Ray et al identified risk factors associated with in-hospital mortality in elderly patients presenting to the Emergency Department with acute respiratory failure. This can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from Universite Pierre et Marie Curie in Paris.
Patient selection: patient > 65 years of age with acute respiratory failure presenting to the Emergency Department
Parameters:
(1) initial therapy in the Emergency Department (ED)
(2) PaCO2 in mm Hg
(3) creatinine clearance
(4) serum brain natriuretic peptide levels (either NT pro-B or B-type)
(5) clinical signs of acute ventilatory failure (use of accessory respiratory muscles, abdominal paradoxical respiration)
|
Parameter |
Finding |
Points |
|
initial therapy in the ED |
appropriate |
0 |
|
|
inappropriate |
1 |
|
PaCO2 |
<= 45 mm Hg |
0 |
|
|
> 45 mm Hg (hypercapnia) |
1 |
|
creatinine clearance |
>= 50 mL per minute |
0 |
|
|
< 50 mL per minute |
1 |
|
serum brain natriuretic peptide |
normal |
0 |
|
|
elevated |
1 |
|
clinical signs of ventilatory failure |
absent |
0 |
|
|
present |
1 |
total number of risk factors =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the risk of in-hospital mortality.
|
Total Score |
In-Hospital Mortality Rate |
|
0 |
1.3% |
|
1 |
6.7% |
|
2 |
13.5% |
|
3 |
24% |
|
4 |
50% |
|
5 |
60% |
Purpose: To evaluate the risk of in-hospital mortality for an elderly patient presenting to the Emergency Department (ED) with acute respiratory failure.
Specialty: Pulmonology
Objective: risk factors
ICD-10: J96.0,
