Scoring systems in prediciting mortality rate of patients applying emergency department

Abstract

Objective: To compare the scoring systems used in intensive care units in terms of predicting the mortality in emergency patients and to determine the most appropriate scoring system for urgent care. Methods: This study was carried out by retrospectively reviewing the files of patients admitted to Ankara Numune Training and Research Hospital emergency medicine clinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admitted to any service of the hospital. This study calculated automatically with the data obtained from the patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Modified Early Warning Score (MEW) and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files were reviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded. The obtained data were entered in SPSS 18 and compared with the scores of APACHE II, SAPS II, MEW and SOFA. Results: Based on area under the curve analysis, APACE II (0.799; 95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting the patients mortality. However, there was no difference between four scoring system in terms of predicting the mortality. Age (P<0.001, odd's ratio 1.055) pulse (P<0.007, odd's ratio 1.025) and SO2 (P<0.003, odd's ratio 0.952) variables were found to be independent risk factors for mortality. Conclusions: Scores such as APACHE II, SAPS II, and SOFA, can not be used to make an urgent decision on the first encounter with the patient even though they are successful in predicting mortality. In this case, MEW could be recommended as the most useful system. As a result, the use of scoring systems in emergency departments is useful and necessary. But, multi-centered and large patient group studies are needed.

Keywords

• Emergency
• Mortality
• Scoring systems