Performance on the APACHE II, SAPS II, SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia.

OBJECTIVE: This study assessed the ability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, and out-of-hospital cardiac arrest (OHCA) score to predict the outcome of OHCA patients who underwent therapeutic hypothermia (TH). METHODS: This study included OHCA patients treated with TH between January 2010 and December 2013. The APACHE II score, SAPS II, and SOFA score were calculated at the time of admission and 24 h and 48 h after intensive care unit admission. The OHCA score was calculated at the time of admission. The area under the curve (AUC) of the receiver operating characteristic curve and logistic regression analysis were used to evaluate outcome predictability. RESULTS: Data from a total of 173 patients were included in the analysis. The APACHE II score at 0 h and 48 h, SAPS II at 48 h, and OHCA score had moderate discrimination for mortality (AUC: 0.715, 0.750, 0.720, 0.740). For neurologic outcomes, the APACHE II score at 0 h and 48 h, SAPS II at 0 h and 48 h, and OHCA score showed moderate discrimination (AUC: 0.752, 0.738, 0.771, 0.771, 0.764). The APACHE II score, SAPS II and SOFA score at various time points, in addition to the OHCA score, were independent predictors of mortality and a poor neurologic outcome. CONCLUSIONS: The APACHE II score, SAPS II, SOFA score, and OHCA score have different capabilities in discriminating and estimating hospital mortality and neurologic outcomes. The OHCA score, APACHE II score and SAPS II at time zero and 48 h offer moderate predictive accuracy. Other scores at 0 h and 48 h, except for the SOFA score, are independently associated with 30-day mortality and poor cerebral performance.

Spontaneous rupture of intercostal artery after severe cough.

Pleural or abdominal hematomas induced by spontaneous rupture of intercostal artery are very rare but can often cause fatal problems leading to hypovolemic shock. Spontaneous rupture of intercostal artery mostly occurs in association with neurofibromatosis type 1, coarctation of aorta, or trauma. In the absence of these conditions, there are very few cases. We report a 39-year-old man who complained of left flank pain after severe cough for a few days. His final diagnosis was hematoma of the left lateral abdominal wall induced by rupture of the left 11th intercostal artery. He was treated immediately by transarterial embolization. Without any serious problems during hospitalization, he was discharged. This case indicates that, in generally healthy individuals, even mild physical force such as cough can lead to rupture of the intercostal artery. Although it is very rare, injury to the intercostal artery should be considered when patients complain of unexplained chest pain, abdominal pain, or flank pain after strong cough or sneezing.