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The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

ABSTRACT: Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model. For each admission, a set of clinical and epidemiological variables was obtained. The main diagnosis at hospitalization was recorded, and all additional or secondary conditions that coexisted at hospital admission or that developed during hospital stay were considered secondary conditions.The derivation and validation datasets included 7268 and 7843 patients, respectively. The in-hospital mortality rate averaged 7.2%. The following variables entered the final model; age, body mass index, mean arterial pressure on admission, prior admission within 3 months, background morbidity of heart failure and active malignancy, and chronic use of statins and antiplatelet agents. The c-statistic (ROC-AUC) of the prediction model was 80.5% without adjustment for main or secondary conditions, 84.5%, with adjustment for the main diagnosis, and 89.5% with adjustment for the main diagnosis and secondary conditions. The accuracy of the predictive model reached 81% on the validation dataset.A prediction model based on clinical data with adjustment for secondary conditions exhibited a high degree of prediction accuracy. We provide a proof of concept that there is an added value for incorporating secondary conditions while predicting probabilities of in-hospital mortality. Further improvement of the model performance and validation in other cohorts are needed to aid hospitalists in predicting health outcomes.

SUBMITTER: Sakhnini A

PROVIDER: S-EPMC5484250 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

Sakhnini Ali A Saliba Walid W Schwartz Naama N Bisharat Naiel N

Medicine 20170601 25

Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from ...[more]

PMID: 28640142

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Project description:Aims/hypothesisHospital admissions for hypoglycaemia represent a significant burden on individuals with diabetes and have a substantial economic impact on healthcare systems. To date, no prognostic models have been developed to predict outcomes following admission for hypoglycaemia. We aimed to develop and validate prediction models to estimate risk of inpatient death, 24 h discharge and one month readmission in people admitted to hospital for hypoglycaemia.MethodsWe used the Hospital Episode Statistics database, which includes data on all hospital admission to National Health Service hospital trusts in England, to extract admissions for hypoglycaemia between 2010 and 2014. We developed, internally and temporally validated, and compared two prognostic risk models for each outcome. The first model included age, sex, ethnicity, region, social deprivation and Charlson score ('base' model). In the second model, we added to the 'base' model the 20 most common medical conditions and applied a stepwise backward selection of variables ('disease' model). We used C-index and calibration plots to assess model performance and developed a calculator to estimate probabilities of outcomes according to individual characteristics.ResultsIn derivation samples, 296 out of 11,136 admissions resulted in inpatient death, 1789/33,825 in one month readmission and 8396/33,803 in 24 h discharge. Corresponding values for validation samples were: 296/10,976, 1207/22,112 and 5363/22,107. The two models had similar discrimination. In derivation samples, C-indices for the base and disease models, respectively, were: 0.77 (95% CI 0.75, 0.80) and 0.78 (0.75, 0.80) for death, 0.57 (0.56, 0.59) and 0.57 (0.56, 0.58) for one month readmission, and 0.68 (0.67, 0.69) and 0.69 (0.68, 0.69) for 24 h discharge. Corresponding values in validation samples were: 0.74 (0.71, 0.76) and 0.74 (0.72, 0.77), 0.55 (0.54, 0.57) and 0.55 (0.53, 0.56), and 0.66 (0.65, 0.67) and 0.67 (0.66, 0.68). In both derivation and validation samples, calibration plots showed good agreement for the three outcomes. We developed a calculator of probabilities for inpatient death and 24 h discharge given the low performance of one month readmission models.Conclusions/interpretationThis simple and pragmatic tool to predict in-hospital death and 24 h discharge has the potential to reduce mortality and improve discharge in people admitted for hypoglycaemia.

