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).

Factors Influencing Specialty and Training Center Choices Among Saudi Medical Residents.

AIM: This cross-sectional study aims to identify and quantify the factors influencing Saudi medical residents in selecting their desired specialty and primary training center, while examining the associations between these factors. METHODS: The study received approval from an institutional ethical committee at King Abdulaziz University. An electronic questionnaire was designed and validated via content, face validity, and the Content Validity Index. The sample size was calculated based on a 95% CI and a 5% margin of error. The study targeted all current residents in the current Saudi Specialty Certificate Programs. Descriptive statistics summarized demographic characteristics, training-related information, and factors influencing the selection of a specialty and training center. Fisher's exact test and Chi-square tests were employed for data analysis. RESULTS: A total of 387 respondents completed the survey, with a 32.3% response rate. The majority of respondents were male (n = 232, 59.9%), and the majority were also married (n = 67.2%), with internal medicine (n = 92, 23.8%) and family medicine (n = 74, 19.1%) being the most prevalent specialties. Notably, 89.4% (n = 346) reported matching into their first-choice specialty, and 67.2% (n = 260) into their first-choice training center. Furthermore, 90.2% (n = 349) had prior training (elective/internship) in their chosen specialty, and 63% (n = 244) had previous training (elective/internship) at their primary training center. Prior exposure to both specialty and center significantly resulted in them being the resident's top choice (p < 0.01). Multiple factors influencing the choice of either the specialty or the center were found to have statistically significant associations with the gender, specialty, residency level, sector of the training center, and timing of the specialty decision (p < 0.05). CONCLUSION: This study reveals the substantial influence of early experiences on Saudi medical residents' specialty and training center choices. It also uncovers gender disparities and variations in the influence of specialty-related factors. Future research with larger and more diverse samples is recommended to gain a deeper understanding of the multifactorial decision-making processes, enabling the development of strategies to better meet the evolving needs and preferences of healthcare professionals in Saudi Arabia.

Features and Outcomes of Confirmed COVID-19 Patients Presenting to the Emergency Department.

Objective This study is aimed to determine whether there is a correlation between demographic characteristics, symptoms, initial vital signs, laboratory findings, and clinical outcome(s) of patients with coronavirus disease 2019 (COVID-19). Methods This descriptive, single-center study retrospectively reviewed data from the medical records of patients confirmed with COVID-19 in a tertiary academic center in Jeddah, Saudi Arabia, between March and June 2020. Results The present study enrolled 1039 patients (mean age ± SD, 45.16 ± 19.33 years) suffering from COVID-19, of whom 60.9% were not known to have any medical illnesses. The most common comorbidity was cardiovascular disease (27.8%). Patients with advanced age (p < 0.001), cardiovascular disease (p < 0.001), diabetes mellitus (p = 0.003), asthma (p = 0.008), renal disease (p = 0.020), fever (p = 0.002), dyspnea (p < 0.001), tachypnea (p < 0.001), low albumin (p < 0.001), low alkaline phosphatase levels (p = 0.008), high C-reactive protein (p = 0.003), high fibrinogen (p = 0.047), and high lactate levels (p = 0.015) were more likely to be admitted. Conclusions Patients with increased age, multiple comorbidities, and unstable initial vital signs at emergency department presentation experienced a more severe course of COVID-19 and required admission.

The Role of Demographic, Clinical, and Laboratory Characteristics in Predicting the In-Hospital Outcomes of Patients With COVID-19.

Objective In this study, we aimed to analyze the role of initial patient characteristics obtained at admission (including sociodemographic, clinical, and laboratory findings) in predicting the outcomes in patients with coronavirus disease 2019 (COVID-19). Methods This descriptive, retrospective cohort study included all hospital-admitted COVID-19-confirmed cases at a tertiary academic center in Jeddah, the Kingdom of Saudi Arabia (KSA), from March to June 2020. A total of 656 patients with a mean age of 50 ± 19.4 years were included. Results Of all the patients recruited, 19.3% required ICU admission, and 19% required mechanical ventilation. The majority (79.9%) of the patients recovered from COVID-19 and were discharged, while 20.1% of them died. Patients with advanced age (p=0.005), male sex (p=0.009), low platelet counts (p=0.015), low hemoglobin levels (p=0.004), low albumin levels (p=0.003), high alkaline phosphatase levels (p=0.002), high blood urea nitrogen levels (p<0.001), and high lactate dehydrogenase levels (p<0.001) were more likely to die. Conclusion Based on our findings, it can be inferred that mortality in COVID-19 is highly associated with advanced age and male gender, low platelet counts, low hemoglobin levels, low albumin levels, high alkaline phosphatase levels, high blood urea nitrogen levels, high lactate dehydrogenase levels, tachypnea, and requirement for mechanical ventilation.

Variation in COVID-19 Disease Severity and Clinical Outcomes Between Different ABO Blood Groups.

The primary objective of this study was to explore whether coronavirus disease 2019 (COVID-19) severity and outcomes varied between different ABO blood groups. This retrospective study included 363 COVID-19 confirmed patients who had their blood group recorded in the hospital medical records, from March to June 2020. Data representing demographics, clinical features, vital signs, laboratory findings, and COVID-19 outcomes were collected. Multivariate logistic regression was used for analysis and the results were adjusted for sociodemographic, clinical, and laboratory variables. The patients' mean age was 50 ± 17.8 years. Of the 363 patients, 30% were blood group A, 22.3% were blood group B, 8.8% were blood group AB, and 38.8% were blood group O. Bivariate analysis showed that patients with blood group AB were more likely to be free of any medical disease (65.6%) compared to other blood groups (p = 0.007). Fever was the most common presenting complaint (66.7%), and it did not significantly vary with changes in ABO blood groups (p = 0.230). Regarding laboratory characteristics, only C-reactive protein (CRP) levels were significantly associated with the blood groups, with high levels seen in blood groups A, B, and O (p = 0.036). In multivariate analysis, variations in emergency department (ED) disposition, requirement of intensive care unit care, and requirement of mechanical ventilation were not statistically significant among the different ABO blood groups. Furthermore, no correlation was found between hospital death and the different ABO blood groups. In conclusion, COVID-19 is most prevalent among patients with blood group O and least prevalent among those with blood group AB. No particular blood group had worse COVID-19 disease severity and outcomes than other blood groups. Therefore, we believe that ABO blood grouping should not be used as a major assessment tool for COVID-19 disease severity and outcome, and other known risk factors should be investigated.