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Prediction of Critical Illness During Out-of-Hospital Emergency Care

dc.contributor.authorSeymour, Christopher W.
dc.contributor.authorKahn, Jeremy M.
dc.contributor.authorCooke, Colin
dc.contributor.authorWatkins, Timothy
dc.contributor.authorHeckbert, Susan
dc.contributor.authorRea, Thomas
dc.date.accessioned2011-06-21T02:52:21Z
dc.date.available2011-06-21T02:52:21Z
dc.date.issued2010-08
dc.identifier.citationJAMA. 2010;304(7):747-754 <http://hdl.handle.net/2027.42/85143>en_US
dc.identifier.urihttps://hdl.handle.net/2027.42/85143
dc.description.abstractCONTEXT: Early identification of nontrauma patients in need of critical care services in the emergency setting may improve triage decisions and facilitate regionalization of critical care. OBJECTIVES: To determine the out-of-hospital clinical predictors of critical illness and to characterize the performance of a simple score for out-of-hospital prediction of development of critical illness during hospitalization. DESIGN AND SETTING: Population-based cohort study of an emergency medical services (EMS) system in greater King County, Washington (excluding metropolitan Seattle), that transports to 16 receiving facilities. PATIENTS: Nontrauma, non-cardiac arrest adult patients transported to a hospital by King County EMS from 2002 through 2006. Eligible records with complete data (N = 144,913) were linked to hospital discharge data and randomly split into development (n = 87,266 [60%]) and validation (n = 57,647 [40%]) cohorts. MAIN OUTCOME MEASURE: Development of critical illness, defined as severe sepsis, delivery of mechanical ventilation, or death during hospitalization. RESULTS: Critical illness occurred during hospitalization in 5% of the development (n = 4835) and validation (n = 3121) cohorts. Multivariable predictors of critical illness included older age, lower systolic blood pressure, abnormal respiratory rate, lower Glasgow Coma Scale score, lower pulse oximetry, and nursing home residence during out-of-hospital care (P < .01 for all). When applying a summary critical illness prediction score to the validation cohort (range, 0-8), the area under the receiver operating characteristic curve was 0.77 (95% confidence interval [CI], 0.76-0.78), with satisfactory calibration slope (1.0). Using a score threshold of 4 or higher, sensitivity was 0.22 (95% CI, 0.20-0.23), specificity was 0.98 (95% CI, 0.98-0.98), positive likelihood ratio was 9.8 (95% CI, 8.9-10.6), and negative likelihood ratio was 0.80 (95% CI, 0.79- 0.82). A threshold of 1 or greater for critical illness improved sensitivity (0.98; 95% CI, 0.97-0.98) but reduced specificity (0.17; 95% CI, 0.17-0.17). CONCLUSIONS: In a population-based cohort, the score on a prediction rule using out-of-hospital factors was significantly associated with the development of critical illness during hospitalization. This score requires external validation in an independent populationen_US
dc.language.isoen_USen_US
dc.titlePrediction of Critical Illness During Out-of-Hospital Emergency Careen_US
dc.typeArticleen_US
dc.subject.hlbsecondlevelInternal Medicine and Specialities
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumPulmonary and Critical Care Medicine, Division ofen_US
dc.contributor.affiliationumInternal Medicine, Department ofen_US
dc.contributor.affiliationumcampusAnn Arboren_US
dc.identifier.pmid20716737
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/85143/1/Seymour - JAMA-2010-747-54.pdf
dc.identifier.doi10.1001/jama.2010.1140
dc.identifier.sourceJAMAen_US
dc.description.mapping114en_US
dc.owningcollnamePulmonary & Critical Care Medicine, Division of


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