Project description:OBJECTIVES:To develop a clinical prediction score for predicting mortality in children following return of spontaneous circulation after in-hospital cardiac arrest. DESIGN:Observational study using prospectively collected data. SETTING:This was an analysis using data from the Get With The Guidelines-Resuscitation registry between January 2000 and December 2015. PATIENTS:Pediatric patients (< 18 yr old) who achieved return of spontaneous circulation. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome was in-hospital mortality. Patients were divided into a derivation (3/4) and validation (1/4) cohort. A prediction score was developed using a multivariable logistic regression model with backward selection. Patient and event characteristics for the derivation cohort (n = 3,893) and validation cohort (n = 1,297) were similar. Seventeen variables associated with the outcome remained in the final reduced model after backward elimination. Predictors of in-hospital mortality included age, illness category, pre-event characteristics, arrest location, day of the week, nonshockable pulseless rhythm, duration of chest compressions, and interventions in place at time of arrest. The C-statistic for the final score was 0.77 (95% CI, 0.75-0.78) in the derivation cohort and 0.77 (95% CI, 0.74-0.79) in the validation cohort. The expected versus observed mortality plot indicated good calibration in both the derivation and validation cohorts. The score showed a stepwise increase in mortality with an observed mortality of less than 15% for scores 0-9 and greater than 80% for scores greater than or equal to 25. The model also performed well for neurologic outcome and in sensitivity analyses for events within the past 5 years and for patients with or without a pulse at the onset of chest compressions. CONCLUSIONS:We developed and internally validated a prediction score for initial survivors of pediatric in-hospital cardiac arrest. This prediction score may be useful for prognostication following cardiac arrest, stratifying patients for research, and guiding quality improvement initiatives.

Project description:ObjectiveTo develop and externally validate a risk algorithm (QAdmissions) to estimate the risk of emergency hospital admission for patients aged 18-100 years in primary care.DesignProspective open cohort study using routinely collected data from general practice linked to hospital episode data during the 2-year study period 1 January 2010 to 31 December 2011.Setting405 general practices in England contributing to the national QResearch database to develop the algorithm. Two validation cohorts to validate the algorithm (1) 202 different QResearch practices and (2) 343 practices in England contributing to the Clinical Practice Research DataLink (CPRD). All general practices had data linked to hospital episode statistics at the individual patient level.ParticipantsWe studied 2 849 381 patients aged 18-100 years in the derivation cohort with over 4.6 million person-years of follow-up. 265 573 of these patients had one or more emergency admissions during follow-up. For the QResearch validation cohort, we identified 1 340 622 patients aged 18-100 years with over 2.2 million person-years of follow-up. Of these patients, 132 723 had one or more emergency admissions during follow-up. The CPRD cohort included 2 475 360 patients aged 18-100 years with over 3.8 million person-years of follow-up. 234 204 of these patients had one or more emergency admissions during follow-up. We excluded patients without a valid NHS number and a valid Townsend score.EndpointFirst (ie, incident) emergency admission to hospital in the next 2 years as recorded on the linked hospital episodes records.Risk factorsCandidate variables recorded on the general practitioner computer system including (1) demographic variables (age, sex, strategic health authority, Townsend deprivation score, ethnicity); (2) lifestyle variables (smoking, alcohol intake); (3) chronic diseases; (4) prescribed medication; (5) clinical values (body mass index, systolic blood pressure); (6) laboratory test results (haemoglobin, platelets, erythrocyte sedimentation rate, ratio of total serum cholesterol to high density lipoprotein cholesterol concentrations, liver function tests). We also included the number of emergency admissions in the preceding year based on information recorded on the linked hospital episodes records.ResultsThe final QAdmissions algorithm incorporated 30 variables. When applied to the QResearch validation cohort, it explained 41% of the variation in women and 43% of that in men. The D statistic for QAdmissions was 1.7 in women and 1.8 in men. The receiver operating curve statistic was 0.78 for men and 0.77 for women. QAdmissions had good performance on all measures of discrimination and calibration. The positive predictive value for emergency admissions for the top tenth of patients at highest risk was 42% and the sensitivity was 39%. The results for the CPRD validation cohort were similar.ConclusionsThe QAdmissions model provided a valid measure of absolute risk of emergency admission to hospital in the general population as shown by its performance in a separate validation cohort. Further research is needed to evaluate the cost-effectiveness of using these algorithms in primary care.

Dataset Information

The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

Publications

The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

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