Stiell et al developed a score for evaluating patients with heart failure in the Emergency Department. This score can help to identify a patient at risk for serious adverse events. The authors are from the University of Ottawa, University of Toronto, Queen's University, University of Calgary and the University of Alberta.
Patient selection: heart failure in the Emergency Department
Outcome: death within 30 days; admission to ICU within 14 days; endotracheal intubation or ventilation within 14 days; AMI within 14 days; coronary artery procedure within 14 days; hemodialysis within 14 days; readmission within 14 days
Parameters:
(1) history of stroke or TIA
(2) history of intubation for respiratory failure
(3) heart rate on arrival in beats per minute
(4) oxygen saturation in percent on arrival
(5) heart rate during 3 minute walk test in beats per minute
(6) acute ischemic changes on ECG
(7) serum urea concentration in mmol/L
(8) serum bicarbonate in mmol/L
(9) serum troponin level
(10) NT-proBNP in ng/L
|
Parameter
|
Finding
|
Points
|
|
history of stroke or TIA
|
no
|
0
|
|
|
yes
|
1
|
|
prior intubation
|
no
|
0
|
|
|
yes
|
2
|
|
heart rate on arrival
|
< 110
|
0
|
|
|
>= 110
|
2
|
|
oxygen saturation
|
>= 90%
|
0
|
|
|
< 90%
|
1
|
|
heart rate after 3 minute walk
|
< 110
|
0
|
|
|
>= 110
|
1
|
|
|
unable to perform
|
1
|
|
acute ischemic change on ECG
|
absent
|
0
|
|
|
present
|
2
|
|
serum urea
|
< 12 mmol/L
|
0
|
|
|
>= 12 mmol/L
|
1
|
|
serum CO2
|
< 35 mmol/L
|
0
|
|
|
>= 35 mmol/L
|
2
|
|
serum troponin
|
not consistent with AMI
|
0
|
|
|
consistent with AMI
|
2
|
|
NT-proBNP
|
< 5,000 ng/L
|
0
|
|
|
>= 5,000 ng/L
|
1
|
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score 15
• The higher the score the greater the risk for serious adverse events.
|
Score
|
Risk
|
|
0
|
3%
|
|
1
|
5%
|
|
2
|
9%
|
|
3
|
16%
|
|
4
|
26%
|
|
5
|
40%
|
|
6
|
55%
|
|
7
|
70%
|
|
8
|
81%
|
|
9
|
89%
|
|
10 to 15
|
> 90%
|
Performance:
• At a score >=2, the sensitivity was 81% and specificity 54%.
