Derivation of a prognostic score for identifying critically ill patients in an emergency department resuscitation room

Abstract

Introduction: Several prognostic scores exist for critically ill patients, including APACHE II, Revised Trauma Score (RTS), Rapid Emergency Medicine Score (REMS) and Modified Early Warning Score (MEWS). However, there is no widely used score specifically designed to predict the likelihood of early intensive care unit (ICU) admission or death in undifferentiated emergency department (ED) resuscitation room patients. We aimed to derive such a score and compare it with other similar scores. Methods: This was a single centre study of consecutive adult resuscitation room patients over one month. Physiological and blood test variables were compared according to the composite primary outcome: admission to ICU or death within 7 days of attendance. Multivariate logistic regression was used to derive a prediction score which was compared with other scores using ROC (receiver operating characteristic) analysis. Results: 330 patients were included in the study, of whom 77 were admitted to ICU or died within 7 days. A prediction score was derived using the following parameters: systolic blood pressure; Glasgow coma score; blood glucose; bicarbonate; white cell count; and a history of metastates. This score significantly out-performed APACHE II, RTS, REMS and MEWS with an area under the ROC curve of 0.909 (95% CI 0.872-0.938). Conclusion: The Prince of Wales Emergency Department Score (PEDS) is a new prognostic score to predict the likelihood of early ICU admission or death in undifferentiated resuscitation room patients. Further studies are needed to validate and refine this potentially useful tool. © 2009 Elsevier Ireland Ltd. All rights reserved.