### Description

Ha et al reported a model for predicting 30-day mortality for a medical patient in the Emergency Department (ED). This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Vietnam and Australia.

Patient selection: medical patient in the Emergency Department

Parameters:

(1) sex

(2) respiratory rate in breaths per minute

(3) oxygen saturation in percent

(4) duration of illness in days, from 0 to 45

(5) Glasgow coma scale (GCS), from 3 to 15

(7) serum urea in mmol/L

(8) serum albumin in g/L

NOTE: The nomogram does not reflect the information shown in Model 2. For example, a GCS of 15 and oxygen saturation of 100% are associated with mortality. Similarly, a respiratory rate of 0 and serum albumin of 5 g/L is associated with survival. There appears to be a problem.

Model as Written

 Parameter Finding Points sex female 13.127 male 0 ICU admission no 55.598 yes 0

points for albumin =

= (1.4826 * (albumin)) - 7.4131

points for duration =

= (2.2222 * (days))

points for GCS =

= (4.5683 * (GCS)) - 13.705

points for oxygen saturation =

= (0.942 * (oxygen sat)) - 47.1

points for respiratory rate =

= (-1.3446 * (rate)) + 87.4

points for urea =

= (-0.8037 * (urea)) + 88.41

total score =

= SUM(points for all of the parameters)

Interpretation:

minimum score: 0

maximum score: 528

The higher the score the greater the risk of mortality.

X =

= (0.000001943 * ((score)^3)) - (0.001911 * ((score)^2)) + (0.6553 * (score)) - 75.48

 Score Mortality Risk < 206.56 < 1% 206.56 to 388.03 1 / (1 + EXP((-1) * X)) > 388.05 > 99%

Correction: Substitute Survival for Mortality

Option 1: The mapping for the nomogram should be to survival risk rather than mortality. Then

mortality risk =

= 1 - (survival risk)

Option 2: The point assignment is the opposite of what it should be, but this would be less likely

 Parameter Finding Points sex male 13.127 female 0 ICU admission yes 55.598 no 0

points for albumin =

= (-1.4826 * (albumin)) + 88.957

points for duration =

= ( -2.2222* (days)) + 100

points for GCS =

= (-4.5683 * (GCS)) + 68.525

points for oxygen saturation =

= (-0.942 * (oxygen sat)) + 94.2

points for respiratory rate =

= (1.3446 * (rate))

points for urea =

= (0.8037 * (urea))

total score =

= SUM(points for all of the parameters)

Interpretation:

minimum score: 0

maximum score: 528

The higher the score the greater the risk of mortality.

X =

= (0.000001943 * ((score)^3)) - (0.001911 * ((score)^2)) + (0.6553 * (score)) - 75.48

 Score Mortality Risk < 206.56 < 1% 206.56 to 388.03 1 / (1 + EXP((-1) * X)) > 388.05 > 99%