Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations
Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations
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DOI：
10.5811/westjem.2017.2.33325
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发表时间：
2017-06-01
影响因子：
3.1
通讯作者：
Schonberg, Mara A.
中科院分区：
文献类型：
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作者：
Ouchi, Kei;Hohmann, Samuel;Schonberg, Mara A.
前言：我们的目标是开发和验证一个指标来预测非创伤性急诊科（ED）插管后老年人的住院死亡率。方法：我们使用了美国近300家医院2008-2015年间22,374名年龄在75岁至75岁之间接受非创伤性ED插管的住院患者的Vizient管理数据，以开发并验证预测院内死亡率的指标。我们随机选择一半的参与者作为发展队列，另一半作为验证队列。考虑到25个潜在的预测因素，我们开发了一个多变量逻辑回归模型，使用最小绝对收缩和选择算子方法来确定与住院死亡率相关的因素。我们使用最终模型的贝塔系数得出的分数来计算风险评分。为了评估最终模型的校准和鉴别性，我们使用了Hosmer-Lemeshow卡方检验和接受者操作特征分析，并比较了开发和验证队列中不同风险组的死亡率。结果：指数住院期间死亡占40%。最终模型包括心肌梗死史、脑血管病史、转移性癌史、年龄、入院诊断败血症、入院诊断脑卒中/颅内出血6个变量。低风险评分（< 6）的患者住院死亡率为31%，而高风险评分（bbb10）的患者住院死亡率为58%。模型的Hosmer-Lemeshow卡方为6.47 (p= 0.09)，验证队列的c统计量为0.62。结论：该模型可用于识别ED插管后死亡风险较高的老年人。
Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED) intubations.Methods: We used Vizient administrative data from hospitalizations of 22,374 adults > 75 years who underwent non-traumatic ED intubation from 2008-2015 at nearly 300 U. S. hospitals to develop and validate an index to predict in-hospital mortality. We randomly selected one half of participants for the development cohort and one half for the validation cohort. Considering 25 potential predictors, we developed a multivariable logistic regression model using least absolute shrinkage and selection operator method to determine factors associated with in-hospital mortality. We calculated risk scores using points derived from the final model's beta coefficients. To evaluate calibration and discrimination of the final model, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis and compared mortality by risk groups in the development and validation cohorts.Results: Death during the index hospitalization occurred in 40% of cases. The final model included six variables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer, age, admission diagnosis of sepsis, and admission diagnosis of stroke/intracranial hemorrhage. Those with low-risk scores (< 6) had 31% risk of in-hospital mortality while those with high-risk scores (> 10) had 58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p= 0.09), and the c-statistic was 0.62 in the validation cohort.Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.