The PEWS Score: Can an Algorithm Predict Worsening Illness in a Hospitalized Child?

By Jeff Russ, MD, PhD – Pediatric/Child Neurology Resident, UCSF

Dr. Jeff Russ

A major task of any pediatric ward provider is to regularly assess a patient’s appearance, vital signs, labs, and risk factors, and integrate these data into a cohesive clinical picture to determine the patient’s acuity and potential need for intervention. This can be especially challenging on busy services or night shifts, where, for example, nurses may divide their time among up to four patients, and a single physician may care for 10–20 patients. Particularly with children, a lot can change between sporadic assessments, making it difficult to triage acuity.

Continue reading “The PEWS Score: Can an Algorithm Predict Worsening Illness in a Hospitalized Child?”

300

We’ve just hit 300 calculators on our website (and iPhone and Android apps), and we thought it might be a good time for reflection.

By the Numbers:

  • The Los Angeles Motor Scale (LAMS) was our 300th calculator!
  • We’ve added over 120 calculators in the past year alone.
  • MDCalc has been around for 12 years.
  • We estimate that we’ve helped with over 15 million patient decisions across the world through our calculators and content in 2016.
  • We’re used in 210 countries.
  • Despite only having been prospectively validated in 2013, the HEART Score is already our 6th most popular calculator.
  • We receive about 5 new calculator requests per week.
  • We have 46 featured interviews with calculator creators that give insight into their thinking about their own scores.
  • We provide calculators for 50+ specialties.
  • We are used by at least 75% of US medical students in their clinical rotations.

Continue reading “300”

Heads Up on Head Injury Algorithms: The Cost of High Sensitivity

By Jeff Russ, MD, PhD – Pediatric/Child Neurology Resident, UCSF

Jeff Russ Headshot BW

Dr. Jeff Russ

Children presenting with head injury are as unremitting in children’s hospitals as the “Frozen” soundtrack, and any physician in a pediatric ED inevitably manages their fair share. The ramifications of missing significant injury to a child’s delicate, developing brain are unnerving. A head CT is central to catching intracranial pathology, but widespread use is not benign, given the risk of malignancy from unnecessary radiation. However, criteria for judiciously navigating this tradeoff remain debated. When is CT appropriate for children with GCS scores of 13-15 and mild symptoms like transient loss of consciousness or vomiting?
Continue reading “Heads Up on Head Injury Algorithms: The Cost of High Sensitivity”

Insights from Dr. Lise Nigrovic, Creator of the Bacterial Meningitis Score for Children

Bacterial meningitis is a rare but serious disease, with mortality approaching 100% when left untreated. On the flip side, many children with mild viral illness are admitted with questionable benefit. The Bacterial Meningitis Score can help support a clinician’s decision to discharge a child safely. We talked with Dr. Lise Nigrovic, first author on the derivation and validation studies.

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Dr. Lise Nigrovic

Why did you develop the Bacterial Meningitis Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians? 

When I was a resident in pediatrics, I found myself admitting well-appearing children who had meningitis, spent two days in the hospital, and then went home after their cultures were negative. Doing that over and over again made me wonder if we could do better and distinguish between children who

Continue reading “Insights from Dr. Lise Nigrovic, Creator of the Bacterial Meningitis Score for Children”

Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis

Antibiotic overuse and misuse is a growing public health concern, and foregoing the administration of antibiotics in cases where they are not needed can be a challenging decision to defend without good evidence to back it up. The Centor Score for Strep Pharyngitis is one of the most practical and useful evidence-based decision tools that helps support clinicians in making those decisions. We interviewed Dr. Robert Centor on developing and using the Centor Score.

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Why did you develop the Centor Score? Was there a clinical experience that inspired you to create a this tool for clinicians?
In 1979, while working in the “non-acute” adult emergency room, a resident asked me how to evaluate a sore throat patient. Having just finished my residency, I started to give a definitive answer, but had a moment of humility and told him that I did not know. We made a treatment decision at the time, and I went to the library to learn more. Continue reading “Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis”

Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule

Subarachnoid hemorrhage, if undiagnosed, can have devastating consequences. While headache is a common presenting complaint in emergency departments, only about 1% of these patients are diagnosed with SAH. The Ottawa SAH Rule helps rule out SAH with 100% sensitivity, to better identify which patients do and do not need further workup. We talked with Dr. Jeffrey Perry, first author of the Ottawa SAH Rule derivation study.

