Thermographic visualization of facial vasoconstriction is associated with 30-day all-cause mortality in medical patients; prospective observational two-site cohort study

2021 ◽  
Vol 20 (2) ◽  
pp. 101-109
Author(s):  
NH Jensen ◽  
◽  
R Sze-Long Lo ◽  
KKC Hung ◽  
M Lorentzen ◽  
...  
Keyword(s):  
Temperature Gradient ◽  
Vital Signs ◽  
Medical Patients ◽  
Supplementary Oxygen ◽  
Reliable Assessment ◽  
All Cause Mortality ◽  
Thermographic Image ◽  
Thermographic Visualization ◽  
Peripheral Temperature ◽  
Acute Patients

Introduction: Quick and reliable assessment of acute patients is required for accurate triage. The temperature gradient between core and peripheral temperature could possibly instantly provide information on circulatory status. Methods: Adult medical patients, who did not receive supplementary oxygen, attending two emergency departments, had a thermographic image taken on arrival. The association between 30-day mortality and gradients was tested using logistic regression. Results: 726 patients were studied, median age was 64 years and 14 (1.9%) died within 30 days. There was a significant association between mortality and temperature gradient, comparable to vital signs, age, and clinical intuition. Conclusion: Temperature gradient between nose and eye had an acceptable discriminatory power for 30-day all-cause mortality.

scholarly journals Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047121
Author(s):  
Devin Incerti ◽  
Shemra Rizzo ◽  
Xiao Li ◽  
Lisa Lindsay ◽  
Vincent Yau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Model ◽  
Vital Signs ◽  
Saturation Temperature ◽  
Full Model ◽  
Good Discrimination ◽  
Hospitalised Patients ◽  
Laboratory Results ◽  
All Cause Mortality ◽  
The Usa

ObjectivesTo develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.DesignRetrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores and calibration plots in the test set.SettingOptum de-identified COVID-19 Electronic Health Record dataset including over 700 hospitals and 7000 clinics in the USA.Participants17 086 patients hospitalised with COVID-19 between 20 February 2020 and 5 June 2020.Main outcome measureAll-cause mortality while hospitalised.ResultsThe full model that included information on demographics, comorbidities, laboratory results, and vital signs had good discrimination (C-index=0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were similar on the training and test sets, suggesting that there was little overfitting. Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index=0.79) was only slightly better than a model that only included age (C-index=0.76). Across the study period, predicted mortality was 1.3% for patients aged 18 years old, 8.9% for 55 years old and 28.7% for 85 years old. Predicted mortality across all ages declined over the study period from 22.4% by March to 14.0% by May.ConclusionAge was the most important predictor of all-cause mortality, although vital signs and laboratory results added considerable prognostic information, with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase and white cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The full model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.

Danger of using core/peripheral temperature gradient as a guide to therapy in shock

1987 ◽  
Vol 15 (9) ◽  
pp. 850-852 ◽  
Author(s):  
IAN WOODS ◽  
ROBERT G. WILKINS ◽  
J. DENIS EDWARDS ◽  
PAUL D. MARTIN ◽  
E. BRIAN FARAGHER
Keyword(s):  
Temperature Gradient ◽  
Peripheral Temperature

1246: CORE PERIPHERAL TEMPERATURE GRADIENT-GUIDED HEMODYNAMIC MANAGEMENT AFTER CARDIAC SURGERY

2018 ◽  
Vol 46 (1) ◽  
pp. 606-606
Author(s):  
Yuki Nakamori ◽  
Hiroyuki Mima ◽  
Takahiro Shimozono ◽  
HIROSHI UETA ◽  
Daisuke Kawakami ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Temperature Gradient ◽  
Hemodynamic Management ◽  
Peripheral Temperature

scholarly journals A negative D-dimer identifies patients at low risk of death within 30 days: a prospective observational emergency department cohort study

QJM ◽  
2019 ◽  
Vol 112 (9) ◽  
pp. 675-680 ◽  
Author(s):  
L E Lyngholm ◽  
C H Nickel ◽  
J Kellett ◽  
S Chang ◽  
T Cooksley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vital Signs ◽  
Low Risk ◽  
Clinical Indication ◽  
Medical Patients ◽  
Prognostic Information ◽  
Registration System ◽  
Civil Registration ◽  
Risk Of Death ◽  
D Dimer

Abstract Objective To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. Design In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. Setting The Hospital of South West Jutland. Patients All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. Main results The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02–0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. Conclusion Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.

