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Valentine S, Cunningham AC, Klasmer B, Dabbah M, Balabanovic M, Aral M, Vahdat D, Plans D. Smartphone movement sensors for the remote monitoring of respiratory rates: Technical validation. Digit Health 2022; 8:20552076221089090. [PMID: 35493956 PMCID: PMC9052820 DOI: 10.1177/20552076221089090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mobile health (mHealth) offers potential benefits to both patients and
healthcare systems. Existing remote technologies to measure respiratory
rates have limitations such as cost, accessibility and reliability. Using
smartphone sensors to measure respiratory rates may offer a potential
solution to these issues. Objective The aim of this study was to conduct a comprehensive assessment of a novel
mHealth smartphone application designed to measure respiratory rates using
movement sensors. Methods In Study 1, 15 participants simultaneously measured their respiratory rates
with the app and a Food and Drug Administration-cleared reference device. A
novel reference analysis method to allow the app to be evaluated ‘in the
wild’ was also developed. In Study 2, 165 participants measured their
respiratory rates using the app, and these measures were compared to the
novel reference. The usability of the app was also assessed in both
studies. Results The app, when compared to the Food and Drug Administration-cleared and novel
references, respectively, showed a mean absolute error of 1.65
(SD = 1.49) and 1.14 (1.44), relative mean absolute
error of 12.2 (9.23) and 9.5 (18.70) and bias of 0.81 (limits of
agreement = –3.27 to 4.89) and 0.08 (–3.68 to 3.51). Pearson correlation
coefficients were 0.700 and 0.885. Ninety-three percent of participants
successfully operated the app on their first use. Conclusions The accuracy and usability of the app demonstrated here in individuals with a
normal respiratory rate range show promise for the use of mHealth solutions
employing smartphone sensors to remotely monitor respiratory rates. Further
research should validate the benefits that this technology may offer
patients and healthcare systems.
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Pana TA, Quinn TJ, Perdomo-Lampignano JA, Szlachetka WA, Knoery C, Mamas MA, Myint PK. Shock index predicts up to 90-day mortality risk after intracerebral haemorrhage. Clin Neurol Neurosurg 2021; 210:106994. [PMID: 34781088 DOI: 10.1016/j.clineuro.2021.106994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/17/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Shock index (SI - heart rate/systolic blood pressure) has been studied as a measure of haemodynamic status. We aimed to determine whether SI measures within 72 h of admission were associated with adverse outcomes in intracerebral haemorrhage (ICH). METHODS Patients were drawn from the Virtual International Stroke Trials Archive-Intracerebral Haemorrhage (VISTA-ICH). Multivariable Cox regressions modelled the relationship between SI (on admission, 24, 48, 72 h) and mortality (at 3-, 7-, and 90-days), 90-day incident pneumonia and cardiovascular events (MACE). Ordinal logistic regressions modelled the relationship between SI and 90-day modified Rankin Scale (mRS). RESULTS 979 patients were included. Baseline SI was not associated with mortality. 24 h SI > 0.7 was associated with 7-day mortality (hazard ratio (95% confidence interval) = 3.14 (1.37-7.19)). 48 h and 72 h SI > 0.7 were associated with 7-day (4.23 (2.07-8.66) and 3.24 (1.41-7.42) respectively) and 90-day mortality (2.97 (1.82-4.85) and 2.05 (1.26-3.61) respectively). SI < 0.5 at baseline, 48 h and 72 h was associated with decreased pneumonia risk. 24 h and 48 h SI > 0.7was associated with increased MACE risk. 48 h and 72 h SI > 0.7 was associated with increased odds of higher 90-day mRS. CONCLUSION Higher-than-normal SI subsequent to initial encounter was associated with higher post-ICH mortality at 3, 7, and 90 days. Lower-than-normal SI was associated with a decreased risk of incident pneumonia.
