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ObjectiveTo evaluate the prognostic value of the Prehospital Index (PHI) for hospitalized patients with acute trauma.Materials and methodsPHI score and the Injury Severity Score (ISS) were determined in 1,802 hospitalized patients with acute trauma. Receiver-operator characteristic (ROC) curves were used to compare the PHI and ISS in subgroups, and corresponding prediction indicators were calculated.ResultsThere were significant differences in PHI score and ISS between the survival group and the death group (Z=2.674, P=0.007). The area under the ROC curve was 0.871 (95% CI 0.855–0.886) for PHI score and 0.792 (95% CI 0.773–0.811) for ISS. Optimal cutoff points to determine the risk of critical illness were PHI ≥4 and ISS ≥22. The sensitivity of the PHI was superior to the ISS (χ2=6.975, P=0.008), but the specificity and the accuracy of the PHI and ISS showed no significant difference (P>0.05).ConclusionThe PHI is valuable in prognostic prediction of hospitalized patients with acute trauma, and it is superior to the ISS. The PHI has such advantages as being simple in operation, easy to learn, capable of reflecting conditions timely and reliably, and suitable for dynamic evaluation and screening for critical patients with trauma.

Abstract. The aim of the present study was to investigate the safety of tirofiban alone and in combination with various treatments in acute ischemic stroke (AIS). A total of 120 patients with AIS were included in the study, and these patients were divided into three treatment groups: Group A (tirofiban alone, n=68), group B (tirofiban plus thrombolytic therapy, n=26), and group C (tirofiban as a 'bridging therapy', n=26). Risk factors, stroke severity, initial imaging, treatment regimens, complications and long-term outcomes were analyzed. In total, eight patients (6.7%) [six patients (23.1%) in group B and two patients (7.7%) in group C] had hemorrhage during or subsequent to treatment. Sixteen patients (six in group A, eight in group B and two in group C) succumbed during the hospital admission period. The mortality rate was 13.3% (8.8% for group A, 30.7% for group B and 7.7% for group C) in the acute phase. A favorable outcome (modified Rankin Scale score, 0-2) in the first three months after stroke was only observed in 43.3% of patients (44.1% in group A, 46.7% in group B and 36.4% in group C). The mean Barthel index was 72.3 in group A, 84.4 in group B and 56.8 in group C (total patient population, 71.0). The results of the present study have shown that stroke treatment with tirofiban is safe in AIS. A large randomized controlled trial in the future is required to decrease the incidence of the minor bleeding complications associated with tirofiban therapy.

Background While the influence of meteorology on carbon monoxide (CO) poisoning has been reported, few data are available on the association between air pollutants and the prediction of CO poisoning. Our objective is to explore meteorological and pollutant patterns associated with CO poisoning and to establish a predictive model. Results CO poisoning was found to be significantly associated with meteorological and pollutant patterns: low temperatures, low wind speeds, low air concentrations of sulfur dioxide (SO2) and ozone (O38h), and high daily temperature changes and ambient CO (r absolute value range: 0.079 to 0.232, all P values < 0.01). Based on the above factors, a predictive model was established: “logitPj = aj - 0.193 * temperature - 0.228 * wind speed + 0.221 * 24 h temperature change + 1.25 * CO - 0.0176 * SO2 + 0.0008 *O38h; j = 1, 2, 3, 4; a1 = -4.12, a2 = -2.93, a3 = -1.98, a4 = -0.92.” The proposed prediction model based on combined factors showed better predictive capacity than a model using only meteorological factors as a predictor. Conclusion Low temperatures, wind speed, and SO2 and high daily temperature changes, O38h, and CO are related to CO poisoning. Using both meteorological and pollutant factors as predictors could help facilitate the prevention of CO poisoning.

Objective. This meta-analysis aimed to determine the prognostic performance of quick sequential organ failure assessment (qSOFA) score in comparison to systemic inflammatory response syndrome (SIRS) in predicting in-hospital mortality in the emergency department (ED) patients. Methods. Eligible studies comparing the performance of qSOFA and SIRS in predicting in-hospital death of ED patients were identified from searching PubMed, Embase, and Cochrane. Raw data were collected, and the pooled sensitivity and specificity were calculated for qSOFA and SIRS. The summary receiver operating curve was also plotted to calculate the area under the curve. Results. A total of 16 prospective studies with 35,756 patients and 2,285 deaths were included. The pooled sensitivity was 0.43 (95% CI: 0.32–0.54) and 0.8 (95% CI: 0.73–0.86) for qSOFA and SIRS, respectively. The pooled specificity was 0.89 (95% CI: 0.84–0.93) and 0.39 (95% CI: 0.3–0.5) for qSOFA and SIRS, respectively. The area under the summary receiver operating curve was 0.76 (95% CI: 0.72–0.8) and 0.67 (95% CI: 0.62–0.72) for qSOFA and SIRS, respectively. A significant heterogeneity was observed for both qSOFA and SIRS studies. Conclusion. The present meta-analysis suggested that qSOFA had a higher specificity but a lower sensitivity as compared with SIRS in predicting in-hospital mortality in the ED patients. qSOFA appeared to be a more concise and simple way to recognize patients at high risk for death. However, the use of SIRS in the ED cannot be completely replaced since the sensitivity of qSOFA was relatively lower.

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