Derivation and validation of a risk score for predicting mortality among inpatients following rapid response team activation

Abstract

Purpose of the studyDespite mature rapid response systems (RRS) for clinical deterioration, individuals activating RRS have poor outcomes, with up to one in four dying in hospital. We aimed to derive and validate a risk prediction tool for estimating risk of 28-day mortality among hospitalised patients following rapid response team (RRT) activation.Study designAnalysis of prospectively collected data on 1151 consecutive RRT activations involving 800 inpatients at a tertiary adult hospital. Patient characteristics, RRT triggers and actions, and mortality were ascertained from medical records and death registries. A multivariable risk prediction regression model, derived from 600 randomly selected patients, was validated in the remaining 200 patients. Main outcome was accuracy of weighted risk score (measured by area under receiver operator curve (AUC)) and performance characteristics for various cut-off scores.ResultsAt 28 days, 150 (18.8%) patients had died. Increasing age, emergency admission, chronic liver disease, chronic kidney disease, malignancy, after-hours RRT activation, increasing National Early Warning Score, major/intense RRT intervention and multiple RRT activations were predictors of mortality. The risk score (0–105) in derivation and validation cohorts had AUCs 0.86 (95% CI 0.82 to 0.89) and 0.82 (95% CI 0.75 to 0.90), respectively. In the validation cohort, cut-off score of 32.5 or higher maximised sensitivity: 81.6% (95% CI 68.4% to 92.1%), specificity: 56.2% (95% CI 49.4% to 63.6%), positive likelihood ratio (LR): 1.9 (95% CI 1.5 to 2.3) and negative LR: 0.3 (95% CI 0.2 to 0.6).ConclusionA validated risk score predicted risk of post-RRT death with more than 80% accuracy, helping to identify patients for whom targeted rescue care may improve survival.

Outcome prediction for patients assessed by the medical emergency team: a retrospective cohort study

“…Previous prognostic risk scores within the MET field have only been presented to a limited extent, principally under dissimilar conditions or with differing endpoints, such as ICU admission and cardiac arrest [20,21]. However, in parallel, a comparable study has been conducted in Australia, which supports our findings in a Scandinavian setting [22]. Similarly, a risk score was developed from the predictors in the multivariable regression model, with acceptable performance in estimating the probability of death following MET assessment.…”

Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study

“…31 Clearly, patients with cancer were at a high risk of dying, especially so if RRT activations were required. 32,33 However, patients with cancer were widely heterogenous, with differences in cancer type, cancer staging, treatment options and response to cancer therapy. As cancer patients are living longer with access to improved cancer treatment, further studies are needed to evaluate how the above factors influence patient outcomes.…”

Evolution of a rapid response team over a ten-year period: One academic center’s experience

“…According to White et al, 19% of patients activated for rapid response die within 28 days. 6 Following the highest risk patients through rapid response systems creates a heavy workload and burden on RRTs. In our hospital RRT calls per 1000 discharges have gone up significantly as the effort to identify high risk patients has increased.…”