Cattermole et al reported a prognostic score for identifying a critically-ill patient in the Emergency Department. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Prince of Wales Hospital, Chinese University of Hong Kong, Univeristy of Melbourne, Tuen Mun Hospital, Queen Mary Hospital and the United Christian Hospital in Hong Kong.
Patient selection: Emergency Department
Outcomes: death or admission to ICU within 7 days, 30-day mortality
Parameters:
(1) systolic blood pressure in mm Hg
(2) Glasgow coma score (GCS)
(3) glucose in mmol/L
(4) HCO2 in mmol.L
(5) white blood cell count
(6) history of metastatic cancer
|
Parameter |
Finding |
Points |
|
systolic blood pressure |
> 140 mm Hg |
-2 |
|
|
100 to 140 mm Hg |
0 |
|
|
< 100 mm Hg |
3 |
|
Glasgow coma score |
13 to 15 |
0 |
|
|
9 to 12 |
4 |
|
|
< 8 |
23 |
|
glucose |
< 3.2 mmol/L |
6 |
|
|
3.2 to 7.0 mmol/L |
0 |
|
|
> 7.0 mmol/L |
4 |
|
HCO3 |
< 22 mmol/L |
16 |
|
|
22 to 26 mmol/L |
0 |
|
|
> 26 mmol/L |
7 |
|
white blood cell count |
> 10,700 per µL |
3 |
|
|
4,000 to 10,700 per µL |
0 |
|
|
< 4,000 per µL |
6 |
|
history of metastatic cancer |
no |
0 |
|
|
yes |
4 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -2
• maximum score: 58
• The higher the score the greater the risk of critical illness.
|
Total Score |
Risk Group |
Poor Outcome |
|
<= 14 |
low |
5% |
|
15 to 29 |
moderate |
48% |
|
>= 30 |
high |
93% |
Performance:
• The area under the curve for poor outcome at 7 days is 0.91.
• The area under the curve for 30-day mortality is 0.90.
