ABSTRACT
Background: Nowadays, there is no gold standard score for prehospital sepsis and sepsis-related mortality identification. The aim of the present study was to analyze the performance of qSOFA, NEWS2 and mSOFA as sepsis predictors in patients with infection-suspected in prehospital care. The second objective is to study the predictive ability of the aforementioned scores in septic-shock and in-hospital mortality. Methods: Prospective, ambulance-based, and multicenter cohort study, developed by the emergency medical services, among patients (n = 535) with suspected infection transferred by ambulance with high-priority to the emergency department (ED). The study enrolled 40 ambulances and 4 ED in Spain between 1 January 2020, and 30 September 2021. All the variables used in the scores, in addition to socio-demographic data, standard vital signs, prehospital analytical parameters (glucose, lactate, and creatinine) were collected. For the evaluation of the scores, the discriminative power, calibration curve and decision curve analysis (DCA) were used. Results: The mSOFA outperformed the other two scores for mortality, presenting the following AUCs: 0.877 (95%CI 0.841-0.913), 0.761 (95%CI 0.706-0.816), 0.731 (95%CI 0.674-0.788), for mSOFA, NEWS, and qSOFA, respectively. No differences were found for sepsis nor septic shock, but mSOFA's AUCs was higher than the one of the other two scores. The calibration curve and DCA presented similar results. Conclusion: The use of mSOFA could provide and extra insight regarding the short-term mortality and sepsis diagnostic, backing its recommendation in the prehospital scenario.
ABSTRACT
The articular evaluation of range of motion (ROM) is currently used to observe imbalance or limitations as possible risk factors or predispositions to suffer future injures. The main aim of this study is to verify the concurrent validity, reliability and reproducibility of the OctoBalance Test (OB) as a valid and reliable tool to measure articular ROM of the upper limb compared to the modified-Upper Quarter Y-Balance Test (mUQYBT). The twenty-five participants were male athletes. All of them were assessed with OB and mUQYBT in medial, superolateral, and inferolateral directions in both right and left arms with a three-minute break during these attempts. The process was repeated a second time with a week gap between measurements. Pearson correlation and linear logarithmic regression were used to examine the relationship between scores obtained with OB and mUQYBT. In order to verify the reliability, the intraclass correlation coefficient (ICC) was used (3.1). Concordance and reproducibility were assessed using Bland-Altman's graph. A perfect correlation and an almost linear logarithmic regression (R2 = 0.97) were observed between both measurement systems, with values of 73.531 ± 21.226 cm in mUQYBT and 69.541 ± 16.330 cm in OB. The differences were minimal between week one and week two. The assessment with Bland's graph showed the concordance and reproducibility of scores, showing the dispersion and the upper and lower limits. OB is shown as valid in comparison to the other test as a reliable and reproducible tool for the assessment of the articular ROM in the upper limb, and it could be used for the evaluation of injuries.
