Objectives: This study aims to answer the question:How well do the In- Service Examinations predict performance int he Written Diplomate Certification Examination? Methodology: Descriptive statistics and measures of central tendencies were used to described the distribution of the data. Linear regression using the Pearson Product Moment Correlation was used to evaluate data. Results: Of the 50 residents who were in the program from 1999 to 2000, only were included in the study. One did not take the In- Service Examination during his 2nd year of residency while the other has yet to take her WDCE. Conclusion: This study found a high positive correlation of scores in the Philippine Board of Anesthesiology ISEs and the WDCE. The In- Service Examination is a useful tool for gauging the readiness of a resident to perform well in the Written Diplomate Certification Examination. It is also a useful method for assessing the rate of improvement of the anesthesiology resident during his training. The results of this study help to established the ISEs as a mean of determining the strengths and weaknesses of anesthesia trainees and their training programs.
Human ; ANESTHESIOLOGY ; CERTIFICATION ; SCORES, CORRELATION

Vasospasm has been known to cause permanent morbidity in 40-70% of survivors who suffered from subarachnoid hemorrhage (SAH). Early recognition of vasospasm is the key to better outcome of SAH. Cerebral angiography is expensive and impractical as a monitoring tool. Transcranial Doppler is operator dependent, and not readily available. The objective of this study is to devise a non invasive tool to screen for cerebral vasospasm following SAH. The proposed vasospasm score was based on clinical and cranial CT scan features. The features are hypertension, admission World Federation of Neurosurgeons Score (WFNS), amount of blood in the cisterns and subarachnoid space, intraventricular hemorrhage and hydrocephalus. Thirty six patients with aneurismal SAH were assessed retrospectively and correlated with the angiogram for vasospasm. The patients’ vasospasm score and their corresponding sensitivity and specificity were: 1 (100%, 0%), 2 (100%, 8%), 3 (100%, 8%), 4 (100%, 8%), 5 (91%, 46%), 6 (74%, 85%), 7 (48%, 85%), 8 (26%, 23%), 9 (3%, 100%), 10 (4%, 100%). A receiver operator characteristic curve was constructed that yielded a cut-off score of 6. The score of 6 was a good trade-off between sensitivity (74%) and specificity (85%). A clinical vasospasm score was proposed to screen for vasospasm after SAH. A score of 4 to 6 was found to correlate with angiographic vasospasm. Prospective study is required to validate the scoring system.
Vasospasm ; Subarachnoid Hemorrhage ; Clinical ; Vasospasm mechanism ; Scores

Humans ; Fasciitis, Necrotizing/diagnosis* ; Prospective Studies ; Organ Dysfunction Scores ; Prognosis

We compared the analgesic profile between patient-controlled analgesia (PCA) using oxycodone and morphine in post total abdominal hysterectomy patients. Eighty-four ASA I or II patients, aged 18 to 65 years who underwent total abdominal hysterectomy were recruited into this prospective, double blind, randomised controlled study. They were randomised to receive either PCA oxycodone 0.7 mg per bolus or PCA morphine 1 mg per bolus for postoperative pain relief. At the end of surgery, all patients received IV morphine 0.1 mg/kg and skin incision was infiltrated with 20 mls of bupivacaine 0.25%. Post-operative pain scores, opioids consumptions, sedation scores and side effects were assessed upon arrival and at 30 minutes after arrival to recovery area, as well as at 6 hours and 24 hours after the operation in the ward. Patients’ overall satisfaction was also assessed 24 hours postoperatively.No significant differences were observed in terms of postoperative pain scores, opioids consumption, sedation scores, side effects as well as patient’s overall satisfaction between the PCA oxycodone and PCA morphine group. Oxycodone was comparable to morphine as PCA in terms of total opioid consumption, pain scores and satisfaction level for patients undergoing total abdominal hysterectomy and therefore may be an alternative to morphine in postoperative pain management as PCA
morphine ; oxycodone ; pain scores ; patient controlled analgesia ; total abdominal hysterectomy

