Validation of a Simple Score for Mortality Prediction in a Cohort of Unselected Emergency Patients

Abstract

Background. Prognostication is an important component of medical decision-making. A patients’ general prognosis can be difficult to measure. The Simple Prognostic Score (SPS) was designed to include patients’ age, mobility, aggregated vital signs, and the treating physician’s decision to admit to aid prognostication. Study Aim. Our study aim is to validate the SPS, compare it with the Emergency Severity Index (ESI) regarding its prognostic performance, and test the interrater reliability of the subjective variable of the decision to admit. Methods. Over a period of 9 weeks all patients presenting to the ED were included, routinely interviewed, final disposition registered, and followed up for one year. The C-statistics of discrimination was used to compare SPS and ESI predictions of 7-day, 30-day, and 1-year mortality. Youden J Statistics and Odds ratio, using logistical regression, were calculated for the Simple Prognostic Score. In a subset, a chart review was performed by senior physicians for a secondary assessment of the decision to admit. Interrater reliability was calculated using percentages and Cohens Kappa. Results. Out of 5648 patients, 3272 (57.9%) had a low SPS (i.e., ≤ 1); none of these patients died within 7 days, 2 (0.1%) died within 30 days after presentation and 19 (0.6%) died within a year. The area under the curve for 1-year mortality of the Simple Prognostic Score was 0.848. Secondary analysis of the interrater agreement for the decision to admit was 92%. Conclusion. In a prospective study of unselected ED patients, the Simple Prognostic Score was validated as a reliable predictor of short- and long-term mortality.

In-Hospital Mortality Prediction Model for Critically Ill Older Adult Patients Transferred from the Emergency Department to the Intensive Care Unit

“…Goodacre et al included age, diagnostic code, malignant tumor, vital signs, and laboratory test results in a prediction model for 7-day mortality in patients admitted to the ED. 24 Busch et al predicted the short-and long- 25 However, these studies were conducted on unselected emergency patients, therefore the in-hospital mortality rate was < 10%, which may have affected the reliability of the results. Severe sample imbalance issues can lead to a decrease in the accuracy of the model, thereby affecting the reliability of the prediction model.…”

A fast emergency department triage score based on mobility, mental status and oxygen saturation compared with the emergency severity index: a prospective cohort study

“…Not surprisingly, all three parameters are included in scores with good prognostic power for short-term mortality. 8 Patients with normal vital signs and mobility showed both low early 8 , 9 and low 1-year mortality. 9 Oxygen saturation is one of the most valuable vital signs for triage.…”

“… 11 , 17 , 18 Prognostic information, such as long-term mortality, may also support appropriate and prudent disposition decisions. 8 In Kitovu Hospital, Uganda, a simple, fast triage [Kitovu Hospital fast triage (KFT)] score, based on mobility, mental status and oxygen saturation, was developed and locally validated against 24 h mortality and the need for hospital admission. 19 We hypothesized that the KFT score might be useful in any ED when demand overwhelms the available resources.…”