Initial Emergency Department Vital Signs Research Articles

Predictors of survival in trauma patients requiring resuscitative thoracotomy: A scoping review

Introduction Resuscitative thoracotomy (RT) is an emergent procedure to gain access to the thoracic cavity to control hemorrhage and other life-threatening injuries. Data predicting survival is variable. This review aims to highlight key predictors of survival and mortality following RT. Methods The EMBASE database was searched using the following terms: [exp. Thoracotomy] AND [Trauma.mp] AND [exp. Survival OR exp. Mortality]. The search was limited to full-text articles in the English language and publications released up to February 27, 2022. Reference lists of included articles were reviewed to identify other studies meeting inclusion criteria. Results Thirty-seven studies were included. Seventy-six outcome predictors were identified. Prehospital outcome predictors included prehospital vital signs, police transport, cardiopulmonary resuscitation, application of a cervical spine collar, and the number of total prehospital procedures performed. In-hospital variables associated with survival included traumatic cardiac arrest (TCA) in the emergency department (ED), initial ED vital signs and cardiac rhythm, Shock Index Pediatric Age-Adjusted score, location of RT, duration of RT, Focused Assessment with Sonography in Trauma findings, amount of blood products, and amount of administered fluids. Conclusions Our study highlights the disparity of data regarding prehospital outcome predictors for trauma patients requiring RT. Most studies focus on injury-specific and in-hospital variables and do not explicitly look at the TCA population. Further work is needed to better define specific variables implicated in enhanced survival across different care settings and to inform management guidelines within these clinical areas.

Initial emergency department vital signs may predict PICU admission in pediatric patients presenting with asthma exacerbation

Objective Severe asthma exacerbations account for a large share of asthma morbidity, mortality, and costs. Here, we aim to identify early predictive factors associated with pediatric intensive care unit (PICU) admission. Methods We performed a retrospective observational study of 5,185 emergency department (ED) encounters at a large children’s hospital, including 86 (1.7%) resulting in PICU admission between 10/1/2015 and 8/7/2018 with ICD9/ICD10 codes for “asthma,” “bronchospasm,” or “wheezing.” Vital signs and demographic information were obtained from electronic health record data and analyzed for each encounter. Predictive factors were identified using adjusted regression models, and our primary outcome was PICU admission. Results Higher mean heart rates (HRs) and respiratory rates (RRs), and lower SpO2 within the first hour of ED presentation were independently associated with PICU admission. Odds of PICU admission increased 70% for each 10 beats/min higher HR, 125% for each 10 breaths/min higher RR, and 34% for each 5% lower SpO2. A binary predictive index using 1-h vitals yielded OR 13.4 (95% CI 8.1–22.1) for PICU admission, area under receiver operator characteristic (AUROC) curve 0.84 and overall accuracy of 80.1%. Results were largely unchanged (AUROC 0.84–0.88) after adjusting for surrogates of asthma severity and initial ED management. In combination with a secondary standardized clinical asthma distress score, positive predictive value increased by sevenfold (6.1%–46%). Conclusions A predictive index using HR, RR, and SpO2 within the first hour of ED presentation accurately predicted PICU admission in this cohort. Automated vital signs trend analysis may help identify vulnerable patients quickly upon presentation.

Longer Prehospital Time Decreases Reliability of Vital Signs in the Field: A Dual Center Study.

