Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study.

Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55-78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5-19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6-23) days versus 8 (4-15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65-0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.

Validación de una escala de predicción clínica para el diagnóstico de tuberculosis pulmonar en Emergencia / Validation of a scale of clinical prediction for the diagnosis of pulmonary tuberculosis in Emergency

Antecedentes: La tuberculosis pulmonar es la enfermedad infecciosa más prevalente a nivel mundial y un problema importante de Salud Pública en el Perú. Objetivo: Determinar el rendimiento diagnóstico de escala de predicción clínica para el despistaje de tuberculosis pulmonar en Emergencia del Hospital Nacional Dos de Mayo. Métodos: Estudio transversal, que incluyó a todos los pacientes adultos atendidos en Emergencia con el diagnóstico sugestivo de tuberculosis pulmonar. Se revisó las historias clínicas de los pacientes a quienes se les solicitó una baciloscopía de esputo espontánea, incluyendo el análisis de radiografía de tórax, se verificaron los resultados de cultivo en medio Ogawa, posteriormente se aplicó la escala de predicción clínica y se evaluó el rendimiento diagnóstico de la escala en base a los resultados del cultivo. Resultados: Durante Abril 2009 hasta Mayo 2010, un total de 145 pacientes se incluyeron, 78 pacientes fueron varones (54,5 por ciento). La edad media fue 58,15±19,86 años. Los síntomas más frecuentes fueron: tos (48,95 por ciento), hemoptisis (16,08 por ciento), baja de peso (18,18 por ciento) y disnea (16,78 por ciento). La mayoría de pacientes no tenía comorbilidad (37,76 por ciento). Los hallazgos radiológicos fueron: infiltrado alveolar superior (32,15 por ciento); infiltrado reticular difuso (30,75 por ciento), cavitaciones (20,3 por ciento), efusión pleural (6.3 por ciento) y neumotórax (4,9 por ciento). El área bajo la curva (ABC) fue 0.66±0.12, obteniendo una sensibilidad de 50 por ciento y una especificidad de 70.2 por ciento en el rendimiento de la escala. La comparación entre el estudio original (ABC 0.809 IC 95 por ciento 0.762-0.856) y el estudio actual (ABC 0.66 IC 95 por ciento 0.54-0.78) fueron significativamente diferentes (p=0.041). Conclusiones: El desempeño de la presente escala en Emergencia del Hospital Nacional Dos de Mayo presenta sensibilidad y especificidad menores al estudio original.

Background: Pulmonary tuberculosis is the most prevalent infectious disease worldwide and a major public health problem in Peru. Objective: To determine the diagnostic performance of clinical prediction scale for screening of pulmonary tuberculosis in the Emergency Department of the Hospital Dos de Mayo. Methods: Cross-sectional study including all adult patients seen in the emergency diagnosis suggestive of pulmonary tuberculosis. The clinical records of patients who were referred for smear spontaneous sputum were subsequently enrolled and a clinical prediction rule was applied, including analysis of chest radiography, the culture result on Ogawa were verified and the performance was evaluated based on the results of culture. Results: During April 2009 to May 2010, a total of 145 patients were included, 78 patients were male (54.5 per cent). The mean age was 58.15 ± 19.86 years. The most common symptoms were cough (48.95 per cent), hemoptysis (16.08 per cent), weight loss (18.18 per cent) and dyspnea (16.78 per cent). Most patients had no comorbidity (37.76 per cent). Radiological findings were superior alveolar infiltrate (32.15 per cent); diffuse reticular infiltrates (30.75 per cent), cavitation (20.3 per cent), pleural effusion (6.3 per cent) and pneumothorax (4.9 per cent). The area under the curve (AUC) was 0.66 ± 0.12, with a sensitivity of 50 per cent and specificity of 70.2 per cent in the performance of the scale. The comparison between the original study (95 per cent CI 0.809 ABC 0762-0856) and the current study (95 per cent CI 0.54 to 0.78 ABC 0.66) were significantly different (p=0.041). Conclusions: The performance of this scale Emergency of the National Hospital Dos de Mayo has lower sensitivity and specificity to the original study.