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A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score

  • Noortje Zelis
    Correspondence
    Corresponding author at: Maastricht University Medical Centre+, Department of Internal Medicine, Division of General Internal Medicine, PO Box 5800, 6202 AZ Maastricht.
    Affiliations
    Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands

    Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands

    CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
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  • Jacqueline Buijs
    Affiliations
    Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands
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  • Peter W. de Leeuw
    Affiliations
    Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands

    Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands

    CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
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  • Sander M.J. van Kuijk
    Affiliations
    Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
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  • Patricia M. Stassen
    Affiliations
    Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands

    School of CAPHRI, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
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Published:February 26, 2020DOI:https://doi.org/10.1016/j.ejim.2020.02.021

      Highlights

      • The RISE UP score accurately predicts 30-day mortality in older ED patients.
      • The score includes variables that are easily available during ED stay.
      • The RISE UP score performs better than four well-known risk stratification scores.
      • By predicting mortality, this score may contribute to personalised medical care.

      Abstract

      Background/Objectives

      Currently, accurate clinical models that predict short-term mortality in older (≥ 65 years) emergency department (ED) patients are lacking. We aimed to develop and validate a prediction model for 30-day mortality in older ED patients that is easy to apply using variables that are readily available and reliably retrievable during the short phase of an ED stay.

      Methods

      Prospective multi-centre cohort study in older medical ED patients. The model was derived through logistic regression analyses, externally validated and compared with other well-known prediction models (Identification of Seniors at Risk (ISAR), ISAR-Hospitalised Patients, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Modified Early Warning Score (MEWS)).

      Results

      Within 30 days after presentation, 66 (10.9%) of 603 patients in the derivation cohort and 105 (13.3%) of 792 patients in the validation cohort died. The newly developed model included 6 predictors: age, ≥2 abnormal vital signs, serum albumin, blood urea nitrogen, lactate dehydrogenase, and bilirubin. The discriminatory value of the model for mortality was very good with an AUC of 0.84 in the derivation and 0.83 in the validation cohort. The final model was excellently calibrated (Hosmer-Lemeshow p-value 0.89). The discriminatory value of the model was significantly higher than that of the four risk stratification scores (highest AUC of 0.69 for ISAR score, p-value 0.007).

      Conclusion

      We developed and externally validated an accurate and simplified prediction model for 30-day mortality in older ED patients. This model may be useful to identify patients at risk of short-term mortality and to apply personalised medical care.

      Keywords

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