Predicting outcome of patients with severe urinary tract infections admitted via the emergency department
| Autor: | Erich Heine, Brian Guetschow, Daniel Young, Joshua Briscoe, Michelle Russin, Steven G. Rothrock, Caitlin Premuroso, David D. Cassidy, David Bailey, Nicholas Toselli, Drew Bienvenu |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Receiver operating characteristic business.industry Urinary system lcsh:Medical emergencies. Critical care. Intensive care. First aid Infectious Disease Retrospective cohort study Emergency department lcsh:RC86-88.9 Confidence interval Threshold probability Decision curve analysis Internal medicine medicine In patient business Original Research |
| Zdroj: | Journal of the American College of Emergency Physicians Open, Vol 1, Iss 4, Pp 502-511 (2020) Journal of the American College of Emergency Physicians Open |
| ISSN: | 2688-1152 |
| Popis: | Objective To evaluate clinical prediction tools for making decisions in patients with severe urinary tract infections (UTIs). Methods This was a retrospective study conducted at 2 hospitals (combined emergency department (ED) census 190,000). Study patients were admitted via the ED with acute pyelonephritis or severe sepsis‐septic shock related UTI. Area under the receiver operating characteristic curve (AUROC) augmented by decision curve analysis and sensitivity of each rule for predicting mortality and ICU admission were compared. Results The AUROC of PRACTICE was greater than that of BOMBARD (0.15 difference, 95% confidence interval [CI] = 0.09–0.22), SIRS (0.21 difference, 95% CI = 0.14–0.28) and qSOFA (0.06 difference, 95% CI = 0–0.11) for predicting mortality. PRACTICE had a greater net benefit compared to BOMBARD and SIRS at all thresholds and a greater net benefit compared to qSOFA between a 1% and 10% threshold probability level for predicting mortality. PRACTICE had a greater net benefit compared to all other scores for predicting ICU admission across all threshold probabilities. A PRACTICE score >75 was more sensitive than a qSOFA score >1 (90% versus 54.3%, 35.7 difference, 95% CI = 24.5–46.9), SIRS criteria >1 (18.6 difference, 95% CI = 9.5–27.7), and a BOMBARD score >2 (12.9 difference, 95% CI = 5–12.9) for predicting mortality. Conclusion PRACTICE was more accurate than BOMBARD, SIRS, and qSOFA for predicting mortality. PRACTICE had a superior net benefit at most thresholds compared to other scores for predicting mortality and ICU admissions. |
| Databáze: | OpenAIRE |
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