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Dr. Jeffrey J. Perry

How did you develop the Ottawa SAH Rule? Was there a particular patient or clinical experience you had?

Two things: One was the apparent subjectivity I noticed as a resident in evaluating patients for SAH, where the criteria for which patients we would investigate seemed to be very different. Some of the patients I thought were very low risk, other physicians would want to still investigate them for SAH, including doing a CT, which didn’t bother me too much, but then they would go on to do an LP, which is very uncomfortable, and time-consuming, and it seemed to contribute to already very prevalent ED overcrowding. So that was the clinical side of things. Continue reading “Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule”

Our Favorite Reads So Far in 2017

When the MDCalc team isn’t scouring PubMed for studies to help our patients (and yours), we also like to read other stuff related to digital health, evidence, and the healthcare industry. It’s always hard to keep up with all the interesting articles on healthcare, and this year medicine has been a popular topic for journalists. So, we thought we’d share some of our favorite articles. Happy reading!

On Digital Health

  1. A.I. VERSUS M.D. What happens when diagnosis is automated? – By Siddhartha Mukherjee, The New Yorker
  2. NHS to start prescribing health apps that help manage conditions – By Matt Reynolds, New Scientist
  3. A digital revolution in health care is speeding upThe Economist
  4. Future challenges for digital healthcare – By Linda Brookes, M.Sc., Medical News Today
  5. Bypassing Clinical Decision Support Tools for Imaging in the ED – By Hossein Jadvar, Medscape

On Evidence Continue reading “Our Favorite Reads So Far in 2017”

Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score

The CHA2DS2-Vasc Score is one of the most widely-used clinical risk scores for stroke. It’s arguably the best validated and is consistently in the top five most popular calcs on MDCalc. Professor Gregory Lip, the newest member of MDCalc’s Scientific Advisory Board, gave us an interview on developing and using the CHA₂DS₂-VASc Score.

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Dr. Gregory Lip

Why did you develop the CHA₂DS₂-VASc Score? Was there a clinical experience that inspired you to create this tool for clinicians?

The availability of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), previously referred to as new or novel oral anticoagulants, has led to a major change in the landscape for stroke prevention in atrial fibrillation (AF). Clinicians are also getting better at understanding how to manage warfarin, recognizing the importance of the average time in therapeutic range (TTR). New data are also re-emerging on the poor evidence for the efficacy and safety of aspirin for stroke prevention in AF. Continue reading “Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score”

Insights from Dr. William Knaus, Creator of the APACHE II Score

The APACHE II Score is the most-referenced risk score for ICU mortality, with over 15,000 citations in PubMed since its publication 22 years ago, and is still used today both clinically and in research. We talked with Dr. William Knaus, first author on the APACHE paper, about his experience in developing the APACHE II Score, as well as the increasing need for technology in healthcare (and its disappointing uptake and implementation).

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Dr. William Knaus

When we started [developing APACHE] in the 1970s, DRGs [diagnosis-related groups] were just coming on the scene, and obviously they were oriented towards the business and financing aspects of healthcare. There’s little correlation to the clinical. But people were relying on DRGs as a way to classify and identify patients, especially in the ICU. So it was important at that time to not so much reinvent the diagnostic system, but to talk about how patients come in at different levels of severity. And at that time, there was really nothing out there. Continue reading “Insights from Dr. William Knaus, Creator of the APACHE II Score”

Dr. Paul Marik Responds: Vitamin C in Sepsis

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Dr. Paul Marik

On April 7, 2017, Paging MDCalc published an interview with three critical care experts regarding the Marik et al study on vitamin C in sepsis. Here is Dr. Marik’s response:

There are $20 billion reasons why there are so many skeptics, and they simply don’t understand the enormous body of research. We did not suck this out of thin air. I really don’t mind the skeptics; it generates discussion, and has raised awareness of the treatment and sepsis (that’s good). Unfortunately, patients will die while skeptics debate its merits. Continue reading “Dr. Paul Marik Responds: Vitamin C in Sepsis”