ABCD2, ABCD2-I, and OTTAWA scores for stroke risk assessment: a direct retrospective comparison.

Transient ischemic attack (TIA) is a neurologic emergency characterized by cerebral ischemia eliciting a temporary focal neurological deficit. Many clinical prediction scores have been proposed to assess the risk of stroke after TIA; however, studies on their clinical validity and comparisons among them are scarce. The objective is to compare the accuracy of ABCD2, ABCD2-I, and OTTAWA scores in the prediction of a stroke at 7, 90 days, and 1 year in patients presenting with TIA. Single-centre, retrospective study including patients with TIA admitted to the Emergency Department of our third-level, University Hospital, between 2018 and 2019. Five hundred three patients were included. Thirty-nine (7.7%) had a stroke within 1 year from the TIA: 9 (1.7%) and 24 (4.7%) within 7 and 90 days, respectively. ABCD2, ABCD2-I, and OTTAWA scores were significantly higher in patients who developed a stroke. AUROCs ranged from 0.66 to 0.75, without statistically significant differences at each time-point. Considering the best cut-off of each score, only ABCD2 > 3 showed a sensitivity of 100% only in the prediction of stroke within 7 days. Among clinical items of each score, duration of symptoms, previous TIA, hemiparesis, speech disturbance, gait disturbance, previous cerebral ischemic lesions, and known carotid artery disease were independent predictors of stroke. Clinical scores have moderate prognostic accuracy for stroke after TIA. Considering the independent predictors for stroke, our study indicates the need to continue research and prompts the development of new tools on predictive scores for TIA.

A Clinical Predictive Model for One-year Colectomy in Adults Hospitalized for Severe Ulcerative Colitis.

Background: Models to predict colectomy in ulcerative colitis (UC) are valuable for identification, clinical management, and follow-up of high-risk patients. Our aim was to develop a clinical predictive model based on admission data for one-year colectomy in adults hospitalized for severe UC. Methods: We performed a retrospective analysis of patients hospitalized at a tertiary academic center for management of severe UC from 1/2013 to 4/2018. Multivariate regression was performed to identify individual predictors of one-year colectomy. Outcome probabilities of colectomy based on the prognostic score were estimated using a bootstrapping technique. Results: Two hundred twenty-nine individuals were included in the final analytic cohort. Four independent variables were associated with one-year colectomy which were incorporated into a point scoring system: (+) 1 for single class biologic exposure prior to admission; (+) 2 for multiple classes of biologic exposure; (+) 1 for inpatient salvage therapy with cyclosporine or a TNF-alpha inhibitor; (+) 1 for age <40. The risk probabilities of colectomy within one year in patients assigned scores 1, 2, 3, and 4 were 9.4% (95% CI, 1.7-17.2), 33.7% (95% CI, 23.9-43.5), 58.5% (95% CI, 42.9-74.1), 75.0% (95% CI, 50.5-99.5). An assigned score of zero was a perfect predictor of no colectomy. Conclusion: Risk factors most associated with one-year colectomy for severe UC included: prior biologic exposure, need for inpatient salvage therapy, and younger age. We developed a simple scoring system using these variables to identify and stratify patients during their index hospitalization.

SEA-MAKE score as a tool for predicting major adverse kidney events in critically ill patients with acute kidney injury: results from the SEA-AKI study.

BACKGROUND: Acute kidney injury (AKI) is a common problem in critically ill patients and associated with high rates of morbidity and mortality. Recently, Major Adverse Kidney Events (MAKE) were introduced as important kidney endpoints. If these endpoints can be predicted, then it may help the physicians to identify high-risk patients and provide the opportunity to have targeted preventive therapy. The objective of this study was to create a simplified scoring system to predict MAKE within 28 days among AKI patients in ICU. METHODS: This is a prospective web-based multicenter cohort study that was conducted in adults who were admitted to the ICU in 17 centers across Thailand from 2013 to 2015. A predicting score was derived from the regression equation with Receiver Operating Characteristic (ROC) analysis to evaluate the diagnostic test and produce predictive models. Internal validation was obtained using the bootstrapping method. RESULTS: From 5071 cases, 2856 (56%) had AKI. Among those with AKI, 1749 (61%) had MAKE. Among those that have MAKE, there were 1175 (41.4%) deaths, 414 (14.4%) were on dialysis and 1154 (40.7%) had non-recovery renal function. The simplified score points of low Glasgow coma scale was 3, tachypnea was 1, vasopressor use was 1, on mechanical ventilation was 2, oliguria was 2, serum creatinine rising ≥ 3 times was 5, high blood urea nitrogen was 3, low hematocrit was 2, and thrombocytopenia was 1. The area under ROC curve for optimism corrected performance was 0.80 (0.78, 0.81). When the cut-off value was 7, the sensitivity, specificity, positive likelihood ratio, and positive predictive values were 0.75, 0.76, 3.10, and 0.84, respectively. When the scoring system was calibrated, the α intercept and ß slope were 1.001 and 0, respectively. CONCLUSIONS: SEA-MAKE scoring system is a new simplified clinical tool that can be used to predict major adverse kidney events in AKI patients. The simplicity of the scoring system is highly likely to be used in resource-limited settings. However, external validation is necessary before widespread use.

Clinical predictive score of predischarge screening for severe hyperbilirubinemia in late preterm and term infants.

BACKGROUND: Early identification and appropriate follow-up of infants at risk of severe hyperbilirubinemia are part of preventing complications. This study aims to develop the clinical predictive score to predict subsequent severe hyperbilirubinemia in healthy Thai infants. METHODS: A case-control study was conducted using medical records of 147 hyperbilirubinemia cases and 147 age-matched controls among healthy late preterm and term Thai newborn infants during January 2015 and December 2016. The routinely measured TcB values at 48-54 hours of age and all predischarge clinical characteristics were collected. Multivariable logistic regression was used to find a clinical prediction model to predict subsequent severe hyperbilirubinemia within 7 days after birth which defined as a postdischarge bilirubin level exceeding the hour-specific recommended threshold for phototherapy by the American Academy of Pediatrics (AAP). RESULTS: The best clinical predictors for subsequent severe hyperbilirubinemia were TcB values at 48-54 hours and gestational age of infants. Predischarge TcB at 48-54 hours of life was classified into 3 levels: < 10 mg/dL, 10-12 mg/dL and > 12 mg/dL. Gestational age was categorized into 5 groups. The risk score derived from these 2 significant factors predicted subsequent severe hyperbilirubinemia with an AuROC curve of 81.0% (95% CI: 76.2-85.9%) in 3 risk group, high, moderate and low. The positive likelihood ratio for subsequent severe hyperbilirubinemia of the high-risk group (score > 5) was 4.53 (95% CI: 2.91-7.04) with specificity of 87.1%. The negative predictive value of low-risk group (score < 3) was 81%. CONCLUSIONS: A simple predischarge prediction score using gestational age and TcB values at 48-54 hours of life was developed. This score classified late preterm and term newborn infants into 3 distinct risk levels and may be useful to identify high-risk infants for outpatient follow-up of subsequent severe hyperbilirubinemia.