Background
In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity.
Methods
The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp stings (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020.
Results
The data of 1131 wasp sting patients from 2011–2019 were included in the training set. Logistic regression analysis showed that tea-colored urine (TCU), number of stings, and lactate dehydrogenase (LDH) and total bilirubin (TBIL) levels were risk factors for developing a SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve (AUC) of 0.918 (95% CI 0.873–0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 hours after admission was significantly lower than that in those who did not receive PE treatment (14.3% vs. 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality.
Conclusions
Patients with WSS scores ≥ 3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.
In the early stages of the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, many cross-infections occurred due to the limited number of wards and insufficient medical staff, which could not cope with the large number of patients visiting the hospital. A series of new infection control measures were implemented in our institution and a Wuhan hospital supported by our medical team, mainly including temporarily transforming the general ward into a passage for the staff to enter the infectious ward and standardizing the procedure for the wearing and removal of personal protection equipment (PPE). These measures significantly improved the situation, and no member of our medical staff was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the middle and late stages of the disease epidemic. We hope that these experiences can provide references for medical institutions that may face an outbreak of COVID-19, especially those in underdeveloped countries and regions.
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