Field vital signs are integral in the American College of Surgeons (ASA) Committee on Trauma (COT) triage criteria for trauma team activation (TTA). Reliability of field vital signs in predicting first emergency department (ED) vital signs, however, may depend upon prehospital time. The study objective was to define the effect of prehospital time on correlation between field and first ED vital signs. All highest level TTAs at two Level I trauma centers (2008-2018) were screened. Exclusions were unrecorded prehospital vital signs and those dead on arrival. Demographics, prehospital time (scene time + transport time), injury data, and vital signs were collected. Differences between field and first ED vitals were determined using the paired Student's t test. Propensity score analysis, adjusting for age, sex, injury severity score (ISS), and mechanism of injury compared outcomes among patients with ISS ≥16. Multivariate linear regression determined impact of prehospital time on vital sign differences between field and ED among propensity-matched patients. After exclusions, 21499 patients remained. Mean prehospital time was 32 vs. 41minutes (P < .001). On propensity score analysis, longer prehospital time was associated with significantly greater differences in systolic blood pressure (SBP) (P < .001), pulse pressure (PP) (P = .003), and Glasgow Coma Scale (GCS) (P < .001). On multivariate analysis, linear regression that demonstrated longer prehospital time was associated with greater differences in SBP, heart rate (HR), and PP (P < .001). Field vital signs are less likely to reflect initial ED vital signs when prehospital times are longer. Given the reliance of trauma triage criteria on prehospital vital signs, medical providers must be cognizant of this pitfall during the prehospital assessment of trauma patients.

Shock Index as a Marker for Mortality Rates in Those Admitted to the Medical Intensive Care Unit from the Emergency Department.

ObjectiveShock index (SI) is defined as the heart rate divided by systolic blood pressure. Studies have shown a correlation between the shock index and mortality in trauma patients in prehospital settings and in the emergency department (ED). The objective of this study was to identify the utility of SI in predicting mortality in the medical intensive care unit (MICU) patients admitted from the ED and transfers from the floor to MICU. DesignWe performed a retrospective analysis of adult patients admitted to the MICU at our urban trauma hospital between January 2015 through August 2015 using ED vital signs to calculate the shock index and identify inpatient deaths. Similar data were examined for inpatient transfers to the MICU.ResultsNine hundred and fifty patients were included in the study; 743 had an SI ≤ 0.99 with a mortality rate of 15.9%. Two hundred and seven patients had a SI ≥ 1.00 with a mortality rate of 22.7%. A higher SI was significant for mortality. There was no statistical significance in SI and mortality rate for patients transferred from the medical floor to the ICU.ConclusionsPatients with an SI ≥ 1.00 from initial ED vital signs correlated with a higher mortality rate. In patients transferred from the floor to MICU, SI ≥ 1.00 did not correlate with a higher mortality rate.

Prehospital Vital Signs Accurately Predict Initial Emergency Department Vital Signs.

Prehospital vital signs are used to triage trauma patients to mobilize appropriate resources and personnel prior to patient arrival in the emergency department (ED). Due to inherent challenges in obtaining prehospital vital signs, concerns exist regarding their accuracy and ability to predict first ED vitals. The objective of this study was to determine the correlation between prehospital and initial ED vitals among patients meeting criteria for highest levels of trauma team activation (TTA). The hypothesis was that in a medical system with short transport times, prehospital and first ED vital signs would correlate well. Patients meeting criteria for highest levels of TTA at a Level I trauma center (2008-2018) were included. Those with absent or missing prehospital vital signs were excluded. Demographics, injury data, and prehospital and first ED vital signs were abstracted. Prehospital and initial ED vital signs were compared using Bland-Altman intraclass correlation coefficients (ICC) with good agreement as >0.60; fair as 0.40-0.60; and poor as <0.40). After exclusions, 15,320 patients were included. Mean age was 39 years (range 0-105) and 11,622 patients (76%) were male. Mechanism of injury was blunt in 79% (n = 12,041) and mortality was three percent (n = 513). Mean transport time was 21 minutes (range 0-1,439). Prehospital and first ED vital signs demonstrated good agreement for Glasgow Coma Scale (GCS) score (ICC 0.79; 95% CI, 0.77-0.79); fair agreement for heart rate (HR; ICC 0.59; 95% CI, 0.56-0.61) and systolic blood pressure (SBP; ICC 0.48; 95% CI, 0.46-0.49); and poor agreement for pulse pressure (PP; ICC 0.32; 95% CI, 0.30-0.33) and respiratory rate (RR; ICC 0.13; 95% CI, 0.11-0.15). Despite challenges in prehospital assessments, field GCS, SBP, and HR correlate well with first ED vital signs. The data show that these prehospital measurements accurately predict initial ED vitals in an urban setting with short transport times. The generalizability of these data to settings with longer transport times is unknown.

Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury

IntroductionAneurysmal subarachnoid hemorrhage (aSAH) is frequently seen in emergency departments. Secondary injury, such as subarachnoid hemorrhage-associated myocardial injury (SAHMI), affects one third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions. The aim of this study was to determine whether patients who present to the emergency department with clinical aSAH are likely to develop SAHMI, as defined by troponin I ≥0.3 ng/mL. MethodsThis was a prospective descriptive study. SAHMI was defined as troponin I ≥0.3 ng/mL. Predictors included demographics and clinical characteristics, severity of injury, admission 12-lead electrogardiogram (ECG), initial emergency department vital signs, and pre-hospital symptoms at time of aneurysm rupture. ResultsOf 449 patients, 126 (28%) had SAHMI. Patients with SAHMI were more likely to report seizures and unresponsiveness with significantly lower Glasgow coma score and higher proportion of Hunt and Hess grades 3 to 5 and Fisher grades III and IV (all P < .05). Patients with SAHMI had higher atrial and ventricular rates and longer QTc intervals on initial ECG (P < .05). On multivariable logistic regression, poor Hunt and Hess grade, report of prehospital unresponsiveness, lower admission Glasgow coma score, and longer QTc interval were significantly and independently predictive of SAHMI (P < .05). DiscussionComponents of the clinical presentation of subarachnoid hemorrhage to the emergency department predict SAHMI. Identifying patients with SAHMI in the emergency department can be helpful in determining surveillance and care needs and informing transfer unit care.Contribution to Emergency Nursing Practice•Neurocardiac nursing assessment in the emergency department can be utilized to triage patients with subarachnoid hemorrhage.•Emergency nurses need to be vigilant for cardiac complications in patient with unresponsiveness at the time of subarachnoid hemorrhage.•Nurses are the first step in patient care. To provide patients with the best care possible, nurses need to be highly competent in recognizing alarming symptoms.

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department.

Introduction: Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness.Methods: This was a retrospective analysis of ED visits by adults from 2007 to 2010 in the National Hospital Ambulatory Medical Care Survey (NHAMCS). We estimated the incidence of SIRS using initial ED vital signs and a Bayesian construct to estimate white blood cell count based on test ordering. We report estimates with Bayesian modified credible intervals (mCIs).Results: We used 103,701 raw patient encounters in NHAMCS to estimate 372,844,465 ED visits over the 4-year period. The moderate estimate of SIRS in the ED was 17.8% (95% mCI: 9.7 to 26%). This yields a national moderate estimate of approximately 16.6 million adult ED visits with SIRS per year. Adults with and without SIRS had similar demographic characteristics, but those with SIRS were more likely to be categorized as emergent in triage (17.7% versus 9.9%, p<0.001), stay longer in the ED (210 minutes versus 153 minutes, p<0.0001), and were more likely to be admitted (31.5% versus 12.5%, p<0.0001). Infection accounted for only 26% of SIRS patients. Traumatic causes of SIRS comprised 10% of presentations; other traditional categories of SIRS were rare.Conclusion: SIRS is very common in the ED. Infectious etiologies make up only a quarter of adult SIRS cases. SIRS may be more useful if modified by clinician judgment when used as a screening test in the rapid identification and assessment of patients with the potential for sepsis. [West J Emerg Med. 2014;15(3):329–336.]

Hyperlactatemia Affects the Association of Hyperglycemia with Mortality in Nondiabetic Adults With Sepsis

