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Vallipuram T, Schwartz BC, Yang SS, Jayaraman D, Dial S. External validation of the ISARIC 4C Mortality Score to predict in-hospital mortality among patients with COVID-19 in a Canadian intensive care unit: a single-centre historical cohort study. Can J Anaesth 2023; 70:1362-1370. [PMID: 37286748 PMCID: PMC10247267 DOI: 10.1007/s12630-023-02512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/19/2022] [Accepted: 12/31/2022] [Indexed: 06/09/2023] Open
Abstract
PURPOSE With uncertain prognostic utility of existing predictive scoring systems for COVID-19-related illness, the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) 4C Mortality Score was developed by the International Severe Acute Respiratory and Emerging Infection Consortium as a COVID-19 mortality prediction tool. We sought to externally validate this score among critically ill patients admitted to an intensive care unit (ICU) with COVID-19 and compare its discrimination characteristics to that of the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores. METHODS We enrolled all consecutive patients admitted with COVID-19-associated respiratory failure between 5 March 2020 and 5 March 2022 to our university-affiliated and intensivist-staffed ICU (Jewish General Hospital, Montreal, QC, Canada). After data abstraction, our primary outcome of in-hospital mortality was evaluated with an objective of determining the discriminative properties of the ISARIC 4C Mortality Score, using the area under the curve of a logistic regression model. RESULTS A total of 429 patients were included, 102 (23.8%) of whom died in hospital. The receiver operator curve of the ISARIC 4C Mortality Score had an area under the curve of 0.762 (95% confidence interval [CI], 0.717 to 0.811), whereas those of the SOFA and APACHE II scores were 0.705 (95% CI, 0.648 to 0.761) and 0.722 (95% CI, 0.667 to 0.777), respectively. CONCLUSIONS The ISARIC 4C Mortality Score is a tool that had a good predictive performance for in-hospital mortality in a cohort of patients with COVID-19 admitted to an ICU for respiratory failure. Our results suggest a good external validity of the 4C score when applied to a more severely ill population.
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Affiliation(s)
| | - Blair C Schwartz
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
| | - Stephen S Yang
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Dev Jayaraman
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Sandra Dial
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
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Balvardi S, Cipolla J, Touma N, Vallipuram T, Barone N, Sivarajan R, Kaneva P, Demyttenaere S, Boutros M, Lee L, Feldman LS, Fiore JF. Impact of the Covid-19 pandemic on rates of emergency department utilization and hospital admission due to general surgery conditions. Surg Endosc 2022; 36:6751-6759. [PMID: 34981226 PMCID: PMC8722748 DOI: 10.1007/s00464-021-08956-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent literature reports a decrease in healthcare-seeking behaviours by adults during the Covid-19 pandemic. Given that emergency general surgery (GS) conditions are often associated with high morbidity and mortality if left untreated, the objective of this study was to describe and quantify the impact of the Covid-19 pandemic on rates of emergency department (ED) utilization and hospital admission due to GS conditions. METHODS This cohort study involved the analysis of an institutional database and retrospective chart review. We identified adult patients presenting to the ED in a network of three teaching hospitals in Montreal, Canada during the first wave of the Covid-19 pandemic (March13-May13, 2020) and a control pre-pandemic period (March13-May13, 2019). Patients with GS conditions were included in the analysis. ED utilization rates, admission rates and 30-day outcomes were compared between the two periods using multivariate regression analysis. RESULTS During the pandemic period, 258 patients presented to ED with a GS diagnosis compared to 351 patients pre-pandemically (adjusted rate ratio (aRR) 0.75; p < 0.001). Rate of hospital admission during the pandemic was also significantly lower (aRR = 0.77, p < 0.001). Patients had a significantly shorter ED stay during the pandemic (adjusted mean difference 5.0 h; p < 0.001). Rates of operative management during the pandemic were preserved compared to the pre-pandemic period. There were no differences in 30-day complications (adjusted odds ratio (aOR) 1.46; p = 0.07), ED revisits (aOR 1.10; p = 0.66) and (re)admissions (aOR 1.42; p = 0.22) between the two periods. CONCLUSION There was a decrease in rates of ED utilization and hospital admissions due to GS conditions during the first wave of the Covid -19 pandemic; however, rates of operative management, complications and healthcare reutilization were unchanged. Although our findings are not generalizable to patients who did not seek healthcare, it was possible to successfully uphold institutional standards of care once patients presented to the ED.
