eccSOFA: SOFA illness severity score adapted to predict in-hospital mortality in emergency critical care patients

Niknam, Kian; Nesbitt, Jason; Mitarai, Tsuyoshi; Nudelman, Matthew; Gordon, Alexandra June; Wilson, Jennifer G.; Kohn, Michael A.

doi:10.1016/j.ajem.2020.12.018

Cited by 5 publications

(7 citation statements)

References 18 publications

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“…Adjustment for Severity of Illness. Adjustment for severity of illness was performed using the eccSOFA score, which is a modified version of the Sequential Organ Failure Assessment score specifically adapted for ICU patients in the ED that was previously validated in our patient population (area under the receiver operating characteristic curve of 0.775; 95% CI, 0.753-0.797) (25). The score was calculated using data collected at the time of the initial ED order for hospital admission.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical data were extracted from the EHR (Epic Systems, Madison, WI) by querying the clinical data warehouse (Clarity, Epic Systems, Madison, WI). Extracted data included demographic characteristics, admission diagnosis, and elements required to calculate emergency critical care Sequential Organ Failure Assessment (eccSOFA) score ( 25 ) for the severity of illness measurement.…”

Section: Methodsmentioning

confidence: 99%

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Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department*

Mitarai

Gordon

Nudelman

et al. 2023

Critical Care Medicine

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Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department* OBJECTIVES: To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED). DESIGN: Single-center, retrospective cohort study using ED-visit data between 2015 and 2019. SETTING: Tertiary academic medical center. PATIENTS: Adult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival. INTERVENTIONS: Dedicated bedside critical care for medical ICU patients by an ED-based intensivist following initial resuscitation by the ED team. MEASUREMENTS AND MAIN RESULTS:Primary outcomes were inhospital mortality and the proportion of patients downgraded to non-ICU status while in the ED within 6 hours of the critical care admission order (ED downgrade <6 hr). A difference-in-differences (DiD) analysis compared the change in outcomes for patients arriving during ECCP hours (2 pm to midnight, weekdays) between the preintervention period (2015-2017) and the intervention period (2017-2019) to the change in outcomes for patients arriving during non-ECCP hours (all other hours). Adjustment for severity of illness was performed using the emergency critical care Sequential Organ Failure Assessment (eccSOFA) score. The primary cohort included 2,250 patients. The DiDs for the eccSOFA-adjusted inhospital mortality decreased by 6.0% (95% CI, -11.9 to -0.1) with largest difference in the intermediate illness severity group (DiD, -12.2%; 95% CI, -23.1 to -1.3). The increase in ED downgrade less than 6 hours was not statistically significant (DiD, 4.8%; 95% CI, -0.7 to 10.3%) except in the intermediate group (DiD, 8.8%; 95% CI, 0.2-17.4). CONCLUSIONS:The implementation of a novel ECCP was associated with a significant decrease in inhospital mortality among critically ill medical ED patients, with the greatest decrease observed in patients with intermediate severity of illness. Early ED downgrades also increased, but the difference was statistically significant only in the intermediate illness severity group. KEY WORDS: critical care medicine; emergency department critical care; emergency medicine; health care delivery models; intensive care unit triage C ritical care delivery in U.S. emergency departments (EDs) is increasing, particularly in urban hospitals (1, 2). Between 2006 and 2014, ED visits for critically ill patients increased by 80% with minimal accompanying growth in available ED capacity and ICU beds (3). The ED is not designed for longitudinal care of the critically ill; previous studies on ED boarding of

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department*

Mitarai

Gordon

Nudelman

et al. 2023

Critical Care Medicine

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“…We used the Sequential Organ Failure Assessment (SOFA) score as modified for use in the ED to measure severity of illness, emergency critical care SOFA (eccSOFA) 13 and compared in-hospital mortality in the prolonged and non-prolonged groups adjusting for severity of illness using logistic regression. Means and SDs for continuous variables and proportions for categorical variables are reported and exact P values and 95% confidence intervals (CIs) are calculated.…”

Section: Discussionmentioning

confidence: 99%

Selection bias in estimating the relationship between prolonged ED boarding and mortality in emergency critical care patients

et al. 2022

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“…We performed univariable analysis on 26 independent variables that were included on the data collection form using complete (non-missing) data and reporting risk ratios for 30-day mortality. For risk ratio reporting of continuous variables, we chose category boundaries based on the 4C Mortality Score (age, respiratory rate, oxygen saturation, blood urea nitrogen (BUN) and CRP) or other published mortality prediction models (body mass index (BMI), creatinine, total bilirubin) 19…”

Section: Methodsmentioning

confidence: 99%

External validation of the 4C Mortality Score for hospitalised patients with COVID-19 in the RECOVER network

et al. 2022

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ObjectivesEstimating mortality risk in hospitalised SARS-CoV-2+ patients may help with choosing level of care and discussions with patients. The Coronavirus Clinical Characterisation Consortium Mortality Score (4C Score) is a promising COVID-19 mortality risk model. We examined the association of risk factors with 30-day mortality in hospitalised, full-code SARS-CoV-2+ patients and investigated the discrimination and calibration of the 4C Score. This was a retrospective cohort study of SARS-CoV-2+ hospitalised patients within the RECOVER (REgistry of suspected COVID-19 in EmeRgency care) network.Setting99 emergency departments (EDs) across the USA.ParticipantsPatients ≥18 years old, positive for SARS-CoV-2 in the ED, and hospitalised.Primary outcomeDeath within 30 days of the index visit. We performed logistic regression analysis, reporting multivariable risk ratios (MVRRs) and calculated the area under the ROC curve (AUROC) and mean prediction error for the original 4C Score and after dropping the C reactive protein (CRP) component.ResultsOf 6802 hospitalised patients with COVID-19, 1149 (16.9%) died within 30 days. The 30-day mortality was increased with age 80+ years (MVRR=5.79, 95% CI 4.23 to 7.34); male sex (MVRR=1.17, 1.05 to 1.28); and nursing home/assisted living facility residence (MVRR=1.29, 1.1 to 1.48). The 4C Score had comparable discrimination in the RECOVER dataset compared with the original 4C validation dataset (AUROC: RECOVER 0.786 (95% CI 0.773 to 0.799), 4C validation 0.763 (95% CI 0.757 to 0.769). Score-specific mortalities in our sample were lower than in the 4C validation sample (mean prediction error 6.0%). Dropping the CRP component from the 4C Score did not substantially affect discrimination and 4C risk estimates were now close (mean prediction error 0.7%).ConclusionsWe independently validated 4C Score as predicting risk of 30-day mortality in hospitalised SARS-CoV-2+ patients. We recommend dropping the CRP component of the score and using our recalibrated mortality risk estimates.

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eccSOFA: SOFA illness severity score adapted to predict in-hospital mortality in emergency critical care patients

Cited by 5 publications

References 18 publications

Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department*

Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department*

Selection bias in estimating the relationship between prolonged ED boarding and mortality in emergency critical care patients

External validation of the 4C Mortality Score for hospitalised patients with COVID-19 in the RECOVER network

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