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Affiliation(s)
- Tiberiu A Pana
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Jesus A Perdomo-Lampignano
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Weronika A Szlachetka
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Charles Knoery
- Centre for Rural Health, University of the Highlands and Islands, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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Batra P, Bhat R, Harit D. Shock index and modified shock index among survivors and nonsurvivors of neonatal shock. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tekten BO, Temrel TA, Sahin S. Confusion, respiratory rate, shock index (CRSI-65) score in the emergency department triage may be a new severity scoring method for community-acquired pneumonia. Saudi Med J 2020; 41:473-478. [PMID: 32373913 PMCID: PMC7253831 DOI: 10.15537/smj.2020.5.25069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To investigate whether confusion, respiratory rate, shock index-age ≥65 years (CRSI-65) score, consisting of basic physiological parameters, can be used for severity prediction in patients with community-acquired pneumonia. Methods: This is a prospective cohort and single-center study conducted in Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey between January 2018 and June 2018. The study investigated CRSI-65 score in predicting 4-week mortality and the need for intensive care for patients with community-acquired pneumonia. Results: A total of 58 patients with community-acquired pneumonia admitted to the emergency department were included in this study. Of the patients, 62.1% were males (n=36), and the mean age of the patients was 72.87 ± 12.30 years. After 4 weeks of follow-up, CURB-65 and CRSI-65 scores showed similar results in predicting mortality with respect to specificity, sensitivity, and positive and negative predictive values. Area under the receiver operating characteristic curve was 0.926 for the CURB-65 (95% confidence interval [CI] 0.853-0.999) and 0.954 for the CRSI-65 (95% CI 0.899-0.999). Conclusion: Similar to the CURB-65 score, the CRSI-65 score appears to be useful in predicting 4-week mortality. The evaluation of CRSI-65 score can be used in emergency department triage, primary care, and non-hospital settings.
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Affiliation(s)
- Beliz O Tekten
- Department of Emergency Medicine, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey. E-mail.
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Community-Acquired Pneumonia. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Guidelines. 2020 Update. Arch Bronconeumol 2020. [PMID: 32139236 DOI: 10.1016/j.arbres.2020.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The guidelines for community-acquired pneumonia, last published in 2010, have been updated to provide recommendations based on a critical summary of the latest literature to help health professionals make the best decisions in the care of immunocompetent adult patients. The methodology was based on 6 PICO questions (on etiological studies, assessment of severity and decision to hospitalize, antibiotic treatment and duration, and pneumococcal conjugate vaccination), agreed by consensus among a working group of pulmonologists and an expert in documentation science and methodology. A comprehensive review of the literature was performed for each PICO question, and these were evaluated in in-person meetings. The American Thoracic Society guidelines were published during the preparation of this paper, so the recommendations of this association were also evaluated. We concluded that the etiological source of the infection should be investigated in hospitalized patients who have suspected resistance or who fail to respond to treatment. Prognostic scales, such as PSI, CURB 65, and CRB65, are useful for assessing severity and the decision to hospitalize. Different antibiotic regimens are indicated, depending on the treatment setting - outpatient, hospital, or intensive care unit - and the resistance of PES microorganisms should be calculated. The minimum duration of antibiotic treatment should be 5 days, based on criteria of clinical stability. Finally, we reviewed the indication of the 13-valent conjugate vaccine in immunocompetent patients with risk factors and comorbidity.
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Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review. J Clin Med 2019; 8:jcm8081144. [PMID: 31370356 PMCID: PMC6723191 DOI: 10.3390/jcm8081144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022] Open
Abstract
Background: To improve outcomes for patients who present to hospital with suspected sepsis, it is necessary to accurately identify those at high risk of adverse outcomes as early and swiftly as possible. To assess the prognostic accuracy of shock index (heart rate divided by systolic blood pressure) and its modifications in patients with sepsis or community-acquired pneumonia. Methods: An electronic search of MEDLINE, EMBASE, Allie and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (WHO ITRP) was conducted from conception to 26th March 2019. Eligible studies were required to assess the prognostic accuracy of shock index or its modifications for outcomes of death or requirement for organ support either in sepsis or pneumonia. The methodological appraisal was carried out using the Downs and Black checklist. Evidence was synthesised using a narrative approach due to heterogeneity. Results: Of 759 records screened, 15 studies (8697 patients) were included in this review. Shock index ≥ 1 at time of hospital presentation was a moderately accurate predictor of mortality in patients with sepsis or community-acquired pneumonia, with high specificity and low sensitivity. Only one study reported outcomes related to organ support. Conclusions: Elevated shock index at time of hospital presentation predicts mortality in sepsis with high specificity. Shock index may offer benefits over existing sepsis scoring systems due to its simplicity.
