in the multivariate Logistic regression analysis to screen out the independent predictive factors for the occurrence of ARDS. According to the results of multivariate Logistic regression analysis, the risk score of patients with ARDS was obtained to construct the risk prediction model of ARDS, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. The established ARDS prediction model was externally validated, and ROC curves were drawn to evaluate the predictive accuracy of the prediction model for the occurrence of ARDS in critically ill patients, and the AUC of the validation set was calculated to analyze the predictive performance of each risk factor on the occurrence of ARDS. Results:A total of 173 patients were enrolled in the training set, including 121 patients without ARDS and 52 patients with ARDS; 77 cases of acute abdomen, 64 cases of sepsis, 60 cases of shock, 51 cases of acidosis, 40 cases of hypoproteinemia, 37 cases of diabetes, 34 cases of craniocerebral injury, 34 cases of abnormal liver function, 28 cases of multiple trauma, 23 cases of malignant tumor, 23 cases of spinal orthopedic surgery, 17 cases of obesity, 12 cases of pneumonia, 11 cases of pulmonary contusion, and 7 cases of chronic kidney disease, chemotherapy in 6 cases, and aspiration in 2 cases. The rates of shock, sepsis, acute abdomen, acidosis, abnormal liver function, lung contusion, pneumonia and aspiration, gender, age, LIPS score, APACHE Ⅱ score, and SOFA score in the ARDS group were significantly higher than those in the non-ARDS group (all P < 0.05), moreover, PaO 2/FiO 2 ratio was significantly lower than that of non-ARDS group ( P < 0.01). Multivariate Logistic regression analysis showed that LIPS score, APACHE Ⅱ score, and PaO 2/FiO 2 ratio were independent risk factors for ARDS in ICU patients with high risk factors for ARDS, and the odds ratio ( OR) was 1.768 [95% confidence interval (95% CI) was 1.380-2.266], 1.242 (95% CI was 1.089-1.417), 0.985 (95% CI was 0.978-0.991), all P < 0.05. ROC curve analysis showed that the AUC of the ARDS prediction model training set was 0.920, the sensitivity was 86.5%, and the specificity was 86.8%; the AUC of the verification set was 0.896, the sensitivity was 96.8%, and the specificity was 76.6%. Conclusion:LIPS score, APACHE Ⅱ score and PaO 2/FiO 2 are independent risk factors for the occurrence of ARDS in ICU patients with high risk factors for ARDS. The ARDS risk prediction model established based on these three indicators has a good predictive ability for the occurrence of ARDS in critically ill patients, wihich needs to be verified by multicenter cohort studies.

Regla de predicción para determinar infestación canina por Echinococcus granulosus / Prediction rule to determine canine infestation by Echinococcus granulosus

Nuestro objetivo fue determinar un score que ayude a predecir la probabilidad de infestación canina por Echinococcus en una zona endémica en hidatidosis. Se realizó un estudio longitudinal en 3 anexos de la provincia de Concepción ubicado en los andes centrales de Perú. La infección canina por Echinococcus granulosus fue definido por la presencia de antígeno identificado en la muestra de heces. El modelo predictivo se obtuvo mediante un análisis de regresión logística basado en los parámetros sociodemográficos, esta regla fue internamente validada por remuestreo de tipo bootstrap. Resultados: De 152 canes que se sometieron al estudio de heces, 76 tuvieron infección por Echinococcus confirmada por antígeno reactivo. Se identificaron 4 factores ponderados dentro de la regla de predicción que, en suma, dieron el puntaje: El can que duerme fuera de casa (3 puntos), alimentar con vísceras crudas al can (3 puntos) y sacrificar al ganado dentro de la casa (2 puntos) y el can se alimenta con croquetas (-2 puntos). Se encontró que esta regla de predicción tuvo valor del área bajo la curva ROC 0,78; (IC 95%: 0,70 ­ 0,86). Estos parámetros de predicción con un puntaje ≥ 3 tenía una sensibilidad del 75% y especificidad del 65,8%, con un valor predictivo positivo del 85,3%. Esta regla ayudará al personal de la salud a identificar a los canes infestados por Echinococcus granulosus, para su intervención anti parasitaria y preventiva en sus dueños(AU)

