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Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study.

https://arctichealth.org/en/permalink/ahliterature129242
Source
Scand J Gastroenterol. 2012 Jan;47(1):28-35
Publication Type
Article
Date
Jan-2012
Author
David Levarett Buck
Morten Vester-Andersen
Morten Hylander Møller
Author Affiliation
Emergency Department, Holbæk Hospital, Denmark.
Source
Scand J Gastroenterol. 2012 Jan;47(1):28-35
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
Aged, 80 and over
Area Under Curve
Decision Support Techniques
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Peptic Ulcer Perforation - mortality - surgery
Predictive value of tests
ROC Curve
Severity of Illness Index
Abstract
The aim of the present study was to compare the ability of four clinical prediction rules to predict adverse outcome in perforated peptic ulcer (PPU): the Boey score, the American Society of Anesthesiologists (ASA) score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the sepsis score.
an observational multicenter study.
a total of 117 patients surgically treated for PPU between 1 January 2008 and 31 December 2009 in seven gastrointestinal departments in Denmark were included. Pregnant and breastfeeding women, non-surgically treated patients, patients with malignant ulcers, and patients with perforation of other organs were excluded.
30-day mortality rate.
the ability of four clinical prediction rules to distinguish survivors from non-survivors (discrimination ability) was evaluated by the area under the receiver operating characteristic curve (AUC), positive predictive values (PPVs), negative predictive values (NPVs), and adjusted relative risks.
Median age (range) was 70 years (25-92 years), 51% of the patients were females, and 73% of the patients had at least one co-existing disease. The 30-day mortality proportion was 17% (20/117). The AUCs: the Boey score, 0.63; the sepsis score, 0.69; the ASA score, 0.73; and the APACHE II score, 0.76. Overall, the PPVs of all four prediction rules were low and the NPVs high.
The Boey score, the ASA score, the APACHE II score, and the sepsis score predict mortality poorly in patients with PPU.
PubMed ID
22126610 View in PubMed
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[Activity registration in intensive care units].

https://arctichealth.org/en/permalink/ahliterature195094
Source
Tidsskr Nor Laegeforen. 2001 Feb 28;121(6):682-5
Publication Type
Article
Date
Feb-28-2001
Author
R. Haagensen
B. Jamtli
H. Moen
O. Stokland
Author Affiliation
Postoperativ/intensivavdelingen Kirurgisk divisjon Ullevål sykehus.
Source
Tidsskr Nor Laegeforen. 2001 Feb 28;121(6):682-5
Date
Feb-28-2001
Language
Norwegian
Publication Type
Article
Keywords
APACHE
Hospital Mortality
Humans
Intensive Care Units - manpower - standards - utilization
Norway
Nursing Staff, Hospital - statistics & numerical data - utilization
Quality Assurance, Health Care
Severity of Illness Index
Treatment Outcome
Abstract
Intensive care treatment is expensive and its capacity is limited. The population of elderly patients with greater need for intensive care increases. It has become more important to evaluate the use of intensive care resources and to compare it with the results of treatment. Diagnoses do not provide a satisfactory description of the stay in the intensive care unit. Scoring systems for severity of illness and for resource needs are therefore of great value. The Norwegian Board of Health has requested all intensive care units in Norway to describe their activities by scoring systems for severity of illness, SAPS II (Simplified Acute Physiology Score II) and for use of resources NEMS (Nine Equivalents of Nursing Manpower Use Score). The systems are generally well recognised, easy to learn and not time-consuming. Through SAPS II and NEMS it is possible to compare results of treatment and use of resources across intensive care units or against a standard.
PubMed ID
11293348 View in PubMed
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Acute acalculous cholecystitis in critically ill patients.

