Incorporation of age into patient early warning scores significantly improves mortality prediction.

Autor:	Martín-Conty JL; Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla la Mancha, Talavera de la Reina, Spain.; Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain., Castro Villamor MA; Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain., Sanz-García A; Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla la Mancha, Talavera de la Reina, Spain.; Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain., Polonio-López B; Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla la Mancha, Talavera de la Reina, Spain.; Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain., López-Izquierdo R; Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain.; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain., Sáez Belloso S; Department of Nursing, Faculty of Nursing, Universidad de Valladolid, Valladolid, Spain.; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain., Delgado Benito JF; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain., Del Pozo Vegas C; Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain.; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain., Conty-Serrano R; Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Toledo, Spain., Eichinger M; Division of Anesthesiology and Intensive Care Medicine 1, Medical University of Graz, Graz, Styria, Austria., Martín-Rodríguez F; Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain.; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain.
Jazyk:	angličtina
Zdroj:	QJM : monthly journal of the Association of Physicians [QJM] 2024 Jul 01; Vol. 117 (7), pp. 503-511.
DOI:	10.1093/qjmed/hcae031
Abstrakt:	Background: Age is a critical factor for the assessment of patients attended by emergency medical services (EMSs). However, how age modifies early warning scores' (EWSs) predictive ability should be unveiled. Aim: To determine how age influences the performance of EWS [National Early Warning Score 2 (NEWS2), VitalPAC-Early Warning Score (ViEWS), Rapid Acute Physiology Score (RAPS) and modified Rapid Emergency Medicine Score (mREMS)] to predict 2-day mortality. The secondary objective was to determine the performance of EWSs at different age ranges. Design: A prospective, observational study performed between November 2019 and July 2023. Methods: A multicenter, ambulance-based study, considering 38 basic life support units and six advanced life support units referring to four tertiary care hospitals. Eligible patients were adults recruited from among all phone requests for emergency assistance who were later evacuated to emergency departments. The primary outcome was 2-day in-hospital mortality (includes all-cause mortality). The main measures were demographical and vital signs needed for EWS calculation. Results and Discussion: A total of 8028 participants fulfilled the inclusion criteria, with 7654 survivors and 374 non-survivors. Among age ranges, the 2-day mortality was 2.8% for the ≤44 years, 3.3% for the 45-64 years, 4.1% for the 65-74 years and 6.7% for the ≥75-year age group. The inclusion of age significantly improved the Area Under the Curve (AUC) in all the scores (P = 0.006 for non-age-adjusted mREMS, P = 0.001 for NEWS2, P = 0.002 for ViEWS, P = 0.028 for RAPS, all compared with their counterparts with age). Conclusion: Our results demonstrated that the incorporation of age into the EWS improved the performance of the scores. These results will allow the EMS to improve patient management and resource optimization by including an easy-to-obtain variable. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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