Dataset Information

Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: an initial alarm score by a prospective prediction model study.

ABSTRACT:

Objectives

To set up a prediction model for the 7-day in-hospital mortality of patients admitted from the emergency department (ED) because it is high but no appropriate initial alarm score is available.

Design

This is a prospective cohort study for prediction model development.

Setting

In a tertiary referred hospital in northern Taiwan.

Participants

ED-admitted medical patients in hospitalist care wards were enrolled during May 2010 to October 2016. Two-thirds of them were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort.

Primary outcome measured

7-day in-hospital mortality.

Results

During the study period, 8649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel Index Score, triage level 1 at the ED, presence of cancer, metastasis and admission diagnoses of pneumonia and sepsis were independently associated with 7 days in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 (0.79-0.85). The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cut-off value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cut-off value was a score of 6.

Conclusion

The 7-day in-hospital mortality in the hospitalist care ward is 2.8%. The initial alarm score could help clinicians to prioritise or exclude patients who need urgent and intensive care.

SUBMITTER: Hsieh MJ

PROVIDER: S-EPMC7783526 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: an initial alarm score by a prospective prediction model study.

Hsieh Ming-Ju MJ Hsu Nin-Chieh NC Lin Yu-Feng YF Shu Chin-Chung CC Chiang Wen-Chu WC Ma Matthew Huei-Ming MH Sheng Wang-Huei WH

BMJ open 20210104 1

<h4>Objectives</h4>To set up a prediction model for the 7-day in-hospital mortality of patients admitted from the emergency department (ED) because it is high but no appropriate initial alarm score is available.<h4>Design</h4>This is a prospective cohort study for prediction model development.<h4>Setting</h4>In a tertiary referred hospital in northern Taiwan.<h4>Participants</h4>ED-admitted medical patients in hospitalist care wards were enrolled during May 2010 to October 2016. Two-thirds of th ...[more]

PMID: 33397665

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Project description:PURPOSE:Sepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis. METHODS:The study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38 °C or lower than 36 °C, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/?L or lower than 4000/?L; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ?18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores. RESULTS:Among the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788-0.963) as compared with 0.75 (0.634-0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%. CONCLUSION:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

Project description:IntroductionBasic emergency management in urban and rural areas is a critical challenge. This paper presents the protocol for developing, validating and piloting an instrument to assess the preparedness of non-hospital health centres which deliver initial emergency care.Methods and analysisThis study will be designed based on a sequential exploratory mixed method in two phases, in each of which there are three steps. In the first step of phase I, an extensive systematic review will be conducted. In the second step, through focus group discussions (FGDs), the experts' views on the definition of domains and items of the instrument will be compiled. In addition, semistructured interviews with the target group will be performed. Then, qualitative framework analysis will be performed. In the last step of phase I, the results of both steps will be triangulated by a panel of experts to define the domains and items to be included in the instrument. Phase II will include content validity, feasibility and reliability of the instrument. Content validity of the instrument will be assessed using modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the instrument will be assessed through its implementation in 10 non-hospital health centres in Tabriz, which will be selected randomly. Reliability will be assessed in a pilot on 30 non-hospital health centres through using stratified random sampling method. Reliability of the instrument will be assessed through measuring internal consistency, test-retest reliability and inter-rater agreement. The main statistical methods for assessing reliability will include Cronbach's alpha, intraclass correlation coefficient and Kendall's tau-b. All the statistical analyses will be performed using Stata V.14.Ethics and disseminationThis study is approved by Tabriz University of Medical Sciences Research Ethics Committee (IR.TBZMED.REC.1397.145). The results of the study will be presented at national scientific conferences and published in peer-reviewed journals.

Dataset Information

Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: an initial alarm score by a prospective prediction model study.

Objectives

Design

Setting

Participants

Primary outcome measured

Results

Conclusion

Publications

Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: an initial alarm score by a prospective prediction model study.

Similar Datasets

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