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Gupta S, Alam A. Shock Index-A Useful Noninvasive Marker Associated With Age-Specific Early Mortality in Children With Severe Sepsis and Septic Shock: Age-Specific Shock Index Cut-Offs. J Intensive Care Med 2018; 35:984-991. [PMID: 30278814 DOI: 10.1177/0885066618802779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aim of the study was to analyze the association of shock index (SI) from 0 to 6 hours with early mortality in severe sepsis/septic shock and to explore its age-specific cut-off values. To investigate association of change in SI over first 6 hours with early mortality. METHODS A prospective cohort study of children (<14 years) admitted in emergency department, tertiary care hospital with severe sepsis or septic shock, divided into 3 groups: group 1: 1 month to <1 year; group 2: 1 to <6 years; group 3: 6 to 12 years. Shock index (SI = heart rate/systolic blood pressure) measured at admission (X0) and hourly till 6 hours (X1-6). Primary outcome was death within 48 hours of admission. Area under receiver operating characteristic curves were constructed for SI (0-6). Optimal cut-offs of SI 0 and SI 6, maximizing both sensitivity and specificity were determined and positive and negative predictive values (PPV, NPV) were calculated. RESULTS From 2015 to 2016, 120 children were recruited. Septic shock was present at admission in 56.7% children. Early mortality was 50%. All hourly shock indices (SI 0-6) were higher among nonsurvivors in group 2 (P ≤ .03) and group 3 (P < .001). In group 1, SI after 2 hours was higher in nonsurvivors (P 2-6: ≤ .02). Area under receiver operating characteristic curves (95% CI) for SI at 0 hour was 0.72 (0.5-0.9), 0.66 (0.5-0.8), and 0.77 (0.6-0.9) and at 6 hours was 0.8 (0.6-1), 0.75 (0.6-0.9), and 0.8 (0.7-1) in 3 groups. The cut-off values of SI 0 (sensitivity; specificity; PPV; NPV) in 3 groups: 1.98 (77; 75; 67; 83), 1.50 (65; 65; 68; 63), and 1.25 (90; 67; 77; 83) and SI6: 1.66 (85; 80; 73; 89), 1.36 (73; 70; 73; 70), and 1.30 (74; 73; 78; 69). Improvement of SI over 6 hours was associated with better outcome. Children with higher SI at both time points had higher mortality than those with SI score below the cut-offs (P = .001). CONCLUSIONS Age-specific SI cut-off values may identify children at high risk of early mortality in severe sepsis/septic shock and allow for better targeted management.
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Affiliation(s)
- Sarika Gupta
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Areesha Alam
- Department of Pediatrics, King George's Medical University, Lucknow, India
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Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3. Am J Emerg Med 2016; 34:2079-2083. [DOI: 10.1016/j.ajem.2016.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022] Open
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Torabi M, Mirafzal A, Rastegari A, Sadeghkhani N. Association of triage time Shock Index, Modified Shock Index, and Age Shock Index with mortality in Emergency Severity Index level 2 patients. Am J Emerg Med 2015; 34:63-8. [PMID: 26602240 DOI: 10.1016/j.ajem.2015.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Shock Index (SI) is considered to be a predictor of mortality in many medical and trauma settings. Many studies have shown its superiority to conventional vital sign measurements in mortality prediction. OBJECTIVES The objectives were to compare mortality and intensive care unit admission prediction of triage time SI, Modified SI (MSI), and Age SI with each other and with triage time blood pressure in Emergency Severity Index (ESI) level 2 patients. METHODS A retrospective medical record review was performed in the internal medicine emergency department of a general hospital in Kerman, Iran. Triage time vital signs were used to calculate the indices. Multivarible regression analysis was used to create the final model. RESULTS A total of 1285 patients triaged to ESI level 2 were enrolled in the study. In the multivariate analysis, SI, MSI, and Age SI were found to be the only variables independently associated with mortality, whereas none of them were associated with intensive care unit admission. Sensitivity, specificity, and area under curve in the receiver operating characteristic curve for the model including SI, MSI, and Age SI were 60.8%, 65.4%, and 0.675, respectively. Sensitivity, specificity, and area under curve did not change significantly by excluding SI, MSI, or Age SI from the final model. CONCLUSION In nontrauma adult patients, triage time SI, MSI, and Age SI are superior to blood pressure for mortality prediction in ESI level 2. They can be used alone or in combination with similar results, but their low sensitivity and specificity make them usable only as an adjunct for this purpose.
