scholarly journals Limited Prognostic Utility of a Simplified Vital Sign Based Risk Calculator in Acute Medical Admissions

2020 ◽  
Vol 19 (3) ◽  
pp. 138-144
Author(s):  
Richard Conway ◽  
◽  
Declan Byrne ◽  
Deirdre O’Riordan ◽  
Bernard Silke ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Vital Sign ◽  
Illness Severity ◽  
Polynomial Model ◽  
Inhospital Mortality ◽  
Risk Calculator ◽  
Major Disease ◽  
Fractional Polynomial ◽  
Prognostic Utility ◽  
Vital Parameters

Background: Accurate efficient prognostication in acute medical admissions remains challenging.Methods: We constructed a Vital Sign based Risk Calculator using vital parameters and Major Disease Categories to predict 30-day in-hospital mortality using a multivariable fractional polynomial model. Results: We evaluated 113,807 admissions in 58,126 patients. The Vital Sign based Risk Calculator predicted 30-day inhospital mortality to increase from 2 points – 3.6% (95%CI 3.4, 3.7) to 12 points – 14.8% (95%CI 14.0, 15.7). AUROC was 0.74 (95%CI 0.72, 0.74). The addition of illness severity and comorbidity data improved AUROC to 0.90 (95%CI 0.89, 0.90). Conclusion: The Vital Sign based Risk Calculator is limited by its simplicity; inclusion of illness severity and comorbidity data improve prediction.

Abstract 416: Four Score Remains Effective Prognostic Tool in Cardiac Arrest After Eliminating Respiratory Component

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jonathan Duskin ◽  
Stephanie Liang ◽  
Katie Dam ◽  
William Spears ◽  
Kushak Suchdev ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Respiratory Rate ◽  
Life Support ◽  
High Specificity ◽  
Urban Hospital ◽  
Significant Difference ◽  
Prognostic Utility ◽  
Four Score

Introduction: The FOUR (Full Outline of UnResponsiveness) score was developed as a more effective alternative to the Glasgow Coma Scale for prognostication of critically-ill neurology patients. Current research on the FOUR score in cardiac arrest is limited, but suggests that it may be useful. Given that whether or not a patient over-breathes the ventilator can often be confounded by the set respiratory rate, hypocarbia, and other factors, we evaluated the FOUR score with and without the respiratory component (FOUR-). Methods: We retrospectively studied 83 cardiac arrest patients treated at an urban hospital from 2011-2018 from the Multimodal outcome characterization in comatose cardiac arrest (MOCHA) registry. FOUR and FOUR- score within first 24 hours (day 1) and 72-96 hours (day 4) after arrest were evaluated for ability to predict in-hospital mortality and survival to discharge. Results: Day 1 FOUR score < 4 had 78% (67%-87%) sensitivity and 57% (29%-82%) specificity, while FOUR- score < 4 had 84% (73%-92%) sensitivity and 50% (23%-77%) specificity for predicting in-hospital mortality. Day 4 FOUR and FOUR- scores < 4 had higher specificities (both 94% [71%-100%]) but lower sensitivities (63% [45%-79%] and 69% [51%-83%], respectively) for mortality than day 1. With outcome changed to survival to discharge, day 1 FOUR score > 8 had 29% (8%-58%) sensitivity and 97% (90%-100%) specificity, while FOUR- > 8 had 21% (5%-51%) sensitivity and 100% (95%-100%) specificity. Day 4 FOUR and FOUR- scores > 8 had lower specificities (89% [73%-97%] and 91% [77%-98%], respectively), but higher sensitivities (53% [28%-77%]) and 47% [23%-72%], respectively) than day 1. There were no differences in mortality between FOUR and FOUR- < 4 on day 1 (p=0.89) or 4 (p=0.95), and no differences in survival between FOUR and FOUR- > 8 on day 1 (p=0.26) or 4 (p=0.85). Conclusions: Both the FOUR and FOUR- scores had high specificity for mortality and survival, which is important given that incorrectly predicting a bad outcome could lead to premature withdrawal of life support. The absence of a significant difference between the FOUR and FOUR- and the stronger prognostic ability of the FOUR- suggest that the respiratory component may not provide additional prognostic utility in cardiac arrest.