https://arctichealth.org/en/permalink/ahliterature9411
Source
Acta Anaesthesiol Scand. 2004 Sep;48(8):986-91
Publication Type
Article
Date
Sep-2004
Author
J. Laurila
H. Syrjälä
P A Laurila
J. Saarnio
T I Ala-Kokko
Author Affiliation
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Finland. jouko.laurila@pp_fimnet.fi
Source
Acta Anaesthesiol Scand. 2004 Sep;48(8):986-91
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
Bacterial Infections - complications - microbiology
Cardiac Surgical Procedures
Cholecystectomy
Cholecystitis - diagnosis - etiology - microbiology
Critical Illness
Female
Humans
Intensive Care Units
Male
Middle Aged
Multiple Organ Failure - etiology
Norepinephrine - administration & dosage - therapeutic use
Palpation
Vasoconstrictor Agents - administration & dosage - therapeutic use
Abstract
BACKGROUND: Acute acalculous cholecystitis (AAC) is a serious complication of critical illness. We evaluated the underlying diseases, clinical and diagnostic features, severity of associated organ failures, and outcome of operatively treated AAC in a mixed ICU patient population. METHODS: The data of all ICU patients who had operatively confirmed AAC during their ICU stay between 1 January 2000 and 31 December 2001 were collected from the hospital records and the intensive care unit's data management system for predetermined variables. RESULTS: Thirty-nine (1%) out of 3984 patients underwent open cholecystectomy for AAC during the two-year period. Infection was the most common admission diagnosis, followed by cardiovascular surgery. The mean APACHE II score on admission was 25, and 64% of the patients had three or more failing organs on the day of cholecystectomy. The mean length of ICU stay before cholecystectomy was 8 days, and the mean total length of ICU stay was 19 days. Most patients (85%) received norepinephrine infusion, and 90% suffered respiratory failure before cholecystectomy. Hospital mortality was 44%. The non-survivors had higher Sequential Organ Failure Assessment (SOFA) scores on the day of cholecystectomy compared to the survivors (12.9 vs. 9.5, P = 0.007). CONCLUSION: Acute acalculous cholecystitis was associated with severe illness, infection, long ICU stay, and multiple organ failure. Mortality was related to the degree of organ failure. Prompt diagnosis and active treatment of AAC can be life-saving in these patients.
PubMed ID
15315616 View in PubMed
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Acute pancreatitis: a prospective study of its incidence, aetiology, severity, and mortality in Iceland.

https://arctichealth.org/en/permalink/ahliterature9887
Source
Eur J Surg. 2002;168(5):278-82
Publication Type
Article
Date
2002
Author
H. Birgisson
P H Möller
S. Birgisson
A. Thoroddsen
K S Asgeirsson
S V Sigurjónsson
J. Magnússon
Author Affiliation
Department of Surgery, Landspítali - University Hospital, Reykjavík, Iceland.
Source
Eur J Surg. 2002;168(5):278-82
Date
2002
Language
English
Publication Type
Article
Keywords
APACHE
Acute Disease
Adult
Aged
Aged, 80 and over
Female
Humans
Iceland - epidemiology
Incidence
Length of Stay
Male
Middle Aged
Pancreatitis - diagnosis - epidemiology - etiology
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To evaluate the incidence, aetiology, severity and mortality of patients with acute pancreatitis. DESIGN: Prospective study. SETTING: University hospital, Iceland. PATIENTS AND METHODS: All 50 patients diagnosed with acute pancreatitis during the one-year period October 1998-September 1999 inclusive. MAIN OUTCOME MEASURES: APACHE II, and Ranson and Imrie scores, and C-reactive protein (CRP) concentrations. The Balthazar-Ranson criteria were used for scoring of computed tomograms (CT). RESULTS: 27 of the 50 patients were male. The median age of the whole series was 60 years (range 19-85). The estimated incidence was 32/100000 for the first attack of acute pancreatitis. The causes were; gallstones 21 (42%), alcohol 16 (32%), miscellaneous 12 (24%), and idiopathic 1 (2%). 15 (33%) of the patients had APACHE II scores > or = 9, 17 (38%) had Ranson scores of > or = 3, 23 (50%) had Imrie scores of > or = 3, and 16 (34%) had CRP concentrations over 210 mg/L during the first 4 days or > 120 mg/L during the first week. Seven patients had severe pancreatitis. 2 patients in the whole group died, and both had clinically severe pancreatitis. CONCLUSIONS: This study indicates that the incidence of less severe acute pancreatitis is rising. Prospective assessment makes it possible to evaluate the aetiological factors more accurately. Measurement of the CRP concentration is an attractive and simple alternative to the severity scoring systems currently in use.
PubMed ID
12375609 View in PubMed
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Acute Physiology and Chronic Health Evaluation II scoring system in acute myocardial infarction: a prospective validation study.

