Shock Index in the early assessment of febrile children at the emergency department : a prospective multicentre study

Funding Information: Funding This work was supported by the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 668303), by the National Institute for Health Research (NIHR) Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University, and by NIHR Academic Clinical Fellowship award (ACL-2018-21-00 to RN). Funding Information: This work was supported by the European Union's Horizon 2020 research and innovation programme (grant agreement no. 668303), by the National Institute for Health Research (NIHR) Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University, and by NIHR Academic Clinical Fellowship award (ACL-2018-21-00 to RN). Publisher Copyright: ©Objective: (1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children. Design/setting: Observational study in 11 European EDs (2017-2018). Patients: Febrile children with measured blood pressure. Main outcome measures: Serious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs). Results: Of 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8. Conclusions: High Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.publishersversionPeer reviewe

Treatment of buccal mucosal carcinomas: A survey amongst head and neck surgeons in the Netherlands

Abstract Objective Currently, there is no up‐to‐date guideline for the treatment of buccal mucosal squamous cell carcinoma (BMSCC) in the Netherlands. A questionnaire was used to investigate the opinions of Dutch head and neck surgeons on BMSCC of the cheek treatment. Methods A questionnaire was sent to all 91 head and neck surgeons in the Netherlands. Their opinions on surgical tumor‐free margins, through‐and‐through defects, and indications for local adjuvant therapy were questioned. Results The response rate was 51%. To prevent a through‐and‐through defect, 67% of the surgeons would accept a deep clinical (macroscopic) margin of ≤5 mm. The less adverse histological characteristics a tumor has, the less consensus there is amongst the surgeons for local adjuvant treatment in case of close margins. Conclusion There is no consensus amongst Dutch head and neck surgeons about the optimal treatment for BMSCC of the cheek. There are different opinions on acceptable resection margins, indications for a through‐and‐through defect, and indications for adjuvant treatment. BMSCC of the cheek treatment should be more uniform and less surgeon dependent. Level of evidence N/

Masterplan Tilburg University

Het masterplan voor Tilburg Universiteit is ontwikkeld door de ontwerpende onderzoeksgroep Bauhütte met een tweeledig doel: a) Tilburg Universiteit voorzien in een langetermijnvisie voor een coherente campusontwikkeling en b) het voorzien voor een kwaliteitsvolle inpassing van toekomstige bouwplannen op de campus. De formele status van het masterplan is dat het als raamwerk dient voor toekomstige bestemmingsplanwijzigingen.De campus van Tilburg, vroeger de Katholieke Universiteit Tilburg geheten, is de meest compacte ‘greenfield campus’ van Nederland en wordt gekenmerkt door een hoge kwaliteit van de bestaande gebouwvoorraad en het landschap. In het bijzonder weerspiegelt het werk van Jos. Bedaux deze kwaliteit; gebouw Cobbenhagen heeft inmiddels een Rijksmonumentenstatus verkregen. Het masterplan reconstrueert en evalueert de groei van de campus door de tijd en beschrijft de (historische) invloed van vooraanstaande (landschaps)architecten zoals Jos. Bedaux, Jan van der Laan, Hugh Maaskant en Pieter Buys inclusief recente ingrepen door Martien Jansen en Christian Kieckens.Het “Masterplan Tilburg University” bevat een geheel aan architectonische, landschappelijke en stedenbouwkundige richtlijnen om toekomstige bouwvragen op een coherente wijze kwalitatief in de campus in te passen.This masterplan for Tilburg University has been developed by the design based research group Bauhütte with a bilateral aim: a) to provide Tilburg University with a long-term vision on the development of the campus into a coherent whole and b) to achieve a qualitative integration of envisioned building schemes within the campus. Its formal status is that the masterplan will serve as a framework for future zoning plan alterations (bestemmingsplanwijzigingen).The campus of Tilburg University, formerly known as the Katholieke Universiteit Tilburg, is the most compact greenfield campus within The Netherlands. The landscaping and existing building stock of the campus is of high quality, mainly reflected within the work by Jos. Bedaux, such as the Cobbenhagen building which gained the status of Rijksmonument (national heritage site). The masterplan reconstructs and evaluates the growth of the campus and assesses the historical influence of distinguished architects and landscapers, such as Jos. Bedaux, Jan van der Laan, Hugh Maaskant and Pieter Buys to more recent interventions by architects Martien Jansen and Christian Kieckens.The “Masterplan Tilburg University” thus contains an overview of architectural, landscaping and urban guidelines to coherently and qualitatively integrate future building schemes within the campus

Novel de novo synthesized phosphate carrier compound ABA-PEG20k-Pi20 suppresses collagenase production in Enterococcus faecalis and prevents colonic anastomotic leak in an experimental model

Item does not contain fulltex

Routine reporting of grey-white matter differentiation in early brain computed tomography in comatose patients after cardiac arrest: A substudy of the COACT trial

Aim: A multimodal approach is advised for neurological prognostication in comatose patients after out-of-hospital cardiac arrest (OHCA). Grey-white matter differentiation (grey-white ratio, GWR) obtained from a brain CT scan performed < 24 hours after return of circulation can be part of this approach. The aims of this study were to investigate the frequency and method of reporting the GWR in brain CT scan reports and their association with outcome. Methods: This is a post-hoc descriptive analysis of the COACT trial. The primary endpoint was the reporting of GWR by the radiologist. Secondary endpoints were APACHE IV score, Cerebral Performance Categories at discharge and 90-day follow-up, Glasgow Coma Scale at discharge, GWR-stratified 1-year survival, and RAND-36 stratified by normal versus abnormal GWR. Associations were analysed using multivariable analysis. Results: A total of 427 OHCA patients were included in this study, 234 (55%) of whom underwent a brain CT scan within 24 hours after ROSC. Median time between arrest and initial CT scan was 12 hours. In 195 patients (83%), the GWR was described in the reports, but always expressed qualitatively. The GWR was deemed abnormal in 57 (29%) CT scans. No differences were found in secondary endpoints between the two groups. Conclusion: GWR was frequently described in CT scan reports. Early abnormal GWR, as assessed qualitatively by a radiologist within 24 hours after ROSC, was a poor predictor of neurological prognosis