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Disposition Decision Support by Laboratory Based Outcome Prediction
Disposition is one of the main tasks in the emergency department. However, there is a lack of objective and reliable disposition criteria, and diagnosis-based risk prediction is not feasible at early time points. The aim was to derive a risk score (TRIAL) based on routinely collected baseline (TRIag...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957752/ https://www.ncbi.nlm.nih.gov/pubmed/33804332 http://dx.doi.org/10.3390/jcm10050939 |
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author | Mueller, Oliver S. Rentsch, Katharina M. Nickel, Christian H. Bingisser, Roland |
author_facet | Mueller, Oliver S. Rentsch, Katharina M. Nickel, Christian H. Bingisser, Roland |
author_sort | Mueller, Oliver S. |
collection | PubMed |
description | Disposition is one of the main tasks in the emergency department. However, there is a lack of objective and reliable disposition criteria, and diagnosis-based risk prediction is not feasible at early time points. The aim was to derive a risk score (TRIAL) based on routinely collected baseline (TRIage level and Age) and Laboratory data—supporting disposition decisions by risk stratification based on mortality. We prospectively included consecutive patients presenting to the emergency department over 18 weeks. Data sets of routinely collected baseline (triage level and age) and laboratory data were used for multivariable logistic regression to develop the TRIAL risk score predicting mortality. Routine laboratory variables and disposition cut-offs were chosen beforehand by expert consensus. Risk stratification was based on low risk (<1%), intermediate risk (1–10%), and high risk (>10%) of in-hospital mortality. In total, 8687 data sets were analyzed. Variables identified to develop the TRIAL risk score were triage level (Emergency Severity Index), age, lactate dehydrogenase, creatinine, albumin, bilirubin, and leukocyte count. The area under the ROC curve for in-hospital mortality was 0.93. Stratification according to the TRIAL score showed that 67.5% of all patients were in the low-risk category. Mortality was 0.1% in low-risk, 3.5% in intermediate-risk, and 26.2% in high-risk patients. The TRIAL risk score based on routinely available baseline and laboratory data provides prognostic information for disposition decisions. TRIAL could be used to minimize admission in low-risk and to maximize observation in high-risk patients. |
format | Online Article Text |
id | pubmed-7957752 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-79577522021-03-16 Disposition Decision Support by Laboratory Based Outcome Prediction Mueller, Oliver S. Rentsch, Katharina M. Nickel, Christian H. Bingisser, Roland J Clin Med Article Disposition is one of the main tasks in the emergency department. However, there is a lack of objective and reliable disposition criteria, and diagnosis-based risk prediction is not feasible at early time points. The aim was to derive a risk score (TRIAL) based on routinely collected baseline (TRIage level and Age) and Laboratory data—supporting disposition decisions by risk stratification based on mortality. We prospectively included consecutive patients presenting to the emergency department over 18 weeks. Data sets of routinely collected baseline (triage level and age) and laboratory data were used for multivariable logistic regression to develop the TRIAL risk score predicting mortality. Routine laboratory variables and disposition cut-offs were chosen beforehand by expert consensus. Risk stratification was based on low risk (<1%), intermediate risk (1–10%), and high risk (>10%) of in-hospital mortality. In total, 8687 data sets were analyzed. Variables identified to develop the TRIAL risk score were triage level (Emergency Severity Index), age, lactate dehydrogenase, creatinine, albumin, bilirubin, and leukocyte count. The area under the ROC curve for in-hospital mortality was 0.93. Stratification according to the TRIAL score showed that 67.5% of all patients were in the low-risk category. Mortality was 0.1% in low-risk, 3.5% in intermediate-risk, and 26.2% in high-risk patients. The TRIAL risk score based on routinely available baseline and laboratory data provides prognostic information for disposition decisions. TRIAL could be used to minimize admission in low-risk and to maximize observation in high-risk patients. MDPI 2021-03-01 /pmc/articles/PMC7957752/ /pubmed/33804332 http://dx.doi.org/10.3390/jcm10050939 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Mueller, Oliver S. Rentsch, Katharina M. Nickel, Christian H. Bingisser, Roland Disposition Decision Support by Laboratory Based Outcome Prediction |
title | Disposition Decision Support by Laboratory Based Outcome Prediction |
title_full | Disposition Decision Support by Laboratory Based Outcome Prediction |
title_fullStr | Disposition Decision Support by Laboratory Based Outcome Prediction |
title_full_unstemmed | Disposition Decision Support by Laboratory Based Outcome Prediction |
title_short | Disposition Decision Support by Laboratory Based Outcome Prediction |
title_sort | disposition decision support by laboratory based outcome prediction |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957752/ https://www.ncbi.nlm.nih.gov/pubmed/33804332 http://dx.doi.org/10.3390/jcm10050939 |
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