scholarly journals P121: Derivation of a clinical decision tool for predicting adverse outcomes among emergency department patients with lower gastrointestinal bleeding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S99-S100
Author(s):  
R. Ramaekers ◽  
C. Leafloor ◽  
J. J. Perry ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Clinical Decision ◽  
Lower Gastrointestinal Bleeding ◽  
Bloody Stool ◽  
Decision Tool ◽  
Serious Adverse Events

Introduction: Lower gastrointestinal bleeding (LGIB) can result in serious adverse events, including recurrent bleeding, need for intervention and death. Endoscopy is important in the management of LGIB, however gastroenterologists have limited resources to safe endoscopy. Risk stratification of LGIB patients can aid physicians in disposition decisions. Objective: to develop a clinical decision tool to accurately identify LGIB patients presenting to the emergency department (ED) who are at risk for 30-day serious adverse events. Methods: We conducted a health records review and included 372 adult ED patients who presented with an acute LGIB. The outcome was a 30-day composite outcome consisting of all-cause death, recurrent LGIB, need for intervention to control the bleed and ICU admission. A second researcher confirmed data-collection of 10% of the data and we calculated a -value for inter-rater reliability. We analyzed the data using stepwise backwards selection and SELECTION=SCORE option and calculated the diagnostic accuracy of the final model. Results: Age 75 years, hemoglobin 100 g/L, INR 2.0, a bloody stool in the ED and a past medical history of colorectal polyps were significant predictors in the multivariable regression analysis. The AUC was 0.83 (95% CI 0.77-0.89), sensitivity 0.96 (0.90-1.00), specificity 0.53 (0.48-0.59), and negative likelihood ratio 0.08 (0.02-0.30) for a cut-off score of 1. Conclusion: This model showed good ability to identify LGIB patients at low risk for adverse events as evidenced by the high AUC, sensitivity and negative likelihood ratio. Future, large prospective studies should be done to confirm the data, after which it should be validated and implemented.

scholarly journals Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

CJEM ◽  
2014 ◽  
Vol 16 (02) ◽  
pp. 120-130 ◽  
Author(s):  
Venkatesh Thiruganasambandamoorthy ◽  
George A. Wells ◽  
Erik P. Hess ◽  
Ekaterina Turko ◽  
Jeffrey J. Perry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Risk Score ◽  
Vital Signs ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Altered Mental Status ◽  
Severe Trauma ◽  
Serious Adverse Events ◽  
Risk Scale

ABSTRACTBackground:Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days.Methods:We conducted a medical record review to include syncope patients age ≥ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/ monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed.Results:Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age ≥ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure < 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen > 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0–10) was found to accurately stratify patients into low risk (score < 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score > 1, ≥ 10% SAE risk).Conclusion:We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this will be a potentially useful clinical decision tool for emergency physicians, may allow judicious use of health care resources, and may improve patient care and safety.

scholarly journals LO31: Identification of high risk factors associated with 30 day serious adverse events among syncope patients transported to the emergency department by emergency medical services

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S38
Author(s):  
L. Yau ◽  
M.A. Mukarram ◽  
S. Kim ◽  
K. Arcot ◽  
K. Thavorn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Heart Disease ◽  
High Risk ◽  
Clinical Decision ◽  
Decision Tool ◽  
Serious Adverse Events ◽  
Factors Associated ◽  
High Risk Factors ◽  
Pathways Of Care

Introduction: The majority of syncope patients transported to the emergency department (ED) by emergency medical services (EMS) are low-risk with very few suffering serious adverse events (SAE) within 30-days and over 50% are diagnosed with vasovagal syncope. These patients can potentially be diverted by EMS to alternate pathways of care (primary care or syncope clinic) if appropriately identified. We sought to identify high-risk factors associated with SAE within 30-days of ED disposition as a step towards developing an EMS clinical decision tool. Methods: We prospectively enrolled adult syncope patients who were transported to 5 academic EDs by EMS. We collected standardized variables at EMS presentation from history, clinical examination and investigations including ECG and ED disposition. We also collected concerning symptoms identified and EMS interventions. Adjudicated SAE included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, hemorrhage and procedural interventions. Multivariable logistic regression was used for analysis. Results: 990 adult syncope patients (mean age 58.9 years, 54.9% females and 16.8% hospitalized) were enrolled with 137 (14.6%) patients suffering SAE within 30-days of ED disposition. Of 42 candidate predictors, we identified 5 predictors that were significantly associated with SAE on multivariable analysis: ECG abnormalities [OR=1.77; 95%CI 1.36-2.48] (non-sinus rhythm, high degree atrioventricular block, left bundle branch block, ST-T wave changes or Q waves), cardiac history [OR=2.87; 95%CI 1.86-4.41] (valvular or coronary heart disease, cardiomyopathy, congestive heart failure, arrhythmias or device insertions), EMS interventions or concerning symptoms [OR=4.88; 95%CI 3.13- 7.62], age >50 years [OR=3.18; 95%CI 1.68-6.02], any abnormal vital signs [OR=1.58; 95%CI 1.03-2.42] (any EMS systolic blood pressure >180 or <100 mmHg, heart rate <50 or >100/minute, respiratory rate >25/minute, oxygen saturation <91%). [C-statistic: 0.81; Hosmer Lemeshow p=0.30]. Conclusion: We identified high-risk factors that are associated with 30-day SAE among syncope patients transported to the ED by EMS. This will aid in the development of a clinical decision tool to identify low-risk patients for diversion to alternate pathways of care.

