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Background-Adverse events (AEs), such as intracranial hemorrhage, thromboembolic event, and progressive aortic insufficiency, create substantial morbidity and mortality during continuous flow left ventricular assist device support yet their relation to blood pressure control is underexplored.

Healthcare burden associated with CDI infections and associated lead extractions has significantly increased in the recent years. Despite an increase in cost associated with CIED infections, mortality remains the same, and is higher in older patients.

IntroductionThe rising prevalence of rapid response teams has led to a demand for risk-stratification tools that can estimate a ward patient’s risk of clinical deterioration and subsequent need for intensive care unit (ICU) admission. Finding such a risk-stratification tool is crucial for maximizing the utility of rapid response teams. This study compares the ability of nine risk prediction scores in detecting clinical deterioration among non-ICU ward patients. We also measured each score serially to characterize how these scores changed with time.MethodsIn a retrospective nested case-control study, we calculated nine well-validated prediction scores for 328 cases and 328 matched controls. Our cohort included non-ICU ward patients admitted to the hospital with a diagnosis of infection, and cases were patients in this cohort who experienced clinical deterioration, defined as requiring a critical care consult, ICU admission, or death. We then compared each prediction score’s ability, over the course of 72 hours, to discriminate between cases and controls.ResultsAt 0 to 12 hours before clinical deterioration, seven of the nine scores performed with acceptable discrimination: Sequential Organ Failure Assessment (SOFA) score area under the curve of 0.78, Predisposition/Infection/Response/Organ Dysfunction Score of 0.76, VitalPac Early Warning Score of 0.75, Simple Clinical Score of 0.74, Mortality in Emergency Department Sepsis of 0.74, Modified Early Warning Score of 0.73, Simplified Acute Physiology Score II of 0.73, Acute Physiology and Chronic Health Evaluation II of 0.72, and Rapid Emergency Medicine Score of 0.67. By measuring scores over time, it was found that average SOFA scores of cases increased as early as 24 to 48 hours prior to deterioration (P = 0.01). Finally, a clinical prediction rule which also accounted for the change in SOFA score was constructed and found to perform with a sensitivity of 75% and a specificity of 72%, and this performance is better than that of any SOFA scoring model based on a single set of physiologic variables.ConclusionsICU- and emergency room-based prediction scores can also be used to prognosticate risk of clinical deterioration for non-ICU ward patients. In addition, scoring models that take advantage of a score’s change over time may have increased prognostic value over models that use only a single set of physiologic measurements.

Objective The lung injury prediction score (LIPS) identifies patients at risk for ARDS in the emergency department (ED) but it has not been validated in non-ED hospitalized patients. We aimed to evaluate whether LIPS identifies non-ED hospitalized patients at risk of developing ARDS at the time of critical care contact. Design Retrospective study. Setting Five academic medical centers. Patients Nine hundred consecutive patients (≥18 y/o) with at least one ARDS risk factor at the time of critical care contact. Interventions None. Measurements and Main Results LIPS was calculated using the worst values within the 12 hours before initial critical care contact. Patients with ARDS at the time of initial contact were excluded. ARDS developed in 124 (13.7%) patients a median of 2 days (IQR 2–3) after critical care contact. Hospital mortality was 22% and was significantly higher in ARDS than non-ARDS patients (48% vs. 18%, p<0.001). Increasing LIPS was significantly associated with development of ARDS (OR 1.31, 95%CI 1.21–1.42) and the composite outcome of ARDS or death (OR 1.26, 95%CI 1.18–1.34). A LIPS ≥ 4 was associated with the development of ARDS (OR 4.17, 95%CI 2.26–7.72), composite outcome of ARDS or death (OR 2.43, 95%CI 1.68–3.49), and ARDS after accounting for the competing risk of death (HR 3.71, 95%CI 2.05–6.72). For ARDS development, the LIPS has an AUROC of 0.70 and a LIPS ≥ 4 has 90% sensitivity (misses only 10% of ARDS cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value. Conclusions In a cohort of non-ED hospitalized patients, the LIPS and LIPS ≥ 4 can identify patients at increased risk of ARDS and/or death at the time of critical care contact but it does not perform as well as in the original ED cohort.

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