Hsieh Ming-Ju, Hsu Nin-Chieh, Lin Yu-Feng, Shu Chin-Chung, Chiang Wen-Chu, Ma Matthew Huei-Ming, Sheng Wang-Huei
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
BMJ Open. 2021 Jan 4;11(1):e040837. doi: 10.1136/bmjopen-2020-040837.
To set up a prediction model for the 7-day in-hospital mortality of patients admitted from the emergency department (ED) because it is high but no appropriate initial alarm score is available.
This is a prospective cohort study for prediction model development.
In a tertiary referred hospital in northern Taiwan.
ED-admitted medical patients in hospitalist care wards were enrolled during May 2010 to October 2016. Two-thirds of them were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort.
7-day in-hospital mortality.
During the study period, 8649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel Index Score, triage level 1 at the ED, presence of cancer, metastasis and admission diagnoses of pneumonia and sepsis were independently associated with 7 days in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 (0.79-0.85). The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cut-off value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cut-off value was a score of 6.
The 7-day in-hospital mortality in the hospitalist care ward is 2.8%. The initial alarm score could help clinicians to prioritise or exclude patients who need urgent and intensive care.
由于急诊科收治患者的7天院内死亡率较高且尚无合适的初始预警评分，故建立该类患者7天院内死亡率的预测模型。
这是一项用于开发预测模型的前瞻性队列研究。
台湾北部的一家三级转诊医院。
2010年5月至2016年10月期间，纳入医院医师护理病房中由急诊科收治的内科患者。其中三分之二被随机分配到推导队列以建立模型，并在验证队列中进行交叉验证。
7天院内死亡率。
在研究期间，共纳入8649例患者进行分析。平均年龄为71.05岁，男性占51.91%。最常见的入院诊断为肺炎（36%）和尿路感染（20.05%）。在推导队列中，多变量Cox比例风险回归显示，低Barthel指数评分、急诊科分诊1级、存在癌症、转移以及肺炎和脓毒症的入院诊断与7天院内死亡率独立相关。基于多变量模型得出的概率，推导组中受试者工作特征曲线下面积为0.81（0.79 - 0.85）。验证队列中的结果与之相当。由六个独立因素修正后的预测评分，对于截断值为4时，灵敏度高，为88.03%，阴性预测值为99.51%；而当截断值为6分时，特异性和阳性预测值分别为89.61%和10.55%。
医院医师护理病房的7天院内死亡率为2.8%。初始预警评分可帮助临床医生对需要紧急和重症护理的患者进行优先排序或排除。
