Roberts et al reported the ALERT score for early prediction of adverse hospital outcome for hospitalized patients. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Manitoba, Dalhousie University, and regional health authorities in Canada.
Patient selection: hospitalized patient on a general medical ward
Adverse outcomes: death during hospitalization, transfer to ICU within 48 hours of admission, or cardiopulmonary resuscitation during the hospitalization
Parameters on admission:
(1) gender
(2) Charlson Comorbidity index (CCI)
(3) actives of daily living (ADL) score of Katz et al
(4) Glasgow coma score (GCS), from 3 to 15
(5) age in years
(6) heart rate in beats per minute
(7) respiratory rate in breaths per minute
(8) white blood cell count in 10^9/L
(9) systolic blood pressure in mm Hg
|
Parameter
|
Finding
|
Points
|
|
gender
|
male
|
0.157
|
|
|
female
|
0
|
|
Charlson comorbidity
|
|
0.071 * (CCI)
|
|
ADL score
|
|
0.053 * (ADL)
|
|
Glasgow coma score
|
|
-0.172 * (GCS)
|
|
age in years
|
|
(0.068 * (age)) - (0.0004 * ((age)^2))
|
|
heart rate
|
|
0.018 * (heart rate)
|
|
respiratory rate
|
|
0.063 * (respiratory rate)
|
|
white blood cell count
|
|
0.029 * (WBC count)
|
|
systolic blood pressure
|
|
(0.000121 * ((SBP)^2)) - (0.041 * (SBP))
|
value of X =
= SUM(points for all of the parameters)) - 3.839
probability of an adverse outcome =
= 1 / (1 + EXP((-10 * X))