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Affiliation(s)
- Mehdi Torabi
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran; Clinical Research Center, Afzalipoor Hospital, Kerman, Iran
| | - Amirhossein Mirafzal
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - Azam Rastegari
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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CUR-65 Score for Community-Acquired Pneumonia Predicted Mortality Better Than CURB-65 Score in Low-Mortality Rate Settings. Am J Med Sci 2015; 350:186-90. [PMID: 26280118 DOI: 10.1097/maj.0000000000000545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low-mortality rate settings. METHODS A retrospective cohort study of 1,230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1,409 adults with CAP. RESULTS The hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort (P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002). CONCLUSIONS CURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.
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Braun E, Kheir J, Mashiach T, Naffaa M, Azzam ZS. Is elevated red cell distribution width a prognostic predictor in adult patients with community acquired pneumonia? BMC Infect Dis 2014; 14:129. [PMID: 24597687 PMCID: PMC3973886 DOI: 10.1186/1471-2334-14-129] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards. Methods The cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization. Results The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels. Conclusions Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score.
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Affiliation(s)
- Eyal Braun
- Departments of Medicine H and B, Rambam Health Care Campus, P,O, Box 9602, 31096 Haifa, Israel.
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Nüllmann H, Pflug MA, Wesemann T, Heppner HJ, Pientka L, Thiem U. External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia. BMC Infect Dis 2014; 14:39. [PMID: 24447823 PMCID: PMC3901892 DOI: 10.1186/1471-2334-14-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 01/20/2014] [Indexed: 12/21/2022] Open
Abstract
Background For patients hospitalised due to community-acquired pneumonia (CAP), mortality risk is usually estimated with prognostic scores such as CRB-65 or CURB-65. For elderly patients, a new score referred to as CURSI has been proposed which uses shock index (SI) instead of the blood pressure (B) and age (65) criteria. The new score has not been externally validated to date. Methods We used data from a hospital-based CAP registry to compare the ability of CURSI, CURB-65 and CRB-65 to predict mortality at day 30 after hospital admission. Patients were stratified by score points as well as score-point-based risk categories, and mortality for each group was assessed. To compare test performance, receiver-operating characteristic (ROC) curves were constructed, and the areas under the curve (AUROC) were calculated with 95% confidence intervals (CI). Results We analysed 553 inpatients (45% females, median age 78 years) hospitalised between 2005 and 2009 for CAP. Overall, mortality at day 30 was 11% (59/553). The study sample was characterised by advanced comorbidity (chronic heart failure: 22%, chronic kidney failure: 27%) and functional impairment (nursing home residency: 26%, dementia: 31%). All risk scores were significantly associated with 30-day mortality. The AUROC values with 95% CI using score points for risk prediction were as follows: 0.63 [0.56-0.71] for CRB-65, 0.68 [0.61-0.75] for CURB-65 and 0.68 [0.61-0.75] for CURSI. The CURSI-defined low-risk group (0 or 1 score point) had a higher mortality (8%) than the low-risk groups defined by CURB-65 and CRB-65 (4% and 3%, respectively). Lowering the cut-off for the CURSI-defined low-risk group (0 point only) would lower the mortality to 4%, making it comparable to the CURB-65-defined low-risk group. Conclusions In our study, the CURSI-defined low-risk group had a higher 30-day mortality than the low-risk groups defined by CURB-65 and CRB-65. Lowering the cut-off value for the CURSI low-risk group would result in a mortality comparable to the CURB-65-defined low risk group. Even then, however, CURSI does not perform better than the established risk scores.
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Affiliation(s)
| | | | | | | | | | - Ulrich Thiem
- Department of Geriatrics, Marienhospital Herne, University of Bochum, Widumer Str, 8, Herne D-44627, Germany.
