scholarly journals Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kuan Ken Lee ◽  
◽  
Dimitrios Doudesis ◽  
Daniella A. Ross ◽  
Anda Bularga ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Primary Outcome ◽  
Clinical Laboratory ◽  
Throat Swab ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Index Test ◽  
Repeated Testing ◽  
Rt Pcr ◽  
Serial Testing

Abstract Background Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. Methods In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results. Results We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53–80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1–3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing. Conclusions In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing.

scholarly journals Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19

2020 ◽  
Author(s):  
Kuan Ken Lee ◽  
Dimitrios Doudesis ◽  
Daniella A. Ross ◽  
Anda Bularga ◽  
Claire L. MacKintosh ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Primary Outcome ◽  
Clinical Laboratory ◽  
Throat Swab ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Index Test ◽  
Repeated Testing ◽  
Rt Pcr ◽  
Serial Testing

AbstractBackgroundAccurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain.MethodsIn a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results.ResultsWe enrolled 1,369 consecutive patients (68 [53-80] years, 47% women) who underwent a total of 3,822 tests (median 2 [1-3] tests per patient). The primary outcome occurred in 36% (496/1,369), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing.ConclusionsIn patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing.

Dose addition of intravenous metronidazole to oral vancomycin improve outcomes in Clostridioides difficile infection?

2019 ◽  
Author(s):  
Ying Wang ◽  
Aaron Schluger ◽  
Jianhua Li ◽  
Angela Gomez-Simmonds ◽  
Hojjat Salmasian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Primary Outcome ◽  
Time Window ◽  
Dual Therapy ◽  
Secondary Outcome ◽  
Index Test ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Improved Outcomes ◽  
Clostridioides Difficile Infection

Abstract Background Guidelines recommend adding intravenous (IV) metronidazole to oral vancomycin for fulminant Clostridioides difficile infection (CDI). This study compared dual therapy with IV metronidazole and oral vancomycin versus vancomycin monotherapy. It assessed prevalence of use and effectiveness of dual therapy in non-fulminant and fulminant CDI. Methods This was a two-center retrospective study conducted from 2010 to 2018. Adult inpatients were included if they had a positive C. difficile PCR performed on an unformed stool and received oral vancomycin within two days (either before or after) of testing. Patients were classified as having received dual therapy if IV metronidazole was given within the same time window, and otherwise as having received vancomycin monotherapy. The primary outcome was  death or colectomy within 90 days after the index test. Logistic regression modeling was used to adjust for CDI severity and other established predictors of CDI outcomes. CDI recurrence was examined as a secondary outcome, adjusting for death as a competing risk. Results The study included 2,114 patients (dual therapy: 993; monotherapy: 1,121) of whom 23% met the primary outcome. There was no association between dual therapy and the primary outcome (adjusted OR (aOR) 1.07, 95% CI 0.79-1.45) which remained true when the analysis was restricted to patients with fulminant CDI (aOR 1.17, 95% CI 0.65-2.10). There was also no association between dual therapy and CDI recurrence. Conclusions Dual therapy with IV metronidazole and oral vancomycin was common for non-fulminant and fulminant CDI, but was not associated with improved outcomes compared to vancomycin alone.

scholarly journals P126: Utilization and outcomes of children presenting to an emergency department by ambulance

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S110-S110
Author(s):  
Z. Cantor ◽  
M. Aglipay ◽  
A. Plint
Keyword(s):  
Primary Outcome ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Patient Discharge ◽  
Primary Objective ◽  
Critically Ill Children ◽  
Secondary Outcome ◽  
Self Presentation ◽  
Discharge Disposition ◽  
Ed Visits

