Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
Int J Clin Pract. 2022 Sep 23;2022:7281693. doi: 10.1155/2022/7281693. eCollection 2022.
Prognostication is an important component of medical decision-making. A patients' general prognosis can be difficult to measure. The Simple Prognostic Score (SPS) was designed to include patients' age, mobility, aggregated vital signs, and the treating physician's decision to admit to aid prognostication. . Our study aim is to validate the SPS, compare it with the Emergency Severity Index (ESI) regarding its prognostic performance, and test the interrater reliability of the subjective variable of the decision to admit.
Over a period of 9 weeks all patients presenting to the ED were included, routinely interviewed, final disposition registered, and followed up for one year. The C-statistics of discrimination was used to compare SPS and ESI predictions of 7-day, 30-day, and 1-year mortality. Youden J Statistics and Odds ratio, using logistical regression, were calculated for the Simple Prognostic Score. In a subset, a chart review was performed by senior physicians for a secondary assessment of the decision to admit. Interrater reliability was calculated using percentages and Cohens Kappa.
Out of 5648 patients, 3272 (57.9%) had a low SPS (i.e., ≤ 1); none of these patients died within 7 days, 2 (0.1%) died within 30 days after presentation and 19 (0.6%) died within a year. The area under the curve for 1-year mortality of the Simple Prognostic Score was 0.848. Secondary analysis of the interrater agreement for the decision to admit was 92%.
In a prospective study of unselected ED patients, the Simple Prognostic Score was validated as a reliable predictor of short- and long-term mortality.
预后是医疗决策的重要组成部分。患者的总体预后难以衡量。简单预后评分（SPS）旨在纳入患者的年龄、活动能力、综合生命体征以及治疗医生决定收治以辅助预后评估。我们的研究目的是验证 SPS，比较其与紧急严重指数（ESI）在预后性能方面的差异，并测试收治决定这一主观变量的组间可靠性。
在 9 周的时间内，纳入所有到急诊科就诊的患者，常规进行访谈，记录最终去向，并进行为期 1 年的随访。使用判别能力的 C 统计量比较 SPS 和 ESI 对 7 天、30 天和 1 年死亡率的预测。使用逻辑回归计算简单预后评分的约登指数和优势比。在一个亚组中，由资深医生进行图表回顾，以对收治决定进行二次评估。使用百分比和 Cohen's Kappa 计算组间可靠性。
在 5648 名患者中，3272 名（57.9%）SPS 较低（即≤1）；这些患者中无 7 天内死亡者，2 名（0.1%）在就诊后 30 天内死亡，19 名（0.6%）在 1 年内死亡。简单预后评分的 1 年死亡率的曲线下面积为 0.848。收治决定的组间一致性的二次分析为 92%。
在一项对急诊科未选择患者的前瞻性研究中，简单预后评分被验证为短期和长期死亡率的可靠预测指标。