Admission hyperglycemia has been reported as a mortality risk factor for septic nondiabetic patients; however, hyperglycemia's known association with hyperlactatemia was not addressed in these analyses. The objective was to determine whether the association of hyperglycemia with mortality remains significant when adjusted for concurrent hyperlactatemia. This was a post hoc, nested analysis of a retrospective cohort study performed at a single center. Providers had identified study subjects during their emergency department (ED) encounters; all data were collected from the electronic medical record (EMR). Nondiabetic adult ED patients hospitalized for suspected infection, two or more systemic inflammatory response syndrome (SIRS) criteria, and simultaneous lactate and glucose testing in the ED were enrolled. The setting was the ED of an urban teaching hospital from 2007 to 2009. To evaluate the association of hyperglycemia (glucose > 200 mg/dL) with hyperlactatemia (lactate ≥ 4.0 mmol/L), a logistic regression model was created. The outcome was a diagnosis of hyperlactatemia, and the primary variable of interest was hyperglycemia. A second model was created to determine if coexisting hyperlactatemia affects hyperglycemia's association with mortality; the main outcome was 28-day mortality, and the primary risk variable was hyperglycemia with an interaction term for simultaneous hyperlactatemia. Both models were adjusted for demographics; comorbidities; presenting infectious source; and objective evidence of renal, respiratory, hematologic, or cardiovascular dysfunction. A total of 1,236 ED patients were included, and the median age was 77 years (interquartile range [IQR] = 60 to 87 years). A total of 115 (9.3%) subjects were hyperglycemic, 162 (13%) were hyperlactatemic, and 214 (17%) died within 28 days of their initial ED visits. After adjustment, hyperglycemia was significantly associated with simultaneous hyperlactatemia (odds ratio [OR] = 4.14, 95% confidence interval [CI] = 2.65 to 6.45). Hyperglycemia and concurrent hyperlactatemia were associated with increased mortality risk (OR = 3.96, 95% CI = 2.01 to 7.79), but hyperglycemia in the absence of simultaneous hyperlactatemia was not (OR = 0.78, 95% CI = 0.39 to 1.57). In this cohort of septic adult nondiabetic patients, mortality risk did not increase with hyperglycemia unless associated with simultaneous hyperlactatemia. The previously reported association of hyperglycemia with mortality in nondiabetic sepsis may be due to the association of hyperglycemia with hyperlactatemia.

338 EMS Sepsis Patients Are Different From Walk-in Sepsis Patients

Study Objectives: Sepsis is a leading cause of morbidity and mortality worldwide. This study is a retrospective review of quality improvement data gathered from a large teaching hospital since November 2009. The aim of this study was to compare outcomes between patients presenting by emergency medical services compared to those presenting directly to the emergency department (ED).Methods: We prospectively identified and reviewed all cases of severe sepsis admitted to the medical intensive care unit from the ED in the 2-year period between 11/1/09 and 10/1/11. Emergency medical services variables extracted were vital signs, blood glucose, presence of altered mental status and transport times. ED variables were initial ED vitals, blood glucose, presence of altered mental status and serum lactate levels. Our primary outcomes were inhospital mortality and length of hospital stay. Groups were dichotomized into those arriving to the ED via emergency medical services and those arriving independent of emergency medical services (controls).Results: Of 359 patients who met study inclusion criteria, 283 (79%) presented by emergency medical services. Two-thirds of the overall group (62%) was male; the average age was57±15 years. Patients presenting via emergency medical services were older than controls (58±14 years versus 52±17, diff= 6, 95%CI=3,10). Emergency medical services transports had lower initial lactate levels (5±4vs 6±4, diff=1,95%CI=0.1, 1.8) and were less likely to present with critically high, shock lactate levels greater than 4 (50% versus 66%, diff=16, 95%CI=0,32). Despite this difference in lactate levels, more emergency medical services patients presented with altered mental status (57% VS 30%, diff=27, 95%CI=9,42) and respiratory difficulty (66% with tachypnea VS 54%, diff=12, 95%CI=3,29). There were no differences between the groups on initial ED vital signs or blood glucose levels. There were no differences in the outcomes of length of hospital stay (10±15 versus 11±17) or mortality (32% versus 30%).Conclusion: Patients with severe sepsis transported by emergency medical services are older and have more overt signs of severity but lower lactate levels than those presenting independent of emergency medical services. Mode of ED arrival was not associated with initial vital signs or short-term mortality. Study Objectives: Sepsis is a leading cause of morbidity and mortality worldwide. This study is a retrospective review of quality improvement data gathered from a large teaching hospital since November 2009. The aim of this study was to compare outcomes between patients presenting by emergency medical services compared to those presenting directly to the emergency department (ED). Methods: We prospectively identified and reviewed all cases of severe sepsis admitted to the medical intensive care unit from the ED in the 2-year period between 11/1/09 and 10/1/11. Emergency medical services variables extracted were vital signs, blood glucose, presence of altered mental status and transport times. ED variables were initial ED vitals, blood glucose, presence of altered mental status and serum lactate levels. Our primary outcomes were inhospital mortality and length of hospital stay. Groups were dichotomized into those arriving to the ED via emergency medical services and those arriving independent of emergency medical services (controls). Results: Of 359 patients who met study inclusion criteria, 283 (79%) presented by emergency medical services. Two-thirds of the overall group (62%) was male; the average age was57±15 years. Patients presenting via emergency medical services were older than controls (58±14 years versus 52±17, diff= 6, 95%CI=3,10). Emergency medical services transports had lower initial lactate levels (5±4vs 6±4, diff=1,95%CI=0.1, 1.8) and were less likely to present with critically high, shock lactate levels greater than 4 (50% versus 66%, diff=16, 95%CI=0,32). Despite this difference in lactate levels, more emergency medical services patients presented with altered mental status (57% VS 30%, diff=27, 95%CI=9,42) and respiratory difficulty (66% with tachypnea VS 54%, diff=12, 95%CI=3,29). There were no differences between the groups on initial ED vital signs or blood glucose levels. There were no differences in the outcomes of length of hospital stay (10±15 versus 11±17) or mortality (32% versus 30%). Conclusion: Patients with severe sepsis transported by emergency medical services are older and have more overt signs of severity but lower lactate levels than those presenting independent of emergency medical services. Mode of ED arrival was not associated with initial vital signs or short-term mortality.