Cystic hydatidosis is an endemic disease in Andean regions, our objective was to determine a score that helps to predict canine Echinococcus infestation in an endemic area with hydatidosis. A longitudinal study was carried out in 3 annexes of the province of Concepción located in the central Andes of Peru. Canine echinococcosis infection was defined by the presence of E. granulosus antigen identified in the stool sample. The predictive model was obtained through a logistic regression analysis based on the sociodemographic parameters, this rule was internally validated by bootstrap type resampling. Results: Of 152 dogs that underwent the stool study, 76 had an Echinococcus infection confirmed by reactive antigen. Four weighted factors were identified within the prediction rule that, in sum, gave the score: The dog that sleeps outside the home (3 points), feeding raw viscera to the dog (3 points), slaughtering the cattle inside the house (2 points) and the dog is fed with croquettes (-2 points). This prediction rule was found to have a value of the area under the ROC curve 0.78 (95% CI: 0.70 - 0.86). At a cutoff point of ≥ 3 points, the prediction rule was found to have a sensitivity of 75% and a specificity of 65.8%, with a positive predictive value of 85.3%. This rule will help health personnel to identify canes infested by Echinococcus granulosus, for their anti-parasitic and preventive intervention in their owners(AU)

Clinical Prediction Score for Community-Onset Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella Species

BACKGROUND: This study aimed to identify the predictors and build a prediction score for community-onset bloodstream infections (CO-BSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species. METHODS: All CO-BSIs caused by E. coli and Klebsiella species from 2012 to 2015 were grouped into derivation (BSIs from 2012 to 2014) and validation (BSIs in 2015) cohorts. A prediction score was built using the coefficients of the multivariate logistic regression model from the derivation cohort. RESULTS: The study included 886 CO-BSIs (594 and 292 in the derivation and validation cohorts, respectively). The independent predictors of CO-BSIs caused by ESBL-producing E. coli and Klebsiella species included: 1) identification of ESBL-producing microorganisms from any clinical culture within one year of admission, 2) beta-lactam or fluoroquinolone treatment within 30 days (with 2 or more courses within 90 days; with 1 course within 90 days), 3) hospitalization within one year, 4) the presence of an indwelling urinary catheter at the time of admission. The area under the curve (AUC) of the clinical prediction score was 0.72 (95% confidence interval [CI], 0.68–0.77). In the validation cohort, the AUC was 0.70 (95% CI, 0.63–0.77). CONCLUSIONS: The results of this study suggest a simple and easy-to-use scoring system to predict CO-BSIs caused by ESBL-producing E. coli and Klebsiella species.

Validate Padua prediction score′s ability to predict the risk of venous thromboembolism in medical inpatients / 中国实用护理杂志

Objective To explore the Padua risk assessment model for the application of the prevention of VTE in medical inpatients. Methods A cross-sectional surgery research method was used. A total of 3 990 patients were interviewed of a hospital between June and August in 2017. The Padua assessment model was used to screen patients for VTE risk assessment. Results 3990 patients were interviewed, in which,a high VTE risk was found in 757 cases, accounting for 18.97%. The number and ratio of patients with high risk of VTE in Respiration department (158/32.18%), Endocrinology department (48/7.00%), Neurology department (91/20.31%), Nephrology department (102/18.58%), Gastroenterology epartment (41/8.63% ), Cardiology department (139/29.45% ), Hematology department (69/ 17.12% ) and Medical oncology department (109/23.40% ). Patients with high risk VTE in 11 risk factors were (246/32.5% ), (58/7.66% ), (531/70.15% ), (4/0.53% ), (92/12.15% ), (493/64.99% ), (74/9.78% ), (89/11.76% ), (131/17.31% ), (25/3.30% ), (72/9.51% ), two groups compare between age≥70 and <70 was statistically significant (χ2=952.20, P=0.00), two group compare between mobility and reduced mobility was statistically significant (χ2=1832.28, P=0.00). Conclusions Medical inpatients have a high risk of VTE, it is suggested that include VTE in clinical quality evaluation standard, establish an effective system of VTE risk management. The Padua risk assessment model has been easy to use. Some medical department should be special attention, and has been great significance to early screening and prevention.

Analysis of risk factors of postpartum hemorrhage and application value of predictive score of postpartum hemorrhage / 天津医药