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Kwok CS, Loke YK, Woo K, Myint PK. Risk prediction models for mortality in community-acquired pneumonia: a systematic review. BIOMED RESEARCH INTERNATIONAL 2013; 2013:504136. [PMID: 24228253 PMCID: PMC3817804 DOI: 10.1155/2013/504136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/07/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several models have been developed to predict the risk of mortality in community-acquired pneumonia (CAP). This study aims to systematically identify and evaluate the performance of published risk prediction models for CAP. METHODS We searched MEDLINE, EMBASE, and Cochrane library in November 2011 for initial derivation and validation studies for models which predict pneumonia mortality. We aimed to present the comparative usefulness of their mortality prediction. RESULTS We identified 20 different published risk prediction models for mortality in CAP. Four models relied on clinical variables that could be assessed in community settings, with the two validated models BTS1 and CRB-65 showing fairly similar balanced accuracy levels (0.77 and 0.72, resp.), while CRB-65 had AUROC of 0.78. Nine models required laboratory tests in addition to clinical variables, and the best performance levels amongst the validated models were those of CURB and CURB-65 (balanced accuracy 0.73 and 0.71, resp.), with CURB-65 having an AUROC of 0.79. The PSI (AUROC 0.82) was the only validated model with good discriminative ability among the four that relied on clinical, laboratorial, and radiological variables. CONCLUSIONS There is no convincing evidence that other risk prediction models improve upon the well-established CURB-65 and PSI models.
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Affiliation(s)
- Chun Shing Kwok
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Yoon K. Loke
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Kenneth Woo
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Phyo Kyaw Myint
- School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
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Abstract
OBJECTIVES Septic shock is frequent in children and is associated with high mortality and morbidity rates. Early recognition of severe sepsis improve outcome. Shock index (SI), ratio of heart rate (HR) and systolic blood pressure (SBP), may be a good noninvasive measure of hemodynamic instability that has been poorly studied in children. The aim of the study was to explore the usefulness of SI as an early index of prognosis for septic shock in children. METHODS The study was retrospective and performed in 1 pediatric intensive care unit at a university hospital. The following specific data were collected at 0, 1, 2, 4, and 6 hours after admission: HR and SBP for SI calculation and lactate concentration. Patients were divided into 2 groups according to their outcome (death/survival). RESULTS A total of 146 children admitted with septic shock between January 2000 and April 2010 were included. Shock index was significantly different between survivors and nonsurvivors at 0, 4, and 6 hours after admission (P = 0.02, P = 0.03, and P = 0.008, respectively). Age-adjusted SIs were different between survivors and nonsurvivors at 0 and 6 hours, with a relative risk of death at these time points of 1.85 (1.04-3.26) (P = 0.03) and 2.17 (1.18-3.96) (P = 0.01), respectively. Moreover, an abnormal SI both at admission and at 6 hours was predictive of death with relative risk of 1.36 (1.05-1.76). CONCLUSIONS In our population of children with septic shock, SI was a clinically relevant and easily calculated predictor of mortality. It could be a better measure of hemodynamic status than HR and SBP alone, allowing for the early recognition of severe sepsis.
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Peterson KL, Hardy BT, Hall K. Assessment of shock index in healthy dogs and dogs in hemorrhagic shock. J Vet Emerg Crit Care (San Antonio) 2013; 23:545-50. [PMID: 24034472 DOI: 10.1111/vec.12090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the shock index (SI) in a population of healthy dogs to a population of dogs with confirmed hemorrhagic shock. DESIGN Retrospective analysis of data collected prospectively from 2 previous studies. SETTING University teaching hospital. ANIMALS Seventy-eight healthy control dogs enrolled in a study to establish a reference interval for a tissue oxygen monitor; 38 dogs with confirmed hemorrhagic shock enrolled in a study to evaluate the tissue oxygen monitor in hemorrhagic shock. The heart rate and systolic blood pressure obtained during the respective studies were used to calculate the SI. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Shock index was significantly higher in the hemorrhage group (median 1.37, range 0.78-4.35) than the control group (median 0.91, range 0.57-1.53); 92% of the dogs in hemorrhagic shock had an SI of >0.91. Compared with controls, dogs in hemorrhagic shock had significantly lower body temperatures (median 38.3°C, range 35.6-39.9°C versus median 38.7°C, range 37.5-39.9°C), higher heart rates (median 150/min, range 120-220/min versus median 110/min range 80-150/min), lower systolic blood pressures (mean 112 mm Hg, SD ±35.8 mm Hg versus mean 125 mm Hg, SD ±21.5 mm Hg), higher lactate concentrations (median 0.51 mmol/L, range 0.078-1.41 mmol/L versus median 0.11 mmol/L, range 0.033-0.33 mmol/L), and lower hemoglobin concentrations (median 81 g/L, range 56-183 g/L versus median 162.5 g/L, range 133-198 g/L). CONCLUSIONS Shock index is a simple and easy calculation that can be used as an additional triage tool and should prompt further investigation for hemorrhage if the values are >0.9.
