Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol.

BACKGROUND: Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS: PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION: PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION: The study is registered at ClinicalTrials.gov (NCT05172479).

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section.

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

Intensive insulin therapy versus conventional insulin therapy for critically ill trauma patients admitted to ICU.

PURPOSE: The objective of our study was to evaluate the beneficial effect of IIT in reducing mortality and morbidity in critically ill trauma patients admitted to ICU. METHOD AND MATERIAL: Nested cohort study within a Randomized Controlled Trial. All trauma patients with GCS < or = 9 included in the original trial were included in this study. Primary outcome was ICU mortality. RESULT: There was no difference in ICU mortality between IIT and CIT groups (6.5% vs. 5.5%, p = 0.67). After adjustment for baseline characteristics, IIT therapy was also not associated with mortality (Adjusted Hazard Ratio 1.33, 95% CI 0.35-5.05). IIT therapy was associated with a significant increase in the incidence of hypoglycemia as compared to CIT, at least one hypoglycemia episode occurred in 18.5% of patients in IIT and 1.3% in the CIT group (P < 0.0001). CONCLUSION: IIT was not associated with survival improvement in trauma patients admitted to ICU and was associated with increased incidence of hypoglycemia.

A learning skills course for the 1st year medical students: an experience at a Saudi medical school.

BACKGROUND: Every year nearly 1,500 students enter into medical program after passing high school and national aptitude exams. However, many students experience frustration, failure, and psychological morbidities like stress, depression, and anxiety because they are not aware of their learning styles or do not have effective learning skills and strategies. The College of Medicine of Al-Imam Muhammad ibn Saud Islamic University has adopted the outcome based, community oriented, Spiral Curriculum. Although the curriculum is innovative, on the other hand, it is very demanding. OBJECTIVE: The purpose of this paper is to share educational structure and evaluation results of the course on effective learning and study skills for the 1st year medical students. METHODS: To prepare our students in order to cope with this demanding but promising curriculum, we conducted an effective and comprehensive learning skills course for 16 weeks in the first semester of year 1 in the medical program. Performance of each student was assessed and the course evaluation was done by students at the end of the course. RESULTS: The attendance of the students throughout the course was over 90%. The average performance of students in the summative assessment was 78% and the course was generally liked by the students. DISCUSSION: Students overall had a positive attitude toward the learning skills course. Majority of the students showed interest in attending the sessions regularly and realized the significance of this course to improve their learning skills.

The renal recovery of critically ill patients with acute renal failure requiring dialysis.

The incidence of acute renal failure (ARF) is increasing and will nearly double over the next decades as the population ages. As a result of ARF, patients will have longer hospital stays and may require dialysis as outpatients. The aim of this cohort study was to examine the renal recovery after the hospital discharge of surviving critically ill patients who developed ARF that required dialysis. During the 3-year study, there were 2574 patients admitted to the intensive care unit; 308 (12%) patients developed ARF and needed dialysis, 86 (28%) patients survived to hospital discharge and 40 (47%) patients continued to require dialysis after discharge. There were no differences of age or gender in the dialysis group from the non-dialysis group. In addition, there were no differences between the groups in terms of the severity of illness, use of mechanical ventilation, history of hypertension, creatinine levels, urine output or use of inotropes. It was not uncommon for surviving patients with ARF that required dialysis to be dialysis dependent upon hospital discharge, which represents an important cause of chronic kidney disease.