Abstract
IntroductionOur goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED) intubations.MethodsWe used Vizient administrative data from hospitalizations of 22,374 adults ≥75 years who underwent non-traumatic ED intubation from 2008–2015 at nearly 300 U.S. hospitals to develop and validate an index to predict in-hospital mortality. We randomly selected one half of participants for the development cohort and one half for the validation cohort. Considering 25 potential predictors, we developed a multivariable logistic regression model using least absolute shrinkage and selection operator method to determine factors associated with in-hospital mortality. We calculated risk scores using points derived from the final model’s beta coefficients. To evaluate calibration and discrimination of the final model, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis and compared mortality by risk groups in the development and validation cohorts.ResultsDeath during the index hospitalization occurred in 40% of cases. The final model included six variables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer, age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Those with low-risk scores (<6) had 31% risk of in-hospital mortality while those with high-risk scores (>10) had 58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09), and the c-statistic was 0.62 in the validation cohort.ConclusionThe model may be useful in identifying older adults at high risk of death after ED intubation.
Highlights
Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED) intubations
Considering 25 potential predictors, we developed a multivariable logistic regression model using least absolute shrinkage and selection operator method to determine factors associated with in-hospital mortality
The model may be useful in identifying older adults at high risk of death after ED intubation. [West J Emerg Med. 2017;18(4)690-697.]
Summary
Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED) intubations. EPs often face much uncertainty about the potential benefit of advanced medical interventions in patients near the end of their lives.[7] During the brief and time-pressured ED encounter, it is often difficult to discern which treatments are not beneficial, especially for seriously ill older adults.[8,9] EPs wish to provide value-concordant care[10] but do not feel adequately trained to discuss goals of care with patients,[11] especially when prognosis is uncertain.[12]
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