Objectives: This study sought to determine the risk factors for short term mortality in the victims of the heat wave of August 2003 in France from among patients evaluated in our emergency department (ED). It was hypothesised that age, temperature, and some long term therapies and pre-existing pathologies were factors associated with short term mortality. Methods: A retrospective analysis of a seven day period. Four experts decided blindly, in pairs, whether a patient had presented with a heat related problem. Inclusion criteria were: core temperature >38˚C and/ or clinical signs of dehydration. Comparisons were made between the survivors and one month nonsurvivors for 57 different items. Short term mortality was defined as death in the ED or within the first month of the ED visit. Results: Of 841 patients attending the ED in the study period, 165 were included in the study, of which most were elderly women. Thirty one (18.8%) died within one month. Factors associated with short term mortality were: a greater degree of dependent living; more severe clinical condition on admission (higher temperature and heart rate, lower blood pressure, hypoxia, and altered mental status); higher values of blood glucose, troponin, and white blood cell count; lower values of serum protein and prothrombin levels; pre-existing ischaemic cardiomyopathy; pneumonia as associated infection; and previous psychotropic treatment. The total number of survivors at one year was 91. Conclusions: Although this study is limited because of the small sample size, the results have helped determine factors useful for future identification of patients at greatest risk of death in order to implement a more efficient patient care protocol. In August 2003, France experienced an unusual and severe heat wave, responsible for an estimated 14 802 excess deaths during a period of 20 days. In Île-de-France, between 4 August and 12 August 2003, maximum temperatures were higher than 35˚C, and the minimum were never lower than 20˚C. In this region (which includes Paris) mortality increased to over 130%; 33% of all deaths registered in France during this period.1 Normally Île-de-France has a temperate climate, and it is rare to have air conditioning in homes and hospitals. The heat wave caused an influx of patients to French emergency services.Our emergency department (ED) is an adult urban teaching emergency service which is part of the university hospital system of the Public Assistance Hospitals of Paris (AP-HP). Our yearly attendance is 43 000 patients. Between 8 August and 14 August 2003, the number of patients attending our ED increased by about 10% compared with the previous year.Until now, studies performed in the setting of heat wave have essentially concerned heat stroke.2 3 This condition requires a fever of >40˚C and altered mental status, and is the best defined of all heat related illnesses. Studies concerning all other clinical presentations, whether heat stress or heat exhaustion, in which signs and symptoms are related to water or salt depletion...

Introduction Vitamin D deficiency in children is related to the augmented risk of bone illnesses, but its effect on critically ill children is still conflicting. This meta‐analysis study was performed to assess the relationship between vitamin D deficiency in children and sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and duration of mechanical ventilation in critically ill children. Methods Through a systematic literature search up to June 2020, 16 studies with 2382 children, 1229 children of them with vitamin D deficiency, were found recording relationships between vitamin D deficiency and sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and/or duration of mechanical ventilation. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated between vitamin D deficiency children to non‐vitamin D deficiency children on the different outcomes in critically ill children using the dichotomous or continuous methods with a random or fixed‐effect model. Results The vitamin D deficiency children category had significantly higher sepsis (OR, 2.35; 95% CI, 1.19‐4.63, P = .01); paediatric risk of mortality III score (OR, 2.19; 95% CI, 1.13‐4.25, P = .02); higher length of hospital stay (OR, 4.26; 95% CI, 0.81‐7.70, P = .02); higher duration of mechanical ventilation (OR, 1.89; 95% CI, 0.22‐3.56, P = .03) compared with that in the non‐vitamin D deficiency children. However, the need for ventilation support in vitamin D deficiency children did not significantly differ from non‐vitamin D deficiency children (OR, 2.00; 95% CI, 0.98‐4.07, P = .06) with relatively higher results in vitamin D deficiency children. Conclusions Vitamin D deficiency in children might have an independent relationship with higher sepsis, paediatric risk of mortality III score, length of hospital stay, and duration of mechanical ventilation. The relation was relative with a higher risk in need for ventilation support with vitamin D deficiency children. This relationship encouraged us to recommend testing vitamin D levels in all critically ill children and providing them with supplemental vitamin D as prophylaxis.

Introduction National Early Warning Score (NEWS) was launched in 2012 by the Royal College of Physicians in UK with an aim to improve the assessment of critical patients and timely detection of clinical deterioration. Objective To assess the performance of NEWS in emergency intensive care unit (EICU) patients in Beijing, PROC. Design prospective cohort study. Setting EICU in a university hospital. Methods The inclusion criteria were patients who stayed in the EICU beds under Department of Emergency Medicine, Xuanwu Hospital of Capital Medical University. Data of patients on admission were collected and calculated NEWS. Main outcome measure was death within 24 hours. The ability to predict mortality was assessed by area under the receiver operating characteristic curve (AUROC) analysis. Results Data on 540 consecutive EICU patients were collected from 1st January, 2013 to 31st March, 2013. Scores of 7 or more were associated with increased risk of death (OR=16.8; 95% CI 6.6-42.9). The AUROC for death within 24 h of admission was 0.85 (95% CI 0.79-0.90). Conclusions NEWS is applicable and feasible for EICU patients in Beijing. This study shows that the prediction power of NEWS for death within 24 hours of acutely ill patients attending Xuan Wu Hospital is comparable to that reported for the United Kingdom patients. (Hong Kong j.emerg.med. 2015;22:137-144)

Background: For critical patients in resuscitation room, the early prediction of potential risk and rapid evaluation of disease progression would help physicians with timely treatment, leading to improved outcome. In this study, it focused on the application of National Early Warning Score on predicting prognosis and conditions of patients in resuscitation room. The National Early Warning Score was compared with the Modified Early Warning Score) and the Acute Physiology and Chronic Health Evaluation II. Objectives: To assess the significance of NEWS for predicting prognosis and evaluating conditions of patients in resuscitation rooms. Methods: A total of 621 consecutive cases from resuscitation room of Xuanwu Hospital, Capital Medical University were included during June 2015 to January 2016. All cases were prospectively evaluated with Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II and then followed up for 28 days. For the prognosis prediction, the cases were divided into death group and survival group. The Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II results of the two groups were compared. In addition, receiver operating characteristic curves were plotted. The areas under the receiver operating characteristic curves were calculated for assessing and predicting intensive care unit admission and 28-day mortality. Results: For the prognosis prediction, in death group, the National Early Warning Score (9.50 ± 3.08), Modified Early Warning Score (4.87 ± 2.49), and Acute Physiology and Chronic Health Evaluation II score (23.29 ± 5.31) were significantly higher than National Early Warning Score (5.29 ± 3.13), Modified Early Warning Score (3.02 ± 1.93), and Acute Physiology and Chronic Health Evaluation II score (13.22 ± 6.39) in survival group (p < 0.01). For the disease progression evaluation, the areas under the receiver operating characteristic curves of National Early Warning Score, Modified Early Warning Score, and Acute Physiology and Chronic Health Evaluation II were 0.760, 0.729, and 0.817 (p < 0.05), respectively, for predicting intensive care unit admission; they were 0.827, 0.723, and 0.883, respectively, for predicting 28-day mortality. The comparison of the three systems was significant (p < 0.05). Conclusion: The performance of National Early Warning Score for predicting intensive care unit admission and 28-day mortality was inferior than Acute Physiology and Chronic Health Evaluation II but superior than Modified Early Warning Score. It was able to rapidly predict prognosis and evaluate disease progression of critical patients in resuscitation room.