Introduction: Children account for a low proportion of paramedic transports. Evidence suggests that many pediatric transports are of low acuity, but there are few studies comparing these patients to those that self-present to the ED. Our primary objective was to determine if illness severity was associated with presentation by ambulance among pediatric patients. Methods: We undertook a single centre, retrospective cohort study at a tertiary care pediatric centre. All patients presenting to the ED in 2015 by any route other than air ambulance were eligible. Patients were divided into two groups based on the route of presentation – ambulance or self-presentation. The primary outcome was disposition decision; the secondary outcome was CTAS level. To determine whether patient discharge disposition or CTAS was associated with the method of arrival, we conducted generalized estimating equations (GEE) to account for correlation within patients with multiple ED visits. Results: Of the 69,092 visits, 69,034 were eligible and analyzed. Of those, 4478 (6.5%) arrived by ambulance, while 64,556 (93.5) self-presented. Those arriving by ambulance had a median age of 10 years [IQR: 2-5 years] vs. 4 years [IQR: 1.75-10 years] in the self-presenting group and were 52.6% male (vs. 52.8%). Two percent of the ambulance cohort were admitted to the ICU (vs. 0.2%), and 16.6% were admitted to the ward (vs. 5%). Patients presenting by ambulance had higher CTAS scores – 5.3% CTAS 1 (vs. 0.3%), 16.4% CTAS 2 (vs. 7.0%), 61.2% CTAS 3 (vs. 45.8%), and 17.1% CTAS 4-5 (vs. 46.9%). The odds of arriving by ambulance were 10.2 x higher for patients admitted to the ICU (OR = 10.2, 95%CI: 7.9 to 13.3) vs. those discharged home. The odds of arriving by ambulance were 64.2 x (OR = 64.2, 95% CI: 48.6 to 84.7) higher for patients CTAS 1 patients vs. CTAS 5 patients. The top 3 complaints among ambulance patients were neurological (22.5%), respiratory (22.7%), and orthopaedic (11.3%). Among self-presenting patients, the top three were general/minor (20.4%), respiratory (16.4%), and gastrointestinal (14.3%). Conclusion: Children presenting to the ED via ambulance are at higher risk for admission to the ward and critical care unit. It is important that paramedics have sufficient training to ensure adequate skills to manage critically ill children. Given the low proportion but higher severity of illness of pediatric transports, further research and consideration must be given to how best to enable paramedics in the management of children.

scholarly journals Utility of Repeat Nasopharyngeal SARS-CoV-2 RT-PCR Testing and Refinement of Diagnostic Stewardship Strategies at a Tertiary Care Academic Center in a Low-Prevalence Area of the United States

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Alexander J Lepak ◽  
Derrick J Chen ◽  
Ashley Buys ◽  
Linda Stevens ◽  
Nasia Safdar
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
False Negative ◽  
The United States ◽  
Inpatient Setting ◽  
Repeated Testing ◽  
Rt Pcr ◽  
Academic Center ◽  
Low Prevalence ◽  
Pcr Test

Abstract Background Multiple factors have led to an extremely high volume of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) testing. Concerns exist about sensitivity and false-negative SARS-CoV-2 RT-PCR testing results. We describe a retrospective observational study examining the utility of repeat nasopharyngeal (NP) SARS-CoV-2 RT-PCR testing at an academic center in a low-prevalence setting. Methods All patients within our health system with >1 NP SARS-CoV-2 RT-PCR test result were included. SARS-CoV-2 RT-PCR testing was performed according to 1 of 4 validated assays. Key clinical and demographic data were collected, including whether the patient was inpatient or outpatient at time of the test and whether the test was performed as part of a person under investigation (PUI) for possible coronavirus disease 2019 or for asymptomatic screening. Results A total of 660 patients had >1 NP SARS-CoV-2 PCR test performed. The initial test was negative in 638. There were only 6 negative-to-positive conversions (0.9%). All 6 were outpatients undergoing a PUI workup 5–17 days after an initial negative result. In >260 inpatients with repeat testing, we found no instances of negative-to-positive conversion including those undergoing PUI or asymptomatic evaluation. Conclusions In a low-prevalence area, repeat inpatient testing after an initial negative result, using a highly analytically sensitive SARS-CoV-2 RT-PCR, failed to demonstrate negative-to-positive conversion. The clinical sensitivity of NP RT-PCR testing may be higher than previously believed. These results have helped shape diagnostic stewardship guidelines, in particular guidance to decrease repeated testing in the inpatient setting to optimize test utilization and preserve resources.

