Kellett John, Deane Breda, Gleeson Margaret
Nenagh Hospital, Nenagh, County Tipperary, Ireland.
Resuscitation. 2008 Jul;78(1):52-8. doi: 10.1016/j.resuscitation.2008.02.011. Epub 2008 Apr 10.
Predictive scores such as APACHE II have been used to assess patients in intensive care units, but few scores have been used to assess acutely ill general medical patients.
Examination of the ability of clinical variables documented at the time of admission to predict early mortality between 15 min and 24 h after admission.
An Irish rural hospital.
10,290 consecutive patients admitted as acute medical emergencies, divided into a derivation cohort of 6947 patients and a validation cohort of 3343 patients.
40 patients of the derivation cohort (0.6%) died within 24h of hospital admission. Multivariate analysis revealed 11 independent predictors of early death from which a simplified model with minimal loss of predictive ability was derived. Since this model contained only the five variables of Hypotension (systolic blood pressure<100 mm Hg), low Oxygen saturation (<90%), low Temperature (<35 degrees C, abnormal ECG and Loss of independence (unable to stand unaided) it was named the HOTEL score (one point for each variable). There were no differences in the early mortality predicted by this score between the derivation and validation cohorts-the area under the receiver operator characteristic curves for the derivation and validation cohorts were 86.5% and 85.4%, respectively. None of the patients with a score of zero died within 15 min and 24 h and a score of one had an early mortality of 0.3% in both cohorts. A score of two had an early mortality of 0.9% in the derivation cohort and 1.7% in the validation cohort, while a score of three or greater had an early mortality of 10.2% in the derivation and 5.6% the validation cohort.
The HOTEL score quickly identifies patients at a low and high risk of death between 15 min and 24 h after admission, thus enabling prompt triage and placement within a health care facility.
诸如急性生理与慢性健康状况评分系统（APACHE II）等预测评分已被用于评估重症监护病房的患者，但很少有评分用于评估急性病普通内科患者。
研究入院时记录的临床变量预测入院后15分钟至24小时内早期死亡率的能力。
一家爱尔兰乡村医院。
10290例连续因急性内科急症入院的患者，分为6947例患者的推导队列和3343例患者的验证队列。
推导队列中的40例患者（0.6%）在入院后24小时内死亡。多变量分析揭示了11个早期死亡的独立预测因素，并据此得出了一个预测能力损失最小的简化模型。由于该模型仅包含低血压（收缩压<100 mmHg）、低氧饱和度（<90%）、低温（<35℃）、异常心电图和独立能力丧失（无法独自站立）这五个变量，因此被命名为HOTEL评分（每个变量计1分）。该评分在推导队列和验证队列中预测的早期死亡率没有差异——推导队列和验证队列的受试者工作特征曲线下面积分别为86.5%和85.4%。评分0分的患者在15分钟至24小时内均未死亡，评分1分的患者在两个队列中的早期死亡率均为0.3%。评分2分的患者在推导队列中的早期死亡率为0.9%，在验证队列中为1.7%，而评分3分及以上的患者在推导队列中的早期死亡率为10.2%，在验证队列中为5.6%。
HOTEL评分能快速识别入院后15分钟至24小时内死亡风险低和高的患者，从而能够在医疗机构内进行及时分诊和安置。
