Predicting outcome of patients with severe urinary tract infections admitted via the emergency department

Autor: Steven G. Rothrock, David D. Cassidy, Brian Guetschow, Drew Bienvenu, Erich Heine, Joshua Briscoe, Nicholas Toselli, Michelle Russin, Daniel Young, Caitlin Premuroso, David Bailey, and ORMC Sepsis Study Group
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of the American College of Emergency Physicians Open, Vol 1, Iss 4, Pp 502-511 (2020)
Druh dokumentu: article
ISSN: 2688-1152
DOI: 10.1002/emp2.12133
Popis: Abstract 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: Directory of Open Access Journals
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