scholarly journals P016: Utilization and outcomes of children presenting to an emergency department by ambulance

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S68-S69
Author(s):  
Z. Cantor ◽  
M. Aglipay ◽  
A. Plint
Keyword(s):  
Primary Outcome ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Patient Discharge ◽  
Primary Objective ◽  
Critically Ill Children ◽  
Secondary Outcome ◽  
Self Presentation ◽  
Discharge Disposition ◽  
Ed Visits

Introduction: Children account for a low proportion of paramedic transports. Evidence suggests that many pediatric transports are of low acuity, but there are few studies comparing these patients to those that self-present to the ED. Our primary objective was to determine if illness severity was associated with presentation by ambulance among pediatric patients. Methods: We undertook a single centre, retrospective cohort study at a tertiary care pediatric centre. All patients presenting to the ED in 2015 by any route other than air ambulance were eligible. Patients were divided into 2 groups based on the route of presentation – ambulance or self-presentation. The primary outcome was disposition decision; the secondary outcome was CTAS level. To determine whether patient discharge disposition or CTAS was associated with method of arrival, we conducted generalized estimating equations (GEE) to account for correlation within patients with multiple ED visits. Results: Of the 69,092 visits, 69,034 were eligible and analyzed. Of those, 4478 arrived by ambulance, while 64,556 self-presented. Those arriving by ambulance had a median age of 10 years [IQR: 2-5 years] vs. 4 years [IQR: 1.75-10 years] in the self-presenting group, and were 52.6% male (vs. 52.8%). Two percent of the ambulance cohort were admitted to the ICU (vs. 0.2%), and 16.6% were admitted to the ward (vs. 5%). Patients presenting by ambulance had higher CTAS scores – 5.3% CTAS 1 (vs. 0.3%), 16.4% CTAS 2 (vs. 7.0% ), 61.2% CTAS 3 (vs. 45.8%), and 17.1% CTAS 4-5 (vs. 46.9%). The odds of arriving by ambulance were 10.2 x higher for patients admitted to the ICU (OR = 10.2, 95%CI: 7.9 to 13.3) vs. those discharged home. The odds of arriving by ambulance was 64.2 x (OR = 64.2, 95% CI: 48.6 to 84.7) higher for patients CTAS 1 patients vs. CTAS 5 patients. The top 3 complaints among ambulance patients were respiratory (22.7%), orthopedic (14.7%), and general/minor (10.3%). Among self-presenting patients, the top three were general/minor (22.5%), respiratory (18.0%), and gastrointestinal (15.7%). Conclusion: Children presenting to the ED via ambulance are at higher risk for admission to the ward and critical care unit. It is important that EMS staff responsible for transporting children be well trained in managing critically ill children. Given the low proportion of pediatric transports, consideration must be given to how best to train EMS services in managing these children.

scholarly journals Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy

2020 ◽  
Vol 17 (12) ◽  
pp. 4417 ◽  
Author(s):  
Edith Lahner ◽  
Emanuele Dilaghi ◽  
Claudio Prestigiacomo ◽  
Giuliano Alessio ◽  
Laura Marcellini ◽  
...  
Keyword(s):  
High Risk ◽  
Teaching Hospital ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Health Workers ◽  
Central Italy ◽  
Nasopharyngeal Swab ◽  
Index Test ◽  
Rt Pcr ◽  
Pcr Assay

(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19–69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.

scholarly journals Effect of Umbilical Cord Milking on Severity of Hypoxic Ischemic Encephalopathy in Asphyxiated Neonates A Pilot study

2021 ◽  
Author(s):  
Roshith J Kumar ◽  
Manoj Varanattu
Keyword(s):  
Pilot Study ◽  
Umbilical Cord ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
Secondary Outcome ◽  
Control Group ◽  
Case Group ◽  
Ischemic Encephalopathy ◽  
Umbilical Cord Milking

