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Comparison of the Poisoning Severity Score, Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II Score with Lactate to assess the outcome in Acute Organophosphorus Poisoning

2023-04-01T00:00:00Z

Title: Comparison of the Poisoning Severity Score, Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II Score with Lactate to assess the outcome in Acute Organophosphorus Poisoning Authors: Krishna, Moorthy.; Manjupriya, S.; Rajesh, K.; Devendra Prasad, K J Abstract: ABSTRACT Introduction: Organophosphorus pesticide self-poisoning is estimated to kill around 200000 people yearly. Early recognition is life-saving as the mortality rates are high following OP Poisoning. Acute Physiology and Chronic Health Evaluation II Score (APACHE II) Sequential Organ Failure Assessment Score (SOFA), and Poisoning Severity Score (PSS) with Lactate, are used to evaluate the prognosis. Materials and Methods: This prospective observational study included 236 individuals with acute OP poisoning who presented to the emergency department and were hospitalized in the critical care unit and step-down ICU. PSS, SOFA, and APACHE II scores were calculated at Emergency Department and followed up with the patient until discharge or death. Results and Discussion: Patients had a mean age of 32.8 ± 13.4 years and were 49.2% female and 50.8% male. Out of 236 patients, 22 patients died and 214 were discharged. The best cut-off values for predicting mortality with PSS, SOFA, and APACHE II scores were 2, 3, and 15, with AUROC of 0.929, 0.970, and 0.984. In addition to Lactate to the above scores, the AUROC increased to 0.981, 0.993, and 0.992, respectively. The study found that SOFA and APACHE II scores with Lactate are significantly associated with mortality and have strong discriminative power in predicting mortality.

A Comparative Study on Predictive Validity of Modified Shock Index, Shock Index, and Age Shock Index in Predicting the Need for Mechanical Ventilation among Sepsis Patients in a Tertiary Care Hospital

2023-03-01T00:00:00Z

Title: A Comparative Study on Predictive Validity of Modified Shock Index, Shock Index, and Age Shock Index in Predicting the Need for Mechanical Ventilation among Sepsis Patients in a Tertiary Care Hospital Authors: Devendra Prasad., K J; Bindu., Hima K C; Abhinov T, Moorthy.; Rajesh, K Abstract: Introduction: The shock index (SI), modified shock index (MSI), and age multiplied by SI (ASI) are used to assess the severity of shock. They are also used to predict the mortality of trauma patients, but their validity for sepsis patients is controversial. The aim of this study is to assess the predictive value of the SI, MSI, and ASI in predicting the need for mechanical ventilation after 24 h of admission among sepsis patients. Methods: A prospective observational study was conducted in a tertiary care teaching hospital. Patients with sepsis (235) diagnosed based on systemic inflammatory response syndrome criteria and quick sequential organ failure assessment were included in the study. The need for mechanical ventilation after 24 h is the outcome variables MSI, SI, and ASI were considered as predictor variables. The utility of MSI, SI, and ASI in predicting mechanical ventilation was assessed by receiver operative curve analysis. Data were analyzed using coGuide. Results: Among the study population, the mean age was 56.12 ± 17.28 years. MSI value at the time of disposition from the emergency room had good predictive validity in predicting mechanical ventilation after 24 h, as indicated by the area under the curve (AUC) of 0.81 (P < 0.001), SI and ASI had fair predictive validity for mechanical ventilation as indicated by AUC (0.78, P < 0.001) and (0.802, P < 0.001), respectively. Conclusion: SI had better sensitivity (78.57%) and specificity (77.07%) compared to ASI and MSI in predicting the need for mechanical ventilation after 24 h in sepsis patients admitted to intensive care units.

