Background: Coronavirus Disease 2019 (COVID-19) is a pandemic of significant international concern, requiring decisive government actions with public understanding and subsequent adherence to control the spread. This study investigated the predictions of the public and healthcare workers (HCWs) at an early stage of the United Kingdom (UK) pandemic to assess their understanding of this novel virus and provide a reflection of the information readily available to them at the time. Method: A cross-sectional survey between the 18th and 20th March 2020 of UK adults was conducted via an anonymous 17-question online questionnaire using a snowball sampling technique. Simple descriptive statistics, repeated measures analysis of variance (ANOVA), and unpaired Mann-Whitney t-tests investigated significance at the P<•05 levels. Results: A total of 823 UK residents responded, of which 12•0% (n=99) were HCWs (doctors and nurses). The primary information sources used by our participants were BBC News, group messaging such as WhatsApp, and NHS England. The majority (38•9%) estimated government-enacted social restrictions would last two to four weeks. Mean best guess of total UK COVID-19 mortality was 1000 to 10,000 deaths, and the majority of participants (77•9%) revealed that they expected their day-today lives to be affected for less than six months in total. HCWs consistently estimated greater duration, scale, and impact of COVID-19 than nonhealthcare workers (Non-HCWs). Conclusion: Survey respondents greatly underestimated the duration and impact of COVID-19 on their personal and public lives. Non-HCWs made greater underestimates than HCWs. This provides a historical reference and highlights a lack of clear information regarding the pandemic at the time of the survey. There is an ongoing need for effective, realistic, and timely communication between government, front-line clinicians, and the general public to manage expectations of the course of the pandemic and, consequently, increase adherence to public health measures.
Background: Early prediction of long-term outcomes after out-of-hospital cardiac arrest (OOHCA) remains a diagnostic challenge. MIRACLE2 is a points-based risk score that has been derived as a simple tool to aid clinicians in prognosticating those at high risk of poor neurological outcomes. To date, the score has been validated in two independent cohorts in the MIRACLE2 study. The aim of this study was to validate the MIRACLE2 score in a further independent cohort, with the primary outcome poor neurological outcome at 6 months (Cerebral Performance Category (CPC) 3-5). Methods: We retrospectively identified all patients treated at the Bristol Royal Infirmary from January 2019 to July 2020 with a primary or secondary ICD-10 diagnosis code for cardiac arrest. Patients were screened against the inclusion and exclusion criteria used in the MIRACLE2 study and the data required to calculate the MIRACLE2 and CPC scores were extracted from medical records. Results: 198 patients met the OOHCA inclusion criteria and were included for analysis. Multivariable logistical regression confirmed 6 out of the 7 MIRACLE2 components as independent predictors of poor neurological outcome at 6 months: age category (60-80 years, OR 6.4, p=0.005; >80 years, OR 148.1, p<0.001), initial non-shockable rhythm (OR 36.9, p<0.001), non-reactivity of pupils (OR 13.7, p=0.002), low pH <7.20 (OR 5.1, p=0.014), adrenaline administration (OR 4.1, p=0.024), changing intra-arrest rhythms (OR 3.4, p=0.048). The MIRACLE2 score had an area under the curve of 0.89. The risk of poor neurological outcome in this cohort, across the previously described MIRACLE2 score risk groups (low <=2, intermediate 3-4, and high >=5), was comparable to that in the MIRACLE2 study (low: 15% vs. 6%; intermediate: 54% vs. 55%; and high: 93% vs. 92%, respectively). Conclusion: The MIRACLE2 score has been externally validated in an independent cohort as an accurate predictor of poor neurological outcome following OOHCA.
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