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Affiliation(s)
- Katherine L Peterson
- Department of Veterinary Clinical Sciences, University of Minnesota, College of Veterinary Medicine, St Paul, MN, 55108
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The usefulness of confusion, urea, respiratory rate, and shock index or adjusted shock index criteria in predicting combined mortality and/or ICU admission compared to CURB-65 in community-acquired pneumonia. BIOMED RESEARCH INTERNATIONAL 2013; 2013:590407. [PMID: 24024203 PMCID: PMC3762190 DOI: 10.1155/2013/590407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 07/16/2013] [Indexed: 11/24/2022]
Abstract
Background and Objectives. The study aims to assess the usefulness of age-independent criteria CURSI and temperature adjusted CURSI (CURASI) compared to CURB-65 in predicting community-acquired pneumonia (CAP) mortality. The criteria, CRSI and CRASI, were adapted for use in primary care and compared to CRB-65. Methods. A retrospective analysis of a prospectively identified cohort of community-acquired pneumonia inpatients was conducted. Outcomes were (1) mortality and (2) mortality and/or ICU admission within six weeks. Results. 95 patients (median age = 61 years) were included. All three criteria had similar sensitivity in predicting mortality alone, with CURB-65 having slightly higher specificity. When predicting mortality and/or intensive care admission, CURSI/CURASI showed higher sensitivity and slightly lower specificity. CRSI and CRASI had higher sensitivity and lower specificity when compared with CRB-65 for predicting both primary and secondary outcomes. Results for both analyses had P values >0.05. Conclusions. In a cohort of younger patients CURSI and adjusted CURSI perform at least as well as CURB-65, with a similar trend for CRSI and adjusted CRSI compared to CRB-65. Further studies are needed in different age groups and in primary and secondary care settings.
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Myint PK, Kwok CS, Majumdar SR, Eurich DT, Clark AB, España PP, Man SY, Huang DT, Yealy DM, Angus DC, Capelastegui A, Rainer TH, Marrie TJ, Fine MJ, Loke YK. The International Community-Acquired Pneumonia (CAP) Collaboration Cohort (ICCC) study: rationale, design and description of study cohorts and patients. BMJ Open 2012; 2:bmjopen-2012-001030. [PMID: 22614174 PMCID: PMC3358618 DOI: 10.1136/bmjopen-2012-001030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To improve the understanding of the determinants of prognosis and accurate risk stratification in community-acquired pneumonia (CAP). DESIGN Multicentre collaboration of prospective cohorts. SETTING 6 cohorts from the USA, Canada, Hong Kong and Spain. PARTICIPANTS From a published meta-analysis of risk stratification studies in CAP, the authors identified and pooled individual patient-level data from six prospective cohort studies of CAP (three from the USA, one each from Canada, Hong Kong and Spain) to create the International CAP Collaboration Cohort. Initial essential inclusion criteria of meta-analysis were (1) prospective design, (2) in English language, (3) reported 30-day mortality and transfer to an intensive or high dependency care and (4) minimum 1000 participants. Common baseline patient characteristics included demographics, history and physical examination findings, comorbidities and laboratory and radiographic findings. PRIMARY AND SECONDARY OUTCOME MEASURES This paper reports the rationale, hypotheses and analytical framework and also describes study cohorts and patients. The authors aim to (1) compare the prognostic accuracy of existing CAP risk stratification tools, (2) assess patient-level determinants of prognosis, (3) improve risk stratification by combined use of scoring systems and (4) understand prognostic factors for specific patient groups. RESULTS The six cohorts assembled from 1991 to 2007 included 13 784 patients (median age 71 years, 54% men). Aside from one randomised controlled study, the remaining five were cohort studies, but all had similar inclusion criteria. Overall, there was 0%-6% missing data. A total of 6159 (44%) had severe pneumonia by Pneumonia Severity Index class IV/V. Mortality at 30 days was 8% (1036). Admission to intensive care or high dependency unit was also 8% (1059). CONCLUSIONS International CAP Collaboration Cohort provides a pooled multicentre data set of patients with CAP, which will help us to better understand the prognosis of CAP.
