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).
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
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”
See Dr. Marik’s response to this article.
A recent small single-center before-and-after trial by Marik et al showed that vitamins in combination with other relatively safe therapies may improve outcomes in sepsis. We asked three critical care physicians to give their thoughts on the debate on vitamin C in sepsis, and our own co-founder and healthcare finance expert Joe Habboushe to weigh in on the cost/price argument. Continue reading “First Scurvy, Now Sepsis: Is Vitamin C the New Old Wonder Drug?”
Ah, sepsis. You can’t solve a problem without defining it, and sepsis has been notoriously difficult to define, let alone treat. The body of data on sepsis is growing, as well as laypeople’s awareness of the disease. Yet it still manages to elude clinicians in many ways. We talked to Dr. Christopher Seymour, Sepsis-3 investigator and creator of the qSOFA Score, about using qSOFA to help in the management of sepsis.
Bonus: We also asked Dr. Seymour about his thoughts on vitamin C in sepsis. Come back to Paging MDCalc next week to see what he (and other critical care docs) had to say! Continue reading “Insights from Dr. Christopher Seymour, Creator of the qSOFA Score”
After a lot of hard work from MDCalc’s development team, we released Version 3.0 of MDCalc.com in January and just this past weekend we launched a few updates with Version 3.1. The new site offers a lot of great new features and customization that make using MDCalc even easier. Let’s jump into it! Continue reading “Tricks Up our New Website’s Sleeve: Version 3.1 is Here!”
The Padua Prediction Score is one of several validated venous thromboembolism (VTE)-related risk scores. It’s particularly useful in helping to determine whether hospitalized inpatients, who often have multiple comorbidities and thus multiple VTE risk factors, would benefit from pharmacologic prophylaxis over mechanical prophylaxis. We interviewed the first author on the derivation study, Dr. Sofia Barbar, for her insights on developing and using the Padua Prediction Score. Continue reading “Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE”
Imagine you went to buy an expensive piece of clothing. Rather than measuring your size, the store owner simply said “well, on average most folks require a medium, so let’s try that on, we can always re-size it later.” Continue reading “PulmCrit Wee: MDCalc for the perfect tape-measure intubation”
Written by Dr. Robert Centor, creator of the Centor Score. Twitter: @medrants
In medical school we spend little time learning about sore throats. After all, it’s just a sore throat.
Group A beta-hemolytic streptococcal (GAS) tonsillitis dominates our sore throat concern, because it can cause acute rheumatic fever and peritonsillar abscess. We have rapid antigen tests for GAS so that we can treat patients with that infection. Continue reading “Sometimes it’s NOT just a sore throat – adolescents and young adults are different”
A 70-year-old woman with peptic ulcer disease comes to the ED with sudden severe abdominal pain. She also has a history of diabetes and hypertension, both well controlled with oral medication. Her vitals at triage show low-grade tachycardia but are otherwise within normal limits. She is peritoneal on exam and an upright chest x-ray reveals free air. While labs are pending, she is made NPO and started on IV fluid resuscitation.
You are the general surgeon called to see the patient, and your history and Continue reading ““Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine”
Paradoxical embolism via patent foramen ovale (PFO) is a rare cause of stroke, but it’s not uncommon to find PFOs in patients without traditional stroke risk factors (about 1 in 4 people in the general population have a PFO). How should patients with no other convincing cause of stroke be counseled, especially if invasive PFO closure is being considered? We talked to Dr. David Thaler, creator of the Risk of Paradoxical Embolism (RoPE) Score, about his research and experience with taking care of patients with cryptogenic stroke.
Dr. David Thaler
Why did you develop the RoPE Score? Was there a clinical experience that inspired you to create this tool for clinicians?
PFOs have interested and frustrated me for years. They’re so common in the general population, and we find them all the time in stroke patients, old ones and young ones. And paradoxical embolism is definitely a thing—there’s no question that it happens—but because the prevalence is so high in the general population, there’s also no question that a lot of the PFOs that we find are incidental. That’s where this started from in my mind: Continue reading “Deciphering Cryptogenic Stroke with Dr. David Thaler, Creator of the RoPE Score”