WAS ADOPTED BY THE ATS BOARD OF DIRECTORS, JULY The “ Diagnostic Standards and Classification of Tuberculosis in Adults and Children” is a. Signs and Symptoms of Pulmonary and Pleural Tuberculosis The ATS-CDC recommendations are contained, for the most part, in three. tuberculosis is both a differential diagnosis for COPD and a potential delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy.
|Published (Last):||25 December 2006|
|PDF File Size:||18.16 Mb|
|ePub File Size:||16.23 Mb|
|Price:||Free* [*Free Regsitration Required]|
The simplification and modification were tested against a prospective 2-center validation cohort of adults with CAP. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort.
High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.
The validation cohort confirmed a similar paradigm. The modified version best predicted mortality. These were more suitable for clinic and emergency department. Despite substantial advances in therapeutic options, the mortality due to community-acquired pneumonia CAP remains unacceptably high. Liapikou et al 3 could not demonstrate an association between hypotension, thrombocytopenia and multilobar involvement, and mortality.
Index of /library
Our study suggests that leukopenia, hypothermia, and hypotension were not associated with mortality. How to deal with the discrepancies? Salih et al 7 recently reported that the criteria could be simplified by removing 3 infrequent variables leukopenia, thrombocytopenia, and hypothermiabut could not improve the prediction of mortality and intensive care unit ICU admission. Therefore, this is the correct application of tuberculosos minor criteria.
Could it even be modified clasuficacion orchestrate a further improvement? Hence, further studies are warranted. We performed a retrospective cohort study of adult patients admitted for the treatment of CAP to the Department of Respiratory Medicine in a Chinese affiliated tertiary tuberculoiss of a medical college from to A prospective 2 center cohort study of adults with CAP between and was conducted at the former department and the Department of Respiratory Afs in an affiliated tertiary clasificwcion of another medical college in China.
The latter hospital had more beds than the former. The simplification and modification were tested against the prospective 2 center validation cohort. Therefore, all patients were regarded as receiving adequate antibiotics and were discharged home when they reached clinical stability and became afebrile.
Ethical approval from the regulation committee Ethical Committee of Shenzhen was granted for the study protocol. Written informed consent except that from the patients with confusion was obtained prior to enrollment. A total of patients were enrolled consecutively, and 15 cases were excluded from the retrospective cohort due to exclusion criteria.
A total of 21 cases were excluded from consecutive patients in the validation cohort.
Index of /library
Clinical and diagnostic data and radiological features were collected. Laboratory variables were measured by the hospital clinical laboratories. All the patients had chest radiographys and computed tomographic scans.
The frontal and lateral chest radiographic findings and computed tomographic scan images were classified independently by 2 senior radiologists Liang and Tuuberculosis.
The statistician was blinded to the study. All statistical analyses were performed with Statistical Package for the Social Science for Windows version Xts test and univariate logistic regression were employed.
The receiver operating characteristic curves were created and the areas under the curves area under the receiver operating characteristic curves [AUCs] were calculated to illustrate and compare the accuracy of the indices. The sensitivities, specificities, positive predictive values PPVsnegative predictive values, and Youden indices were also calculated. With relatively important differences in the presentation, the prospective validation cohort included more severely ill patients.
The hospital mortalities were 1.
The validation cohort confirmed a similar pattern x 2 clasificacionn, P The sensitivity, specificity, PPV, and Youden index of modified minor criteria for predicting mortality were the best pattern in the retrospective cohort. The highest accuracy of modified minor criteria in the retrospective cohort was illustrated by the highest AUC of 0.
Modified minor criteria was performed similarly for the prediction of mortality in the retrospective cohort, but better in the validation cohort, compared with CURB score. We found that the 4 noncontributory or infrequent variables leukopenia, hypothermia, hypotension, and thrombocytopenia could be removed and that the deletion improved PPV and AUC for the prediction of mortality in the 2 cohorts.