Objective To explore the risk factors of postpartum hemorrhage and the application value of predicting score of postpartum hemorrhage. Methods A total of 126 cases of postpartum hemorrhage hospitalized in our hospital from January 2013 to December 2016 were included in observation group, and 674 puerperae without postpartum hemorrhage were used as the control group. Data of the gestational age, delivery time, delivery mode and fetal weight were investigated, and the predictive scores of postpartum hemorrhage were compared between the two groups. Logistic regression analysis was carried out on influencing factors of postpartum hemorrhage. The value of postpartum hemorrhage prediction score in diagnosing postpartum hemorrhage was evaluated by ROC curve. Results The proportions of patients ≥35 years old, BMI≥24 kg/m2, the number of abortion≥2 times, production time≥2 times, cesarean section, fetal weight≥4000 g and pregnancy rates were 44.44%, 47.62%, 40.48%, 44.44%, 64.29%, 43.65%and 66.67%in observation group, which were significantly higher than those of control group (P<0.05). The predictive score of postpartum hemorrhage was higher in observation group than that in control group[(6.83 ± 1.25) points vs. (2.01 ± 0.98) points, t=48.356, P<0.01]. Logistic regression analysis showed that the fetal weight ≥ 4000 g, cesarean section, patients with pregnancy complications and abortion≥2 times were risk factors of postpartum hemorrhage (OR=4.195, 7.553, 5.596 and 7.192, P<0.05). Prediction of postpartum hemorrhage ROC curve AUC was 0.657 evaluated by postpartum prediction scale, and when the total score ≥4 points, the sensitivity of predicting postpartum hemorrhage was 81.25%, specificity was 65.55%. Conclusion Postpartum hemorrhage is related to fetal birth weight, cesarean section, pregnancy complications and the number of abortions. The predictive score of postpartum hemorrhage is expected to be an effective tool for predicting postpartum hemorrhage in clinical practice.

Analysis of risk factors of postpartum hemorrhage and application value of predictive score of postpartum hemorrhage / 天津医药

Objective To explore the risk factors of postpartum hemorrhage and the application value of predicting score of postpartum hemorrhage. Methods A total of 126 cases of postpartum hemorrhage hospitalized in our hospital from January 2013 to December 2016 were included in observation group, and 674 puerperae without postpartum hemorrhage were used as the control group. Data of the gestational age, delivery time, delivery mode and fetal weight were investigated, and the predictive scores of postpartum hemorrhage were compared between the two groups. Logistic regression analysis was carried out on influencing factors of postpartum hemorrhage. The value of postpartum hemorrhage prediction score in diagnosing postpartum hemorrhage was evaluated by ROC curve. Results The proportions of patients ≥35 years old, BMI≥24 kg/m2, the number of abortion≥2 times, production time≥2 times, cesarean section, fetal weight≥4000 g and pregnancy rates were 44.44%, 47.62%, 40.48%, 44.44%, 64.29%, 43.65%and 66.67%in observation group, which were significantly higher than those of control group (P<0.05). The predictive score of postpartum hemorrhage was higher in observation group than that in control group[(6.83 ± 1.25) points vs. (2.01 ± 0.98) points, t=48.356, P<0.01]. Logistic regression analysis showed that the fetal weight ≥ 4000 g, cesarean section, patients with pregnancy complications and abortion≥2 times were risk factors of postpartum hemorrhage (OR=4.195, 7.553, 5.596 and 7.192, P<0.05). Prediction of postpartum hemorrhage ROC curve AUC was 0.657 evaluated by postpartum prediction scale, and when the total score ≥4 points, the sensitivity of predicting postpartum hemorrhage was 81.25%, specificity was 65.55%. Conclusion Postpartum hemorrhage is related to fetal birth weight, cesarean section, pregnancy complications and the number of abortions. The predictive score of postpartum hemorrhage is expected to be an effective tool for predicting postpartum hemorrhage in clinical practice.

Analysis of risk factors for acute kidney injury in patients with non-ST-segment elevation myocardial infarction / 中华急诊医学杂志

Objective To investigate the risk factors for acute kidney injury (AKI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI),and to establish a prediction score system for AKI.Methods Totally 296 patients with NSTEMI,who were admitted to the emergency room and further transferred to the Cardiovascular Department in Shantou Central Hospital,were enrolled during January 2011 to April 2014.All patients were divided into AKI group and non-AKI group.Demographics,clinical data and laboratory examinations were collected before and after AKI.AKI risk factors and its OR values were determined after statistically analyzed data by One-Way ANOVA,multivariate logistic regression analysis.Prediction score system for AKI was further established by area under the ROC curve and Hosmer-Lemeshow goodness of fit tests.Results For total 296 patients,the incidence of AKI was 18.4％,including 35 (64.8％) patients in stage Ⅰ,12 (22.2％) patients in stage Ⅱ and 7 (13.0％) patients in stage Ⅲ.Logistic analysis showed that age,heart function (Killip),anemia,the time to emergency department after AMI attack,and absence β-blocker were independent factors associated with AKI.Prediction score system was established which the highest score was 13.A risk score of 3.5 points was determined by Youden' s index,as the optimal cut-off for predict AKI.Patients with ≤3.0 points were considered at low risk,and ≥4.0 points were considered at high risk for AKI.The prediction score system of AKI showed adequate discrimination (area under ROC curve was 0.806) and calibration (Hosmer-Lemeshow statistic test,P =O.503).Conclusions Age,heart function (Killip),anemia,the time to emergency department after AMI attack,and absence β-blocker were independent factors associated with AKI.The clinical prediction score system may help clinicians to make pre-intervention for NSTEMI patients with high AKI risk.

