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Specificity of the Ambulatory Simplified Acute Physiologic Score
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Abstract:
Introduction: Mortality is a frequent phenomenom in emergency departement and a major public health concern. The use of mortality prognostic scores such as Ambulatory Simplified Acute Physiologic Score (ASAPS) remains a possibility to improve patient management in order to reduce mortality. Therefore, we proposed to conduct a study on patients admitted to our emergency department, in order to assess the ASAPS accuracy in our context. Patients and Method: This is a cohort, prospective, monocentric, descriptive and analytical study, during 4 months period in 2020. The study framework was in the Army Training Hospital Omar Bongo Ondimba (ATHOBO). We included all patients admitted in emergency room for at least 24 hours for a medical disease. The main purpose was to determine the ASAPS specificity in (ATHOBO) emergency department using the pivotal value of 8 points to do so. Results: During the study period, there were 3425 visits to emergency department among which we included 593 patients in the study. The patients’ average age was 47.37 ± 19.14 years. The sex ratio (M/W) was 1.16. The main reason for consultation was the flu-like syndrome in 15.18 % of cases. The admitted patients’ average ASAPS was 3.9 ± 3.22. The global mortality was 17.54%. For an ASAPS key value at 8, the specificity was 90.2% and the sensibility was 43.3%. Regarding the most seriously ill patients admitted in vital emergency reception room, the average ASAPS was 7 ± 2.9. The vital emergency reception room mortality was 37.16%. Conclusion: ASAPS is a nonspecific severity index, only based on clinical criteria. Our study showed a good ASAPS specificity and a good correlation between mortality and the score. However, this score has a bad sensibility due to the medical history and minimal blood test absence.
| [1] | Collectif Dalloz. Article R 712-65 du Code de la santé publique, décret du 9 mai 1995. Dalloz, 112. |
| [2] | Obermeyer, Z., Abujaber, S., Makar, M., Stoll, S., Kayden, S.R., Wallis, L.A., et al. (2015) Emergency Care in 59 Low-and Middle-Income Countries: A Systematic Review. Bulletin of the World Health Organization, 93, 577-586. https://doi.org/10.2471/blt.14.148338 |
| [3] | Bérard, L., Zeller, J. and Schaeffer, M. (2018) Décès et limitations thérapeutiques aux urgences: Étude rétrospective des pratiques dans un centre hospitalier français pendant quatre ans. Annales françaises de médecine d’urgence, 8, 223-230. https://doi.org/10.3166/afmu-2018-0064 |
| [4] | Sima Zue, A., Chani, M., Nsafu, D.N. and Carpentier, J.P. (2002) Le contexte tropical influence-t-il la morbidité et la mortalité? Médecine Tropicale, 62, 256. |
| [5] | Guartite, A., Khaleq, K., Rabai, O. and Louardi, H. (2004) 099 Analyse critique de la mortalité aux urgences. Journal Européen des Urgences, 17, 42. https://doi.org/10.1016/s0993-9857(04)97116-6 |
| [6] | Mbengono, J.A.M., Bengono, R.B., Nkodo, J.M., et al. (2015) Etiologies des décès dans les services d’urgences et de réanimation dans deux hôpitaux de la ville de Yaoundé. Health Sciences and Diseases, 16, 1-5. |
| [7] | Moukagni, K.J. (2019) Mortalité au service d’accueil des urgences des hopitaux d’instruction des armées (Omar Bongo Ondimba et Akanda). Mémoire. Université des Sciences de la Santé. |
| [8] | Fourestié, V., Roussignol, E., Elkharrat, D., Rauss, A. and Simon, N. (1994) Classification clinique des malades des urgences: Définition et reproductibilité: Association pour la recherche aux urgences. Réanimation Urgences, 3, 573-578. https://doi.org/10.1016/s1164-6756(05)80760-1 |
| [9] | Subbe, C.P., et al. (2001) Validation of a Modified Early Warning Score in Medical Admissions. QJM, 94, 521-526. https://doi.org/10.1093/qjmed/94.10.521 |
| [10] | Ferreira, F.L., Bota, D.P., Bross, A., Mélot, C. and Vincent, J.L. (2001) Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients. JAMA, 286, 1754-1758. |
| [11] | Gall, J.L., Loirat, P., Alperovitch, A., Glaser, P., Granthil, C., Mathieu, D., et al. (1984) A Simplified Acute Physiology Score for ICU Patients. Critical Care Medicine, 12, 975-977. https://doi.org/10.1097/00003246-198411000-00012 |
| [12] | Le Gall, J.R. (1990) Les facteurs pronostiques des maladies infectieuses en réanimation. Lettre de l'’nfectiologue, 5, 185-190. |
| [13] | Dia, N.M., Diallo, I., Manga, N.M., Diop, S.A., Fortes-Deguenonvo, L., Lakhe, N.A., et al. (2015) Intérêt de l’indice de gravité simplifié ambulatoire (IGSA) appliqué à des patients admis dans l’unité de soins intensifs (USI) d’un service de pathologie infectieuse à Dakar. Bulletin de la Société de Pathologie Exotique, 108, 175-180. https://doi.org/10.1007/s13149-015-0418-x |
| [14] | Tchoua, R., Vemba, A., Koumba, C.T. and Nsafu, D.N. (1999) Gravité des malades de réanimation à la fondation Jeanne Ebori de Libreville. Médecine d’Afrique Noire, 46, 496-499. |
| [15] | Le Conte, P., Amelineau, M., Trewick, D. and Batard, É. (2005) Décès survenus dans un service d’accueil et d’urgence: Analyse retrospective sur une période de 3 mois. La Presse Médicale, 34, 566-568. https://doi.org/10.1016/s0755-4982(05)83980-6 |
| [16] | Colpan, A., Akinci, E., Erbay, A., Balaban, N. and Bodur, H. (2005) Evaluation of Risk Factors for Mortality in Intensive Care Units: A Prospective Study from a Referral Hospital in Turkey. American Journal of Infection Control, 33, 42-47. https://doi.org/10.1016/j.ajic.2004.09.005 |
| [17] | Hirokawa, K., Utsuyama, M., Hayashi, Y., Kitagawa, M., Makinodan, T. and Fulop, T. (2013) Slower Immune System Aging in Women versus Men in the Japanese Population. Immunity & Ageing, 10, Article No. 19. https://doi.org/10.1186/1742-4933-10-19 |
| [18] | Guidet, B. and Aegerter, P. (2009) Indices de gravité et happlications en réanimation. Le Praticien en Anesthésie Réanimation, 13, 6-18. https://doi.org/10.1016/j.pratan.2008.12.007 |
| [19] | Menthonnex, E., Egard, F., Torres, J.P., Koch, F. and Godart, J. (1997) L’indice de gravité simplifié ambulatoire à la phase préhospitalière. Médecine Urgence Paris, 19, 59-64. |
