Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care.
Am J Emerg Med
; 31(5): 830-4, 2013 May.
Article
em En
| MEDLINE
| ID: mdl-23602758
ABSTRACT
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.
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Base de dados:
MEDLINE
Assunto principal:
Indicadores Básicos de Saúde
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Técnicas de Apoio para a Decisão
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Hiperglicemia
Tipo de estudo:
Etiology_studies
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Evaluation_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article