Multicenter Development and Validation of a Risk Stratification Tool for Ward Patients.
Am J Respir Crit Care Med. 2014 Aug 4;
Authors: Churpek MM, Yuen TC, Winslow C, Robiscek AA, Meltzer DO, Gibbons RD, Edelson DP
Rationale: Most ward risk scores were created using subjective opinion in individual hospitals and only utilize vital signs. Objectives: To develop and validate a risk score using commonly collected electronic health record (EHR) data. Methods: All patients hospitalized on the wards in five hospitals were included in this observational cohort study. Discrete-time survival analysis was used to predict the combined outcome of cardiac arrest (CA), intensive care unit (ICU) transfer, or death on the wards. Laboratory results, vital signs, and demographics were utilized as predictor variables. The model was developed in the first 60% of the data at each hospital and then validated in the remaining 40%. The final model was compared to the Modified Early Warning Score (MEWS) using the area under the receiver operating characteristic curve (AUC). Measurements and Main Results: A total of 269,999 patient admissions were included, with 424 CAs, 13,188 ICU transfers, and 2,840 deaths occurring during the study period. The derived model was more accurate than the MEWS in the validation dataset for all outcomes (AUC 0.83 vs. 0.74 for CA, 0.79 vs. 0.73 for ICU transfer, 0.94 vs. 0.90 for death, and 0.82 vs. 0.76 for the combined outcome; p-value<0.01 for all comparisons). This accuracy improvement was seen across all hospitals. Conclusions: We developed an accurate ward risk stratification tool using commonly collected EHR variables in a large multicenter dataset. Further study is needed to determine whether implementation in real-time would improve patient outcomes.
PMID: 25089847 [PubMed - as supplied by publisher]