Notes on liability medical in Peru
VI. La responsabilidad civil del establecimiento sanitario
This study was supported by unrestricted grands by ZonMW (projectnumber 171101003), the Bronovo Research Foundation and the Franje1 Foundation. There was no role of the funding organizations in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript; or decision to submit the manuscript for publication.
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SUPPLEMENTARY DATA
Supplementary Figures
Figure S1. Workflow of enrolled patients
454 patients assessed for eligibility
372 patients included in the trial
82 patients excluded, not meeting inclusion criteria
313 evaluable patients
Lost to follow up before first follow up visit: 2 patients No blood sample available for biomarker analysis: 57 patients
Control: 185 patients Intervention: 128 patients
Figure S2. Relationship between MR-proADM, PCT and CRP with the PRACTICE score
Figure S3. Prediction for hospitalization upon initial ED presentation
MR-proADM: Mid-regional proadrenomedullin; PCT: Procalcitonin; CRP: C-reactive protein
Figure S4. Prediction for hospitalization in patients originally treated as outpatients
MR-proADM: Mid-regional proadrenomedullin; PCT: Procalcitonin; CRP: C-reactive protein
Supplementary Tables
Table S1. Composition of the PRACTICE score
Characteristic Allocated points*
Demographic
Age (men) Age (years)
Age (women) Age (years) - 10
Nursing home resident +10
Comorbidity †
Malignancy +30
Congestive heart failure +10
Cerebrovascular disease +10
Liver cirrhosis +20
Renal disease +10
Signs & Symptoms
Altered mental status +20
Respiratory rate ≥ 30/min +20
Systolic blood pressure < 90 mm Hg +20
Pulse ≥ 125/min +10
Temperature ≥ 40 OC +15
*A total score individual patient score is obtained by summing the points for each characteristic.
†Malignancy is defined as any cancer except basal- or squamous-cell cancer of the skin that was active within the previous year of presentation. Congestive heart failure is defined as ventricular dysfunction for which the patient is prescribed medication and/or consults a hospital-based medical specialist. Cerebrovascular disease is defined as a history of stroke or transient ischemic attack. Liver disease is defined as a clinical diagnosis of cirrhosis. Renal disease is defined as a history of chronic renal disease.
According to risk class the following recommendations will apply:
< 75 points strong recommendation towards home-based management 75-100 points consider home-based management
>100 points strong recommendation towards hospital admission
Table S2. Bacteria isolated from baseline cultures Control period (N = 185) Intervention period(N = 128) Urine cultures Escherichia coli 94 (53) 49 (42) Klebsiella spp 11 (6) 7 (6) Proteus spp 5 (3) 4 (3) Enterococcus spp 2 (1) - Pseudomonas aeruginosa - 1 (1) Staphylococcus aureus 1 (1) 1 (1) Other 7 (4) 5 (4)
Contaminated / mixed flora 20 (11) 24 (20)
Total positive urine cultures 140/176 (79)* 91/117 (78)*
Blood cultures Escherichia coli 36 (20) 21 (17) Klebsiella spp 4 (2) 4 (3) Proteus spp - 1 (1) Enterobacter spp 1 (1) - Staphylococcus aureus 1 (1) 2 (2)
Beta haemolytic streptococcus 1 (1) 2 (2)
Citrobacter spp 1 (1) -
Salmonella paratyphi - 1 (1)
Total positive blood cultures 44/177 (25)# 31/125 (25)#
Data are presented as N (%). *Urine cultures were not performed in 9 patients in the control period and 11 patients in the intervention period. #Blood cultures were not obtained in 8 patients in the control period and 3 patients in the intervention period.
Table S3. ROC values for predicting a severe course of fUTI
Variable AUC SE 95% CI MR-proADM 0.86 0.035 0.79 - 0.92 PCT 0.69 0.056 0.58 - 0.80 PRACTICE 0.80 0.039 0.74 - 0.87 MR-proADM + PRACTICE 0.88 0.028 0.82 - 0.93 PCT + PRACTICE 0.82 0.035 0.77 - 0.86 MR-proADM + PCT 0.86 0.034 0.81 - 0.90 MR-proADM + PCT + PRACTICE 0.86 0.033 0.82 - 0.90
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Table S4. ROC values for predicting the need for hospital admission Variable AUC SE 95% CI MR-proADM 0.68 0.042 0.60 - 0.76 PCT 0.63 0.047 0.54 - 0.72 PRACTICE 0.72 0.038 0.64 - 0.79 MR-proADM + PRACTICE 0.72 0.037 0.65 - 0.79 PCT + PRACTICE 0.72 0.038 0.67 - 0.77 MR-proADM + PCT 0.68 0.042 0.62 - 0.73 MR-proADM + PCT + PRACTICE 0.72 0.039 0.66 - 0.77