Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations

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Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations

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Title: Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations
Author: Ouchi, Kei; Hohmann, Samuel; Goto, Tadahiro; Ueda, Peter; Aaronson, Emily L.; Pallin, Daniel J.; Testa, Marcia A.; Tulsky, James A.; Schuur, Jeremiah D.; Schonberg, Mara A.

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Citation: Ouchi, Kei, Samuel Hohmann, Tadahiro Goto, Peter Ueda, Emily L. Aaronson, Daniel J. Pallin, Marcia A. Testa, James A. Tulsky, Jeremiah D. Schuur, and Mara A. Schonberg. 2017. “Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations.” Western Journal of Emergency Medicine 18 (4): 690-697. doi:10.5811/westjem.2017.2.33325. http://dx.doi.org/10.5811/westjem.2017.2.33325.
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Abstract: Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED) intubations. Methods: We used Vizient administrative data from hospitalizations of 22,374 adults ≥75 years who underwent non-traumatic ED intubation from 2008–2015 at nearly 300 U.S. hospitals to develop and validate an index to predict in-hospital mortality. We randomly selected one half of participants for the development cohort and one half for the validation cohort. Considering 25 potential predictors, we developed a multivariable logistic regression model using least absolute shrinkage and selection operator method to determine factors associated with in-hospital mortality. We calculated risk scores using points derived from the final model’s beta coefficients. To evaluate calibration and discrimination of the final model, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis and compared mortality by risk groups in the development and validation cohorts. Results: Death during the index hospitalization occurred in 40% of cases. The final model included six variables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer, age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Those with low-risk scores (<6) had 31% risk of in-hospital mortality while those with high-risk scores (>10) had 58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09), and the c-statistic was 0.62 in the validation cohort. Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.
Published Version: doi:10.5811/westjem.2017.2.33325
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468075/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:33490971
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