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{ "pk": 10502, "title": "Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations", "subtitle": null, "abstract": "Introduction:\n Our goal was to develop and validate an index to predict in-hospital mortality in olderadults after non-traumatic emergency department (ED) intubations.\nMethods:\n We used Vizient administrative data from hospitalizations of 22,374 adults >75 years whounderwent non-traumatic ED intubation from 2008-2015 at nearly 300 U.S. hospitals to develop andvalidate an index to predict in-hospital mortality. We randomly selected one half of participants for thedevelopment cohort and one half for the validation cohort. Considering 25 potential predictors, wedeveloped a multivariable logistic regression model using least absolute shrinkage and selection operatormethod to determine factors associated with in-hospital mortality. We calculated risk scores using pointsderived from the final model’s beta coefficients. To evaluate calibration and discrimination of the finalmodel, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis andcompared mortality by risk groups in the development and validation cohorts.\nResults:\n Death during the index hospitalization occurred in 40% of cases. The final model included sixvariables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer,age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Thosewith low-risk scores (<6) had 31% risk of in-hospital mortality while those with high-risk scores (>10) had58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09), andthe c-statistic was 0.62 in the validation cohort.\nConclusion:\n The model may be useful in identifying older adults at high risk of death after ED intubation.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Mortality prediction, geriatrics, shared decision making" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/20611292", "frozenauthors": [ { "first_name": "Kei", "middle_name": "", "last_name": "Ouchi", "name_suffix": "", "institution": "Department of Emergency Medicine\nBrigham and Women's Hospital\nHarvard Medical School", "department": "None" }, { "first_name": "Samuel", "middle_name": "", "last_name": "Hohmann", "name_suffix": "", "institution": "Vizient, Center for Advanced Analytics, Irving, Texas\nRush University, Department of Health Systems Management, Chicago, Illinois", "department": "None" }, { "first_name": "Tadahiro", "middle_name": "", "last_name": "Goto", "name_suffix": "", "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Peter", "middle_name": "", "last_name": "Ueda", "name_suffix": "", "institution": "Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts", "department": "None" }, { "first_name": "Emily", "middle_name": "L.", "last_name": "Aaronson", "name_suffix": "", "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Daniel", "middle_name": "J.", "last_name": "Pallin", "name_suffix": "", "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Marcia", "middle_name": "A.", "last_name": "Testa", "name_suffix": "", "institution": "Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts\nHarvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, Massachusetts", "department": "None" }, { "first_name": "James", "middle_name": "A.", "last_name": "Tulsky", "name_suffix": "", "institution": "Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts\nBrigham and Women’s Hospital, Department of Medicine, Division of Palliative Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Jeremiah", "middle_name": "D.", "last_name": "Schuur", "name_suffix": "", "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Mara", "middle_name": "A.", "last_name": "Schonberg", "name_suffix": "", "institution": "Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts", "department": "None" } ], "date_submitted": "2016-12-14T17:52:07Z", "date_accepted": "2016-12-14T17:52:07Z", "date_published": "2017-04-19T20:46:51Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10502/galley/5773/download/" } ] }