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Can we predict mortality in the emergency department?

Published:December 18, 2019DOI:https://doi.org/10.1016/j.ejim.2019.12.004
      Conway et al. performed a retrospective study using administrative data to assess the utility of two parameters to predict 30-day mortality during an emergency department (ED) visit [

      Conway R., Byrne D., O'Riordan D., Silke B. Comparative influence of acute illness severity and comorbidity on mortality. In Press, In This Issue 2019.

      ]. They evaluated the potential prognostic roles of a newly developed Comorbidity Index that assess patient comorbidities, and an Acute Illness Severity Score (AISS) that quantifies the severity of the present illness. The authors stratified mortality risk, and correlated the severity of the acute disease and the comorbidity burden to clinical outcomes. For example, a patient with pneumonia and severe respiratory failure but no comorbidities might have a mortality risk similar to that of a patient with a mild pneumonia and a complicated medical history. They highlighted an insight of every physician who works in the clinical setting: clinical outcome is not determined entirely by the acute illness, but is also influenced by the patient's frailty. In addition, they found that higher AISS values were associated with lower prognostic accuracy of the comorbidity index for the prediction of mortality.
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      References

      1. Conway R., Byrne D., O'Riordan D., Silke B. Comparative influence of acute illness severity and comorbidity on mortality. In Press, In This Issue 2019.

        • Barnett K.
        • Mercer S.W.
        • Norbury M.
        • Watt G.
        • Wyke S.
        • Guthrie B
        Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.
        Lancet. 2012; 380: 37-43
        • Vermeiren S.
        • Vella-Azzopardi R.
        • Beckwee D.
        • et al.
        Frailty and the prediction of negative health outcomes: a meta-analysis.
        J Am Med Dir Assoc. 2016; 17 (e1-1163.e17): 1163
        • Jørgensen R.
        • Brabrand M.
        Screening of the frail patient in the emergency department: a systematic review.
        Eur J Intern Med. 2017; 45: 71-73
        • Silva-Obregón J.A.
        • Quintana Diaz M.
        • Saboya-Sanchez S.
        • et al.
        Frailty as a predictor of short- and long-term mortality in critically ill older medical patients.
        J Crit Care. 2019; 55: 79-85
        • Mathers C.D.
        • Loncar D.
        Projections of global mortality and burden of disease from 2002 to 2030.
        PLoS Med. 2006; 3: e442
        • Corazza G.R.
        • Klersy C.
        • Formagnana P.
        • Lenti M.V.
        • Padula D.
        Consensus panel. A consensus for the development of a vector model to assess clinical complexity.
        Intern Emerg Med. 2017; 12: 1313-1318
        • Perkins G.D.
        • et al.
        A randomized trial of epinephrine in out-of-hospital cardiac arrest.
        N Engl J Med. 2018; 379: 711-721
        • Bonzi M.
        • Peta J.
        • Fusco A.
        et al. Comment to assessment of epinephrine efficacy in out-of-hospital cardiac arrest.
        Intern Emerg Med. 2019; 14: 1155
        • Copeland-Fields L.
        • Griffin T.
        • Jenkins T.
        • Buckley M.
        • Wise L.C
        Comparison of outcome predictions made by physicians, by nurses, and by using the Mortality Prediction model.
        Am J Crit Care. 2001 Sep; 10: 313-319
        • Ouchi K.
        • Strout T.
        • Haydar S.
        • et al.
        Association of emergency clinicians' assessment of mortality risk with actual 1-month mortality among older adults admitted to the hospital.
        JAMA Network Open. 2019; 2e1911139
        • Haydar S.A.
        • Strout T.D.
        • Bond A.G.
        • Han P.K
        Prognostic value of a modified surprise question designed for use in the emergency department setting.
        Clin Exp Emerg Med. 2019; 6: 70-76