Salih et al 7 recently discovered that a simplified score excluding 3 variables leukopenia, hypothermia, and thrombocytopenia was performed similarly for the prediction of mortality and ICU admission. The additional omission of hypotension criterion could effectively help to orchestrate an improvement in predicting mortality. Inclusion of nonpredictive variables might incur higher false positive rate clasificxcion.
Which mechanism might be envisaged to interpret the effectiveness of the additional omission in the current study? The cardiac output and the peripheral resistance produce blood pressure.
Incorporation of the blood pressure criterion into a severity scoring system may lead to false negativity in the older people who have high prevalence of systolic hypertension owing to increasing age.
The performance of scores did vary significantly between different studies in different healthcare systems. If the population of patients to which the score is being applied is significantly different from the original derivation it may be necessary to perform local recalibration of the score. Kelly et al 18 found that patients greater than 65 years of age had a higher incidence of altered mental status on presentation and that CURB scores and pneumonia severity index were higher in the older patients.
Future prospective clinical multicenter studies should also be ays to assess the generalizability. This might be envisaged to interpret the reason why modified minor criteria was performed better than CURB score for the prediction of mortality in the validation cohort.
But why not in the retrospective cohort? CURB scoring system performs well at identifying patients with pneumonia who have a low risk of death. This might be the causation. The current findings might have implications for the management of the disease, especially at the emergency department, which may improve survival.
The patients with CAP might be triaged more appropriately according to simplified minor criteria, and most accurately by using the modified version. They might help us make more accurate clinical decisions about where these patients should be treated at ICU vs non-ICUand need for advance care. Sound site decision can optimize initial antibiotic treatment and is beneficial to reducing mortality.
What we tuberculowis might constitute 2 more pragmatic rules, which were more suitable for clinic and emergency department, to predict mortality from CAP. This study has 3 main limitations. First, this was a prospective 2 center, not a multicentre, validation cohort study.
Second, there were relatively small samples. The findings might have been more robust with a greater number of patients met the criteria. Finally, the clinical outcomes data on ICU utilization were not collected. Accuracy of ICU admission prediction is pivotal to improve patient management.
The authors thank the medical science and technology foundation of Guangdong province in No. Athe planned science and technology project of Shenzhen municipality in No. FTWS for the support. H-YL, QG, and W-DS made substantial contributions to conception and design, were in charge of data collection, and wrote the manuscript. MJ was in charge of statistical analysis. We are indebted to the coasificacion, further education physicians, and postgraduates of the Departments of Respiratory Medicine for making contributions to this study.
The study was funded by the medical science and technology clasifcacion of Guangdong province in No. The authors have no conflicts of interest to disclose. National Center for Biotechnology InformationU. Journal List Medicine Baltimore v.
Published online Sep Author information Article notes Copyright and License information Disclaimer. This article has been corrected. This article has been cited by other articles in PMC. Open in a separate window. Outcome The main outcome measure was hospital mortality. Data Collection A total of patients were enrolled consecutively, and 15 cases were excluded from the retrospective cohort due to exclusion criteria.
Associations With Hospital Mortality The hospital mortalities were 1. Acknowledgements The authors thank the medical science and technology foundation of Guangdong province in No. Contributed by H-YL, QG, and W-DS made substantial contributions to conception and design, were in charge of data collection, and wrote the manuscript.
Contributed by We are indebted to the nurses, further education physicians, and postgraduates of the Departments of Respiratory Medicine for making contributions to this study.
Clin Infect Dis ; 44 Suppl 2: Evaluation of compliance with bundle treatment in the management of severe infection.
Clin Infect Dis ; Respir Med ; Eur Respir J ; Weight of the CURB criteria for community-acquired pneumonia in a very low-mortality-rate clasificacjon. Intern Med ; Guidelines for the management of adults with community-acquired pneumonia.
Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med tuberculpsis Surviving Sepsis Campaign international guidelines for management of severe sepsis and septic shock