Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Flow diagram of enrollment and testing of RADx-UP study participants.

A visualization of the flow of screening, exclusion, enrollment, testing, and final sample size of the analysis. Abbreviations: RADx-UP, Rapid Acceleration of Diagnostics–Underserved Populations.</p

COVID-19 vaccinations and related beliefs and attitudes among RADx-UP study participants by drug use status, Miami, Florida, March 2021 –October 2022.

COVID-19 vaccinations and related beliefs and attitudes among RADx-UP study participants by drug use status, Miami, Florida, March 2021 –October 2022.</p

S1 Data -

The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49–0.81; p</div

Percent of RADx-UP participants who reported substance use stratified by type of substance, Miami, Florida, March 2021 –October 2022.

A visualization of the percentage of participants who reported substance use stratified by type of substance. Cannabis use was defined as a response of “yes” to “Have you used marijuana in the past 12 months?”. Cocaine/crack use, hallucinogen use, heroin/fentanyl use, and methamphetamine use was defined as a response of “About once per month”, “About once or twice per week”, or “Daily or almost daily” to “In the past 12 months, have you used any of the following drugs: cocaine or crack, heroin, fentanyl, crystal meth (methamphetamine), hallucinogens (like LSD, psilocybin, PCP, ketamine), ecstasy?” for each of the individual drugs. Prescription drug misuse was defined as a response of “About once per month”, “About once or twice per week”, or “Daily or almost daily” to “In the past 12 months, how often have you used prescription drugs just for the feeling, more than prescribed, or that were not prescribed for you?”. Abbreviations: RADx-UP, Rapid Acceleration of Diagnostics–Underserved Populations.</p

Characteristics of RADx-UP study participants by drug use status.

Characteristics of RADx-UP study participants by drug use status.</p

COVID-19 testing and related beliefs and attitudes among RADx-UP study participants by drug use status, Miami, Florida, March 2021 –October 2022.

COVID-19 testing and related beliefs and attitudes among RADx-UP study participants by drug use status, Miami, Florida, March 2021 –October 2022.</p

Univariate and multiple binary logistic regressions for COVID-19 vaccination status and COVID-19 positivity by drug use status, Miami, Florida, March 2021 –October 2022.

Univariate and multiple binary logistic regressions for COVID-19 vaccination status and COVID-19 positivity by drug use status, Miami, Florida, March 2021 –October 2022.</p

STROBE statement—checklist of items that should be included in reports of <i>cross-sectional studies</i>.

STROBE statement—checklist of items that should be included in reports of cross-sectional studies.</p