Urgent and Emergency Carehttp://hdl.handle.net/20.500.12904/532024-03-29T10:24:55Z2024-03-29T10:24:55ZPrognostic accuracy of emergency department triage tools for adults with suspected COVID-19: The PRIEST observational cohort study.Sherwood Forest Hospitals NHS Foundation Trusthttp://hdl.handle.net/20.500.12904/14572021-06-03T11:53:05Z2020-09-01T00:00:00ZPrognostic accuracy of emergency department triage tools for adults with suspected COVID-19: The PRIEST observational cohort study.
Sherwood Forest Hospitals NHS Foundation Trust
Objectives: The World Health Organisation (WHO) and National Institute for Health and Care Excellence (NICE) recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to estimate the accuracy of triage tools for predicting severe illness in adults presenting to the emergency department (ED) with suspected COVID-19 infection. Methods: We undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the United Kingdom (UK). We collected data from people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020, and used presenting data to determine the results of assessment with the following triage tools: the WHO algorithm, NEWS2, CURB-65, CRB-65, PMEWS and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome. Results: We analysed data from 20892 adults, of whom 4672 (22.4%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2614 (12.5%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point) 0.70; SFAHP (7-point) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.96 and 0.95 respectively), at the expense of specificity (0.31 and 0.27 respectively). NEWS2 showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used. Conclusion: CURB-65, PMEWS and NEWS2 provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity.
Author preprint CC-BY 4.0 International license.
2020-09-01T00:00:00ZPrognostic accuracy of emergency department triage tools for children with suspected COVID-19: The PRIEST observational cohort study.Sherwood Forest Hospitals NHS Foundation Trusthttp://hdl.handle.net/20.500.12904/14562021-06-03T11:53:05Z2020-09-01T00:00:00ZPrognostic accuracy of emergency department triage tools for children with suspected COVID-19: The PRIEST observational cohort study.
Sherwood Forest Hospitals NHS Foundation Trust
Objectives: Emergency department clinicians can use triage tools to predict adverse outcome and support management decisions for children presenting with suspected COVID-19. We aimed to estimate the accuracy of triage tools for predicting severe illness in children presenting to the emergency department (ED) with suspected COVID-19 infection. Methods: We undertook a mixed prospective and retrospective observational cohort study in 44 EDs across the United Kingdom (UK). We collected data from children attending with suspected COVID-19 between 26 March 2020 and 28 May 2020, and used presenting data to determine the results of assessment using the WHO algorithm, swine flu hospital pathway for children (SFHPC), Paediatric Observation Priority Score (POPS) and Childrens Observation and Severity Tool (COAST). We recorded 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome. Results: We collected data from 1530 children, including 26 (1.7%) with an adverse outcome. C-statistics were 0.80 (95% confidence interval 0.73-0.87) for the WHO algorithm, 0.80 (0.71-0.90) for POPS, 0.76 (0.67-0.85) for COAST, and 0.71 (0.59-0.82) for SFHPC. Using pre-specified thresholds, the WHO algorithm had the highest sensitivity (0.85) and lowest specificity (0.75), but POPS and COAST could optimise sensitivity (0.96 and 0.92 respectively) at the expense of specificity (0.25 and 0.38 respectively) by using a threshold of any score above zero instead of the pre-specified threshold. Conclusion: Existing triage tools have good but not excellent prediction for adverse outcome in children with suspected COVID-19. POPS and COAST could achieve an appropriate balance of sensitivity and specificity for supporting decisions to discharge home by considering any score above zero to be positive.
Preprint CC-BY 4.0 International license.
2020-09-01T00:00:00ZCharacteristics and mortality of severe influenza cases treated with parenteral aqueous zanamivir, United Kingdom, October 2009 to January 2011.Sherwood Forest Hospitals NHS Foundation Trusthttp://hdl.handle.net/20.500.12904/14192021-06-03T11:48:36Z2019-01-01T00:00:00ZCharacteristics and mortality of severe influenza cases treated with parenteral aqueous zanamivir, United Kingdom, October 2009 to January 2011.
Sherwood Forest Hospitals NHS Foundation Trust
BACKGROUND: Aqueous zanamivir solution, an investigational product, was provided by the manufacturer on compassionate grounds for parenteral administration to severe H1N1pdm09 influenza cases during the 2009 pandemic. OBJECTIVE: To describe characteristics and outcomes of UK patients receiving parenteral zanamivir therapy. METHODS: Collaborators at multiple hospital sites gathered retrospective data on patients receiving aqueous zanamivir therapy between Q4 2009 and Q1 2011. We present analysis of the demographics, clinical features, treatment and outcomes of this cohort. RESULTS: Data on 185 cases were obtained (response rate of 38%; median age 43 years; 62% male; 17% non-Caucasian ethnic group). Most frequent co-morbidities included cancer, immunosuppression and respiratory conditions. Most patients received intravenous zanamivir alone (90%), for durations of up to 21 days. 13% of cases had adverse effects related to zanamivir therapy. Thirty four percentage of cases died. No significant relationship was seen between mortality and timing or route of administration of aqueous zanamivir therapy. CONCLUSIONS: The response rate of this observational study of the outcomes of treatment of severe influenza was low, allowing limited conclusions to be drawn. Some potential adverse effects were noted. Clinicians should carefully consider potential risks and benefits of use of this product. New treatment options are urgently required to improve outcomes for patients with severe influenza infections.
Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0)
2019-01-01T00:00:00ZHuman Infection with Fusobacterium necrophorum without Jugular Venous Thrombosis: A Varied Presentation of Lemierre’s Syndrome.Kumar, Yashwanthttp://hdl.handle.net/20.500.12904/14182021-06-03T11:48:36Z2017-10-24T00:00:00ZHuman Infection with Fusobacterium necrophorum without Jugular Venous Thrombosis: A Varied Presentation of Lemierre’s Syndrome.
Kumar, Yashwant
Lemierre’s syndrome is also known as postangina septicemia, which is commonly caused by Fusobacterium necrophorum also known as Necrobacillus and also by other microorganisms like Staphylococcus, Streptococcus, Peptostreptococcus, and Bacteroides. Though the disease starts as an upper respiratory tract infection, it may spread and cause thrombophlebitis of the internal jugular vein. It may present itself through cranial nerve palsy or sepsis involving distant organs like the lungs or bones. It is also known as forgotten disease because of its rarity. Fusobacterium necrophorum usually causes infection in animals and rarely affects humans. We hereby present a case of Necrobacillus infection which did not cause any thrombophlebitis but resulted in severe pneumonia and acute kidney injury, leading to respiratory failure and requiring mechanical ventilation.
Publisher version available.
2017-10-24T00:00:00Z