https://arctichealth.org/en/permalink/ahliterature54776
Source
Crit Care Med. 1995 May;23(5):854-9
Publication Type
Article
Date
May-1995
Author
U. Ludwigs
J. Hulting
Author Affiliation
Medical Intensive Care Unit, Department of Medicine, Södersjukhuset, Stockholm, Sweden.
Source
Crit Care Med. 1995 May;23(5):854-9
Date
May-1995
Language
English
Publication Type
Article
Keywords
APACHE
Aged
Analysis of Variance
Chi-Square Distribution
Comparative Study
Hospital Mortality
Humans
Middle Aged
Myocardial Infarction - diagnosis - mortality
Prognosis
Prospective Studies
Reproducibility of Results
Research Support, Non-U.S. Gov't
Risk factors
Sensitivity and specificity
Survivors - statistics & numerical data
Sweden - epidemiology
Abstract
OBJECTIVE: To study the usefulness of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system for prognostication of inhospital mortality in acute myocardial infarction. DESIGN: A prospective validation study. SETTING: A medical intensive care unit (ICU) at a university hospital. PATIENTS: Over a 3-yr period, 2,007 admissions of 1,714 patients with acute myocardial infarction were studied. In readmissions to the medical ICU during the same hospital stay, only the first admission was studied. MEASUREMENTS AND MAIN RESULTS: Mean age of the patients was 72 +/- 10 yrs. The medical ICU mortality rate was 13% and total hospital mortality rate was 16%. Mean APACHE II score was 11.6 +/- 6.5. There was a close correlation between observed and predicted mortality rates in classes of patients with various APACHE II scores. Observed mortality in patients with scores of 20 to 24 was higher than the predicted mortality (p
PubMed ID
7736743 View in PubMed
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Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years.

https://arctichealth.org/en/permalink/ahliterature118376
Source
Acta Anaesthesiol Scand. 2013 Jan;57(1):37-45
Publication Type
Article
Date
Jan-2013
Author
M I Sigurdsson
K. Sigvaldason
T S Gunnarsson
A. Moller
G H Sigurdsson
Author Affiliation
Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland. gislihs@landspitali.is
Source
Acta Anaesthesiol Scand. 2013 Jan;57(1):37-45
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
APACHE
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Follow-Up Studies
Hospital Mortality
Humans
Iceland - epidemiology
Infant
Intensive Care
Logistic Models
Male
Middle Aged
Positive-Pressure Respiration
Prognosis
Respiratory Distress Syndrome, Adult - epidemiology - mortality - therapy
Respiratory Function Tests
Respiratory Insufficiency - epidemiology - etiology
Sex Factors
Survival
Survival Analysis
Young Adult
Abstract
The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years.
Analysis of all patients in Iceland who fulfilled the consensus criteria for ARDS in 1988-2010. Demographic variables, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and ventilation parameters were collected from hospital charts.
The age-standardised incidence of ARDS during the study period was 7.2 cases per 100,000 person-years and was increased by 0.2 cases per year (P?
Notes
Comment In: Acta Anaesthesiol Scand. 2013 Jan;57(1):1-223216359
PubMed ID
23216361 View in PubMed
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Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores.