Background: The present study was aimed to evaluate the effect of umbilical cord milking technique on severity of Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated neonates and assessed by Modified Sarnats staging as primary outcome, APGAR score at 5 minutes and Respiratory support requirement as secondary outcome. Methods: This was a randomized, controlled pilot study conducted in neonatology department at a tertiary care centre, Thrissur, Kerala. The neonates were divided into two groups non milking group, control (n=38) and umbilical cord milking, case [UCM] (n=32) and their outcomes were compared. In the intervention group, the cord was cut at 30 cm from umbilical stump within 30 seconds of birth and euthermia was maintained. The umbilical cord was raised and milked from the cut end towards the infant 3 times with speed at 10 cm/sec and then clamped 2 to 3 cm from the umbilical stump. In the control group, the umbilical cord was clamped without doing cord milking. Results: In this study moderate to severe HIE were less in case group 46.9 % than control group 55.1% and less neonates 44.7 % had Mild HIE in control group compared to case group 53.1% even though result was statistically not significant as primary outcome (p value not significant). Eight neonates (21.6%) in control group had Apgar at 5 min score 0 to 3, whereas only 4 (12.5%) neonates in cord milking group. Conclusions: The insufficient knowledge of placental transfusion limits and benefits leads to a wide variation in the management of cord clamping. It would be useful to standardise the UCM procedure in order to offer protocols applicable to clinical practice, and to spread knowledge among professionals through educational programs.

Risk Stratification in COVID-19 Pneumonia – Determining the Role of Lung Ultrasound

2021 ◽  
Author(s):  
Valeria Tombini ◽  
Mirko Di Capua ◽  
Nicolò Capsoni ◽  
Andrea Lazzati ◽  
Marta Bergamaschi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Roc Curve ◽  
Primary Outcome ◽  
Clinical Laboratory ◽  
Curve Analysis ◽  
Secondary Outcome ◽  
Roc Curve Analysis ◽  
Additional Tool ◽  
Factors Associated ◽  
Independent Risk Factors

AbstractLUS patterns of COVID-19 pneumonia have been described and shown to be characteristic. The aim of the study was to predict the prognosis of patients with COVID-19 pneumonia, using a score based on LUS findings. Materials and Methods An observational, retrospective study was conducted on patients admitted to Niguarda hospital with a diagnosis of COVID-19 pneumonia during the period of a month, from March 2nd to April 3rd 2020. Demographics, clinical, laboratory, and radiological findings were collected. LUS was performed in all patients. The chest was divided into 12 areas. The LUS report was drafted using a score from 0 to 3 with 0 corresponding to A pattern, 1 corresponding to well separated vertical artifacts (B lines), 2 corresponding to white lung and small consolidations, 3 corresponding to wide consolidations. The total score results from the sum of the scores for each area. The primary outcome was endotracheal intubation, no active further management, or death. The secondary outcome was discharge from the emergency room (ER). Results 255 patients were enrolled. 93.7 % had a positive LUS. ETI was performed in 43 patients, and 24 received a DNI order. The general mortality rate was 15.7 %. Male sex (OR 3.04, p = 0.014), cardiovascular disease and hypertension (OR 2.75, p = 0.006), P/F (OR 0.99, p < 0.001) and an LUS score > 20 (OR 2.52, p = 0.046) were independent risk factors associated with the primary outcome. Receiver operating characteristic (ROC) curve analysis for an LUS score > 20 was performed with an AUC of 0.837. Independent risk factors associated with the secondary outcome were age (OR 0.96, p = 0.073), BMI (OR 0.87, p = 0,13), P/F (OR 1.03, p < 0.001), and LUS score < 10 (OR 20.9, p = 0.006). ROC curve analysis was performed using an LUS score < 10 with an AUC 0.967. Conclusion The extent of lung abnormalities evaluated by LUS score is a predictor of a worse outcome, ETI, or death. Moreover, the LUS score could be an additional tool for the safe discharge of patient from the ER.