PURPOSE: The aim of the study was to validate abbreviated mortality in emergency department sepsis (MEDS) scoring system by comparing it with original MEDS score and to assess the prognostic value of other prognostic factor for sepsis patients including multiple organ dysfunction score (MODS), sepsis-related organ failure assessment (SOFA) score, and serum procalcitonin level. METHODS: Adult patients visiting emergency department (ED) with evidence of septic shock were enrolled to the study. MEDS score, MODS, and SOFA score were calculated based on initial clinical data. Receiver-operating characteristics (ROC) analyses were used to assess the prognostic factors for predicting mortality. Kaplan-Meier survival analyses (KMSA) were used to determine whether the prognostic factors had correlation with survival time. RESULTS: Only MODS showed significant predicting power for mortality (p=0.003, area under curve=0.625). Estimated median survival of all the patients calculated by KMSA was 11.0 (standard error 1.7) days, and predefined criteria of all prognostic factors showed significant differences in survival time. CONCLUSION: MEDS, abbreviated MEDS, MODS, and SOFA scoring systems were useful factors for predicting survival time of septic shock patients visiting ED.
Adult ; Calcitonin ; Emergencies ; Humans ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Protein Precursors ; Sepsis ; Shock, Septic

The Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) task force assessed the latest pathophysiological parameters associated with sepsis and septic shock and defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This SEPSIS-3 definition may be applied using relevant clinical and biological criteria including changes in the Sequential Organ Failure Assessment score and serum lactate levels. The new definition does not include criteria for systemic inflammatory response syndrome or the concept of 'severe sepsis.' The SEPSIS-3 definition aims to devise more precise descriptions of sepsis and to improve clinical care. However, there are important questions relating to the clinical application of the new definition. We review the main characteristics and limitations of previous definitions and discuss some of the potential controversies raised by the new framework.
Advisory Committees ; Consensus ; Lactic Acid ; Organ Dysfunction Scores ; Sepsis* ; Shock, Septic ; Systemic Inflammatory Response Syndrome

OBJECTIVE: To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score III (PRISM III), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis. METHODS: A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM III, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system. RESULTS: The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM III and pSOFA had a similar predictive value (P=0.210), while PRISM III had a better predictive value than PCIS (P=0.045). PRISM III had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM III and PCIS. CONCLUSIONS All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM III and PCIS.
Child ; Critical Illness ; Humans ; Organ Dysfunction Scores ; Prognosis ; ROC Curve ; Retrospective Studies ; Sepsis

OBJECTIVE: To study the significance of the level of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum and bronchoalveolar lavage fluid (BALF), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score in evaluating the conditions and prognosis of children with severe pneumonia. METHODS: A total of 76 children with severe pneumonia who were admitted from August 2017 to October 2019 were enrolled as the severe pneumonia group. According to the treatment outcome, they were divided into a non-response group with 34 children and a response group with 42 children. Ninety-four children with common pneumonia who were admitted during the same period of time were enrolled as the common pneumonia group. One hundred healthy children who underwent physical examination in the outpatient service during the same period of time were enrolled as the control group. The serum level of sTREM-1, APACHE II score, and SOFA score were measured for each group, and the level of sTREM-1 in BALF was measured for children with severe pneumonia. The correlation of the above indices with the severity and prognosis of severe pneumonia in children was analyzed. RESULTS: The severe pneumonia group had significantly higher serum sTREM-1 level, APACHEII score, and SOFA score than the common pneumonia group and the control group (P<0.05). For the children with severe pneumonia, the non-response group had significant increases in the levels of sTREM-1 in serum and BALF and SOFA score on day 7 after admission, while the response group had significant reductions in these indices, and there were significant differences between the two groups (P<0.05). Positive correlation was found between any two of serum sTREM-1, BALF sTREM-1, and SOFA score (P<0.05). APACHE II score was not correlated with serum sTREM-1, BALF sTREM-1, and SOFA score (P>0.05). CONCLUSIONS The level of sTREM-1 in serum and BALF and SOFA score can be used to evaluate the severity and prognosis of severe pneumonia in children.
APACHE ; Bronchoalveolar Lavage Fluid ; Child ; Humans ; Organ Dysfunction Scores ; Pneumonia ; Prognosis ; ROC Curve ; Sepsis ; Triggering Receptor Expressed on Myeloid Cells-1

