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- Title
Comparing In-Hospital Mortality Prediction by Senior Emergency Resident's Judgment and Prognostic Models in the Emergency Department.
- Authors
Rahmatinejad, Zahra; Peiravi, Samira; Hoseini, Benyamin; Rahmatinejad, Fatemeh; Eslami, Saeid; Abu-Hanna, Ameen; Reihani, Hamidreza
- Abstract
Background. A comparison of emergency residents' judgments and two derivatives of the Sequential Organ Failure Assessment (SOFA), namely, the mSOFA and the qSOFA, was conducted to determine the accuracy of predicting in-hospital mortality among critically ill patients in the emergency department (ED). Methods. A prospective cohort research was performed on patients over 18 years of age presented to the ED. We used logistic regression to develop a model for predicting in-hospital mortality by using qSOFA, mSOFA, and residents' judgment scores. We compared the accuracy of prognostic models and residents' judgment in terms of the overall accuracy of the predicted probabilities (Brier score), discrimination (area under the ROC curve), and calibration (calibration graph). Analyses were carried out using R software version R-4.2.0. Results. In the study, 2,205 patients with median age of 64 (IQR: 50-77) years were included. There were no significant differences between the qSOFA (AUC 0.70; 95% CI: 0.67-0.73) and physician's judgment (AUC 0.68; 0.65-0.71). Despite this, the discrimination of mSOFA (AUC 0.74; 0.71-0.77) was significantly higher than that of the qSOFA and residents' judgments. Additionally, the AUC-PR of mSOFA, qSOFA, and emergency resident's judgments was 0.45 (0.43-0.47), 0.38 (0.36-0.40), and 0.35 (0.33-0.37), respectively. The mSOFA appears stronger in terms of overall performance: 0.13 vs. 0.14 and 0.15. All three models showed good calibration. Conclusion. The performance of emergency residents' judgment and the qSOFA was the same in predicting in-hospital mortality. However, the mSOFA predicted better-calibrated mortality risk. Large-scale studies should be conducted to determine the utility of these models.
- Subjects
HOSPITAL medical staff; JUDGMENT (Psychology); HOSPITAL emergency services; CONFIDENCE intervals; CRITICALLY ill; PATIENTS; MULTIPLE organ failure; HOSPITAL mortality; RISK assessment; DESCRIPTIVE statistics; QUESTIONNAIRES; RESEARCH funding; PREDICTION models; SENSITIVITY &; specificity (Statistics); LOGISTIC regression analysis; RECEIVER operating characteristic curves; DATA analysis software; LONGITUDINAL method; DISEASE risk factors
- Publication
BioMed Research International, 2023, p1
- ISSN
2314-6133
- Publication type
Article
- DOI
10.1155/2023/6042762