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Affiliation(s)
- Phyo Kyaw Myint
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Chun Shing Kwok
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Allan B Clark
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Pedro P España
- Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | - Shin Yan Man
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - David T Huang
- Department of Emergency Medicine at the University of Pittsburgh School of Medicine and The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Donald M Yealy
- VA Pittsburgh Healthcare System and Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derek C Angus
- Department of Emergency Medicine at the University of Pittsburgh School of Medicine and The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | | | - Michael J Fine
- VA Pittsburgh Healthcare System and Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yoon K Loke
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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Guo Q, Li HY, Zhou YP, Li M, Chen XK, Liu H, Peng HL, Yu HQ, Chen X, Liu N, Liang LH, Zhao QZ, Jiang M. Weight of the CURB-65 criteria for community-acquired pneumonia in a very low-mortality-rate setting. Intern Med 2012; 51:2521-7. [PMID: 22989821 DOI: 10.2169/internalmedicine.51.8159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The CURB-65 score is a simple well validated tool for the assessment of severity in community-acquired pneumonia (CAP). The weight of each criterion in very low-mortality-rate settings is unclear. The purpose of this study was to determine the weight in such setting. METHODS This study retrospectively reviewed 1,230 adult patients admitted for CAP from 2005 to 2009. RESULTS The 30-day mortality rose sharply from 0%, 1.0%, 8.2% and 16.7%, respectively, for patients with CURB-65 scores of 0, 1, 2 and 3 to 100.0% for patients with the scores of 4 (x(2) = 219.494, p<0.001). Confusion had the strongest association with mortality (odds ratio, 22.148). The presence of low blood pressure was not associated with mortality. Confusion, urea >7 mmol.L(-1) and age ≥ 65 yrs showed independent relationships with mortality (Odds ratio, 11.537, 5.988 and 10.462; respectively). Urea >7 mmol.L(-1) was most strongly associated with the sequential organ failure assessment (SOFA) scores [rank correlation coefficient (r(s)), 0.352]. Confusion had the closest relationship with hospital length of stay (r(s), 0.114). Age ≥ 65 yrs had the strongest association with costs (r(s), 0.223). Conclusion The individual CURB-65 criteria were of unequal weight for predicting the 30-day mortality, SOFA scores, hospital length of stay and costs in a very low-mortality-rate setting, and a low blood pressure was not associated with mortality.
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Affiliation(s)
- Qi Guo
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, China.
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Sankaran P, Kamath AV, Tariq SM, Ruffell H, Smith AC, Prentice P, Subramanian DN, Musonda P, Myint PK. Are shock index and adjusted shock index useful in predicting mortality and length of stay in community-acquired pneumonia? Eur J Intern Med 2011; 22:282-5. [PMID: 21570648 DOI: 10.1016/j.ejim.2010.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/11/2010] [Accepted: 12/17/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Community Acquired Pneumonia (CAP) is a common infection which is associated with a significant mortality. Shock index, heart rate divided by blood pressure, has been shown to predict mortality in several conditions including sepsis, acute myocardial infarction and traumatic injuries. Very little is known about the prognostic value of shock index in community acquired pneumonia (CAP). OBJECTIVE To examine the usefulness of shock index (SI) and adjusted shock index (corrected to temperature) (ASI) in predicting mortality and hospital length of stay in patients admitted to hospital with CAP. METHODS A prospective study was conducted in three hospitals in Norfolk & Suffolk, UK. We compared risk of mortality and longer length of stay for low (=<1.0, i.e. heart rate =< systolic BP) and high (>1.0, i.e. heart rate > systolic BP) SI and ASI adjusting for age, sex and other parameters which have been shown to be associated with mortality in CAP. RESULTS A total of 190 patients were included (males=53%). The age range was 18-101 years (median=76 years). Patients with SI & ASI >1.0 had higher likelihood of dying within 6 weeks from admission. The adjusted odds ratio for 30 days mortality were 2.48 (1.04-5.92; p=0.04) for SI and 3.16 (1.12-8.95; p=0.03) for ASI. There was no evidence to suggest that they predict longer length of stay. CONCLUSION Both SI and ASI of >1.0 predict 6 weeks mortality but not longer length of stay in CAP.
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Affiliation(s)
- Prasanna Sankaran
- Department of Respiratory Medicine, Norfolk and Norwich University Hospital, UK.
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