The prediction of early mortality by the ROX index of oxygenation and respiratory rate in diverse Canadian and Ugandan cohorts of unselected patient: a post-hoc retrospective analysis of 80,558 patient observations

Kellett, John; Sikakulya, Franck Katembo; Nickel, Christian H.

doi:10.52964/amja.0900

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…In addition, the ROX Index has been proposed to support clinicians with the bedside assessment of respiratory function ( 15 ). ROX Index is calculated from the patient's oxygen saturation, their inspired oxygen concentration, and their respiratory rate, and has been found to be an independent predictor of mortality in acutely ill patients (16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Using Vital Signs to Place Acutely Ill Patients Quickly and Easily into Clinically Helpful Pathophysiologic Categories: Derivation and Validation of Eight Pathophysiologic Categories in Two Distinct Patient Populations of Acutely Ill Patients

Kellett¹,

Holland²,

Candel³

2023

The Journal of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

Using Vital Signs to Place Acutely Ill Patients Quickly and Easily into Clinically Helpful Pathophysiologic Categories: Derivation and Validation of Eight Pathophysiologic Categories in Two Distinct Patient Populations of Acutely Ill Patients

Kellett¹,

Holland²,

Candel³

2023

The Journal of Emergency Medicine

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“… 9 Oxygen saturation is one of the most valuable vital signs for triage. 10 In a busy ED, all these parameters may rapidly identify a patient at low risk of early death, who could be managed as outpatient. ‘Red flag’ situations in which patients should not wait are rapidly and easily identified by the Emergency Severity Index (ESI) algorithm and other commonly used triage systems.…”

Section: Introductionmentioning

confidence: 99%

A fast emergency department triage score based on mobility, mental status and oxygen saturation compared with the emergency severity index: a prospective cohort study

Riedel

Espejo

Bingisser

et al. 2023

QJM: An International Journal of Medicine

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Background Waiting for triage in overburdened emergency departments (ED) has become an increasing problem, which endangers patients. A fast triage system to rapidly identifying low acuity patients should divert care and resources to more urgent cases. Aim Objective of this study was to compare the performance of the Kitovu Hospital fast triage score (KFT) with the Emergency Severity Index (ESI), using mortality and hospital admission as proxies for the patients’ acuity. Design A prospective observational study of consecutive patients presenting to a Swiss academic ED. Methods Patients were prospectively triaged into one of five ESI strata, and retrospectively assessed by the KFT score, which awards 1 point each for altered mental status, impaired mobility, and oxygen saturation <94%. Results The KFT score had a lower discrimination than the ESI for hospital admission, but a higher discrimination for mortality from 24-hour to one year after ED presentation. 5544 (67%) patients were assigned to the lowest acuity by the KFT score compared with 2,374 (28·7%) by the ESI; there was no significant difference in the 24-hour mortality of patients who were deemed low acuity by either score. Conclusion Compared to the ESI, the KFT score identifies more than twice as many patients at low risk of early death. Therefore, this score might help to identify patients who could be managed through alternative pathways. This may be particularly helpful in situations of ED crowding and access block.

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“…Only a handful of studies have evaluated the ability of the index to predict adverse outcomes in acute diseases, such as coronavirus disease 2019 (COVID-19) and sepsis [2][3][4]. However, one small preliminary study from a Canadian teaching hospital and a low-resource hospital in Africa looking at three markedly different unselected patient populations found the ROX index to be a powerful discriminator of early mortality [5].…”

Section: Introductionmentioning

confidence: 99%

The prediction of 24-h mortality by the respiratory rate and oxygenation index compared with National Early Warning Score in emergency department patients: an observational study

Candel

Groot

Nissen

et al. 2022

European Journal of Emergency Medicine

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BackgroundThe ROX index combines respiratory rate and oxygenation to predict the response to oxygen therapy in pneumonia. It is calculated by dividing the patient's oxygen saturation, by the inspired oxygen concentration, and then by the respiratory rate (e.g. 95%/0.21/16 = 28). Since this index includes the most essential physiological variables to detect deterioration, it may be a helpful risk tool in the emergency department (ED). Although small studies suggest it can predict early mortality, no large study has compared it with the National Early Warning Score (NEWS), the most widely validated risk score for death within 24 h. Aim The aim of this study was to compare the ability of the ROX index with the NEWS to predict mortality within 24 h of arrival at the hospital. Methods This was a retrospective observational multicentre analysis of data in the Netherlands Emergency Department Evaluation Database (NEED) on 270 665 patients attending four participating Dutch EDs. The ROX index and NEWS were determined on ED arrival and prior to ED treatment. ResultsThe risk of death within 24 h increased with falling ROX and rising NEWS values. The area under the receiving operating characteristic curves for 24-h mortality of NEWS was significantly higher than for the ROX index [0.92; 95% confidence interval (CI), 0.91-0.92 versus 0.87; 95% CI, 0.86-0.88; P < 0.01]. However, the observed and predicted mortality by the ROX index was identical to mortality of 5%, after which mortality was underestimated. In contrast, up to a predicted 24-h mortality of 3% NEWS slightly underestimates mortality, and above this level over-estimates it. The standardized net benefit of ROX is slightly higher than NEWS up to a predicted 24-h mortality of 3%. Conclusion The prediction of 24-h mortality by the ROX index is more accurate than NEWS for most patients likely to be encountered in the ED. ROX may be used as a first screening tool in the ED.

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The prediction of early mortality by the ROX index of oxygenation and respiratory rate in diverse Canadian and Ugandan cohorts of unselected patient: a post-hoc retrospective analysis of 80,558 patient observations

Cited by 3 publications

References 16 publications

Using Vital Signs to Place Acutely Ill Patients Quickly and Easily into Clinically Helpful Pathophysiologic Categories: Derivation and Validation of Eight Pathophysiologic Categories in Two Distinct Patient Populations of Acutely Ill Patients

Using Vital Signs to Place Acutely Ill Patients Quickly and Easily into Clinically Helpful Pathophysiologic Categories: Derivation and Validation of Eight Pathophysiologic Categories in Two Distinct Patient Populations of Acutely Ill Patients

A fast emergency department triage score based on mobility, mental status and oxygen saturation compared with the emergency severity index: a prospective cohort study

The prediction of 24-h mortality by the respiratory rate and oxygenation index compared with National Early Warning Score in emergency department patients: an observational study

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