Risk stratification

Guest Editorial – Risk Stratification in Acute Medicine

Guest Editorial, Volume 21, Issue 2, Pages 65-120 (2022)

The Nobel-winning physicist Niels Bohr famously said that “prediction is very difficult, especially if it’s about the future.” Nevertheless, the prediction of rapid clinical deterioration has acquired its place in Acute Medicine. Time-urgent medical emergencies can benefit significantly from early detection when treatment delays increase the risk of death. Many Early Warning Systems (EWS) have thus been developed to stratify those at high risk of deterioration. It has been demonstrated that different types of EWS, including the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and NEWS2, are clinically useful when identifying rapid deterioration. However, as we are inundated with risk stratification tools, it can be hard to decide which we should or should not use.

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Thermographic visualization of facial vasoconstriction is associated with 30-day all-cause mortality in medical patients; prospective observational two-site cohort study

Original Articles, Volume 20, Issue 2, Pages 89-156 (2021)

Introduction: Quick and reliable assessment of acute patients is required for accurate triage. The temperature gradient between core and peripheral temperature could possibly instantly provide information on circulatory status.

Methods: Adult medical patients, who did not receive supplementary oxygen, attending two emergency departments, had a thermographic image taken on arrival. The association between 30-day mortality and gradients was tested using logistic regression.

Results: 726 patients were studied, median age was 64 years and 14 (1.9%) died within 30 days. There was a significant association between mortality and temperature gradient, comparable to vital signs, age, and clinical intuition.

Conclusion: Temperature gradient between nose and eye had an acceptable discriminatory power for 30-day all-cause mortality.

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Thermographic visualization of facial vasoconstriction is associated with 30-day all-cause mortality in medical patients; prospective observational two-site cohort study Read More

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