Lorenzo Falsetti1, Marianna Martino2, Vincenzo Zaccone3, Giovanna Viticchi4, Alessia Raponi5, Gianluca Moroncini6, Agnese Fioranelli2, Chiara di Pentima2, Alessandro Martini2, Cinzia Nitti3, Aldo Salvi3, Maurizio Burattini2, Nicola Tarquinio2. 1. Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 10, Ancona, Italy. drfalsetti@yahoo.it. 2. Internal Medicine Department, INRCA-IRCCS Hospital, Osimo (Ancona), Italy. 3. Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 10, Ancona, Italy. 4. Clinica di Neurologia, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy. 5. Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy. 6. Clinica Medica, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
Abstract
PURPOSE: To reduce intensive care unit overcrowding and optimize resources, elderly patients affected by suspected infection with declining clinical conditions could be managed in internal medicine departments with stepdown beds. However, commonly used prognostic scores, as Sequential Organ Failure Assessment (SOFA) or quick SOFA (qSOFA) have never been studied in this specific setting. The aim of this study was to evaluate the role and the accuracy of SOFA and qSOFA as prognostic scores in a population of elderly patients with suspected infection admitted to stepdown beds of two internal medicine departments. METHODS: Elderly patients admitted from the emergency department in the stepdown beds of two different internal medicine departments for suspected infection were assessed with SOFA and qSOFA scores at the admission. All patients were treated according to current guidelines. Age, sex, comorbidities, Charlson comorbidity index, SOFA and qSOFA were assessed. In-hospital death and length of hospital admission were also recorded. RESULTS: 390 subjects were enrolled. In-hospital death occurred in 144 (36.9%) patients; we observed that both SOFA (HR 1.189; 95% CI 1.128-1.253; p < 0.0001) and qSOFA (HR 1.803; 95% CI 1.503-2.164; p < 0.0001) scores were independently associated with an increased risk of in-hospital death. However, the accuracy of both SOFA (AUC: 0.686; 95% CI 0.637-0.732; p < 0.0001) and qSOFA (AUC: 0.680; 95% CI 0.641-0.735; p < 0.0001) in predicting in-hospital death was low in this population. CONCLUSION: Elderly patients admitted to stepdown beds for suspected infection experience a high rate of in-hospital death; both SOFA and qSOFA scores can be useful to identify a group of patients who can benefit from admission to an intermediate care environment, however their accuracy is low.
PURPOSE: To reduce intensive care unit overcrowding and optimize resources, elderly patients affected by suspected infection with declining clinical conditions could be managed in internal medicine departments with stepdown beds. However, commonly used prognostic scores, as Sequential Organ Failure Assessment (SOFA) or quick SOFA (qSOFA) have never been studied in this specific setting. The aim of this study was to evaluate the role and the accuracy of SOFA and qSOFA as prognostic scores in a population of elderly patients with suspected infection admitted to stepdown beds of two internal medicine departments. METHODS: Elderly patients admitted from the emergency department in the stepdown beds of two different internal medicine departments for suspected infection were assessed with SOFA and qSOFA scores at the admission. All patients were treated according to current guidelines. Age, sex, comorbidities, Charlson comorbidity index, SOFA and qSOFA were assessed. In-hospital death and length of hospital admission were also recorded. RESULTS: 390 subjects were enrolled. In-hospital death occurred in 144 (36.9%) patients; we observed that both SOFA (HR 1.189; 95% CI 1.128-1.253; p < 0.0001) and qSOFA (HR 1.803; 95% CI 1.503-2.164; p < 0.0001) scores were independently associated with an increased risk of in-hospital death. However, the accuracy of both SOFA (AUC: 0.686; 95% CI 0.637-0.732; p < 0.0001) and qSOFA (AUC: 0.680; 95% CI 0.641-0.735; p < 0.0001) in predicting in-hospital death was low in this population. CONCLUSION: Elderly patients admitted to stepdown beds for suspected infection experience a high rate of in-hospital death; both SOFA and qSOFA scores can be useful to identify a group of patients who can benefit from admission to an intermediate care environment, however their accuracy is low.
Authors: N Tarquinio; G Viticchi; V Zaccone; M Martino; A Fioranelli; P Morciano; G Moroncini; C Di Pentima; A Martini; C Nitti; A Salvi; M Burattini; L Falsetti Journal: Intern Emerg Med Date: 2021-01-11 Impact factor: 3.397
Authors: Raúl López-Izquierdo; Pablo Del Brio-Ibañez; Francisco Martín-Rodríguez; Alicia Mohedano-Moriano; Begoña Polonio-López; Clara Maestre-Miquel; Antonio Viñuela; Carlos Durantez-Fernández; Miguel Á Castro Villamor; José L Martín-Conty Journal: Int J Environ Res Public Health Date: 2020-11-12 Impact factor: 3.390
Authors: GianLuca Colussi; Giacomo Perrotta; Pierpaolo Pillinini; Alessia G Dibenedetto; Andrea Da Porto; Cristiana Catena; Leonardo A Sechi Journal: BMC Emerg Med Date: 2021-12-07