https://arctichealth.org/en/permalink/ahliterature168850
Source
J Crit Care. 2006 Jun;21(2):142-50
Publication Type
Article
Date
Jun-2006
Author
Monica Norena
Hubert Wong
Willie D Thompson
Sean P Keenan
Peter M Dodek
Author Affiliation
Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada V6Z 1Y6.
Source
J Crit Care. 2006 Jun;21(2):142-50
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
British Columbia
Comorbidity
Coronary Care Units - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Regression Analysis
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Treatment Outcome
Abstract
Comparison of outcomes among intensive care units (ICUs) requires adjustment for patient variables. Severity of illness scores are associated with hospital mortality, but administrative databases rarely include the elements of these scores. However, these databases include the elements of comorbidity scores. The purpose of this study was to compare the value of these scores as adjustment variables in statistical models of hospital mortality and hospital and ICU length of stay after adjustment for other covariates.
We used multivariable regression to study 1808 patients admitted to a 13-bed medical-surgical ICU in a 400-bed tertiary hospital between December 1998 and August 2003.
For all patients, after adjusting for age, sex, major clinical category, source of admission, and socioeconomic determinants of health, we found that Acute Physiology and Chronic Health Evaluation (APACHE) II and comorbidity scores were significantly associated with hospital mortality and that comorbidity but not APACHE II was significantly associated with hospital length of stay. Separate analysis of hospital survivors and nonsurvivors showed that both APACHE II and comorbidity scores were significantly associated with hospital length of stay and APACHE II score was associated with ICU length of stay.
The value of APACHE II and comorbidity scores as adjustment variables depends on the outcome and population of interest.
PubMed ID
16769457 View in PubMed
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Adverse events are common on the intensive care unit: results from a structured record review.

https://arctichealth.org/en/permalink/ahliterature124542
Source
Acta Anaesthesiol Scand. 2012 Sep;56(8):959-65
Publication Type
Article
Date
Sep-2012
Author
L. Nilsson
A. Pihl
M. Tågsjö
E. Ericsson
Author Affiliation
Division of Drug Research, Anesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Sweden. lena.nilsson@lio.se
Source
Acta Anaesthesiol Scand. 2012 Sep;56(8):959-65
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
APACHE
Adolescent
Adult
Adverse Drug Reaction Reporting Systems
Aged
Aged, 80 and over
Child
Child, Preschool
Drug-Related Side Effects and Adverse Reactions - epidemiology - prevention & control
Female
Harm Reduction
Hospital Mortality
Humans
Infant
Infant, Newborn
Intensive Care Units - statistics & numerical data
Longevity
Male
Medical Errors
Medical Records
Middle Aged
Retrospective Studies
Sweden
Young Adult
Abstract
Intensive care is advanced and highly technical, and it is essential that, despite this, patient care remains safe and of high quality. Adverse events (AEs) are supposed to be reported to internal quality control systems by health-care providers, but many are never reported. Patients on the intensive care unit (ICU) are at special risk for AEs. Our aim was to identify the incidence and characteristics of AEs in patients who died on the ICU during a 2-year period.
A structured record review according to the Global Trigger Tool (GTT) was used to review charts from patients cared for at the ICU of a middle-sized Swedish hospital during 2007 and 2008 and who died during or immediately after ICU care. All identified AEs were scored according to severity and preventability.
We reviewed 128 records, and 41 different AEs were identified in 25 patients (19.5%). Health care-associated infections, hypoglycaemia, pressure sores and procedural complications were the most common harmful events. Twenty two (54%) of the AEs were classified as being avoidable. Two of the 41 AEs were reported as complications according to the Swedish Intensive Care Registry, and one AE had been reported in the internal AE-reporting system.
Almost one fifth of the patients who died on the ICU were subjected to harmful events. GTT has the advantage of identifying more patient injuries caused by AEs than the traditional AE-reporting systems used on many ICUs.
PubMed ID
22571769 View in PubMed
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Anemia and blood transfusion practices in the critically ill: a prospective cohort review.

