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- Jung, Christian, et al.
(författare)
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A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention
- 2019
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Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 52, s. 141-148
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.
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| 2. |
- Titley, Helen A., et al.
(författare)
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A global evaluation of multi-model ensemble tropical cyclone track probability forecasts
- 2020
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Ingår i: Quarterly Journal of the Royal Meteorological Society. - : Wiley. - 0035-9009 .- 1477-870X. ; 146:726, s. 531-545
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Tidskriftsartikel (refereegranskat)abstract
- At the Met Office, dynamic ensemble forecasts from the Met Office Global and Regional Ensemble Prediction System (MOGREPS-G), the European Centre for Medium-Range Weather Forecasts Ensemble (ECMWFENS) and National Centers for Environmental Prediction Global Ensemble Forecast System (NCEP GEFS) global ensemble forecast models are post-processed to identify and track tropical cyclones. The ensemble members from each model are also combined into a 108-member multi-model ensemble. Track probability forecasts are produced for named tropical cyclones showing the probability of a location being within 120 km of a named tropical cyclone at any point in the next 7 days, and also broken down into each 24-hour forecast period. This study presents the verification of these named-storm track probabilities over a two-year period across all global tropical cyclone basins, and compares the results from basin to basin. The combined multi-model ensemble is found to increase the skill and value of the track probability forecasts over the best-performing individual ensemble (ECMWF ENS), for both overall 7-day track probability forecasts and 24-hour track probabilities. Basin-based and storm-based verification illustrates that the best performing individual ensemble can change from basin to basin and from storm to storm, but that the multi-model ensemble adds skill in every basin, and is also able to match the best performing individual ensemble in terms of overall probabilistic forecast skill in several high-profile case-studies. This study helps to illustrate the potential value and skill to be gained if operational tropical cyclone forecasting can continue to migrate away from a deterministic-focused forecasting environment to one where the probabilistic situation-based uncertainty information provided by the dynamic multi-model ensembles can be incorporated into operational forecasts and warnings.
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