Shock. 2023 May 22. doi: 10.1097/SHK.0000000000002150. Online ahead of print.
OBJECTIVES: Patients with cardiopulmonary symptoms admitted to the emergency department (ED) have high mortality and intensive care unit admission rates. We developed a new scoring system comprising concise triage information, point-of-care ultrasound (POCUS), and lactate levels to predict vasopressor requirements.
METHODS: This retrospective observational study was conducted at a tertiary academic hospital. Patients with cardiopulmonary symptoms who visited the ED and underwent POCUS between January 2018 and December 2021 were enrolled. The influence of demographic and clinical findings on the requirement for vasopressor support within 24 h of ED admission was investigated. A new scoring system was developed using key components after stepwise multivariable logistic regression analysis. Prediction performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
RESULTS: A total of 2,057 patients were analyzed. A stepwise multivariable logistic regression model showed high predictive performance in the validation cohort (AUC 0.87). Eight key components were selected - hypotension, chief complaint, and fever at ED admission, way of ED visit, systolic dysfunction, regional wall motion abnormalities, IVC status, serum lactate level. The scoring system was developed based on the beta coefficients of each component: accuracy 0.8079, sensitivity 0.8057, specificity 0.8214, PPV 0.9658, and NPV 0.4035, with a cut-off value according to the Youden index.
CONCLUSION: A new scoring system was developed to predict vasopressor requirements in adult ED patients with cardiopulmonary symptoms. This system can serve as a decision-support tool to guide efficient assignment of emergency medical resources.