Scoring systems in prediciting mortality rate of patients applying emergency department

摘要

Objective: To compare the scoring systems used in intensive care units in terms of predictingthe mortality in emergency patients and to determine the most appropriate scoring system forurgent care. Methods: This study was carried out by retrospectively reviewing the files ofpatients admitted to Ankara Numune Training and Research Hospital emergency medicineclinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admittedto any service of the hospital. This study calculated automatically with the data obtained fromthe patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHEⅡ), Simplified Acute Physiology Score (SAPS Ⅱ), Modified Early Warning Score (MEW)and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files werereviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded.The obtained data were entered in SPSS 18 and compared with the scores of APACHE Ⅱ,SAPS Ⅱ, MEW and SOFA. Results: Based on area under the curve analysis, APACE Ⅱ (0.799;95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting thepatients mortality. However, there was no difference between four scoring system in terms ofpredicting the mortality. Age (P<0.001, odd's ratio 1.055) pulse (P<0.007, odd's ratio 1.025)and SO2 (P<0.003, odd's ratio 0.952) variables were found to be independent risk factors formortality. Conclusions: Scores such as APACHE Ⅱ, SAPS Ⅱ, and SOFA, can not be used tomake an urgent decision on the first encounter with the patient even though they are successfulin predicting mortality. In this case, MEW could be recommended as the most useful system.As a result, the use of scoring systems in emergency departments is useful and necessary. But,multi-centered and large patient group studies are needed.