Background Dysthyroid optic neuropathy (DON) is one of the most serious visual loss threats for patients with Graves’ ophthalmopathy (GO). Barrett’s index (BI) and intracranial-fat prolapse have been used in diagnosing DON. However, these parameters are rarely used in Southeast Asian populations with a variety of cut-off values. Objective To evaluate the performance of BI and fat prolapse in diagnosing of DON, and to study the correlation between their parametric values with visual acuity (VA) and visual field defect (VF). Methods Between January 2011 and December 2020, orbits affected by GO were retrospectively reviewed and classified into 2 groups based on the presence or absence of DON. All orbital-computed-tomography (CT) scans were measured for BI and fat prolapse. Diagnostic performance of BI and fat prolapse was analyzed and evaluated in relation to visual outcome. Results We included orbits with DON (23 orbits) and the absence of DON (61 orbits). BI was significantly higher in patients in the DON group (47.68 ± 12.52%) compared to the absence of DON (37.55 ± 10.88%), p < 0.001. The presence of fat prolapse was significantly higher in the DON group (p = 0.003). BI at 40% provided best diagnostic performance with sensitivity of 78.3%/specificity of 63.9%. The presence of fat prolapse 4.5 mm via the superior-ophthalmic-fissure (SOF) had a lower sensitivity compared with fat prolapse 2.5 mm. Comparison between area under the curve (AUC) of BI and fat prolapse revealed no statistically significant difference (AUC 0.742 and 0.705 in BI and fat prolapse, respectively, p = 0.607). A negative correlation between the BI and fat prolapse with VA and VF was observed (p < 0.001). Conclusion Measurement of BI is a simple diagnostic method for detecting DON in Thai populations. The presence of fat prolapse (2.5 mm) provides a lower sensitivity compared with a BI at 40%. A slightly larger BI or fat prolapse should be suspected of DON for early treatment.

Objective: To identify predictors for hospital mortality among inter-hospital transferred patients in low-resource settings of rural hospitals in Thailand.Methods: We conducted a retrospective cohort study of patients transferred from emergency room(ER) of a community hospital to its designated tertiary care hospital in a western province of Thailand. During March 2018 and February 2019, medical records of 412 patients were reviewed and extracted for potential predictor variables and outcomes. We defined deaths within 72 hrs after a transfer as primary outcome and overall hospital mortality as secondary outcome. Multivariate logistic regression analysis was performed to identify predictors of the outcomes adjusted for potential confounders.Results: Out of 412 patients, a total of 37 patients (9.0%) died during the stay in receiving hospital and 18 (4.4%) of them died within 72 hrs after transfer. Top ten primary diagnostic categories included road traffic injuries (19.7%), acute appendicitis (9.7%), and acute myocardial infarction (5.1%). Univariate analysis revealed early mortality (<72 hrs) was associated with NEWS2, Emergency Severity Index (ESI), cardiac arrest prior to transfer, use of vasoactive agents, endotracheal intubation and admitting service. Using multiple logistic regression model  adjusted for  the predictors identified by univariate analysis, we found early mortality was independently associated with NEWS2 ≥ 9 (compared to NEWS2 0-6) with OR= 17.51(95%CI 3.16-97.00)  and vasoactive medication use (OR= 5.46, 95%CI 1.39-21.46). Similarly, overall mortality was also independently associated with NEWS2 ≥ 9(OR= 4.76, 95%CI 1.31–17.36)  and  vasoactive medication use (OR= 7.51,95%CI  2.76–20.45).Conclusion: This study identified predictors of early (<72 hrs) hospital mortality and overall hospital mortality among ER patients transferred from a rural community hospital to its designated tertiary care hospital in Thailand, a middle-income country with universal healthcare coverage. The findings might be helpful to inform decision-making dealing with the inter-hospital transfer of ER patients in resource-poor rural settings with similar case-mix.