Effect of advanced age and vital signs on admission from an ED observation unit

ObjectivesThe primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission. MethodsWe conducted a prospective, observational cohort study of ED patients placed in an ED-basedobservation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at acutoff of 65 years or more. Vital signs were examined continuously and at commonly accepted cutoffs.We additionally controlled for demographics, comorbid conditions, laboratory values, and observation protocol. ResultsThree hundred patients were enrolled, 12% (n = 35) were 65 years or older, and 11% (n = 33) required admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07%-14.9%) in older adults and 12.1% (95% CI, 8.4%-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR], 0.30; 95% CI, 0.05-1.67). Predictors of admission included systolic pressure 180 mm Hg or greater (OR, 4.19; 95% CI, 1.08-16.30), log Charlson comorbidity score (OR, 2.93; 95% CI, 1.57-5.46), and white blood cell count 14 000/mm3 or greater (OR, 11.35; 95% CI, 3.42-37.72). ConclusionsAmong patients placed in an ED observation unit, age 65 years or more is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure 180 mm Hg or greater was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion.

Can death unrelated to secondary causes be predicted in intubated comatose tricyclic antidepressant-poisoned patients?

Context. It has been stated that the level of consciousness at presentation is the most sensitive clinical predictor of dysrhythmia and seizure in patients with tricyclic antidepressant (TCA) overdose. Objective. To assess the prognostic value of the clinical characteristics and electrocardiographic (ECG) parameters in intubated comatose TCA-poisoned patients for predicting death. Materials and methods. In this retrospective, unmatched case-control study – conducted in Loghman-Hakim Poison Hospital in Tehran, Iran, between March 2005 and September 2010 – the medical charts of 25 non-survived (cases) and 72 survived (controls) TCA-poisoned patients, initially presenting with deep coma (GCS ≤ 8) and being intubated before or after hospital presentation, were evaluated. Exclusion criteria were multiple drug ingestion, head trauma, underlying heart diseases, history of previous convulsive disorders, and late death. Age, gender, specific TCA ingested, manner of poisoning, time between ingestion and presentation, occurrence of seizure, and the patient's initial emergency department vital signs were extracted and recorded. The first 12-lead ECG performed after hospital presentation was evaluated. Results. Ten cases and none of the controls had advanced ECG changes (ventricular fibrillation, torsades des pointes, or asystole). Using a logistic regression model, from variables with a statistically significant difference between the two groups (i.e. ingestion of nortriptyline and amitriptyline, pulse and respiratory rates at presentation, occurrence of seizure [before and after presentation or both], height of R wave in lead aVR, T40-ms frontal plane QRS axis, and occurrence of premature ventricular contraction), only seizure after hospital presentation reached significance regarding prediction of death (OR = 40.88; 95% CI = 9.93–168.39; p < 0.001). Conclusion. Neither ECG parameters nor clinical characteristics of the intubated comatose patients with TCA toxicity predicts death in patients who had not died due to the secondary causes. The only prognostic indicator of death in such patients is seizure after hospital presentation.