scholarly journals Administrative data is as good as medical chart review for comorbidity ascertainment in patients with infections in Singapore

2016 ◽  
Vol 144 (9) ◽  
pp. 1999-2005 ◽  
Author(s):  
J. HWANG ◽  
A. CHOW ◽  
D. C. LYE ◽  
C. S. WONG
Keyword(s):  
Infectious Disease ◽  
Hospital Mortality ◽  
Medical Record ◽  
Administrative Data ◽  
Illness Severity ◽  
Medical Record Review ◽  
Disease Research ◽  
Infectious Disease Research ◽  
Infection Source ◽  
Record Review

SUMMARYThe Charlson comorbidity index (CCI) is widely used for control of confounding from comorbidities in epidemiological studies. International Classification of Diseases (ICD)-coded diagnoses from administrative hospital databases is potentially an efficient way of deriving CCI. However, no studies have evaluated its validity in infectious disease research. We aim to compare CCI derived from administrative data and medical record review in predicting mortality in patients with infections. We conducted a cross-sectional study on 199 inpatients. Correlation analyses were used to compare comorbidity scores from ICD-coded administrative databases and medical record review. Multivariable regression models were constructed and compared for discriminatory power for 30-day in-hospital mortality. Overall agreement was fair [weighted kappa 0·33, 95% confidence interval (CI) 0·23–0·43]. Kappa coefficient ranged from 0·17 (95% CI 0·01–0·36) for myocardial infarction to 0·85 (95% CI 0·59–1·00) for connective tissue disease. Administrative data-derived CCI was predictive of CCI ⩾5 from medical record review, controlling for age, gender, resident status, ward class, clinical speciality, illness severity, and infection source (C = 0·773). Using the multivariable model comprising age, gender, resident status, ward class, clinical speciality, illness severity, and infection source to predict 30-day in-hospital mortality, administrative data-derived CCI (C = 0·729) provided a similar C statistic as medical record review (C = 0·717, P = 0·8548). In conclusion, administrative data-derived CCI can be used for assessing comorbidities and confounding control in infectious disease research.

Differences in Procedure Use, In-Hospital Mortality, and Illness Severity by Gender for Acute Myocardial Infarction Patients

Medical Care ◽  
1997 ◽  
Vol 35 (2) ◽  
pp. 158-171 ◽  
Author(s):  
Lisa I. Iezzoni ◽  
Arlene S. Ash ◽  
Michael Shwartz ◽  
Yevgenia D. Mackiernan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Illness Severity

Role of Initial Albumin Levels Among Other Liver Tests and Prognostic Scores in Predicting In-Hospital Mortality and Illness Severity in Critically Ill Septic Patients

CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A405
Author(s):  
Paris Charilaou ◽  
Vaia Florou ◽  
Damodar Penigalapati ◽  
Haris Rana ◽  
Capecomorin S Pitchumoni ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Illness Severity ◽  
Prognostic Scores ◽  
Liver Tests

scholarly journals Fitting the Fractional Polynomial Model to Non-Gaussian Longitudinal Data

2017 ◽  
Vol 8 ◽  
Author(s):  
Ji Hoon Ryoo ◽  
Jeffrey D. Long ◽  
Greg W. Welch ◽  
Arthur Reynolds ◽  
Susan M. Swearer
Keyword(s):  
Longitudinal Data ◽  
Polynomial Model ◽  
Fractional Polynomial ◽  
Non Gaussian

scholarly journals The increased mortality associated with a weekend emergency admission is due to increased illness severity and altered case-mix

2011 ◽  
Vol 10 (4) ◽  
Author(s):  
Olga Mikulich ◽  
◽  
Elizabeth Callaly ◽  
Kathleen Bennett ◽  
Deirdre O’Riordan ◽  
...  
Keyword(s):  
Risk Model ◽  
Gastrointestinal Disease ◽  
Emergency Admission ◽  
Illness Severity ◽  
Case Mix ◽  
Inhospital Mortality ◽  
Unadjusted Odds Ratio ◽  
Co Morbidity ◽  
Multivariate Logistic Model ◽  
Illness Severity Score