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Affiliation(s)
- Saba Balvardi
- Department of Surgery, McGill University, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Josie Cipolla
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Nawar Touma
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Tharaniya Vallipuram
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Natasha Barone
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Reginold Sivarajan
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Ave, R2-104, Montreal, QC, H3G 1A4, Canada.
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Ahmed Z, Lau CH, Poole M, Arshinoff D, El-Andari R, White A, Johnson G, Doucet VM, Yilmaz R, Shi G, Natheir S, Hampshire J, Fazlollahi AM, Ramazani F, Elfaki L, Wang L, Desrosiers T, Lee M, Nisar M, Parapini ML, Larrivée S, White A, Dhillon J, Deng SX, Balamane S, Lee-Wing V, White A, Lee D, Gibert Y, Gervais V, Daniel R, Minor S, Ko G, Nguyen MA, Zablotny S, Lemieux V, Roach E, Ho J, Aggarwal I, Solish M, Lee JM, Rajendran L, Datta S, Gariscsak P, Johnson G, Del Fernandes R, Daud A, Fahey B, Zafar A, Worrall AP, Kheirelseid E, McHugh S, Moneley D, Naughton P, Fazlollahi AM, Bakhaidar M, Alsayegh A, Yilmaz R, Del Maestro RF, Harley JM, Ungi T, Fichtinger G, Zevin B, Stolz E, Bozso SJ, Kang JJ, Adams C, Nagendran J, Li D, Turner SR, Moon MC, Zheng B, Vergis A, Unger B, Park J, Gillman L, Petropolis CJ, Winkler-Schwartz A, Mirchi N, Fazlollahi A, Natheir S, Del Maestro R, Wang E, Waterman R, Kokavec A, Ho E, Harnden K, Nayak R, Malthaner R, Qiabi M, Christie S, Yilmaz R, Winkler-Schwarz A, Bajunaid K, Sabbagh AJ, Werthner P, Del Maestro R, Bratu I, Noga M, Bakhaidar M, Alsayegh A, Winkler-Schwartz A, Harley JM, Del Maestro RF, Côté D, Mortensen-Truscott L, McKellar S, Budiansky D, Lee M, Henley J, Philteos J, Gabinet-Equihua A, Horton G, Levin M, Saleem A, Monteiro E, Lin V, Chan Y, Campisi P, Meloche-Dumas L, Patocskai E, Dubrowski A, Beniey M, Bélanger P, Khondker A, Kangasjarvi E, Simpson J, Behzadi A, Kuluski K, Scott TM, Sidhu R, Karimuddin AA, Beaudoin A, McRae S, Leiter J, Stranges G, O’Brien D, Singh G, Zheng B, Moon MC, Turner SR, Salimi A, Zhu A, Tsang M, Greene B, Jayaraman S, Brown P, Zelt D, Yacob M, Keijzer R, Shawyer AC, Muller Moran HR, Ryan J, Mador B, Campbell S, Turner S, Ng K, Behzadi A, Benaskeur YI, Kasasni SM, Ammari N, Chiarella F, Lavallée J, Lê AS, Rosca MA, Semsar-Kazerooni K, Vallipuram T, Grabs D, Bougie É, Salib GE, Bortoluzzi P, Tremblay D, Kruse CC, McKechnie T, Eskicioglu C, Posel N, Fleiszer D, Berger-Richardson D, Brar S, Lim DW, Cil TD, Castelo M, Greene B, Lu J, Brar S, Reel E, Cil T, Diebel S, Nolan M, Bartolucci D, Rheault-Henry M, Abara E, Doyon J, Lee JM, Archibald D, Wadey V, Maeda A, Jackson T, Okrainec A, Leclair R, Braund H, Bunn J, Kouzmina E, Bruzzese S, Awad S, Mann S, Appireddy R, Zevin B, Gariscsak P, Liblik K, Winthrop A, Mann S, Abankwah B, Weinberg M, Cherry A, Lemieux V, Doyon J, Hamstra S, Nousiainen M, Wadey V, Marini W, Nadler A, Khoja W, Stoehr J, Aggarwal I, Liblik K, Mann S, Winthrop A, Lowy B, Vergis A, Relke N, Soleas E, Lui J, Zevin B, Nousiainen M, Simpson J, Musgrave M, Stewart R, Hall J. Canadian Conference for the Advancement of Surgical Education (C-CASE) 2021: Post-Pandemic and Beyond Virtual Conference AbstractsBlended learning using augmented reality glasses during the COVID-19 pandemic: the present and the futureActivating emotions enhance surgical simulation performance: a cluster analysisTraining in soft-tissue resection using real-time visual computer navigation feedback from the Surgery Tutor: a randomized controlled trialSonoGames: delivering a point of care ultrasound curriculum through gamificationTeaching heart valve surgery techniques using simulators: a reviewPortable, adjustable simulator for cardiac surgical skillsDesign and validity evidence for a unique endoscopy simulator using a commercial video gameComparison of a novel silicone flexor tendon repair model to a porcine tendon repair