Coslovsky et al reported a clinical model for predicting the death of a patient in the Emergency Department. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Bern.
Patient selection: Emergency Department patient
Parameters:
(1) age in years
(2) reduced peripheral circulation
(3) mechanical ventilation at the time of ED arrival
(4) SpO2/FIO2 ratio (above or below the median of all observations)
(5) history of ED visit in past 12 months
(6) mean arterial pressure in mm Hg
(7) Glasgow coma scale (GCS)
(8) APACHE II diagnostic category on arrival at ED
|
Parameter
|
Finding
|
Points
|
|
age in years
|
|
(0.0006 * ((age)^2)) + (0.11 * (age))
|
|
reduced peripheral circulation
|
no
|
0
|
|
|
yes
|
1.41
|
|
mechanical ventilation
|
no
|
0
|
|
|
yes
|
0.98
|
|
SpO2/FIO2 ratio
|
< 4.2 (below median)
|
0
|
|
|
>= 4.2 (above median)
|
-1.82
|
|
ED visit in past year
|
no
|
0
|
|
|
yes
|
0.49
|
|
MAP
|
|
(0.0003 * ((MAP)^2)) - (0.07 * (MAP))
|
|
GCS
|
14 or 15
|
0
|
|
|
11 to 13
|
1.31
|
|
|
9 or 10
|
2.12
|
|
|
6 to 8
|
3.16
|
|
|
3 to 5
|
4.53
|
|
APACHE II
|
respiratory condition
|
0
|
|
|
cardiovascular
|
-0.25
|
|
|
neurological
|
-0.56
|
|
|
gastrointestinal
|
0.63
|
|
|
trauma
|
-0.70
|
|
|
other
|
0.15
|
where:
• The impact of age seems to dominate at older ages.
value of X =
= SUM(points for all of the parameters) - 3.75
probability of death in the ED =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.92.
