Dataset Information

Development of a risk predictive scoring system to identify patients at risk of representation to emergency department: a retrospective population-based analysis in Australia.

ABSTRACT:

Objective

To examine the characteristics of frequent visitors (FVs) to emergency departments (EDs) and develop a predictive model to identify those with high risk of a future representations to ED among younger and general population (aged ?70 years).

Design and setting

A retrospective analysis of ED data targeting younger and general patients (aged ?70 years) were collected between 1 January 2009 and 30 June 2016 from a public hospital in Australia.

Participants

A total of 343 014 ED presentations were identified from 170?134 individual patients.

Main outcome measures

Proportion of FVs (those attending four or more times annually), demographic characteristics (age, sex, indigenous and marital status), mode of separation (eg, admitted to ward), triage categories, time of arrival to ED, referral on departure and clinical conditions. Statistical estimates using a mixed-effects model to develop a risk predictive scoring system.

Results

The FVs were characterised by young adulthood (32.53%) to late-middle (26.07%) aged patients with a higher proportion of indigenous (5.7%) and mental health-related presentations (10.92%). They were also more likely to arrive by ambulance (36.95%) and leave at own risk without completing their treatments (9.8%). They were also highly associated with socially disadvantage groups such as people who have been divorced, widowed or separated (12.81%). These findings were then used for the development of a predictive model to identify potential FVs. The performance of our derived risk predictive model was favourable with an area under the receiver operating characteristic (ie, C-statistic) of 65.7%.

Conclusion

The development of a demographic and clinical profile of FVs coupled with the use of predictive model can highlight the gaps in interventions and identify new opportunities for better health outcome and planning.

SUBMITTER: Ahn E

PROVIDER: S-EPMC6173240 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Development of a risk predictive scoring system to identify patients at risk of representation to emergency department: a retrospective population-based analysis in Australia.

Ahn Euijoon E Kim Jinman J Rahman Khairunnessa K Baldacchino Tanya T Baird Christine C

BMJ open 20181004 9

<h4>Objective</h4>To examine the characteristics of frequent visitors (FVs) to emergency departments (EDs) and develop a predictive model to identify those with high risk of a future representations to ED among younger and general population (aged ≤70 years).<h4>Design and setting</h4>A retrospective analysis of ED data targeting younger and general patients (aged ≤70 years) were collected between 1 January 2009 and 30 June 2016 from a public hospital in Australia.<h4>Participants</h4>A total of ...[more]

PMID: 30287606

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Project description:OBJECTIVE:To derive and validate a new clinical prediction rule to risk-stratify emergency department (ED) patients admitted with suspected sepsis. DESIGN:Retrospective prognostic study of prospectively collected data. SETTING:ED. PARTICIPANTS:Patients aged ?18 years who met two Systemic Inflammatory Response Syndrome criteria or one Red Flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted. PRIMARY OUTCOME MEASURE:In-hospital all-cause mortality. METHOD:The data were divided into derivation and validation cohorts. The simplified-Mortality in Severe Sepsis in the ED score and quick-SOFA scores, refractory hypotension and lactate were collectively termed 'component scores' and cumulatively termed the 'Risk-stratification of ED suspected Sepsis (REDS) score'. Each patient in the derivation cohort received a score (0-3) for each component score. The REDS score ranged from 0 to 12. The component scores were subject to univariate and multivariate logistic regression analyses. The receiver operator characteristic (ROC) curves for the REDS and the components scores were constructed and their cut-off points identified. Scores above the cut-off points were deemed high-risk. The area under the ROC (AUROC) curves and sensitivity for mortality of the high-risk category of the REDS score and component scores were compared. The REDS score was internally validated. RESULTS:2115 patients of whom 282 (13.3%) died in hospital. Derivation cohort: 1078 patients with 140 deaths (13%). The AUROC curve with 95% CI, cut-off point and sensitivity for mortality (95% CI) of the high-risk category of the REDS score were: derivation: 0.78 (0.75 to 0.80); ?3; 85.0 (78 to 90.5). VALIDATION:0.74 (0.71 to 0.76); ?3; 84.5 (77.5 to 90.0). The AUROC curve and the sensitivity for mortality of the REDS score was better than that of the component scores. Specificity and mortality rates for REDS scores of ?3, ?5 and ?7 were 54.8%, 88.8% and 96.9% and 21.8%, 36.0% and 49.1%, respectively. CONCLUSION:The REDS score is a simple and objective score to risk-stratify ED patients with suspected sepsis.

Project description:BackgroundStudies on the reliability of the MTS and its predictive power for hospitalisation and mortality in the older population have demonstrated mixed results. The objective is to evaluate the performance of the Manchester Triage System (MTS) in older patients (?65?years) by assessing the predictive ability of the MTS for emergency department resource utilisation, emergency department length of stay (ED-LOS), hospitalisation, and in-hospital mortality rate. The secondary goal was to evaluate the performance of the MTS in older surgical versus medical patients.MethodsA retrospective cohort study was conducted of all emergency department visits by patients ?65?years between 01 and 09-2011 and 31-08-2012. Performance of the MTS was assessed by comparing the association of the MTS with emergency department resource utilisation, ED-LOS, hospital admission, and in-hospital mortality in older patients and the reference group (18-64?years), and by estimating the area under the receiver operating characteristics curves.ResultsData on 7108 emergency department visits by older patients and 13,767 emergency department visits by patients aged 18-64?years were included. In both patient groups, a higher emergency department resource utilisation was associated with a higher MTS urgency. The AUC for the MTS and hospitalisation was 0.74 (95%CI 0.73-0.75) in older patients and 0.76 (95%CI 0.76-0.77) in patients aged 18-64?years. Comparison of the predictive ability of the MTS for in-hospital mortality in older patients with patients aged 18-64?years revealed an AUC of 0.71 (95%CI 0.68-0.74) versus 0.79 (95%CI 0.72-0.85). The majority of older patients (54.8%) were evaluated by a medical specialty and 45.2% by a surgical specialty. The predictive ability of the MTS for hospitalisation and in-hospital mortality was higher in older surgical patients than in medical patients (AUC 0.74, 95%CI 0.72-0.76 and 0.74, 95%CI 0.68-0.81 versus 0.69, 95%CI 0.67-0.71 and 0.66, 95%CI 0.62-0.69).ConclusionThe performance of the MTS appeared inferior in older patients than younger patients, illustrated by a worse predictive ability of the MTS for in-hospital mortality in older patients. The MTS demonstrated a better performance in older surgical patients than older medical patients regarding hospitalisation and in-hospital mortality.

Dataset Information

Development of a risk predictive scoring system to identify patients at risk of representation to emergency department: a retrospective population-based analysis in Australia.

Objective

Design and setting

Participants

Main outcome measures

Results

Conclusion

Publications

Development of a risk predictive scoring system to identify patients at risk of representation to emergency department: a retrospective population-based analysis in Australia.

Similar Datasets

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