Does ProCore fine needle biopsy really improve the clinical outcome of endoscopic ultrasound-guided sampling of pancreatic masses?

2021 ◽  
Author(s):  
Gabriele Delconte ◽  
Federica Cavalcoli ◽  
Andrea Magarotto ◽  
Giovanni Centonze ◽  
Cristina Bezzio ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Clinical Performance ◽  
Negative Likelihood Ratio ◽  
Fine Needle Biopsy ◽  
Fine Needle ◽  
Sensitivity Specificity

Introduction: Fine Needle Biopsy (FNB) has been suggested to provide better histological samples as compared to endoscopic ultrasound fine needle aspiration (EUS-FNA). However, studies comparing EUS-FNA and EUS-FNB for pancreatic lesions reported contrasting results. The aim of this study was to compare the clinical performance of EUS-FNA versus EUS-FNB with ProCore needle for the investigation of pancreatic lesions. Methods: We reviewed all patients undergoing EUS for the investigation of pancreatic lesions from August 2012 to September 2018. From August 2012 to January 2015 all procedures were performed with standard needles, whereas from February 2015 to September 2018 the use of ProCore needles had been introduced. Data on diagnostic accuracy, number of needle passes and/or adverse events were collected. Results: 324 patients were retrospectively evaluated: 190 (58.6%) underwent EUS-FNA and 134 (41.4%) EUS-FNB. Both EUS-FNA and EUS-FNB showed high diagnostic accuracy for malignancy [94% (CI 95%:89-97%) vs 94% (CI 95%:89-98%)]. Notable, there were no differences between EUS-FNA and EUS-FNB in terms of sensitivity, specificity, positive and negative likelihood ratio, histological core tissue retrieval, adverse events or number of needle passes. However, subgroup analysis noted a higher diagnostic accuracy for 25G EUS-FNB as compared to 25G EUS-FNA (85,7% vs 55,5%; *p=0.023). Conclusion: EUS-FNB with ProCore needle is safe and feasible in pancreatic lesions. ProCore needle did not provide any advantage in terms of diagnostic accuracy, sensitivity, specificity, positive and/or negative likelihood ratio, or acquisition of core specimen, therefore its routine application is not

scholarly journals Adverse Events during Bowel Preparation and Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding Compared with Elective Non-Gastrointestinal Bleeding

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0138000 ◽  
Author(s):  
Ryota Niikura ◽  
Naoyoshi Nagata ◽  
Takuro Shimbo ◽  
Toshiyuki Sakurai ◽  
Tomonori Aoki ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Bowel Preparation ◽  
Lower Gastrointestinal Bleeding

Acceptability of a mobile clinical decision tool amongst Emergency Department clinicians: development and evaluation of The Ottawa Rules App

2018 ◽  
Author(s):  
Michelle Paradis ◽  
Ian Stiell ◽  
Katherine M Atkinson ◽  
Julien Guerinet ◽  
Yulric Sequeira ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Decision ◽  
Decision Tool ◽  
Ottawa Rules

scholarly journals Hemostatic Efficacy and Safety of the Hemostatic Powder UI-EWD in Patients with Lower Gastrointestinal Bleeding

2021 ◽  
Author(s):  
Boram Cha ◽  
Dong Hyun Lee ◽  
Jongbeom Shin ◽  
Jin-Seok Park ◽  
Kye Sook Kwon ◽  
...  
Keyword(s):  
Treatment Group ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
South Korea ◽  
Conventional Treatment ◽  
Therapy Group ◽  
Lower Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Conventional Treatment Group ◽  
Hemostatic Powder

Abstract Background and Aims: Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/NexpowderTM, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB. Patients and Methods: We conducted a retrospective cohort study of LGIB at a single tertiary center in south korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated. Results: The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded.Conclusion: Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.

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