The Performance of a Modified Glasgow Blatchford Score in Predicting Clinical Interventions in Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding: A Vietnamese Prospective Multicenter Cohort Study

BACKGROUND/AIMS: To compare the performance of a modified Glasgow Blatchford score (mGBS) to the Glasgow Blatchford score (GBS) and the pre-endoscopic Rockall score (RS) in predicting clinical interventions in Vietnamese patients with acute nonvariceal upper gastrointestinal bleeding (AN-VUGIB). METHODS: A prospective multicenter cohort study was conducted in five tertiary hospitals from May 2013 to February 2014. The mGBS, GBS, and pre-endoscopic RS scores were prospectively calculated for all patients. The accuracy of mGBS was compared with that of GBS and pre-endoscopic RS using area under the receiver operating characteristic curve (AUC). Clinical interventions were defined as blood transfusions, endoscopic or radiological intervention, or surgery. RESULTS: There were 395 patients including 128 (32.4%) needing endoscopic treatment, 117 (29.6%) requiring blood transfusion and two (0.5%) needing surgery. In predicting the need for clinical intervention, the mGBS (AUC, 0.707) performed as well as the GBS (AUC, 0.708; p=0.87) and outperformed the pre-endoscopic RS (AUC, 0.594; p<0.001). However, none of these scores effectively excluded the need for endoscopic intervention at a threshold of 0. CONCLUSIONS: mGBS performed as well as GBS and better than pre-endoscopic RS for predicting clinical interventions in Vietnamese patients with ANVUGIB.

Readmission to Medical Intensive Care Units: Risk Factors and Prediction

PURPOSE: The objectives of this study were to find factors related to medical intensive care unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. MATERIALS AND METHODS: We performed a retrospective cohort study of 343 consecutive patients who were admitted to the medical ICU of a single medical center from January 1, 2008 to December 31, 2012. We analyzed a broad range of patients' characteristics on the day of admission, extubation, and discharge from the ICU. RESULTS: Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29-8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29-7.09), application of continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85-9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07-1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01-1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66-0.86). CONCLUSION: By using specific risk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.

Contrast Induced Nephropathy Risk Prediction Assessment: Usefulness among Africans Undergoing Intravenous Contrast Procedures.

Aims: To validate the CIN predictive risk score developed by Mehran et al in the study population. Study Design: This is a hospital-based prospective observational study. Place and Duration of Study: Department of Medicine and Department of Radiology, University of Benin Teaching Hospital, Edo State, Nigeria. September 2009 to March 2010. Methodology: One hundred and forty-two (142) out of 180 patients undergoing intravenous contrast procedures completed the study. They were recruited consecutively over a 6-month period. Data on their sociodemographic characteristics and health status were collated. A modified version of Mehran’s CIN risk prediction chart was included in the questionnaire. Venous blood and urine were collected for serum creatinine and biochemical estimations before contrast exposure and up to 72 hours post-exposure. Results: The frequency of CIN was 35.9%. Majority of the patients studied had low risk scores. Although CIN (+) patients had higher total risk scores when compared to CIN (-) patients, it did not reach statistical significance (P=.600). Baseline renal insufficiency, anaemia and age >55 years were significant risk factors for CIN and predictive of CIN in univariate but not multivariate analysis. Conclusion: The CIN predictive score by Mehran et al. did not sufficiently identify patients at risk for CIN in the population studied.

Diagnostic Scores for Appendicitis: A Systematic Review of Scores’ Performance.

