qSOFA is a Poor Predictor of Short-Term Mortality in All Patients: A Systematic Review of 410,000 Patients

Background: To determine the validity of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) in the prediction of outcome (in-hospital and 1-month mortality, intensive care unit (ICU) admission, and hospital and ICU length of stay) in adult patients with or without suspected infections where qSOFA was calculated and reported; Methods: Cochrane Central of Controlled trials, EMBASE, BIOSIS, OVID MEDLINE, OVID Nursing Database, and the Joanna Briggs Institute EBP Database were the main databases searched. All studies published until 12 April 2018 were considered. All studies except case series, case reports, and conference abstracts were considered. Studies that included patients with neutropenic fever exclusively were excluded. Results: The median AUROC for in-hospital mortality (27 studies with 380,920 patients) was 0.68 (a range of 0.55 to 0.82). A meta-analysis of 377,623 subjects showed a polled AUROC of 0.68 (0.65 to 0.71); however, it also confirmed high heterogeneity among studies (I2 = 98.8%, 95%CI 98.6 to 99.0). The median sensitivity and specificity for in-hospital mortality (24 studies with 118,051 patients) was 0.52 (range 0.16 to 0.98) and 0.81 (0.19 to 0.97), respectively. Median positive and negative predictive values were 0.2 (range 0.07 to 0.38) and 0.94 (0.85 to 0.99), respectively

Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial

<div><p>Background</p><p>Soft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control.</p><p>Objectives</p><p>To investigate the analgesic effect of paracetamol, ibuprofen and the combination of both in the treatment of soft tissue injury in an ED, and the side effect profile of these drugs.</p><p>Methods</p><p>Double-blind, double dummy, placebo-controlled randomised controlled trial. 782 adult patients presenting with soft tissue injury without obvious fractures attending the ED of a university hospital in the New Territories of Hong Kong were recruited. Patients were randomised using a random number table into three parallel arms of paracetamol only, ibuprofen only and a combination of paracetamol and ibuprofen in a 1:1:1 ratio. The primary outcome measure was pain score at rest and on activity in the first 2 hours and first 3 days. Data was analysed on an intention to treat basis.</p><p>Results</p><p>There was no statistically significant difference in pain score in the initial two hours between the three groups, and no clinically significant difference in pain score in the first three days.</p><p>Conclusion</p><p>There was no difference in analgesic effects or side effects observed using oral paracetamol, ibuprofen or a combination of both in patients with mild to moderate pain after soft tissue injuries attending the ED.</p><p>Trial registration</p><p>The study is registered with ClinicalTrials.gov (no. <a href="https://clinicaltrials.gov/ct2/show/NCT00528658" target="_blank">NCT00528658</a>).</p></div

Reduction in VAS score (a) at rest and (b) on activity for the three treatment arms within 3 days.

<p>Reduction in VAS score (a) at rest and (b) on activity for the three treatment arms within 3 days.</p

Reduction in VAS score (a) at rest and (b) on activity for the three treatment arms during the ED phase.

<p>Reduction in VAS score (a) at rest and (b) on activity for the three treatment arms during the ED phase.</p

Participants' characteristics (n = 782).

<p>Values are percentages of participants unless stated otherwise.</p

The level of satisfaction (maximum score 10) for the analgesic effect of the treatment received.

<p>The level of satisfaction (maximum score 10) for the analgesic effect of the treatment received.</p

Proportion with ‘no worse than mild pain’ at baseline, 2 hours, 3 days and the proportion of adequate responders.

<p>Proportion with ‘no worse than mild pain’ at baseline, 2 hours, 3 days and the proportion of adequate responders.</p

Summary of primary outcomes VAS and the univariate analysis.

<p>Summary of primary outcomes VAS and the univariate analysis.</p

CONSORT flow chart describing progress of patients through randomised trial.

<p>CONSORT flow chart describing progress of patients through randomised trial.</p