Abstract 12983: Impact of Door to Balloon Time on Outcome of Patients Presenting With Different Symptom Onset to Door Time

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Razvan T Dadu ◽  
Ana Davis ◽  
Jaromir Bobek ◽  
Mahboob Alam ◽  
Rajiv Goswami ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Late Presentation ◽  
Secondary Outcome ◽  
Significant Difference ◽  
St Elevation ◽  
The Impact

Objective: Delay in reperfusion > 4h in patients with ST elevation myocardial infarction (STEMI) is associated with negative outcomes. We sought out to examine the impact of DTBT on 30-day cardiovascular outcomes and persistent ST elevation (STE) on the post reperfusion EKG, in patients with different symptom onset to door time (SOTDT). Methods: 122 consecutive patients undergoing primary percutaneous coronary intervention for STEMI in a tertiary care county hospital from 2011-2013 are included. All patients had DTBT ≤ 90min. Patients were divided into 3 groups according to their SOTDT: Group1 ≤ 90min, Group2 between 90min and 4h and Group3 >4h. Each group was further divided in 2 subgroups based on median DTBT of the entire population. The primary outcome was a composite endpoint of mortality, re-hospitalization for chest pain or heart failure, repeat revascularization and re-infarction at 30 days. A secondary outcome was persistence of > 50% STE on the post reperfusion EKG. Results: Median SOTDT was 129 min and the median DTBT was 47min for all included patients in the study. The 3 groups had comparable baseline characteristics. The mean DTBT was similar (49±20 min, 47±18 min and 50±16 min, p=0.7). In the 3 groups, the primary outcome was present in 16.7 %, 16.2 % and 35%, respectively (p=0.08) and there was a significant difference in STE resolution: 16.7%, 17.1% and 78.6%, respectively (p<0.001). Group 1 and 3 demonstrate that short DTBT (≤ 47 min) does not affect overall outcomes compared to those with longer DTBT (> 47 min). In group 2, patients with DTBT ≤ 47min had significantly lower persistent STE on EKG (0% vs 36.8%, p=0.002) and a trend to a favorable clinical outcome (table). Conclusion: Patients with intermediate SOTDT seem to benefit mostly from shorter DTBT compared to all other patient groups. Achieving shorter DTBT may have no impact on outcome in patients with very early or very late presentation. Larger studies are needed to further confirm these findings.

scholarly journals Blatchford Score Is Superior to AIMS65 Score in Predicting the Need for Clinical Interventions in Elderly Patients with Nonvariceal Upper Gastrointestinal Bleed

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Khalid Abusaada ◽  
Fnu Asad-ur-Rahman ◽  
Vladimir Pech ◽  
Umair Majeed ◽  
Shengchuan Dai ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Gastrointestinal Bleed ◽  
Upper Gastrointestinal Bleed ◽  
Upper Gastrointestinal ◽  
Operator Curve

Background. Blatchford and AIMS65 scores were developed to risk stratify patients with upper gastrointestinal bleed (UGIB). We sought to assess the performance of Blatchford and AIMS65 scores in predicting outcomes in elderly patients with nonvariceal UGIB.Methods. A retrospective cohort study of elderly patients (over 65 years of age) with nonvariceal UGIB admitted to a tertiary care center. Primary outcome was a combined outcome of in-hospital mortality, need for any therapeutic endoscopic, radiologic, or surgical intervention, rebleeding within 30 days, or blood transfusion. Secondary outcome was a combined outcome of in-hospital mortality or need for an intervention to control the bleed.Results. 164 patients were included. The primary outcome occurred in 119 (72.5%) patients. The secondary outcome occurred in 12 patients (7.2%). Blatchford score was superior to AIMS65 score in predicting the primary outcome (area under the receiver-operator curve (AUROC) 0.84 versus 0.68, resp.,p<0.001). Both scores performed poorly in predicting the secondary outcome (AUROC 0.56 versus 0.52, resp.,p=0.18).Conclusions. Blatchford score could be useful in predicting the need for hospital based interventions in elderly patients with nonvariceal UGIB. Blatchford and AIMS65 scores are poor predictors of the need for a therapeutic intervention to control bleeding.

Sign in / Sign up

Export Citation Format

Share Document