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A risk scoring system to identify emergency department patients with heart failure at high risk for serious adverse events.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Stiell, Ian G. Clement, Catherine M. Brison, Robert J. Rowe, Brian H. Borgundvaag, Bjug Aaron, Shawn D. Lang, Eddy L. Calder, Lisa Anne Perry, Jeffrey J. Forster, Alan J. Wells, George A. |
| Copyright Year | 2013 |
| Abstract | OBJECTIVES There are no validated guidelines to guide physicians with difficult disposition decisions for emergency department (ED) patients with heart failure (HF). The authors sought to develop a risk scoring system to identify HF patients at high risk for serious adverse events (SAEs). METHODS This was a prospective cohort study at six large Canadian EDS that enrolled adult patients who presented with acute decompensated HF. Each patient was assessed for standardized clinical and laboratory variables as well as for SAEs defined as death, intubation, admission to a monitored unit, or relapse requiring admission. Adjusted odds ratios for predictors of SAEs were calculated by stepwise logistic regression. RESULTS In 559 visits, 38.1% resulted in patient admission. Of 65 (11.6%) SAE cases, 31 (47.7%) occurred in patients not initially admitted. The multivariate model and resultant Ottawa Heart Failure Risk Scale consists of 10 elements, and the risk of SAEs varied from 2.8% to 89.0%, with good calibration between observed and expected probabilities. Internal validation showed the risk scores to be very accurate across 1,000 replications using the bootstrap method. A threshold of 1, 2, or 3 total scores for admission would be associated with sensitivities of 95.2, 80.6, or 64.5%, respectively, all better than current practice. CONCLUSIONS Many HF patients are discharged home from the ED and then suffer SAEs or death. The authors have developed an accurate risk scoring system that could ultimately be used to stratify the risk of poor outcomes and to enable rational and safe disposition decisions. |
| Starting Page | 17 |
| Ending Page | 26 |
| Page Count | 10 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://em.osumc.edu/education/journalClub/HFSAE.pdf |
| PubMed reference number | 23570474v1 |
| Alternate Webpage(s) | https://doi.org/10.1111/acem.12056 |
| DOI | 10.1111/acem.12056 |
| Journal | Academic emergency medicine : official journal of the Society for Academic Emergency Medicine |
| Volume Number | 20 |
| Issue Number | 1 |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Accident and Emergency department Adverse event Calibration Cessation of life Coordinating Center Data Collection Ehlers-Danlos Syndrome Erectile dysfunction Heart failure High Risk Acute Leukemia Hospital admission Hospitalization Intubation Lithium Odds Ratio Patient Visit Patients Probability Renal Replacement Therapy Respiratory Distress Syndrome, Adult Score pediatric acute myeloblastic leukemia |
| Content Type | Text |
| Resource Type | Article |