OBJECTIVE: To explore the prognostic value of early multiple detection indicators in combination with sequential organ failure assessment (SOFA) in sepsis patients. METHODS: A retrospective analysis was conducted. Patients with sepsis admitted to the department of critical care medicine of Huanggang Central Hospital of Yangtze University from May 2020 to May 2022 were selected as the research subjects. Coagulation indicators, inflammatory factors, blood routine, liver and kidney function, and blood gas analysis were collected at admission. Organ dysfunction was assessed based on the SOFA score within 24 hours after admission. Patients were divided into a survival group and a death group according to the outcome of 28 days in ICU. Differences in the above indicators between the two groups were compared. Multifactorial Logistic regression analysis was used to analyze prognostic factors of 28-day mortality in sepsis patients. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive performance of various indicators, the SOFA score, and the combine model for the 28-day outcome in patients with sepsis. RESULTS: A total of 101 patients with sepsis were enrolled, 56 patients survived and 45 patients died. Compared to the survival group, patients in the death group were older, the proportion of patients with septic shock was larger, the SOFA score, and the proportion of pulmonary infection were higher, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly prolonged, the prothrombin activity (PTA) was significantly shortened, and antithrombin (AT) was significantly decreased, the levels of hypersensitivity C-reactive protein (hs-CRP), blood urea nitrogen (BUN), total bilirubin (TBil), and lactic acid (Lac) were significantly increased, while the platelet count (PLT) was significantly decreased. Multifactorial Logistic regression analysis showed that pulmonary infection [odds ratio (OR) = 0.010, 95% confidence interval (95%CI) was 0.001-0.164, P = 0.001], AT (OR = 0.944, 95%CI was 0.910-0.978, P = 0.002), hs-CRP (OR = 1.008, 95%CI was 1.001-1.015, P = 0.017), Lac (OR = 1.619, 95%CI was 1.195-2.193, P = 0.002), and SOFA score (OR = 1.363, 95%CI was 1.076-1.727, P = 0.010) were independent prognostic factors for 28-day mortality in patients. A combined model was constructed using pulmonary infection, AT, hs-CRP, Lac, and SOFA score. ROC curve analysis showed that the area under the ROC curve (AUC) for the combine model in predicting sepsis prognosis was 0.936 (95%CI was 0.869-0.975, P < 0.001), which was higher in value compared to single indicators (AUC of AT, hs-CRP, Lac, and SOFA score were 0.775, 0.666, 0.802, 0.796, respectively, all P < 0.05). CONCLUSIONS The predictive ability of the SOFA score for sepsis patient outcomes is limited. The combine model combining infection site, AT, hs-CRP, and Lac shows better predictive ability.
Humans ; Organ Dysfunction Scores ; Retrospective Studies ; C-Reactive Protein ; ROC Curve ; Sepsis/metabolism* ; Prognosis ; Anticoagulants ; Antithrombin III ; Intensive Care Units

BACKGROUNDComorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients. Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS), which is a component of the acute physiology and chronic health evaluation (APACHE) II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.

METHODSA total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of-sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score (APS), sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS. The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.

RESULTSOf all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WIC, CHS, APACHE II, and SOFA scores than the non-surviving patients (P < 0.05). Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WIC, CHS and APS scores (P < 0.05). The AUC for the hospital mortality were 0.564 (95% confidence interval (CI) 0.496-0.631) of CHS, 0.663 (95% CI 0.599-0.727) of WIC, 0.770 (95% CI 0.718-0.822) of APACHE II, 0.856 (95% CI 0.815-0.897) of the CHS combined with other administrative data, and 0.857 (95% CI 0.817-0.897) of the WIC combined with other administrative data. The diagnostic value of WIC was better than that of CHS (P = 0.0015).

CONCLUSIONSThe WIC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WIC might be an even better predictor of the mortality of septic patients with comorbidities than CHS.

APACHE ; Adult ; Aged ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Organ Dysfunction Scores ; Sepsis ; mortality ; pathology ; Severity of Illness Index