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Esbjerg, Denmark

Straede M.,Sydvestjysk Sygehus Esbjerg | Brabrand M.,Sydvestjysk Sygehus Esbjerg | Brabrand M.,University of Southern Denmark
PLoS ONE | Year: 2014

Background: Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Methods: Pre-planned prospective observational cohort study. Setting: Danish 460-bed regional teaching hospital. Findings: We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ2 = 2.68 (10 degrees of freedom), P = 0.998 and χ2 = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ2 = 5.56 (10 degrees of freedom), P = 0.234. Conclusion: We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision. © 2014 Stræde, Brabrand. Source

Brabrand M.,Sydvestjysk Sygehus Esbjerg | Knudsen T.,Sydvestjysk Sygehus Esbjerg | Hallas J.,University of Southern Denmark
BMJ Open | Year: 2013

Objectives: Risk assessment is an important part of emergency patient care. Risk assessment tools based on biochemical data have the advantage that calculation can be automated and results can be easily provided. However, to be used clinically, existing tools have to be validated by independent researchers. This study involved an independent external validation of four risk stratification systems predicting death that rely primarily on biochemical variables. Design: Prospective observational study. Setting: The medical admission unit at a regional teaching hospital in Denmark. Participants: Of 5894 adult (age 15 or above) acutely admitted medical patients, 205 (3.5%) died during admission and 46 died (0.8%) within one calendar day. Interventions: None. Main outcome measures: The main outcome measure was the ability to identify patients at an increased risk of dying (discriminatory power) as area under the receiver-operating characteristic curve (AUROC) and the accuracy of the predicted probability (calibration) using the Hosmer-Lemeshow goodness-offit test. The endpoint was all-cause mortality, defined in accordance with the original manuscripts. Results: Using the original coefficients, all four systems were excellent at identifying patients at increased risk (discriminatory power, AUROC ?0.80). The accuracy was poor (we could assess calibration for two systems, which failed). After recalculation of the coefficients, two systems had improved discriminatory power and two remained unchanged. Calibration failed for one system in the validation cohort. Conclusions: Four biochemical risk stratification systems can risk-stratify the acutely admitted medical patients for mortality with excellent discriminatory power. We could improve the models for use in our setting by recalculating the risk coefficient for the chosen variables. Source

Blichfeldt-Lauridsen L.,Sydvestjysk Sygehus Esbjerg | Hansen B.D.,Sydvestjysk Sygehus Esbjerg
Acta Anaesthesiologica Scandinavica | Year: 2012

Myasthenia gravis (MG) is a disease affecting the nicotinic acetylcholine receptor of the post-synaptic membrane of the neuromuscular junction, causing muscle fatigue and weakness. The myasthenic patient can be a challenge to anesthesiologists, and the post-surgical risk of respiratory failure has always been a matter of concern. The incidence and prevalence of MG have been increasing for decades and the disease is underdiagnosed. This makes it important for the anesthesiologist to be aware of possible signs of the disease and to be properly updated on the optimal perioperative anesthesiological management of the myasthenic patient. The review is based on electronic searches on PubMed and a review of the references of the articles. The following keywords were used: myasthenia gravis AND neuromuscular blocking agents, myasthenia gravis AND sevoflurane, myasthenia gravis AND epidural, myasthenia gravis AND neuromuscular blockade reversal and myasthenia gravis AND pyridostigmine. The articles included were from reviews and clinical trials written in English. MG patients can easily be anesthetized without need for post-surgery mechanical ventilation whether it is general anesthesia or peripheral nerve block. Volatile anesthesia or the use of an epidural for the patient makes it possible to avoid the use of neuromuscular blocking agents, and when used, it should be in smaller doses and the patient should be carefully monitored. This review shows that with thorough pre-operative evaluation, continuing the daily pyridostigmine and careful monitoring the MG patient can be managed safely. © 2011 The Authors Acta Anaesthesiologica Scandinavica. Source

Brabrand M.,Sydvestjysk Sygehus Esbjerg | Knudsen T.,Sydvestjysk Sygehus Esbjerg | Hallas J.,University of Southern Denmark
BMC Health Services Research | Year: 2011

Background: To examine the prognostic significance of fulfilling at least one of the Appropriateness Evaluation Protocol (AEP) criteria. Methods. Prospective observational cohort study at medical admission units at a regional teaching hospital in Denmark. 3,050 consecutively admitted patients were included, median age 66 (IQR: 50-77), 48% female. We assessed the fulfilment of the AEP criteria and mortality data, length of stay, readmissions and co-morbidity. We analyzed the association between day of admission and time of day and compared the opinion of the admitting doctors and nurses on the relevancy of admission. Results: 61.9% of the patients fulfilled the AEP criteria. Patients fulfilling were older (p < 0.001), had a higher in-hospital mortality (p < 0.001), a higher 30-days mortality (p < 0.001), a longer length of stay (p < 0.001), more readmissions within 30 days (p < 0.001) and higher co-morbidity (p < 0.001). There were no association between day of admission and fulfilment of AEP criteria, but significantly fewer patients fulfilled the AEP criteria in the morning hours (p < 0.05). The nurses found 79.1% of the admissions relevant with a sensitivity of 84.8% and a specificity of 30.1% with a Kappa of 0.16. The doctors found 76.2% of the admissions relevant with a sensitivity of 86.4% and a specificity of 40.9% and a Kappa of 0.29. Conclusions: Fulfilment of the AEP criteria adequately reflect increased morbidity and mortality of acutely admitted medical patients. © 2011 Brabrand et al; licensee BioMed Central Ltd. Source

Brabrand M.,Sydvestjysk Sygehus Esbjerg | Hosbond S.,University of Southern Denmark | Folkestad L.,Sydvestjysk Sygehus Esbjerg
European Journal of Emergency Medicine | Year: 2011

Objectives The interobserver variability of capillary refill time (CRT) has been questioned. Earlier studies of interobserver variability of CRT have been on a large number of patients but with few observers. The objective of our study was to investigate how a large group of nurses and nurse assistants would grade CRT. Methods We recorded a video of the index finger of six medical patients and these were shown to nurses and nurse assistants. They were asked to record the CRT and whether they found this value to be normal. The data were analyzed using the Fleiss Kappa Coefficient Analysis and graded according to the Landis and Koch correlation. Correlation between the exact numbers was evaluated using interclass correlation. Results Nine nurse assistants and 37 nurses participated. The patients were aged between 44 and 87 years. All but one patient had a systolic blood pressure reading above 130 mmHg. All had arterial blood oxygen saturation above 92% and all but one had normal body temperature. The j value for normality was 0.56. The interclass correlation of measurement of CRT was 0.62. Conclusion This is the largest interobserver study of CRT when looking at the number of observers. We found an only moderate agreement for the exact value of CRT and a moderate agreement for normality. We believe that CRT should be used with caution in clinical practice. European Journal of Emergency Medicine 18:46-49 © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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