Predicción de ingreso hospitalario en los pacientes con bajo nivel de prioridad de triaje atendidos en un servicio de urgencias / Predicting hospital admission of patients with emergencies considered low priority according to assigned triage level

RESUMEN

OBJETIVOS: Desarrollar un modelo predictivo de ingreso hospitalario desde triaje de los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con el nivel poco urgente-no urgente de prioridad de visita. MÉTODO: Estudio observacional de cohortes retrospectivo unicéntrico. Se incluyeron los episodios de pacientes > 15años con niveles IV-V MAT-SET atendidos en un SUH durante 2015. Se evaluaron 14 variables demográficas, datos de proceso y constantes vitales. La variable dependiente fue el ingreso hospitalario. Se utilizaron modelos de regresión basados en ecuaciones de estimación generalizadas. RESULTADOS: Se incluyeron 53.860 episodios, 3.430 (6,4%) ingresaron. La mediana de edad fue de 44,5 años (RIC31,1-63,9), 54,1% mujeres. Un 19,3% de los episodios tenían registrados las constantes vitales (CV). El modelo con mayor capacidad predictiva incluía las siguientes variables edad ≥ 85 años (ORa = 6,72; IC 95% 5,26-8,60), sexo masculino (ORa = 1,46; IC 95% 1,28-1,66), procedencia de atención primaria (ORa = 1,94; IC 95% 1,64-2,29), de otro hospital de agudos (ORa = 11,22; IC 95% 4,42-28,51), llegada en ambulancia (ORa = 3,72; IC 95%3,16-4,40),consulta previa a urgencias las 72 horas previas (ORa = 2,15; IC 95% 1,60-2,87), presión arterial sistólica ≥ 150mmHg (ORa = 0,83; IC 95%0,71-0,97), presión arterial diastólica < 60 mmHg (ORa = 1,57; IC 95% 1,25-1,98), temperatura axilar > 37ºC (ORa = 2,29; IC 95% 1,91-2,74), frecuencia cardiaca > 100 latidos/minuto (ORa 1,65; IC 95%1,40-1,96) y saturación basal de oxígeno < 93% (ORa = 2,66; IC 95% 1,86-3,81) y 93-95% (ORa = 1,70; IC 95%1,42-2,05). El área bajo la curva COR fue de 0,82 (IC 95% 0,80-0,83). CONCLUSIONES: Este modelo predictivo permitiría identificar desde el triaje a aquellos pacientes que, siendo poco urgentes o no urgentes, tienen mayor probabilidad de ingreso y darles una atención diferencial dentro del mismo nivel de prioridad

ABSTRACT

OBJECTIVE: To develop a model to predict hospital admission of patients in cases assessed as nonurgent or semi-urgent on emergency department triage. METHODS: Single-center observational study of a retrospective cohort. We included cases of patients older than 15 years whose emergency was classified as level IV-V according to the Andorran-Spanish triage model (MAT-SET, the Spanish acronym). Fourteen independent variables included demographic and care process items as well as vital signs. The dependent variable was hospital admission. The regression models were based on generalized estimating equations. RESULTS: A total of 53 860 episodes were included; 3430 patients (6.4%) were admitted. The median (interquartile range) age was 44.5 (31.1-63.9) years, and 54.1% were female. Vital signs were recorded in 19.3% of the episodes. The model that best predicted admission included the following variables age > 84 years (adjusted odds ratio [aOR], 6.72; 95% CI,5.26-8.60); male sex (aOR, 1.46; 95% CI, 1.28-1.66); referral from a primary care center (aOR, 1.94; 95% CI, 1.64-2.29); referral from another acute-care hospital (aOR, 11.22; 95% CI, 4.42-28.51); arrival by ambulance (aOR, 3.72; 95% CI,3.16-4.40); revisit < 72 hours (aOR, 2.15; 95% CI, 1.60-2.87); systolic blood pressure ≥ 150 mmHg (aOR, 0.83; 95% CI,0.71-0.97); diastolic blood pressure < 60 mmHg (aOR, 1.57; 95% CI, 1.25-1.98); axillary temperature > 37°C (aOR, 2.29;95% CI, 1.91-2.74); heart rate > 100 beats/min (aOR, 1.65; 95% CI, 1.40-1.96); baseline oxygen saturation in arterialblood (SaO2) < 93% (aOR, 2.66; 95% CI, 1.86-3.81); and SaO293%-95% (aOR, 1.70; 95% CI, 1.42-2.05). The area under the receiver operating characteristic curve for the model was 0.82 (95% CI; 95% CI, 0.80-0.83). CONCLUSION: The model predicts which patients are more likely to be admitted after their cases were initially considered non urgent or semi-urgent on triage. Patients found to be at risk can then be given greater attention than others in the same triage level