https://arctichealth.org/en/permalink/ahliterature143669
Source
Heart Lung. 2010 May-Jun;39(3):217-25
Publication Type
Article
Author
Jissy Thomas
Louise Jensen
Susan Nahirniak
R T Noel Gibney
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Source
Heart Lung. 2010 May-Jun;39(3):217-25
Language
English
Publication Type
Article
Keywords
APACHE
Adolescent
Adult
Aged
Aged, 80 and over
Alberta - epidemiology
Anemia - epidemiology - therapy
Comorbidity
Critical Illness
Erythrocyte Transfusion
Female
Hemoglobins
Humans
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Phlebotomy - statistics & numerical data
Prevalence
Prospective Studies
Statistics as Topic
Young Adult
Abstract
Nearly 75% of critically ill patients develop anemia in the intensive care unit (ICU). Anemia can be treated with red blood cell (RBC) transfusions, although evidence suggests that lower hemoglobin levels are tolerated in the critically ill. Despite such recommendations, variation exists in clinical practice.
A prospective cohort was assessed for anemia and RBC transfusion practices in 100 consecutive adults admitted to our General Systems ICU.
The prevalence of anemia in this cohort was 98%. Mean blood loss via phlebotomy was 25+/-10.3 mL per patient per day. The RBC transfusion rate for the ICU stay was 40%, increasing to 70% in patients whose ICU stay was >7 days. The mean pretransfusion level of hemoglobin was 7.35+/-0.47 mg/dL for the total cohort, and 8.2+/-0.65 mg/dL for those with a history of cardiovascular disease.
Anemia was common in this critically ill cohort, with hemoglobin levels continuing to drop with ICU stay. Pretransfusion hemoglobin levels were lower than reported by others, yet the RBC transfusion rate was comparable. There was no association between anemia and phlebotomy practices in our ICU.
PubMed ID
20457342 View in PubMed
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Anticholinergic activity in cerebrospinal fluid and serum in individuals with hip fracture with and without delirium.

https://arctichealth.org/en/permalink/ahliterature105435
Source
J Am Geriatr Soc. 2014 Jan;62(1):94-102
Publication Type
Article
Date
Jan-2014
Author
Watne LO
Hall RJ
Molden E
Raeder J
Frihagen F
MacLullich AMJ
Juliebø V
Nyman A
Meagher D
Wyller TB
Author Affiliation
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Source
J Am Geriatr Soc. 2014 Jan;62(1):94-102
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
APACHE
Activities of Daily Living
Aged
Aged, 80 and over
Cholinergic Antagonists - blood - cerebrospinal fluid
Comorbidity
Delirium - diagnosis - etiology
Female
Hip Fractures - complications
Humans
Male
Middle Aged
Norway
Prospective Studies
Questionnaires
Scotland
Severity of Illness Index
Abstract
To examine whether anticholinergic activity (AA) in cerebrospinal fluid (CSF) and serum is associated with risk of delirium in individuals with hip fracture.
Prospective cohort study.
Two university hospitals in Oslo, Norway, and Edinburgh, UK.
Individuals admitted with acute hip fracture (N = 151).
Participants were assessed daily for delirium using the Confusion Assessment Method (preoperatively and postoperative days 1-5 (all) or until discharge (participants with delirium)). Prefracture cognitive function was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Serum was collected preoperatively and CSF at the onset of spinal anesthesia. AA in serum (SAA) and CSF samples was determined according to a muscarinic radio receptor bioassay. The association between AA measures and delirium was evaluated using logistic multivariate analyses.
Fifty-two (54%) of the participants in Oslo and 20 (39%) in Edinburgh developed delirium. There was no statistically significant difference in AA between participants with and without delirium in Oslo (serum: 7.02 vs 6.08 pmol/mL, P = .54; CSF: 0.39 vs 0.48 pmol/mL, P = .26) or in Edinburgh (serum: 1.35 vs 1.62 pmol/mL, P = .76; CSF: 0.36 vs 0.31 pmol/mL, P = .93). Nor was there any difference in SAA (Oslo, P = .74; Edinburgh, P = .51) or CSF AA (Oslo, P = .21; Edinburgh, P = .93) when participants were subdivided into prevalent, incident, subsyndromal, and never delirium. Stratifying participants according to prefracture cognitive status (IQCODE) gave the same results.
This is the first study of AA in CSF of individuals with and without delirium. The study does not support the hypothesis that central (CSF) or peripheral (serum) AA is an important mechanism of delirium in individuals with hip fracture.
Notes
Comment In: J Am Geriatr Soc. 2014 Jul;62(7):1414-525039529
Comment In: J Am Geriatr Soc. 2014 Jul;62(7):141525039530
PubMed ID
24383557 View in PubMed
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150 records – page 1 of 15.