Surgical Intervention in Patients With Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score
| Autor: | Udi Shapira, Ishai Levin, Neta Solomon, Benny Almog, Yuval Fouks, Aviad Cohen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Decision Support Techniques Cohort Studies 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Internal medicine Pelvic inflammatory disease Odds Ratio medicine Electronic Health Records Humans 030212 general & internal medicine Ovarian Diseases Treatment Failure Abscess Retrospective Studies 030219 obstetrics & reproductive medicine Framingham Risk Score business.industry Medical record Obstetrics and Gynecology Retrospective cohort study General Medicine Odds ratio Fallopian Tube Diseases medicine.disease tubo-ovarian abscess Confidence interval Logistic Models Female Risk assessment business |
| Zdroj: | Obstetrical & Gynecological Survey. 74:585-587 |
| ISSN: | 1533-9866 0029-7828 |
| DOI: | 10.1097/01.ogx.0000585132.55787.ae |
| Popis: | Study Objective To identify the clinical characteristics associated with surgical intervention in patients with tubo-ovarian abscess (TOA). Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Tertiary university-affiliated hospital. Patients Three hundred thirty-five patients were diagnosed with TOA based on sonographic and clinical criteria. Patients who underwent surgical intervention were compared with patients managed conservatively. Intervention Electronic medical records were used to identify patients who were diagnosed with TOA between 2007 and 2015. All patients received the same antibiotic regimen upon admission. The data extracted included microbial and pathologic reports. Clinical characteristics such as disease severity and outcomes were compared. The clinical predictors available on patient admission for surgical intervention were identified retrospectively. A logistic regression was used to determine the independent predictors of treatment failure. A risk score was created by giving a nominal weight to each predictor. The score was validated by a random bootstrap analysis. An additional validation cohort that consisted of patients diagnosed with TOA during the 2 years after the original study period was applied to the final score. Measurements and Main Results The following variables of patients who underwent surgical intervention in comparison with those successfully treated and were enrolled into the score analysis differed significantly: age at admission (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3–3.5), mean leukocytosis at admission (OR, 2.2; 95% CI, 1.3–3.6), ultrasonographic measurement of abscess diameter (OR, 3.6 95% CI, 2.0–6.3), and the presence of bilateral abscess (OR, 2.2; 95% CI, 1.3–3.9). Risk groups A, B, C, and D were positively correlated with the need for surgical intervention. Those in the highest risk group D had an antibiotic failure rate of 92%, as compared with those with the lowest risk group, in which there was a 20% risk of antibiotic failure. Conclusions Antibiotic treatment failure for TOA can be predicted on patient admission using a novel risk assessment score. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|