Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care.
Background: We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups. Methods: This study was done in a university-affiliated medical center. Con...
| Published in: | American Journal of Emergency Medicine Vol. 31; no. 5; pp. 830 - 835 |
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| Main Authors: | , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Elsevier B.V.
May2013
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123509277&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 123509277 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07356757 1X2 jtl: American Journal of Emergency Medicine issn: 07356757 maglogo: N pubinfo: dt: May2013 vid: 31 iid: 5 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 123509277 123509277 123509277 10.1016/j.ajem.2013.02.010 123509277 ppf: 830 ppct: 5 formats: tig: atl: Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care. aug: au: Chien-Cheng Huang Shu-Chun Kuo Tsair-Wei Chien Hung-Jung Lin How-Ran Guo Wei-Lung Chen Jiann-Hwa Chen Su-Hen Chang Shih-Bin Su affil: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan sug: subj: Hospital Mortality Risk Factors Hyperglycemia Emergency Service Critical Care Human Male Female Tachycardia Hypotension Anemia Coma ROC Curve Descriptive Statistics Adult Middle Age Aged P-Value Scales Survival Analysis Mann-Whitney U Test Data Analysis Software Chi Square Test Fisher's Exact Test Multiple Regression Sensitivity and Specificity Multivariate Analysis Odds Ratio Confidence Intervals Logistic Regression Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups. Methods: This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets--the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint. Results: We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits (25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set. Conclusions: The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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