OBJECTIVE: To prospectively validate the Sepsis in Obstetrics Score, a pregnancy-specific sepsis scoring system, to identify risk for intensive care unit (ICU) admission for sepsis in pregnancy.
METHODS: This is a prospective validation study of the Sepsis in Obstetrics Score. The primary outcome was admission to the ICU for sepsis. Secondary outcomes included admission to a telemetry unit and time to administration of antibiotic therapy. We evaluated test characteristics of a predetermined score of 6 or greater.
RESULTS: Between March 2012 and May 2015, 1,250 pregnant or postpartum women presented to the emergency department and met systemic inflammatory response syndrome criteria. Of those, 425 (34%) had a clinical suspicion or diagnosis of an infection, 14 of whom (3.3%) were admitted to the ICU. The Sepsis in Obstetrics Score had an area under the curve of 0.85 (95% CI 0.76-0.95) for prediction of ICU admission for sepsis. This is within the prespecified 15% margin of the area under the curve of 0.97 found in the derivation cohort. A score of 6 or greater had a sensitivity of 64%, specificity of 88%, positive predictive value of 15%, and negative predictive value of 98.6%. Women with a score 6 or greater were more likely to be admitted to the ICU (15% compared with 1.4%, P<.01), admitted to a telemetry unit (37.3% compared with 7.2%, P<.01), and have antibiotic therapy initiated (90% compared with 72.9%, P<.01), initiated more quickly (3.2 compared with 3.7 hours, P=.03), although not within 1 hour (5.6 compared with 3.4%, P=.44).
CONCLUSION: The Sepsis in Obstetrics Score is a validated pregnancy-specific score to identify risk of ICU admission for sepsis with the threshold score of 6 having a negative predictive value of 98.6%. Adherence to antibiotic administration guidelines is poor.
The pathways that women follow to reach EmergencyObstetric and Neonatal Care (EmONC) once a decision has been made to seek care ... conducted using NVIVO 10 software AbstractText: Once the decision is made to seek emergencyobstetric care, the pregnant woman may face a series of complex steps before she ...
Qualitative data provided context and a deeper understanding of the factors contributing to each delay.Critical delays exist both outside and within the healthcare system that contribute to the development and timely repair of obstetric fistula. Healthcare system strengthening, particularly with regard to emergencyobstetric care, is critical to reduce the burden of obstetric fistula in women in Tanzania.
Zambia's maternal mortality ratio was estimated at 398/100,000 live births in 2014. Successful aversion of deaths is dependent on availability and usability of signal functions for emergencyobstetric and neonatal care. Evidence of availability, usability and quality of signal functions in urban settings in Zambia is minimal as previous research has evaluated their distribution in rural settings.
Eclampsia (1), Postpartum Hemorrhage (1), Pre-Eclampsia (1), more mentions
... of the PAMG-1 and fFN tests using real-world data for the prediction of spontaneous preterm delivery (sPTD) in patients presenting to an emergencyobstetrical unit with threatened preterm labour (PTL) by conducting a retrospective audit of patient medical records over two different one-year time periods during which ...
... for critical care organization implementation is discussed AbstractText: A critical care organization that incorporates functional clinical horizontal and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk will be better positioned to succeed in ...
AbstractText: To provide a 360-degree description of ICU-to-ward transfers AbstractText: Prospective cohort study of 451 adults transferred from a medical-surgicalICU to a hospital ward in 10 Canadian hospitals July 2014-January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24-72 h ...
... Surgical Apgar Score (SAS) is relatively weakly associated with post-operative outcomes in emergencysurgery, compared with elective surgery... SAS may be useful for prediction of poor outcomes after emergencysurgery AbstractText: A retrospective study was conducted in patients who underwent emergency abdominal or cerebral surgery from January 2005 to December 2010 ...
OBJECTIVES: To determine the relative contributions of patient risk profile, local and individual clinical practice on length of hospital stay after cardiac surgery.
DESIGN: Ten-year audit of prospectively collected consecutive cardiac surgical cases. Case-mix adjusted outcomes were analysed in models that included random effects for centre, surgeon and anaesthetist.
SETTING: UK centres providing adult cardiac surgery.
PARTICIPANTS: 10 of 36 UK specialist centres agreed to provide outcomes for all major cardiac operations over 10 years. After exclusions (duplicates, cases operated by more than one consultant, deaths and procedures for which the EuroSCORE risk score for cardiac surgery is not appropriate), there were 107 038 cardiac surgical procedures between April 2002 and March 2012, conducted by 127 consultant surgeons and 190 consultant anaesthetists.
MAIN OUTCOME MEASURE: Length of stay (LOS) up to 3 months postoperatively.
RESULTS: The principal component of variation in outcomes was patient risk (represented by the EuroSCORE and remaining patient heterogeneity), accounting for 95.43% of the variation for postoperative LOS. The impact of the surgeon and centre was moderate (intra-class correlation coefficients ICC=2.79% and 1.59%, respectively), whereas the impact of the anaesthetist was negligible (ICC=0.19%). Similarly, 96.05% of the variation for prolonged LOS (>11 days) was attributable to the patient, with surgeon and centre less but still influential components (ICC=2.12% and 1.66%, respectively, 0.17% only for anaesthetists). Adjustment for year of operation resulted in minor reductions in variation attributable to surgeons (ICC=2.52% for LOS and 2.23% for prolonged LOS).
