An objective method for early diagnosis of gram-negative septicemia in burned children.

The present investigation was undertaken to standardize the early diagnosis of Gram-negative septicemia in burned children. Data were collected by means of a matrix which encompassed eight clinical variables routinely monitored by nursing personnel. These variables were evaluated according to their severity using a numerical scale of 0 to 3. A sepsis score was thus calculated for each of 243 burned patients, three times a day throughout their entire hospitalization. Eighty patients with suspiciously high scores (controls) were subjected to a battery of ten laboratory tests aimed at confirming the presence or absence of septicemia. During the 26 months of the study 16 patients (22 episodes) had clinical and laboratory evidence of Gram-negative septicemia. Multiple regression and discriminant analysis techniques were then used to develop statistical models for early diagnosis of septicemia. The two most practical and reliable of these are reported herein. Model I and II would have predicted the diagnosis of sepsis, 83% and 86% of the time, respectively, 1 day before the diagnosis was made using conventional methods. The false positive rates of Models I and II were 7% and 3%, respectively. On the basis of this information it seems possible and rewarding to utilize decision-making charts for monitoring and diagnosis of septicemia.

A controlled study of the effects of single doses of hydrocortisone on the resolution of acute attacks of asthma.

To evaluate the effects of corticosteroids on the resolution of acute attacks of asthma, 38 young, acutely ill, asthmatic subjects were given a single intravenous injection of either 0.25, 0.50 or 1.0 g of hydrocortisone hemisuccinate or a placebo (sterile saline solution) in a random, double blind manner. Each was then treated with isoproterenol, at hourly intervals, for a minimum of six hours, and the serial changes in plethysmography, spirometry, lung volumes, subjective complaints and physical findings that occurred as the patients improved were observed. No statistical differences were found in any of the physiologic or clinical variables between those patients given any dose of steroids and their matched controls. From this it has been concluded that hydrocortisone, in the doses and route of administration employed, does not produce any immediate benefits in the treatment of acute asthma.

Variability of closing volume measurements in normal man.

Single breath oxygen measurements of closing volumes were performed in triplicate in 15 healthy nonsmoking young adults 3 times per day for 5 consecutive days. The purpose of the investigation was to determine the degree of variability in this test of lung function and, if possible, to specify its cause. The results demonstrated that sizable differences in the absolute volume for closing volume and for closing volume as a percentage of vital capacity can be present from trial to trial in any given person even though the technical aspects of the procedure are seemingly highly standardized. The reasons for this were found to be a combination of (1) the inherent variation in the expired volume that marked the onset of airway closure, (2) reader difficulties in detecting the onset of phase IV, and (3) variations in the expired vital capacity due to incomplete filling and/or emptying of the subject's lungs. The differences were not due to daily or diurnal rhythms or to a training effect.