Details

Autor(en) / Beteiligte

• Brink, Anniek
• Schuttevaer, Romy
• Alsma, Jelmer
• Zietse, Robert
• Schuit, Stephanie Catherine Elisabeth
• Lingsma, Hester Floor
• Ashkenazi, Itamar

Titel

Predicting 30-day mortality using point-of-care testing; an external validation and derivation study

Ist Teil von

• PloS one, 2020-09, Vol.15 (9), p.e0239318-e0239318

Ort / Verlag

San Francisco: Public Library of Science

Erscheinungsjahr

2020

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Early risk stratification for guiding treatment priority in the emergency department (ED) is becoming increasingly important. Existing prediction models typically use demographics, vital signs and laboratory parameters. Laboratory-based models require blood testing, which may cause substantial delay. However, these delays can be prevented by the use of point-of-care testing (POCT), where results are readily available. We aimed to externally validate a laboratory-based model for mortality and subsequently assessed whether a POCT model yields comparable performance. All adult patients visiting the ED of a university hospital between January 1.sup.st, 2012 and December 31.sup.st, 2016 were retrospectively reviewed for inclusion. Primary outcome was defined as 30-day mortality after ED presentation. We externally validated one existing prediction model including age, glucose, urea, sodium, haemoglobin, platelet count and white blood cell count. We assessed the predictive performance by discrimination, expressed as Area under the Curve (AUC). We compared the existing model to an equivalent model using predictors that are available with POCT (i.e. glucose, urea, sodium and haemoglobin). Additionally, we internally validated these models with bootstrapping. We included 34,437 patients of whom 1,942 (5.6%) died within 30 days. The AUC of the laboratory-based model was 0.794. We refitted this model to our ED population and found an AUC of 0.812, which decreased only slightly to 0.790 with only POCT parameters. Our POCT-model performs similar to existing laboratory-based models in identifying patients at high risk for mortality, with results available within minutes. Although the model needs further validation and evaluation, it shows the potential of POCT for early risk stratification in the ED.