A simple prognostic score predicts one‐year mortality of alert and calm emergency department patients: A prospective two‐center observational study

Abstract

Study Objective To derive and validate a prognostic score to predict 1‐year mortality using vital signs, mobility and other variables that are readily available at the bedside at no additional cost. Methods Post hoc analysis of two independent prospective observational studies in two emergency departments, one in Denmark and the other in Switzerland. Participants Alert and calm emergency department patients. Measurements The prediction of mortality from presentation to 365 days by vital signs, mobility and other variables that are readily available at the bedside at no additional cost. Results One thousand six hundred and eighteen alert and calm patients were in the Danish cohort and 1331 in the Swiss cohort. Logistic regression identified age >68 years, abnormal vital signs, impaired mobility and the decision to admit as significant predictors of 365‐day mortality. A simple prognostic score awarded one point to each of these predictors. Less than two of these predictors were present in 45.6% of patients, and only 0.4% of these patients died within a year. If two or more of these predictors were present, 365‐day mortality increased exponentially. Conclusion Age >68 years, the decision for hospital admission, any vital sign abnormality at presentation and impaired mobility at presentation are equally powerful predictors of 1‐year mortality in alert and calm emergency department patients. If validated by others these predictors could be used to discharge patients with confidence since nearly half of these patients had less than two predictors and none of them died within 30 days. However, when two or more predictors were present 365‐day mortality increased exponentially.

The clinical frailty scale predicts 1‐year mortality in emergency department patients aged 65 years and older

“…The primary endpoint was 1‐year all‐cause mortality. Data on all‐cause mortality at the 1‐year follow‐up were collected using a combination of electronic health records, official registries, insurance data, contact with patients, primary care physicians or patients' proxies as previously demonstrated 4 . Sufficient power for our analysis was targeted at an inclusion of 2100 patients, including 5% for missing data 35,36 …”

“…Longer term prognostication is likely more dependent on physiological reserve such as the degree of frailty rather than how ill or seriously injured the patient was at ED presentation 4 . Such prognostication is relevant as accurate predictions empower more informed shared decision‐making, 5,6 and should ideally encompass the period of acute illness or injury.…”

“…seriously injured the patient was at ED presentation. 4 Such prognostication is relevant as accurate predictions empower more informed shared decision-making, 5,6 and should ideally encompass the period of acute illness or injury. Second, predictions about mortality guided by frailty measures enable physicians not usually invested in geriatrics to consider concepts essential to appropriate geriatric care.…”

COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing

“…This process was based on previous safety data regarding informal triage and physiological reserve (e.g., mobility). In detail, unimpaired mobility, low physician disease severity ratings (PDSR), and normal vital signs are associated with a very favorable prognosis [ 3 , 4 , 5 , 6 , 7 ]. We hypothesized that these principles hold true for a coordinated large-scale testing process.…”

Limited Prognostic Utility of a Simplified Vital Sign Based Risk Calculator in Acute Medical Admissions

“…A number of prognostic scores have been developed with the goal of identifying those patients who are safe to discharge from the Emergency Department (ED). 17,18 Chang et al 19 recently reported that even minor abnormalities in physiology (vital signs -heart or respiratory rate and blood pressure) at presentation to the ED were predictive of early death, but with considerable overlap to others who did not suffer an early death. Patients with Major Disease Categories (MDCs) of malignant neoplasm, coronary heart disease, chronic obstructive pulmonary disease, congestive heart failure or neurological disease, had a greater likelihood for early death following an ED visit.…”