Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA.
Emergency Department, Stanford Health Care, Stanford, USA.
Am J Emerg Med. 2021 Mar;41:145-151. doi: 10.1016/j.ajem.2020.12.018. Epub 2020 Dec 14.
Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most existing illness severity scores are based on data that is not available at the time of the hospital admission decision or cannot be extracted from the electronic health record (EHR). We adapted the SOFA score to create a new illness severity score (eccSOFA) that can be calculated at the time of ICU admission order entry in the ED using EHR data. We evaluated this score in a cohort of emergency critical care (ECC) patients at a single academic center over a period of 3 years.
This was a retrospective cohort study using EHR data to assess predictive accuracy of eccSOFA for estimating in-hospital mortality risk. The patient population included all adult patients who had a critical care admission order entered while in the ED of an academic medical center between 10/24/2013 and 9/30/2016. eccSOFA's discriminatory ability for in-hospital mortality was assessed using ROC curves.
Of the 3912 patients whose in-hospital mortality risk was estimated, 2260 (57.8%) were in the low-risk group (scores 0-3), 1203 (30.8%) in the intermediate-risk group (scores 4-7), and 449 (11.5%) in the high-risk group (scores 8+). In-hospital mortality for the low-, intermediate, and high-risk groups was 4.2% (95%CI: 3.4-5.1), 15.5% (95% CI 13.5-17.6), and 37.9% (95% CI 33.4-42.3) respectively. The AUROC was 0.78 (95%CI: 0.75-0.80) for the integer score and 0.75 (95% CI: 0.72-0.77) for the categorical eccSOFA.
As a predictor of in-hospital mortality, eccSOFA can be calculated based on variables that are commonly available at the time of critical care admission order entry in the ED and has discriminatory ability that is comparable to other commonly used illness severity scores. Future studies should assess the calibration of our absolute risk predictions.
在急诊室（ED）中收治 ICU 患者的情况正在增加。疾病严重程度评分可能有助于急诊医师对风险进行分层，以指导更早地将患者转移到 ICU，并通过调整基线死亡率风险来评估 ICU 前干预措施。大多数现有的疾病严重程度评分是基于在医院入院决策时不可用或无法从电子健康记录（EHR）中提取的数据。我们改编了 SOFA 评分，创建了一个新的疾病严重程度评分（eccSOFA），可以在 ED 中下达 ICU 入院医嘱时使用 EHR 数据进行计算。我们在一个为期 3 年的单所学术中心的急诊危重病（ECC）患者队列中评估了该评分。
这是一项回顾性队列研究，使用 EHR 数据评估 eccSOFA 对估计院内死亡率风险的预测准确性。患者人群包括 2013 年 10 月 24 日至 2016 年 9 月 30 日期间在学术医疗中心的 ED 中下达重症监护入院医嘱的所有成年患者。使用 ROC 曲线评估 eccSOFA 对院内死亡率的区分能力。
在所估计的 3912 例患者的院内死亡率中，2260 例（57.8%）为低危组（评分 0-3），1203 例（30.8%）为中危组（评分 4-7），449 例（11.5%）为高危组（评分 8+）。低、中、高危组的院内死亡率分别为 4.2%（95%CI：3.4-5.1）、15.5%（95%CI 13.5-17.6）和 37.9%（95%CI 33.4-42.3）。整数评分的 AUC 为 0.78（95%CI：0.75-0.80），分类 eccSOFA 的 AUC 为 0.75（95%CI：0.72-0.77）。
作为院内死亡率的预测指标，eccSOFA 可以根据在 ED 下达重症监护入院医嘱时通常可用的变量进行计算，其区分能力与其他常用的疾病严重程度评分相当。未来的研究应评估我们的绝对风险预测的校准情况。
