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Novel model for predicting inpatient mortality after emergency admission to hospital in Singapore: retrospective observational study.

ABSTRACT: OBJECTIVES:To identify risk factors for inpatient mortality after patients' emergency admission and to create a novel model predicting inpatient mortality risk. DESIGN:This was a retrospective observational study using data extracted from electronic health records (EHRs). The data were randomly split into a derivation set and a validation set. The stepwise model selection was employed. We compared our model with one of the current clinical scores, Cardiac Arrest Risk Triage (CART) score. SETTING:A single tertiary hospital in Singapore. PARTICIPANTS:All adult hospitalised patients, admitted via emergency department (ED) from 1 January 2008 to 31 October 2017 (n=433?187 by admission episodes). MAIN OUTCOME MEASURE:The primary outcome of interest was inpatient mortality following this admission episode. The area under the curve (AUC) of the receiver operating characteristic curve of the predictive model with sensitivity and specificity for optimised cut-offs. RESULTS:15?758 (3.64%) of the episodes were observed inpatient mortality. 19 variables were observed as significant predictors and were included in our final regression model. Our predictive model outperformed the CART score in terms of predictive power. The AUC of CART score and our final model was 0.705 (95% CI 0.697 to 0.714) and 0.817 (95% CI 0.810 to 0.824), respectively. CONCLUSION:We developed and validated a model for inpatient mortality using EHR data collected in the ED. The performance of our model was more accurate than the CART score. Implementation of our model in the hospital can potentially predict imminent adverse events and institute appropriate clinical management.

SUBMITTER: Xie F

PROVIDER: S-EPMC6773418 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Novel model for predicting inpatient mortality after emergency admission to hospital in Singapore: retrospective observational study.

Xie Feng F Liu Nan N Wu Stella Xinzi SX Ang Yukai Y Low Lian Leng LL Ho Andrew Fu Wah AFW Lam Sean Shao Wei SSW Matchar David Bruce DB Ong Marcus Eng Hock MEH Chakraborty Bibhas B

BMJ open 20190926 9

<h4>Objectives</h4>To identify risk factors for inpatient mortality after patients' emergency admission and to create a novel model predicting inpatient mortality risk.<h4>Design</h4>This was a retrospective observational study using data extracted from electronic health records (EHRs). The data were randomly split into a derivation set and a validation set. The stepwise model selection was employed. We compared our model with one of the current clinical scores, Cardiac Arrest Risk Triage (CART) ...[more]

PMID: 31558458

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Project description:ObjectiveTo predict hospital admission at the time of ED triage using patient history in addition to information collected at triage.MethodsThis retrospective study included all adult ED visits between March 2014 and July 2017 from one academic and two community emergency rooms that resulted in either admission or discharge. A total of 972 variables were extracted per patient visit. Samples were randomly partitioned into training (80%), validation (10%), and test (10%) sets. We trained a series of nine binary classifiers using logistic regression (LR), gradient boosting (XGBoost), and deep neural networks (DNN) on three dataset types: one using only triage information, one using only patient history, and one using the full set of variables. Next, we tested the potential benefit of additional training samples by training models on increasing fractions of our data. Lastly, variables of importance were identified using information gain as a metric to create a low-dimensional model.ResultsA total of 560,486 patient visits were included in the study, with an overall admission risk of 29.7%. Models trained on triage information yielded a test AUC of 0.87 for LR (95% CI 0.86-0.87), 0.87 for XGBoost (95% CI 0.87-0.88) and 0.87 for DNN (95% CI 0.87-0.88). Models trained on patient history yielded an AUC of 0.86 for LR (95% CI 0.86-0.87), 0.87 for XGBoost (95% CI 0.87-0.87) and 0.87 for DNN (95% CI 0.87-0.88). Models trained on the full set of variables yielded an AUC of 0.91 for LR (95% CI 0.91-0.91), 0.92 for XGBoost (95% CI 0.92-0.93) and 0.92 for DNN (95% CI 0.92-0.92). All algorithms reached maximum performance at 50% of the training set or less. A low-dimensional XGBoost model built on ESI level, outpatient medication counts, demographics, and hospital usage statistics yielded an AUC of 0.91 (95% CI 0.91-0.91).ConclusionMachine learning can robustly predict hospital admission using triage information and patient history. The addition of historical information improves predictive performance significantly compared to using triage information alone, highlighting the need to incorporate these variables into prediction models.

Project description:ObjectiveHypoalbuminaemia is an important prognostic factor. It may be associated with poor nutritional states, chronic heart and kidney disease, long-standing infection and cancer. Hypotension is a hallmark of circulatory failure. We evaluated hypoalbuminaemia and hypotension synergism as predictor of in-hospital mortality and intensive care unit (ICU) admission.DesignWe retrospectively analysed emergency department (ED) visits from January 2011 to December 2019.SettingData were retrieved from five Mount Sinai health system hospitals, New York.ParticipantsWe included consecutive ED patients ≥18 years with albumin measurements.Primary and secondary outcome measuresClinical outcomes were in-hospital mortality and ICU admission. The rates of these outcomes were stratified by systolic blood pressure (SBP) (<90 vs ≥90 mm Hg) and albumin levels. Variables included demographics, presenting vital signs, comorbidities (measured as ICD codes) and other common blood tests. Multivariable logistic regression models analysed the adjusted OR of different levels of albumin and SBP for predicting ICU admission and in-hospital mortality. The models were adjusted for demographics, vital signs, comorbidities and common laboratory results. Patients with albumin 3.5-4.5 g/dL and SBP ≥90 mm Hg were used as reference.ResultsThe cohort included 402 123 ED arrivals (27.9% of total adult ED visits). The rates of in-hospital mortality, ICU admission and overall admission were 1.7%, 8.4% and 47.1%, respectively. For SBP <90 mm Hg and albumin <2.5 g/dL, mortality and ICU admission rates were 34.0% and 40.6%, respectively; for SBP <90 mm Hg and albumin ≥2.5 g/dL 8.2% and 24.1%, respectively; for SBP ≥90 mm Hg and albumin <2.5 g/dL 11.4% and 18.6%, respectively; for SBP ≥90 mm Hg and albumin 3.5-4.5 g/dL 0.5% and 6.4%, respectively. Multivariable analysis showed that in patients with hypotension and albumin <2.5 g/dL the adjusted OR for in-hospital mortality was 37.1 (95% CI 32.3 to 42.6), and for ICU admission was 5.4 (95% CI 4.8 to 6.1).ConclusionCo-occurrence of hypotension and hypoalbuminaemia is associated with poor hospital outcomes.

Project description:BACKGROUND:The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. OBJECTIVE:To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. METHODS:Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ?1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. RESULTS:The analysis included 2?322?112 emergency admissions (81.9% via an A and E department). With a 5?unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ?95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139?673 fewer GP admissions (456?232 vs 316?559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. CONCLUSIONS:Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear.

Dataset Information

Novel model for predicting inpatient mortality after emergency admission to hospital in Singapore: retrospective observational study.

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Novel model for predicting inpatient mortality after emergency admission to hospital in Singapore: retrospective observational study.

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