Soft Tissue Infections and Emergency Department Disposition: Predicting the Need for Inpatient Admission

Little empiric evidence exists to guide emergency department (ED) disposition of patients presenting with soft tissue infections. This study's objective was to generate a clinical decision rule to predict the need for greater than 24-hour hospital admission for patients presenting to the ED with soft tissue infection. This was a retrospective cohort study of consecutive patients presenting to a tertiary care hospital ED with diagnosis of nonfacial soft tissue infection. Standardized chart review was used to collect 29 clinical variables. The primary outcome was >24-hour hospital admission (either general admission or ED observation unit), regardless of initial disposition. Patients initially discharged home and later admitted for more than 24 hours were included in the outcome. Data were analyzed using classification and regression tree (CART) analysis and multivariable logistic regression. A total of 846 patients presented to the ED with nonfacial soft tissue infection. After merging duplicate records, 674 patients remained, of which 81 (12%) required longer than 24-hour admission. Using CART, the strongest predictors of >24-hour admission were patient temperature at ED presentation and mechanism of infection. In the multivariable logistic regression model, initial patient temperature (odds ratio [OR] for each degree over 37 degrees C = 2.91, 95% confidence interval [CI] = 1.65 to 5.12) and history of fever (OR = 3.02, 95% CI = 1.41 to 6.43) remained the strongest predictors of hospital admission. Despite these findings, there was no combination of factors that reliably identified more than 90% of target patients. Although we were unable to generate a high-sensitivity decision rule to identify ED patients with soft tissue infection requiring >24-hour admission, the presence of a fever (either by initial ED vital signs or by history) was the strongest predictor of need for >24-hour hospital stay. These findings may help guide disposition of patients presenting to the ED with nonfacial soft tissue infections.

Operational performance of validated physiologic scoring systems for predicting in-hospital mortality among critically ill emergency department patients*

New Simplified Acute Physiology Score (SAPS) II, Morbidity Probability Model at admission (MPM0 II), and Logistic Organ Dysfunction System (LODS) have all demonstrated high accuracy for predicting mortality in intensive care unit populations. We tested the prognostic accuracy of these instruments for predicting mortality among a cohort of critically ill emergency department patients. Secondary analysis of a randomized controlled trial. Urban, tertiary emergency department, census >100,000. Nontrauma emergency department patients admitted to an intensive care unit, aged >17 yrs, with initial emergency department vital signs consistent with shock (systolic blood pressure <100 mm Hg or shock index >1.0), and with agreement of two independent observers for at least one sign and symptom of inadequate tissue perfusion. Emergency department variables needed for calculation of each scoring system were prospectively collected, and published formulas were used to calculate the probability of in-hospital death for each scoring system. The main outcome was actual in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each scoring system. Ninety-one of 202 patients (45%) were included. The mean age was 56 +/- 16 yrs, 42% were female, the mean initial systolic blood pressure was 84 +/- 13 mm Hg, and the average length of stay in the emergency department was 4.2 +/- 2.0 hrs. The in-hospital mortality rate was 21%. The area under the receiver operating characteristic curve for calculated probability of in-hospital mortality for SAPS II was 0.72 (95% confidence interval, 0.57-0.87), for MPM0 II 0.69 (95% confidence interval, 0.54-0.84), and for LODS 0.60 (95% confidence interval, 0.45-0.76). Using variables available in the emergency department, three previously validated intensive care unit scoring systems demonstrated moderate accuracy for predicting in-hospital mortality.