RESUMEN
Background: The application of a risk stratification pathway is necessary for the emergency department (ED) to assess the severity of the disease and the need for escalation of therapy. We aimed to implement the National Early Warning Score 2 (NEWS2) pathway at triage to differentiate patients who are stable or critically ill with no invasive investigations at the time of admission during the coronavirus disease of 2019 (COVID-19) era in comparison to other clinical risk scores. Methods: One hundred and four patients were collected from April 1, 2021, to June 1, 2021, during the second wave of the COVID-19 pandemic at an academic medical center in India. The NEWS2 scoring system and the quick sepsis-related organ failure assessment (qSOFA) score were introduced as part of the initial assessment in the triage area of the ED. Data were assessed using the area under the receiving operating characteristic (AUROC) curve for NEWS2 and qSOFA scores, respectively. Results: In the study, NEWS2 classification indicated that 25% of patients required continuous monitoring, of which 12.7% subsequently deteriorated within 24 h of admission and 7% died. Both, NEWS2 (threshold 0; 1, AUROC 0.883; 95%; confidence interval [CI] 0.8-0.966) and qSOFA (threshold 0; 1, AUROC 0.851; 95% CI 0.766-29 0.936) effectively identified COVID-19 patients in the ED at risk for clinical deterioration. There was no significant difference in the diagnostic performance of qSOFA and NEWS2 (DeLong's test P = 0.312). Conclusion: Both NEWS2 and qSOFA effectively-identified COVID-19 patients in the ED at risk for clinical deterioration with no significant statistical difference. However, a triage level risk stratification score can be developed with the inclusion of blood parameters on admission to further validate the practice.
RESUMEN
Objectives: The purpose of this study is to evaluate the epidemiology, neuro-ophthalmic, and clinical characteristics of intracranial space occupying lesions (ICSOLs) in adult patients. Methods: All patients above 16 years presenting with brain tumors confirmed by magnetic resonance imaging and treated surgically in our institute were included in this study. Epidemiology of the patients along with neurological and ophthalmic manifestation was evaluated. Results: A total of 252 patients were included in the study ranging from 18 years to 79 years. Supratentorial location was more common than infratentorial location. The most common neurological symptom in our study was headache followed by seizures. Ophthalmic manifestations were present in (73.4%) of patients. The most common visual symptoms and signs were visual loss, strabismus, papilledema, and visual field defects. The most common histopathological diagnosis seen in our study was meningiomas followed by high-grade gliomas. Conclusion: Ocular signs and symptoms can be considered as a window to the brain through which ICSOLs can be detected. The most common neurological manifestation of ICSOL in our study was headache with or without true localizing signs and symptoms. More frequently, these patients present to an ophthalmologist before a neurosurgeon with related ocular manifestations. Hence, through our study, we emphasize the importance of a detailed ophthalmological examination in these patients which can aid in early diagnosis and prompt management of such lesions.