Centro de Simulación Clínica Avanzada, Facultad de Medicina, Universidad de Valladolid, Valladolid, España. Unidad Móvil de Emergencias, Gerencia de Emergencias Sanitarias de Castilla y León (SACYL), Valladolid, España.
Unidad de Análisis de Datos (UAD) del Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, España.
Emergencias. 2020 Jun;32(3):177-184.
To develop and validate a prehospital risk model to predict early in-hospital mortality (#48 hours) in patients aged 65 years or older.
Prospective multicenter observational study in a cohort of patients aged 65 years or older attended by advanced life support emergency services and transferred to 5 Spanish hospitals between April 2018 and July 2019. We collected demographic, clinical and laboratory variables. A risk score was constructed and validated based on the analysis of prehospital variables associated with death within 48 hours. Predictors were selected by logistic regression.
A total of 1759 patients were recruited. The median age was 79 years (interquartile range, 72-85 years), and 766 (43.5%) were women. One hundred eight patients (6.1%) died within 48 hours. Predictors in the Prehospital Older Adults Warning Scale (POAWS) were age, systolic blood pressure, temperature, the ratio of oxygen saturation to the fraction of inspired oxygen, score on the Glasgow coma scale, and lactic acid concentration in venous blood. The area under the receiver operating characteristic curve of the model to predict early mortality was 0.853 (95% CI, 0.80-0.91; P<.001). Mortality in patients at high risk (POAWS score, >7) was 69%.
The prehospital POAWS score can be used to stratify risk for death within 48 hours in patients aged 65 years or older.
开发和验证一种用于预测 65 岁及以上患者住院早期（48 小时内）死亡率的院前风险模型。
这是一项前瞻性多中心观察性研究，纳入了 2018 年 4 月至 2019 年 7 月期间由高级生命支持急救服务接诊并转至 5 家西班牙医院的 65 岁及以上患者队列。我们收集了人口统计学、临床和实验室变量。基于与 48 小时内死亡相关的院前变量分析，构建并验证了风险评分。使用逻辑回归选择预测因子。
共纳入 1759 例患者。中位年龄为 79 岁（四分位距，72-85 岁），766 例（43.5%）为女性。108 例（6.1%）患者在 48 小时内死亡。院前老年人预警评分（POAWS）中的预测因子包括年龄、收缩压、体温、血氧饱和度与吸入氧分数的比值、格拉斯哥昏迷评分和静脉血乳酸浓度。该模型预测早期死亡率的受试者工作特征曲线下面积为 0.853（95%置信区间，0.80-0.91；P<.001）。高危患者（POAWS 评分>7）的死亡率为 69%。
院前 POAWS 评分可用于分层 65 岁及以上患者 48 小时内死亡风险。