CONCLUSIONS: Patient risk profile is the primary determinant of variation in LOS, and as a result, current initiatives to reduce hospital stay by modifying consultant performance are unlikely to have a substantial impact. Therefore, substantially reducing hospital stay requires shifting away from a one-size-fits-all approach to cardiac surgery, and seeking alternative treatment options personalised to high-risk patients.
AbstractText: The admission of high-risk patients to criticalcare after surgery is a recommended standard of care... The EPIdemiology of CriticalCare after Surgery study aims to address these uncertainties AbstractText: One-week observational ... Data will also be collected on criticalcare referral and admission, surgical cancellations and criticalcare occupancy.
... this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy.This pre-post curriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum.
Hemorrhage (3), Anaphylaxis (1), Cardiopulmonary Arrest (1), more mentions
... Intensive Care Unit (ICU) stay and increased frequency of postoperative ICU complications, in patients undergoing major cardiac surgery.Adult patients, undergoing elective coronary artery bypass grafting with or ... in other interventional studies, those who had a tracheostomy before surgery, required emergencysurgery or were due to be admitted on the day of ...
... and nephrotoxicity of nebulized versus IV amikacin in postcardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram--negative bacilli AbstractText: Prospective, randomized, controlled study on surgical patients divided into two groups AbstractText: Postcardiac surgeryICU AbstractText: The first gtroup was administered IV amikacin 20 mg/kg once daily.
Infectious Diseases (2) Pneumonia (5), Ventilator-Associated Pneumonia (3), more mentions
AbstractText: To assess the safety of discharging cardiac surgical patients from the intensivecare unit (ICU) to wards while the patients are still receiving a dopamine infusion AbstractText: Retrospective ... years and admitted between September 1, 2015 and September 16, 2016 to the ICU and subsequently discharged to a surgical ward.
Postoperative intensivecare unit (ICU) stay after cardiac surgeries has been extensively studied, but little attention has been given to ICU stay following transcatheter aortic valve replacement (TAVR. This study examined ICU stay after TAVR.Two hundred and forty-five patients who underwent TAVR between April 2010 and October 2016 were studied retrospectively.
After exclusion, 2018 outcome-labelled episodes remained.Area under the receiver operating characteristic curve (AUROC) for prediction of unplanned ICU readmission or in-hospital death within 48 hours of first ICU discharge.In 10-fold cross-validation, an ensemble predictor was trained on data from both the target hospital and ...
AbstractText: Emergency general surgeries (EGS) contribute to half of all surgical mortality nationwide, are associated with a 50% complication rate, and have a 15% readmission rate within 30-days... Keyword: emergency general surgery. Keyword: hospital volume. Keyword: mortality. Keyword: readmissions. Keyword: surgeon volume.
... must have an organized approach to detect easily remediable causes, prevent ongoing neurologic injury, and determine a hierarchical plan for diagnostic tests, treatments, and neuromonitoring. Coma was chosen as an Emergency Neurological Life Support protocol because timely medical and surgical interventions can be life-saving, and the initial work-up of such patients is critical to establishing a correct diagnosis.
We describe the steps of the surgical technique in detail and we analyze crucial issues associated with the technique AbstractText: We have performed this emergencyoperation in two patients with acute early stroke after CAS. Both patients presented recovery of their previous neurologic deficits and had uneventful postoperative course AbstractText: We illustrate the technique of emergent removal of the thrombosed ...
BACKGROUND: Many adverse pregnancy outcomes in the UK could be prevented with better intrapartum care. Training for intrapartum emergencies has been widely recommended but there are conflicting data about their effectiveness. Observational studies have shown sustained local improvements in perinatal outcomes associated with the use of the PRactical Obstetric Multi-Professional Training - (PROMPT) training package. However this effect needs to be investigated in the context of randomised study design in settings other than enthusiastic early adopter single-centres. The main aim of this study is to determine the effectiveness of PROMPT to reduce the rate of term infants born with low APGAR scores.
METHODS: THISTLE (Trial of Hands-on Interprofessional Simulation Training for Local Emergencies) is a multi-centre stepped-wedge clustered randomised controlled superiority trial conducted across 12 large Maternity Units in Scotland. On the basis of prior observational findings all Units have been offered the intervention and have been randomly allocated in groups of four Units, to one of three intervention time periods, each six months apart. Teams of four multi-professional clinicians from each participating Unit attended a two-day PROMPT Train the Trainers (T3) programme prior to the start of their allocated intervention step. Following the T3 training, the teams commenced the implementation of local intrapartum emergency training in their own Units by the start of their allocated intervention period. Blinding has not been possible due to the nature of the intervention. The aim of the study is to follow up each Unit for at least 12-months after they have commenced their local courses. The primary outcome for the study is the proportion of Apgar scores <7 at 5 min for term vaginal or emergency caesarean section births (≥37 weeks) occurring in each of the study Units. These data will be extracted from the Information Services Division Scottish Morbidity Record 02, a national routine data collection on pregnancy and births. Mixed or marginal logistic regression will be employed for the main analysis.
DISCUSSION: THISTLE is the first stepped wedge cluster randomised trial to evaluate the effectiveness of an intrapartum emergencies training programme. The results will inform training, trainers and policy going forward.
TRIAL REGISTRATION: ISRCTN11640515 (registered on 09/09/2013).