Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Epidemiologia e distribuição de lesões extrarrenais de uremia em 161 cães / Epidemiology and distribution of extrarenal lesions of uremia in 161 dogs

Com o objetivo de determinar a epidemiologia e as características morfológicas, incluindo a localização anatômica, das lesões extrarrenais de uremia, bem como determinar as principais lesões do sistema urinário associadas à ocorrência de uremia, foram revisados os protocolos de necropsias de cães realizadas no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria de janeiro de 1996 a dezembro de 2012 (17 anos). Nesse período foram necropsiados 4.201 cães, sendo que 161 (3,8%) apresentaram lesões extrarrenais de uremia. Em 134 cães (83,2%) foram descritos sinais clínicos associados à uremia. As lesões extrarrenais mais frequentes, em ordem decrescente, foram: gastrite ulcerativa e hemorrágica (56,5%), mineralização de tecidos moles (55,9%), edema pulmonar (47,2%), estomatite e/ou glossite ulcerativa (30,4%), endocardite/trombose atrial e aórtica (28,6%), hiperplasia das paratireoides (9,3%), osteodistrofia fibrosa (8,1%), anemia (6,2%), laringite ulcerativa (5%), enterite ulcerativa/hemorrágica (3,7%), esofagite fibrinonecrótica (1,9%) e pericardite fibrinosa (1.9%). Na maioria dos casos as lesões extrarrenais de uremia foram decorrentes de azotemia prolongada por lesões renais graves, sendo as mais prevalentes a nefrite intersticial e a glomerulonefrite.

The aim of this study was to determine the epidemiology and the morphological characteristics (including the anatomic localization) of the extrarenal uremic lesions, as well as to describe the main lesions of the urinary system associated with the occurrence of uremia, through analysis of the protocols of necropsies performed in dogs from January 1996 to December 2012 (17 years) at the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria. A total of 4,201 dogs were necropsied and 161 (3.8%) had extrarenal uremic lesions. In 134 dogs (83.2%) clinical signs associated with uremia were reported. The extrarenal lesions more often observed, in descending order of prevalence, were ulcerative and hemorrhagic gastritis (56.5%), soft-tissue mineralization (55.9%), pulmonary edema (47.2%), ulcerative stomatitis and/or glossitis (30.4%), endocarditis/atrial and aortic thrombosis (28.6%), parathyroid hyperplasia (9.3%), fibrous osteodystrophy (8.1%), anemia (6.2%), ulcerative laryngitis (5%), ulcerative and hemorrhagic enteritis (3.7%), fibrinonecrotic esophagitis (1.9%), and fibrinous pericarditis (1.9%). In most of the cases, the extrarenal lesions of uremia were due to prolonged azotemia secondary to severe renal lesions, such as interstitial nephritis and glomerulonephritis (the most prevalent ones).

Influencia de la diálisis peritoneal aguda en la evolución clínica y laboratorial de pacientes urémicos, Hospital Regional Honorio Delgado, oct. 93 a set. 95

La insuficiencia renal crónica terminal es un cuadro grave, que denota una función renal muy deteriorada o ausente, que es irreversible y conlleva a la muerte si no se trata oportuna y adecuadamente. En el HRHD se está realizando diálisis peritoneal aguda como forma de tratamiento a estos pacientes, desconociéndose los resultados. Siendo el motivo de nuestro estudio precisamente determinar la influencia de la DPA en la evolución clínica y laboratorial de los pacientes urémicos crónicos. Para lograr esto se desarrolló un trabajo multivariado, retrospectivo, transversal y analítico. Encontrándose una frecuencia de 0.66 por ciento de pacientes, con predominio de mujeres(varones/mujeres=0.78) y con una edad promedio de 57,88 años DS=17.30. La etiología no pudo definirse en el 24.39 por ciento, siendo las causas más frecuentes la nefropatía diabética y la uropatía obstructiva. Las principales manifestaciones urémicas: anemia crónica, acidosis metabólica, hiperkalemia, encefalopatía urémica, hipertensión, hiperfosfatemía e insufeciencia cardíaca congestiva. Se realizaron 14 procedimientos de diálisis, con un tiempo medio de 103 hrs(DS=ñ55.3) por paciente, acumulándose 1442 hrs de experiencia. Realizándose 43.5 recambios(DS=ñ34.7), utilizándose 2000 ml por recambio; en todos los casos se utilizó catéter rígido, para DPA y el acceso fue infraumbilical. Se obtuvo una ultrafiltración promedio de 96.6 ml por recambio(DS=ñ64). Se logró una disminución significativa p=0.001 de los valores de urea, creatinina, potasio, pH, bicarbonato y CO2T; PCO2, P=0.001; así como una mejoría clínica significativa. Las principales complicaciones de diálisis peritoneal fueron dolor abdominal(64.29 por ciento), dificultad en la salida de líquido(42.86 por ciento), hipokalemia(35.71 por ciento) y alcalosis respiratoria(28.57 por ciento). Ningún paciente falleció durante el procedimiento, sólo en dos pacientes la diálisis no fue efectiva, falleciendo 1 y 7 días de terminada esta. La causa más frecuente de muerte fue el edema agudo de pulmón. En conclusión podemos decir que la diálisis peritoneal aguda influyó favorablemente en la evolución de los pacientes urémicos con una efectividad inmediata del 85.7 por ciento