Central-peripheral temperature gradient: an early diagnostic sign of late-onset neonatal sepsis in very low birth weight infants

2012 ◽  
Vol 40 (5) ◽  
Author(s):  
José Luis Leante-Castellanos ◽  
José M. Lloreda-García ◽  
Ana García-González ◽  
Caridad Llopis-Baño ◽  
Carmen Fuentes-Gutiérrez ◽  
...  
Keyword(s):  
Birth Weight ◽  
Temperature Gradient ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Low Birth Weight Infants ◽  
Diagnostic Sign ◽  
Peripheral Temperature ◽  
Early Diagnostic

Extended-Duration Enoxaparin for Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients: An Evaluation of the EXCLAIM Study Based on a Recently Recommended Composite Efficacy Endpoint.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1870-1870 ◽  
Author(s):  
Sebastian M. Schellong ◽  
Russell D. Hull ◽  
Victor F. Tapson ◽  
Manuel Monreal ◽  
Meyer-Michel Samama ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Composite Endpoint ◽  
Medical Patients ◽  
Double Blind ◽  
Once Daily ◽  
All Cause Mortality ◽  
Standard Duration ◽  
Extended Duration ◽  
Level 1 ◽  
Reduced Mobility

Abstract Introduction The EXCLAIM study has shown that in acutely ill medical patients who have received a standard 10-day period of prophylaxis with enoxaparin, extended-duration prophylaxis with enoxaparin for 4 weeks reduces the relative risk of the primary composite endpoint of asymptomatic proximal deep-vein thrombosis (DVT), symptomatic DVT or pulmonary embolism (PE), and fatal PE by 44% compared with placebo (2.8% vs 4.9%; RR 0.56; 95% CI 0.39–0.80; p=0.0011). We assessed the consistency of these results using the composite efficacy endpoint recently proposed for venous thromboembolism (VTE) prophylaxis studies by the European Committee for Medicinal Products for Human Use (CHMP) which, in addition, takes all-cause mortality into account. Methods Patients enrolled in the EXCLAIM study had a recent reduced mobility (≤3 days) due to a medical illness, were aged 40 years or older, and had anticipated level 1 (total bed rest or sedentary without bathroom privileges) or level 2 (level 1 with bathroom privileges) reduced mobility with further risk factors. Eligible patients received enoxaparin 40mg SC once-daily for 10±4 days. Patients were then double-blind randomized and received either enoxaparin 40mg SC once-daily or placebo for a further 28±4 days. Asymptomatic DVT were diagnosed by bilateral compression ultrasound after completion of the randomized treatment period. Suspected cases of symptomatic DVT or PE were confirmed by objective tests. Fatal PE were confirmed by autopsy where possible. Data were analyzed using the CHMP-recommended composite efficacy endpoint of proximal DVT, adjudicated PE and all-cause mortality. Results Eligible patients enrolled at 370 sites in 20 countries received standard-duration prophylaxis with enoxaparin. Of these, 4114 patients were double-blind randomized and 4040 received extended-duration prophylaxis with enoxaparin (n=2013) and placebo (n=2027), respectively. Extended-duration enoxaparin reduced the relative risk of the CHMP composite endpoint by 26% compared with placebo (5.8% vs 7.9%; RR 0.74; 95% CI 0.58–0.95; p=0.018). Conclusion The significant reduction in the incidence of the primary efficacy endpoint associated with the use of extended-duration enoxaparin compared with placebo, following standard duration enoxaparin, was consistent when applying both the pre-defined EXCLAIM and the CHMP-recommended composite endpoints, the latter of which included all-cause mortality in addition to proximal DVT and adjudicated PE.

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