No abstract

Key Clinical MessageThe artery of Percheron (AOP) infarction always manifests as paramedian bilateral thalamic infarcts and might present as paramedian midbrain infarcts. Despite the limited MRA evaluation, due to small size of the artery, careful evaluation of the patient's history, the clinical presentation with imaging findings can facilitate the proper diagnosis.

Background Definitions and clinical criteria for sepsis have been revised in 2016. A simple bedside score ('qSOFA' , for quick Sequential [Sepsis-Related] Organ Failure Assessment) has been proposed, which incorporates hypotension (systolic blood pressure ≤100 mmHg), altered mental status and respiratory rate ≥ 22/min: the presence of at least two of these criteria has been associated with poor outcomes typical of sepsis. The aim of this study was to evaluate qSOFA as a predictor of 30-day mortality in a model with other predictors of death among patients admitted to a single-centre emergency department (ED). Methods A historical cohort study among prospectively registered patients with suspected or documented infection. The admission period was from 1 st of November 2013 to 31 th of October 2014. Baseline clinical data and data for survival were obtained from a standard sepsis admission form, the patient records and The Danish Civil Registration System. Logistic regression analysis was used to adjust for potential confounders and to determine whether the predictive factors for death in the crude analyses were independently associated with 30-day mortality. Results A total of 434 patients were included in the study. Fifty-seven (13.1%; 95% confidence interval [CI] 9.9-16.3%) patients died during the first 30 days. Among several potential confounders tested in the model we found that age (odds ratio [OR] 1.29; 95% CI 1.03-1.61), Charlson Comorbidity Score ≥ 3 (OR 3.83; 95% CI 1.41-10.37), qSOFA score ≥2 (OR 4.78; 95% CI 2.09-10.91) and lactate values (lactate values < 2.0 as reference) within the interval 2.00-3.99 (OR 2.21; 95% CI 1.06-4.62) and lactate values ≥ 4.0 (OR 3.97; 95% CI 1.44-2,92) were associated with 30-day mortality. Conclusion qSOFA can be helpful to identify infectious patients in an ED with increased risk of 30-day mortality.