The impact of alcohol intoxication on early Glasgow Coma Scale‑Pupil reactivity score in patients with traumatic brain injury: A prospective observational study

2022-03-01T00:00:00Z

Title: The impact of alcohol intoxication on early Glasgow Coma Scale‑Pupil reactivity score in patients with traumatic brain injury: A prospective observational study Authors: Thamminaina, A.; Devendra Prasad, K.J.; Abhilash, T.; Krishna Moorthy, D.G.S.R.; Rajesh, K. Abstract: Background: A simple arithmetic combination of the Glasgow Coma Scale (GCS) score and pupillary response, the GCS‑Pupil (GCS‑P), extends the information provided about the patient outcome to an extent comparable to that obtained using more complex methods. The objective of the study was to compare the changes in the GCS‑P score of patients with traumatic brain injury (TBI) under alcohol intoxication and nontoxication over time. Methods: A prospective observational study was done in a hospital at the Level I trauma center. The patients admitted to the emergency department (ED) with TBI were the study participants. They were grouped into intoxicated and nonintoxicated based on blood alcohol concentration (BAC). BAC of 0.08% and above was considered intoxication. GCS‑P score in the ED and the best day 1 GCS‑P score were the outcome variables. For nonnormally distributed quantitative parameters, medians and interquartile range were compared between study groups using Mann–Whitney U‑test. P <0.05 was considered statistically significant. Results: A total of 216 patients were included in the final analysis. There was no statistically significant difference between BAC in GCS‑P score at different follow‑up periods, GCS‑P score (ED), and GCS‑P score (best day 1). Conclusion: This prospective observational study showed a low GCS‑P score for alcohol‑intoxicated patients compared to nonintoxicated patients, which was not statistically significant. There was no significant difference in emergency GCS‑P score and best day 1 score between alcohol‑intoxicated and nonintoxicated patients.

Prediction of Outcome Based on Trauma and Injury Severity Score, IMPACT and CRASH Prognostic Models in Moderate-to-Severe Traumatic Brain Injury in the Elderly.

2021-07-01T00:00:00Z

Title: Prediction of Outcome Based on Trauma and Injury Severity Score, IMPACT and CRASH Prognostic Models in Moderate-to-Severe Traumatic Brain Injury in the Elderly. Authors: Siva Rama Krishna Moorthy, Dhoni Ganesh; Krishnappa, Rajesh; Manju Priya, Sarathy; Abhinov, Thaminaina; Devendra Prasad, Kalavagunta Jyothiswarapillai Abstract: Objectives: This study aimed to evaluate the trauma and injury severity score (TRISS), IMPACT (international mission for prognosis and analysis of clinical trials), and CRASH (corticosteroid randomization after significant head injury) prognostic models for prediction of outcome after moderate‑to‑severe traumatic brain injury (TBI) in the elderly following road traffic accident. Design: This was a prospective observational study. Materials and Methods: This was a prospective observational study on 104 elderly trauma patients who were admitted to tertiary care hospital, over a consecutive period of 18 months from December 2016 to May 2018. On the day of admission, data were collected from each patient to compute the TRISS, IMPACT, and CRASH and outcome evaluation was prospectively done at discharge, 14th day, and 6‑month follow‑up. Results: This study included 104 TBI patients with a mean age of 66.75 years and with a mortality rate of 32% and 45%, respectively, at discharge and at the end of 6 months. The predictive accuracies of the TRISS, CRASH (computed tomography), and IMPACT (core, extended, laboratory) were calculated using receiver operator characteristic (ROC) curves for the prediction of mortality. Best cutoff point for predicting mortality in elderly TBI patients using TRISS system was a score of ≤88 (sensitivity 94%, specificity of 80%, and area under ROC curve 0.95), similarly cutoff point under the CRASH at 14 days was score of >35 (100%, 80%, 0.958); for CRASH at 6 months, best cutoff point was at >84 (88%, 88%, 0.959); for IMPACT (core), it was >38 (88%, 93%, 0.976); for IMPACT (extended), it was >27 (91%, 89%, 0.968); and for IMPACT (lab), it was >41 (82%, 100%, 0.954). There were statistical differences among TRISS, CRASH (at 14 days and 6 months), and IMPACT (core, extended, lab) in terms of area under the ROC curve (P < 0.0001). Conclusion: IMPACT (core, extended) models were the strongest predictors of mortality in moderate‑to‑severe TBI when compared with the TRISS, CRASH, and IMPACT (lab) models.