JAMA Logo Individuals facing a risk of critical illness after the out-of-hospital emergency care may be difficult to distinguish. Scientists have apparently developed a prediction score for such patients to understand the development of critical illness during hospitalization like severe sepsis and determine the need for mechanical ventilation or risk of death. The model encompasses factors such as age, blood pressure, heart and respiratory rate of the patient.

The developed tool is claimed to anticipate risk of critical illness during out-of-hospital care in non-injured and non-cardiac arrest patients. The study authors believe that out-of-hospital factors can differ between patients capable as well as incapable of suffering from critical illness during hospitalization. In the process of making the prediction score, scientists went through previously recorded analysis.

Scientists highlight, “Hospitals vary widely in quality of critical care. Consequently, the outcomes of critically ill patients may be improved by concentrating care at more experienced centers. By centralizing patients who are at greater risk of mortality in referral hospitals, regionalized care in critical illness may achieve improvements in outcome similar to trauma networks. Early identification of nontrauma patients in need of critical care services in the emergency setting may improve triage decisions and facilitate regionalization of critical care.”

The emergency medical services (EMS) system in greater King County, Washington without the addition of metropolitan Settle was included in the study. These services seem to provide transport to 16 receiving facilities. Also data for nontrauma, non-cardiac arrest adult patients transported to a hospital by King County EMS from 2002 through 2006 was comprised in the study. The experts apparently associated eligible records with complete data of about 144,913 people along with hospital discharge information. They further randomly split it into development and validation. While 87,266 forming 60 percent were encompassed in development, 57,647 representing 40 percent were introduced in validation.

Experts quote, “We demonstrate the role that simple physiologic assessment can play in risk stratification in the prehospital period among noninjured patients. The model provides an important foundation for future efforts to identify patients at greatest risk of critical illness using information from the out-of-hospital phase of emergency care. Although improved accuracy and external validation are required, this model provides a foundation for future efforts to identify noninjured patients who may benefit from coordinated systems that regionalize emergency care.”

Christopher W. Seymour, M.D., M.Sc., of Harborview Medical Center, University of Washington, Seattle, and colleagues found that critical illness took place during hospitalization in 4,835 patients that formed 5 percent of the development. Similar results were probably monitored in 3,121 patients of validation as cohorts. Experts describe multivariable predictors of critical illness as severe sepsis, delivery of mechanical ventilation, or death during hospitalization.

These predictors may include older age, lower systolic blood pressure, abnormal respiratory rate, lower Glasgow Coma Scale score, lower pulse oximetry that is the measurement of oxygenation of hemoglobin, and nursing home residence during out-of-hospital care. The newly developed score employed at 4 or higher possibly allowed authors to ascertain sensitivity as 0.22 and specificity as 0.98.

The study was published in the August 18 issue of JAMA.