Hayashida, KeiKondo, YutakaHifumi, ToruShimazaki, JunyaOda, YasutakaShiraishi, ShinichiroFukuda, TatsumaSasaki, JunichiShimizu, Keiki2018-06-272018Hayashida, Kei, Yutaka Kondo, Toru Hifumi, Junya Shimazaki, Yasutaka Oda, Shinichiro Shiraishi, Tatsuma Fukuda, Junichi Sasaki, and Keiki Shimizu. 2018. “A novel early risk assessment tool for detecting clinical outcomes in patients with heat-related illness (J-ERATO score): Development and validation in independent cohorts in Japan.” PLoS ONE 13 (5): e0197032. doi:10.1371/journal.pone.0197032. http://dx.doi.org/10.1371/journal.pone.0197032.http://nrs.harvard.edu/urn-3:HUL.InstRepos:37160192Background: We sought to develop a novel risk assessment tool to predict the clinical outcomes after heat-related illness. Methods: Prospective, multicenter observational study. Patients who transferred to emergency hospitals in Japan with heat-related illness were registered. The sample was divided into two parts: 60% to construct the score and 40% to validate it. A binary logistic regression model was used to predict hospital admission as a primary outcome. The resulting model was transformed into a scoring system. Results: A total of 3,001 eligible patients were analyzed. There was no difference in variables between development and validation cohorts. Based on the result of a logistic regression model in the development phase (n = 1,805), the J-ERATO score was defined as the sum of the six binary components in the prehospital setting (respiratory rate≥22 /min, Glasgow coma scale<15, systolic blood pressure≤100 mmHg, heart rate≥100 bpm, body temperature≥38°C, and age≥65 y), for a total score ranging from 0 to 6. In the validation phase (n = 1,196), the score had excellent discrimination (C-statistic 0.84; 95% CI 0.79–0.89, p<0.0001) and calibration (P>0.2 by Hosmer-Lemeshow test). The observed proportion of hospital admission increased with increasing J-ERATO score (score = 0, 5.0%; score = 1, 15.0%; score = 2, 24.6%; score = 3, 38.6%; score = 4, 68.0%; score = 5, 85.2%; score = 6, 96.4%). Multivariate analyses showed that the J-ERATO score was an independent positive predictor of hospital admission (adjusted OR, 2.43; 95% CI, 2.06–2.87; P<0.001), intensive care unit (ICU) admission (3.73; 2.95–4.72; P<0.001) and in-hospital mortality (1.65; 1.18–2.32; P = 0.004). Conclusions: The J-ERATO score is simply assessed and can facilitate the identification of patients with higher risk of heat-related hospitalization. This scoring system is also significantly associated with the higher likelihood of ICU admission and in-hospital mortality after heat-related hospitalization.en-USMedicine and Health SciencesCritical Care and Emergency MedicineHealth CareHealth Care FacilitiesHospitalsPediatricsBiology and Life SciencesPhysiologyPhysiological ParametersBody TemperatureOral MedicinePeople and PlacesGeographical LocationsAsiaJapanEarth SciencesGeographyGeographic AreasUrban AreasSocial SciencesSociologyEducationMedical EducationMedical HumanitiesJournal Article2018-06-2710.1371/journal.pone.0197032