David K Wagner | PubMed Health

PubMed2003

Validaty of Siriraj Stroke Scoring.

OBJECTIVE: To study the sensitivity and specificity of Siriraj Stroke Scoring (SSS) and to validate the accuracy of SSS in acute supratentorial stroke syndromes. DESIGN: Noninterventional descriptive study. PLACE AND DURATION OF STUDY: Department of Neurology, Pakistan Institute Of Medical Sciences, Islamabad, and Department of Medicine, Federal Government Services Hospital, Islamabad, from July to December 2000 and February to July 2002, respectively. SUBJECTS AND METHODS: One hundred (100) consecutive cases of acute supratentorial strokes were studied in accordance with SSS and sensitivity and specificity of SSS for supratentorial infarction and haemorrhage was tested against the computerised brain scanning (CT) as a gold standard. Siriraj Stroke Scoring was applied. Patients with subarachnoid haemorrhage and transient ischemic attacks were excluded from the study. The findings were recorded, compared and statistically analyzed. RESULTS: Out of 100 patients 45 were male and 55 female with mean age of 59 years. Sixty-two patients had hypertension, 36 patients had one or more atheroma markers (diabetes, coronary artery disease and claudication). Mean diastolic blood pressure was 98 mmHg with range of 60-140 mmHg and mean systolic blood pressure of 163 mmHg with the range of 90-240 mmHg. Forty-eight patients had cerebral infarction, 36 had cerebral hemorrhage while 16 were borderline cases on the basis of Siriraj stroke scoring. CT brain showed 56 and 39 patients had cerebral infarction and haemorrhage respectively while 5 of CT scans were normal. The sensitivity and specificity of SSS for cerebral infarction was 71 and 85 respectively and for intracerebral haemorrhage, it was 73 and 90 respectively. The positive predictive values of SSS for cerebral infarction and haemorrhage were 87% and 83 respectively. CONCLUSION: The siriraj stroke scoring system is a valid and specific scoring system for the diagnosis of acute supratentorial stroke and intracerebral haemorrhage.

Adult↗

PubMed2002

Computer-generated trauma management plans: comparison with actual care.

TraumAID is a computer-based decision aid that uses decision rules and logical deduction to generate management plans for the initial definitive management of injured patients; its use is currently confined to assessing penetrating thoracoabdominal injuries in nonpregnant adults. These management plans were compared to trauma center care in an American urban medical school hospital. The TraumAID program was available to trauma chief residents for patient care during the "golden hour." Resulting changes in plans were documented by the residents. For 15 months the management plans for all applicable patients were documented serially, as were computer plans and outcomes. The sequential care and computer-generated care plans were then blinded and judged by three other trauma surgeons as to acceptability and preference. A consecutive series of 97 patients was evaluated. The residents used the computer for 40 cases during patient care. In 5 of the 40 cases, they altered their evaluation, diagnosis, or treatment; in none of these 5 was the alteration judged an error. Of the 97 patients, 10 had adverse outcomes, 2 of which were judged potentially avoidable, with unacceptable errors in management. TraumAID's plans were acceptable for both. In 31 cases previously managed by the judges themselves, the TraumAID plans were preferred by the judge to the care he or she had provided, by a ratio of 25:6 (p < 0.01). In a preliminary assessment, computer-generated, patient-specific protocols for the acute management of injuries were preferred to actual care previously given by the judges themselves and were associated with improved care and potential improvement in outcome.

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