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).

Knowledge, Attitudes, and Practices of Military Personnel Regarding Heat-Related Illness.

INTRODUCTION: Heat-related illnesses are a global concern, affecting millions of people and leading to numerous deaths annually. Since military personnel are exposed to heat, the purpose of the study was to evaluate military personnel's knowledge, attitudes, and practices (KAP) related to heat-related illnesses. Their KAP may help to prevent heat-related illness.  Methods: We conducted a cross-sectional study using a structured online questionnaire on 168 military personnel who were training and working in a high-temperature and high-humidity environment all year round in Jeddah, Saudi Arabia. The questionnaire assessed the KAP and associated factors and was distributed as a Google Form. RESULTS: The mean knowledge score was 9.04 (range = 2-13, SD = 1.832), the mean awareness score was 9.61 (range = 4-15, SD = 2.415), and the mean practice score was 3.39 (range = 0-6, SD = 1.703). Most participants correctly identified symptoms (n=130; 77.4%). In terms of attitudes, most participants showed a good attitude (n=151; 81%), though 24.4% did not perceive the risk. Regarding practice, most were attentive to heat-related illness signs and hydration(75.6%), but there were gaps in receiving briefings from doctors (69%) and adequate guidance on treatment (56%). There was a split opinion on whether commanders adjust field activities based on temperature warnings (54.8% Yes, 45.2% No). There were no significant differences in knowledge scores based on age or educational level (both p>0.05), while some age and education-related differences were noted in practice scores (p<0.05). There was a positive correlation between knowledge and attitudes (r = 0.222, p = 0.004), knowledge and practices (r = 0.165, p = 0.033), and attitudes and practice (r=0.326, p < 0.001). CONCLUSION: Our study found that military personnel generally possess good knowledge of heat-related illnesses and good attitudes and practices concerning heat-related illnesses. However, there are areas in need of improvement, and enhancing awareness and practical implementation of preventive measures, along with the development of precise guidance and protocols, should involve active collaboration between military commanders and healthcare professionals.