Development and validation of a knowledge-driven risk calculator for critical illness in COVID-19 patients.

Facing the novel coronavirus disease (COVID-19) pandemic, evidence to inform decision-making at all care levels is essential. Based on the results of a study by Petrilli et al., we have developed a calculator using patient data at admission to predict critical illness (intensive care, mechanical ventilation, hospice care, or death). We report a retrospective validation of the calculator on 145 consecutive patients admitted with COVID-19 to a single hospital in Israel. Despite considerable differences between the original and validation study populations, of 18 patients with critical illness, 17 were correctly identified (sensitivity: 94.4%, 95% CI, 72.7%-99.9%; specificity: 81.9%, 95% CI, 74.1%-88.2%). Of 127 patients with non-critical illness, 104 were correctly identified. Our results indicate that published knowledge can be reliably applied to assess patient risk, potentially reducing the cognitive burden on physicians, and helping policymakers better prepare for future needs.

The effect of nuchal cord on perinatal mortality and long-term offspring morbidity.

OBJECTIVE: To evaluate perinatal and long-term cardiovascular and respiratory morbidities of children born with nuchal cord. STUDY DESIGN: A large population-based cohort analysis of singleton deliveries was conducted. Maternal and birth characteristics, as well as cardiovascular and respiratory morbidity incidence were evaluated. Kaplan-Meier survival curves were used to compare cumulative hospitalization incidence between groups. Cox regression models were used to control for possible confounders and follow-up length. RESULTS: 243,682 deliveries were included. Of them, 34,332 (14.1%) were diagnosed with nuchal cord. Perinatal mortality rate was comparable between groups (0.5 vs. 0.6%, p = 0.16). Kaplan-Meier survival curves demonstrated no significant differences in cumulative cardiovascular or respiratory morbidity incidence between groups (log rank p = 0.69 and p = 0.10, respectively). Cox regression models reaffirmed a comparable risk for hospitalization between groups (aHR = 0.99 (95% CI 0.85-1.14, p = 0.87) and aHR = 0.97 (95% CI 0.92-1.02, p = 0.28). CONCLUSIONS: Nuchal cord is not associated with higher rate of perinatal mortality nor long-term cardiorespiratory morbidity.

Does nuchal cord at birth increase the risk for cerebral palsy?

BACKGROUND: Nuchal cord is a common finding in pregnancy. It is unclear whether a nuchal cord at birth causes birth asphyxia and raises the risk for developing cerebral palsy of the offspring. AIM: To evaluate the incidence of cerebral palsy in children born with and without nuchal cord. STUDY DESIGN: A population-based cohort analysis including all singleton deliveries over >20 years at a single tertiary medical center was conducted. The incidence of cerebral palsy in children up to 18 years of age was evaluated. Kaplan-Meier survival curve was used to compare cumulative incidence between the groups, and a Cox proportional hazards model was used to control for confounders. RESULTS: During the study period, 243,682 singleton deliveries met the inclusion criteria. Of them, 14.1% (n = 34,332) were diagnosed with nuchal cord at birth. Rates of cerebral palsy were comparable between the groups (0.1% vs. 0.1%, OR = 1.03, 95% CI 0.69-1.52, p = 0.89). The Kaplan-Meier survival curve demonstrated no significant differences in cumulative incidence of cerebral palsy for children born with or without nuchal cord (log rank p = 0.92, Fig. 1). The Cox proportional hazards model, controlled for preterm delivery, maternal age, diabetes and hypertensive disorders, showed no association between nuchal cord and cerebral palsy (adjusted HR = 1.06; 95% CI 0.71-1.57; p = 0.77). CONCLUSION: In our population, nuchal cord at birth was not associated with higher risk for cerebral palsy.