Clinical validation demonstrates concordance of qSOFA and POC lactate Bayesian model: Results from the ACDC Phase-2 program.

Sepsis is a common and lethal medical problem. The objective of this study was to validate a Bayesian Model that integrates qSOFA and prehospital Lactate, with a comparison analysis from a real clinical data of patients with sepsis. METHODS: We conducted a two tired validation study with one arm focusing on Bayesian modeling and a second retrospective observational arm addressing real data validation. For Bayesian modeling, sensitivity and specificity of prehospital lactate were attained from pooled meta-analysis data. Later, for clinical validation, we used data from 2016 to 2017 of ED patients diagnosed with sepsis. Pretest probabilities from qSOFA score where combined with prehospital lactate and inserted into a Bayesian model to calculate posttest probabilities. Absolute and relative diagnostic gains were calculated. Statistical significance was assessed via t-test, chi square and odds ratio. P value was set to be 0.05. RESULTS: For the Bayesian arm; meta-analysis data for prehospital lactate resulted in a positive likelihood ratio (LR+) of 1.69 and negative likelihood ratio (LR-) of 0.44. Integration of lactate and qSOFA demonstrated significant post-test improvements. On the Clinical Validation arm, 1470 patients were included with 176 patients meeting analysis criteria. When comparing qSOFA + Abnormal Lactate vs qSOFA and normal Lactate, the ICU vs Non-ICU cohorts were statistically different (p < 0.01) Odds Ratio: 2.35 (95% CI [1.22-4.6]). CONCLUSION: Bayesian mathematical model demonstrated that a qSOFA-based clinical decision can be complemented by the use of point of-care lactate. These results were confirmed by our clinical validation arm.

Síndrome de médula espinal anclada en un cachorro bulldog inglés. Reporte de un caso / Síndrome de medula amarrada em um cão da raça bulldog inglês. Reporte do caso / Tethered spinal cord syndrome in an english bulldog puppy. A case report

El síndrome de médula espinal anclada es una patología del desarrollo diagnosticada en seres humanos pero de poco reporte en medicina de pequeñas especies animales. En este artículo se presenta un caso de disrafismo espinal, vértebra lumbar supernumeraria, espina bífida con meningocele, médula espinal anclada y seno dermoide en un cachorro de raza bulldog inglés de cuatro meses de edad, que presentó un cuadro clínico de incontinencia fecal, atrofia muscular en miembros pelvianos y ataxia. Se describe el procedimiento diagnóstico, el tratamiento y la evolución clínica del paciente. Con este reporte se pretende que el médico veterinario considere dentro de sus diagnósticos diferenciales la posibilidad de una afección de tipo neurológico cuando el paciente presente signos clínicos tipo incontinencias fecal y urinaria, ataxia y debilidad de miembros pelvianos, en perros de razas con predisposición a sufrir este tipo de síndrome; además, llamar la atención sobre este tipo de patologías que en la mayoría de los casos podrían ser subdiagnosticadas.

Tethered spinal cord syndrome is a developmental disease diagnosed in human but of rare report in small animal practice. In this report a case of spinal disrafism, spina bifida with menyngocele, tethered cord syndrome and dermoid sinus is described in a four months old English bulldog male, that presented a clinical condition of faecal incontinence, muscular atrophy in pelvic limbs and ataxia. The diagnostic procedure, treatment and evolution of the patient are described. The purpose of this report is to provide the practitioner with diagnostic tools to include a neurological entity as a differential diagnosis when attending a patient presenting clinical signs such as fecal and urinary incontinency, ataxia and pelvic limbs debility, in dogs of breeds predisposed to suffering this syndrome; in addition, to highlight this neurological pathologies that could be under diagnosed in most of the cases.

E síndrome de medula amarrada é uma doença diagnosticada em desenvolvimento humano, mas de rara incidência em prática dos pequenos animais. Neste relatório o caso clinica de disrafismos do tubo neural, espinha bífida com meningocele, e síndrome de seios dermoides são descrito em um cão da raça bulldog inglês de quatro meses de idade, que apresentou uma condição clínica de incontinência fecal, atrofia muscular nos membros pélvicos e ataxia. O procedimento diagnóstico, tratamento e evolução do paciente são descritos. O objetivo do presente articule consiste em fornecer o praticante com ferramentas diagnósticas para incluir uma entidade neurológica como um diagnóstico diferencial quando freqüenta um doente apresentar sinais clínicos tais como incontinência fecal e urinária, ataxia e debilidade de membros pélvicos, em cães de raças predispostas a este síndrome; além disso, para destacar estas patologias neurológicas que poderiam estar sob diagnosticada na maioria dos casos.