Aims: Several scoring systems have been developed for diagnosis of appendicitis. This study aims to systematically explore how those scores were derived and validated, and to compare their performance. Study Design: Systematic review. Place and Duration of Study: We searched Medline from 1949 and EMBASE from 1974 to March 2012 to identify relevant articles published in English. Methodology: Information about model development and performance was extracted. The “risk of bias” assessment tool was developed based on a critical appraisal guide for clinical prediction rules. Calibration (O/E ratio) and discrimination (C-statistic) coefficients were estimated. A meta-analysis was applied to pool calibration coefficients and Cstatistics. Results: Forty-four out of 468 studies were eligible. Of these, 14 developed or modified diagnostic scoring systems and 30 validated existing models. Four scores had been most frequently validated, i.e., Alvarado, modified Alvarado, Fenyo, and Eskelinen. Among them, only the Eskelinen model was derived based on a multivariate regression whereas the rest used univariate or non-statistical methodology. All studies reported very good but imprecise calibration. For discrimination, the pooled C-statistics for these corresponding scores were 0.77, 0.86, 0.81, and 0.84 respectively. In the external validation, the discriminative performance decreased about 25.3% and 10.1% for the Alvarado and Fenyo scores respectively. Conclusion: The research methods for scoring systems of appendicitis were inconsistent. More efficient scoring systems which have been internally and externally validated are required.

Evaluation of the effect of crisis prediction score nursing in reducing complication and nursing deficiencies in patients with myasthenia gravis complicated with thymoma / 中国实用护理杂志

Objective To evaluate the effect of crisis prediction score nursing in reducing complication and nursing deficiencies in patients with myasthenia gravis complicated with thymoma.Methods 46 patients were randomly divided into the study group and the control group,the study group was given with crisis prediction score nursing,the control group was given with individual nursing.The postoperative complications incidence,hospitalization time,nursing defect rate,patient satisfaction were compared between two groups,and Osserman efficacy evaluation was implemented.Results Compared with the control group,postoperative complications (hemorrhage,pneumothorax,respiratory tract infections and myasthenia gravis crisis)rates and nursing defect rate in the study group were lower,hospitalization time shortened,and patients' satisfaction degree increased.Conclusions The crisis prediction score care can significantly reduce postoperative complications and nursing defect rate,which is important for patients' health.

The diagnostic values of Wells score and modified Geneva score for pretesting acute pulmonary embolism: a prospective study / 中华内科杂志

Objective To assess the diagnostic predictive value of Wells score and modified Geneva score for acute pulmonary embolism by prospective case series and to explore a more suitable scoring system for Chinese population.Methods All the patients suspected of pulmonary embolism (PE) and received CT pulmonary angiography (CTPA) were enrolled consecutively in Fuxing Hospital,Capital Medical University,China,from June 2009 to August 2011.Before CTPA test or on condition that test results were unknown,clinical scoring was assessed prospectively by the Wells score and the modified Geneva score.The probability of PE in each patient was assessed and the patients were divided into low,moderate and high probability groups according to the clinical scores.The result of CTPA was used as the diagnostic gold standard for PE.Diagnostic accuracy in each group was analyzed.The predictive accuracy of both scores was compared by AUCROC curve.Results A total of 139 patients met our enrollment criteria and 117 eligible patients entered our study at last.PE was diagnosed in 47 patients by CTPA with an overall prevalence of 40.2％.Prevalence of PE in the low,moderate and high pretest probability groups assessed by the Wells score and by the simplified modified Geneva score were 7.1％ (3/42),42.9％ (21/49),88.5％ (23/26)and 10.0％ (3/30),48.1％ (37/77),7/10,respectively.AUCROC curves for the Wells score and the simplified modified Geneva score were 0.872 ( 95％ CI 0.810-0.933 ) and 0.734 ( 95％ CI 0.643-0.825 )respectively,with a significant difference ( P =0.005 ).Conclusion The Wells score is more accurate for clinical predicting acute PE than the modified Geneva score.

Prediction value of the early prediction score system of multiple organ dysfunction syndrome in the elderly / 中华急诊医学杂志

Objective To evaluate the prediction value of the early prediction score system of multiple organ dysfunction syndrome in the elderly (MODSE). Method A total of 393 patients with pulmonary infection, who were above60 years old, were divided into non MODSE(n =224) and MODSE group(n = 169) and were scored by the early prediction score system of MODSE. Independent-samples t Test was used to analyze the difference of forecast score between MODSE and non MODSE group. Receiver operating characteristic (ROC) curve was drawn,and the area under the curve was calculated. The prediction accuracy of scores for MODSE was assessed using sen-sitivity and specificity, and the optimal forecast point for MODSE was found. Results The score of MODSE group was higber than that of non MODSE[(19.38±12.049) vs. (45.78±20.257), P <0.001]. The area under the ROC curve was 0.889 (P <0.001) ond 95% (0.857～0.920). As the value of forecast score was 27.5, the sensitivity of the early prediction score system of MODSE was 82.8 %, the specificity of the early prediction score system of MODSE was 80.3 %. Conclusions The early prediction score system of MODSE is valuable in predic-tion of MODSE, which may be used to forecast MODSE and find the high risk population of MODSE.