Objective: To determine the number of emergency department (ED) patients with severe sepsis who are admitted to the ICU and to assess whether the predisposition, infection, response and organ failure (PIRO) score can be used as a clinical decision-making tool for guiding the disposition of ED sepsis patients to wards or the ICU.
Methods: This is a prospective study including ED patients with severe sepsis and septic shock. The PIRO score and in-hospital mortality were assessed in patients admitted to wards and ICUs. The sensitivity and specificity of the PIRO score and clinical judgement of the ED physician for guiding adequate disposition to wards or the ICU were assessed.
Results: A total of 47 of 153 patients were admitted to the ICU. Thirty-nine of 106 ward admissions had a 'do not resuscitate' status (not included in analysis). Mortality was 1.5 and 21% in patients initially admitted to a ward and the ICU, respectively. Unanticipated transfer from the ward to the ICU occurred in eight of 67 patients, resulting in higher mortality (38%, P=0.002, false negatives). Nine surviving patients admitted to the ICU for mere observation for less than 1 day were defined as false positives. Sensitivity of clinical judgement and of PIRO score (cut-off 9.5) alone or combined with clinical judgement were 0.92, 0.75 and 0.98, respectively (P<0.001). For specificity, these were 0.71, 0.56 and 0.40, respectively (P<0.001).
Conclusion: Two-thirds of ED patients with severe sepsis were admitted to the ward, of whom ∼13% clinically deteriorated, resulting in ICU admission and higher mortality. The PIRO score adds little value over clinical judgement in guiding adequate disposition to wards or the ICU.
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http://dx.doi.org/10.1097/MEJ.0b013e32834d6efb | DOI Listing |
Ann Surg Oncol
December 2024
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Objective: This study aimed to compare adverse in-hospital outcomes in ileal conduit versus neobladder urinary diversion type after radical cystectomy (RC) in contemporary versus historical patients.
Methods: Patients were identified within the National Inpatient Sample (NIS 2000-2019). Propensity score matching (PSM; 1:2 ratio) and multivariable logistic regression models (LRMs) were used.
Infect Drug Resist
November 2024
Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Background: Community-acquired pneumonia (CAP) is a significant global health issue, leading to high morbidity and mortality rates. Despite the existence of various severity scoring systems, accurately predicting patient outcomes remains challenging. The CAP-PIRO (Predisposition, Insult, Response, and Organ dysfunction) scoring system offers a comprehensive approach to evaluating CAP severity and prognosis.
View Article and Find Full Text PDFAm J Emerg Med
January 2025
Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Background: Every hospital admission is associated with healthcare costs and a risk of adverse events. The need to identify patients who do not require hospitalization has emerged with the profound increase in hospitalization rates due to infectious diseases during the last decades, especially during the COVID-19 pandemic. This study aimed to identify predictors of safe early discharge (SED) in patients presenting to the emergency department (ED) with a suspected infection meeting the Systemic Inflammatory Response Syndrome (SIRS) criteria.
View Article and Find Full Text PDFSci Rep
August 2024
Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
Hereditary transthyretin (ATTRv) amyloidosis is a rare, adult-onset, progressive, multisystemic condition caused by TTR pathogenic variants. Reliable biomarkers are needed to allow early diagnosis and to monitor disease severity and progression. We measured serum concentrations of growth differentiation factor-15 (GDF-15) and uromodulin (Umod) in ATTRv patients to evaluate correlations with standard markers of disease severity (FAP stage and PND score).
View Article and Find Full Text PDFFront Psychol
July 2024
Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy.
Objective: High risk of degraded quality of life and psychological distress is observed in patients diagnosed with sinonasal, nasopharyngeal, and laryngeal cancers, which could be caused by exposure to carcinogens in workplaces. This review aimed to investigate the psychological impact of diagnosis associated with the possible occupational etiology of such neoplasms and to explore the instruments that evaluate the quality of life (QoL), anxiety, and depression in these patients.
Methods: Studies were considered for the review only if they described aspects of the psychological impact of the diagnosis of sinonasal, nasopharyngeal, and laryngeal cancers and reported results distinguished by the tumor site.
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