IntroductionOur aim was to study the outcomes and predictors of in-hospital cardiopulmonary resuscitation (CPR) among adult patients at a tertiary care centre in Pakistan.MethodsWe conducted a retrospective chart review of all adult patients (age ≥14 years), who underwent CPR following cardiac arrest, in a tertiary care hospital during a 5-year study period (June 1998 to June 2003). We excluded patients aged 14 years or less, those who were declared dead on arrival and patients with a “do not resuscitate” order. The 1- and 6-month follow-ups of discharged patients were also recorded.ResultsWe found 383 cases of adult in-hospital cardiac arrest that underwent CPR. Pulseless electrical activity was the most common initial rhythm (50%), followed by asystole (30%) and ventricular tachycardia/fibrillation (19%). Return of spontaneous circulation was achieved in 72% of patients with 42% surviving more than 24 h, and 19% survived to discharge from hospital. On follow-up, 14% and 12% were found to be alive at 1 and 6 months, respectively. Multivariable logistic regression identified three independent predictors of better outcome (survival >24 h): non-intubated status [adjusted odds ratio (aOR):3.1, 95% confidence interval (CI):1.6–6.0], location of cardiac arrest in emergency department (aOR: 18.9, 95% CI:7.0–51.0) and shorter duration of CPR (aOR:3.3, 95% CI:1.9–5.5).ConclusionOutcome of CPR following in-hospital cardiac arrest in our setting is better than described in other series. Non-intubated status before arrest, cardiac arrest in the emergency department and shorter duration of CPR were independent predictors of good outcome.
The objective of this study was to compare the efficacy of Clinical Evaluation and modified Alvarado scoring system in diagnosing acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at Surgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: This study consisted of eighty patients. Patients were divided in two groups. Group A for complete clinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring system comprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea, vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively and undergoing emergency appendectomy during this period, age >12 years and both gender. Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant female patients and those who did not give written consent. Results: A total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male (n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively. Conclusion: We conclude that modified Alvarado score can be used safely and effectively in diagnosing acute appendicitis in adult males especially as the score increases from seven to nine.
Objectives: The objective of this study was to compare the efficacy of ClinicalEvaluation and modified Alvarado scoring system in diagnosing acute appendicitis. StudyDesign: Cross sectional study. Place and Duration of Study: This study was conducted atSurgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: Thisstudy consisted of eighty patients. Patients were divided in two groups. Group A for completeclinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring systemcomprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea,vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively andundergoing emergency appendectomy during this period, age >12 years and both gender.Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant femalepatients and those who did not give written consent. Results: A total of 80 patients were includedin the study, placed alternatively into two groups of 40 patients each with majority being male(n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients ofGroup A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared onthe basis of Gender for the two groups, the positive predictive value for male patients of GroupA and B was 90.09% and 89.28% respectively, but for females the positive predictive valueof Group A and B was 100% and 50% respectively. Conclusion: We conclude that modifiedAlvarado score can be used safely and effectively in diagnosing acute appendicitis in adultmales especially as the score increases from seven to nine.
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