Background: A weekend emergency medical admission has been associated with a higher mortality. We have examined all weekend admissions to St James’ Hospital, Dublin between 2002 and 2009. Methods: We divided admissions by weekday or weekend (Saturday or Sunday) presentation. We utilised a multivariate logistic model, to determine whether a weekend admission was independently predictive of 30 day outcome. Results: There were 49337 episodes recorded in 25883 patients; 30-day inhospital mortality at the weekend (9.9% vs. 9.0%) had an unadjusted Odds Ratio of 1.11 (95% CI 0.99, 1.23: p=0.057). In the full risk (unlike the univariate) model, a weekend admission was not independently predictive (OR 1.05; 95% CI: 0.88, 1.24). The case-mix for a weekend admission differed; with more neurological diagnoses (22.8% vs 20.4% : p = 0.001) and less gastrointestinal disease (18.3% vs 21.1% : p = 0.001). A biochemistry only illness severity score predicted a higher mortality for weekend admissions. Conclusion: Patients admitted at the weekend had an approximate 11% increased 30-day in-hospital mortality, compared with a weekday admission. However, admission at the weekend was not independently predictive in a risk model that included Illness Severity (age and biochemical markers) and co-morbidity. Sicker patients, with a worse outcome, are admitted over the weekend; these considerations should inform the allocation of healthcare resources.

The sixth vital sign: prehospital end-tidal carbon dioxide predicts in-hospital mortality and metabolic disturbances

2014 ◽  
Vol 32 (2) ◽  
pp. 160-165 ◽  
Author(s):  
Christopher L. Hunter ◽  
Salvatore Silvestri ◽  
George Ralls ◽  
Steven Bright ◽  
Linda Papa
Keyword(s):  
Carbon Dioxide ◽  
Hospital Mortality ◽  
Vital Sign ◽  
Metabolic Disturbances ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

scholarly journals Does Risk Calculator by Nationwide Survey Match The Postoperative Outcome in Patients Who Underwent Major Hepatectomy?

2020 ◽  
Author(s):  
Atsushi Nanashima ◽  
Naoya Imamura ◽  
Masahide Hiyoshi ◽  
Koichi Yano ◽  
Takeomi Hamada ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Major Hepatectomy ◽  
Nationwide Survey ◽  
Hospital Death ◽  
Risk Calculator ◽  
Biliary Malignancy ◽  
Co Morbidity ◽  
Hepatobiliary Diseases

Abstract Background: To clarify significance of the present National Clinical Database risk calculator (NCD-RC) for hepatectomy in Japan, relationship between perioperative parameters or outcomes in major hepatectomy and the mortality rate by NCD-RC was examined. Methods: Patient demographics, co-morbidity, surgical records, postoperative morbidity or mortality were examined and compared to the 30 days- or in-hospital-mortality rate among 55 patients with hepatobiliary diseases who underwent hemi- or more-extended hepatectomy and central (segment 458) hepatectomy. The cut-off percent for high risk mortality before hepatectomy was set at 5% in this period. Results: In-hospital morbidity over CD III was 17 (28%), The 30-day mortality and in-hospital mortality was nil and two (3%), respectively. Male patient showed significantly higher in-hospital mortality rate (p<0.01). In the 37 patients (group woML), mean age was 67.8±8.7 years old ranging 45 and 84. Others included A) with severe complications or mortality in whom low mortality rate (group wML, n=13), B) without severe complications neither mortality in whom high mortality rate (group woMH, n=7), and C) with severe complications or mortality in whom high mortality rate (group wMH, n=4 (6.5%)). Age, distribution of elderly patients, gender, the hepatobiliary diseases and the prevalence of preoperative co-morbidity were not significantly different between groups. In the group wML, the bile leakage was dominant and, however, the in-hospital death was not observed. In the group wMH, all operations were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy and two died of hepatic failure and, however, the prevalence of RH-BDR was not significantly higher in comparison with other groups. Conclusions: Predictive mortality rate by risk calculator under nationwide survey did not always match with patient outcomes in the actual clinical setting and further improvement will be required. In case of RH-BDR for biliary malignancy with high predictive rate, the careful perioperative managements is important under the present nationwide database.

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