Bingisser Roland, Baerlocher Severin Manuel, Kuster Tobias, Nieves Ortega Ricardo, Nickel Christian H
Emergency Department, University Hospital, CH-4031 Basel, Switzerland.
J Clin Med. 2020 Mar 11;9(3):762. doi: 10.3390/jcm9030762.
Our objective was to compare informal physicians' disease severity ratings (PDSR) at presentation with the well-established Emergency Severity Index (ESI) in order to test for non-inferiority of the discriminatory ability regarding hospitalization, intensive care, and mortality. We made a prospective observational study with consecutive enrollment. At presentation, the PDSR and subsequently Emergency Severity Index (ESI) levels were recorded. The primary outcome was the non-inferiority of the discriminatory ability (PDSR versus ESI) regarding hospitalization, intensive care, and mortality. The secondary outcomes were the reliability, the predictive validity, and the safety of PDSR. We included 6859 patients. The median age was 51 years (interquartile range (IQR) = 33 to 72 years); 51.4% were males. There were 159 non-survivors (2.4%) at the 30 day follow-up. The PDSR's discriminatory ability was non-inferior to the ESI's discriminatory ability. The safety assessment showed mortality of <0.5% in low-acuity patients in both tools. The predictive validity increased by 3.5 to 7 times if adding high-acuity PDSR to ESI in all categories with mortality of >1%. Our data showed the non-inferiority of PDSR compared with ESI regarding discriminatory ability, a moderate reliability, and an acceptable safety of both tools.
我们的目标是比较非正式医生在患者就诊时给出的疾病严重程度评分（PDSR）与成熟的急诊严重程度指数（ESI），以测试在住院、重症监护和死亡率方面的区分能力是否不劣于后者。我们进行了一项前瞻性观察性研究，连续纳入患者。在患者就诊时，记录PDSR以及随后的急诊严重程度指数（ESI）水平。主要结局是在住院、重症监护和死亡率方面区分能力（PDSR与ESI相比）的非劣效性。次要结局是PDSR的可靠性、预测效度和安全性。我们纳入了6859例患者。中位年龄为51岁（四分位间距（IQR）=33至72岁）；51.4%为男性。在30天随访时有159例非幸存者（2.4%）。PDSR的区分能力不劣于ESI的区分能力。安全性评估显示，两种工具中低 acuity 患者的死亡率均<0.5%。在所有死亡率>1%的类别中，如果在ESI基础上增加高 acuity PDSR，预测效度提高3.5至7倍。我们的数据显示，与ESI相比，PDSR在区分能力、适度可靠性和两种工具均可接受的安全性方面不劣于ESI。