modelAssessment system using deep learningChallenges addressed with solutions, simulation in undergraduate and postgraduate surgical education, innovative education or research in surgical educationMachine learning distinguishes between skilled and less-skilled psychological performance in virtual neurosurgical performanceA powerful new tool for learning anatomy as a medical studentDevelopment and effectiveness of a telementoring approach for neurosurgical simulation training of medical studentsA team based learning approach to general otolaryngology in undergraduate medical educationStudent-led surgery interest group outreach for high school mentorship: a diversity driven initiativeRetrospective evaluation of novel case-based teaching series for first year otolaryngology residentsHarassment in surgery: assessing differences in perceptionFactors associated with medical student interest in pursuing a surgical residency: a cross-sectional survey studyUnderstanding surgical education experiences: an examination of 2 mentorship modelsLeadership development programs for surgical residents: a narrative review of the literatureValidation of knee arthroscopy simulator scoring system against subjective video analysis scoringCharacterizing the level of autonomy in Canadian cardiac surgery residentsMentorship patterns among medical students successfully matched to a surgical specialityStaying safe with laparoscopic cholecystectomy: the use of landmarking and intraoperative time-outsEndovascular aneurysm repair has changed the training paradigm of vascular residentsImplementation of a standardized handover in pediatric surgeryProcedure-specific assessment in cardiothoracic and vascular surgery: a scoping reviewLongitudinal mentorship-based programs for junior medical students increases exposure, confidence, and interest in surgeryCreating a green-shift in surgical education: a scoping review of initiatives and methods to make perioperative care more sustainableA novel plastic surgery residency bootcamp: structure and utilityVideo-based coaching for surgical residents: a systematic review and meta-analysisVirtual patient cases aligned with EPAs provide innovative e-learning strategiesAchieving competency in the CanMEDS roles for surgical trainees in the COVID-19 era: What have we learned and where do we go?Profiles of burnout and response to the COVID-19 pandemic among general surgery residents at a large academic training programLearner-driven telemedicine curriculum during the COVID-19 pandemicCentralized basic orthopaedic surgery virtual examinations — assessment of examination environmentEffects of the COVID-19 pandemic on surgical resident training: a nationwide survey of Canadian program directorsExploring the transition to virtual care in surgery and its impact on clinical exposure, teaching, and assessment during the COVID-19 pandemiecImpact of COVID-19 on procedural skills training and career preparation of medical studentsVirtual surgical shadowing for undergraduate medical students amidst the COVID-19 pandemicEducational impact of the COVID-19 third wave on a competency-based orthopedic surgery programVirtualization of postgraduate residency interviews: a ransforming practice in health care educationAn informational podcast about Canadian plastic surgery training programs: “Doctority Canada: Plastic Surgery.”Virtual versus in-person suture training: an evaluation of synchronous and asynchronous teaching paradigmsMerged virtual reality teaching of the fundamentals of laparoscopic surgery: a randomized controlled trialShould surgical skills be evaluated during virtual CaRMS residency interviews? A Canadian survey of CaRMS applicants and selection committee members during the COVID-19 pandemicImpact of the COVID-19 pandemic on surgical education for medical students: perspectives from Canada’s largest faculty of medicine. Can J Surg 2021. [PMCID: PMC8628843 DOI: 10.1503/cjs.018821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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