Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Multicenter Study
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Early identification of geriatric patients at high risk for mortality is important to guide clinical care, medical decision making, palliative discussions, quality assurance, and research. We sought to identify injured older adults at highest risk for 30-day mortality using an empirically derived scoring system from available data and to compare it with current prognostic scoring systems. ⋯ Older, injured adults transported by EMS to a large variety of trauma and nontrauma hospitals were more likely to die within 30 days if they required emergent airway management or had a higher comorbidity burden. When compared to other risk measures and holding sensitivity constant near 90%, the GTRI had higher specificity, despite a lower AUROC. Using GTOS II or the GTRI may better identify high-risk older adults than traditional scores, such as ISS, but identification of an ideal prognostic tool remains elusive.
-
Multicenter Study
What is the specificity of the aortic dissection detection risk score in a low prevalence population?
Acute aortic syndrome (AAS) is a time-sensitive and difficult-to-diagnose aortic emergency. The American Heart Association (AHA) proposed the acute aortic dissection detection risk score (ADD-RS) as a means to reduce miss rate and improve time to diagnosis. Previous validation studies were performed in a high prevalence population of patients. We do not know how the rule will perform in a lower-prevalence population. This is important because application of a rule with low specificity would increase imaging rates and complications. Our goal was to assess if the diagnostic accuracy of the score would be maintained in a low-prevalence population that we are attempting to risk stratify in the emergency department (ED). ⋯ Our study confirms that in North America the prevalence of AAS in those undergoing advanced imaging is low. The ADD-RS in this population has a low specificity. A lack of defined inclusion criteria and a low specificity limits the application of this rule in practice.
-
This is a prospective observational study looking to validate a previously derived decision rule designed to help safely discharge opioid overdose patients from the emergency department after 1 hour. They included a convenience sample of 538 adult patients who had received naloxone pre-hospital and compared the Hospital Observation Upon Reversal (HOUR) rule with clinical judgement. ⋯ The HOUR rule had a sensitivity of 84.1% (95% CI 76.2-92.1%) and a specificity of 62.1% (95% CI 57.6-66.5%), which was very similar to clinical judgement. Clinical judgement would have missed 12 adverse events, while the HOUR rule would have missed 13, although most of those adverse events were probably minor.