TY - JOUR
T1 - Short-term mortality in older medical emergency patients can be predicted using clinical intuition
T2 - A prospective study
AU - Zelis, Noortje
AU - Mauritz, Arisja N.
AU - Kuijpers, Lonne I. J.
AU - Buijs, Jacqueline
AU - de Leeuw, Peter W.
AU - Stassen, Patricia M.
N1 - Funding Information:
Noortje Zelis was funded by Zuyderland MC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank I. Luu (MSc) for the design of the figures. In addition, we would like to thank all patients and medical staff of Zuyderland Medical Centre and Maastricht University Medical Centre+ who contributed to this study.
Publisher Copyright:
© 2019 Zelis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/1/2
Y1 - 2019/1/2
N2 - BackgroundOlder emergency department (ED) patients are at risk for adverse outcomes, however, it is hard to predict these. We aimed to assess the discriminatory value of clinical intuition, operationalized as disease perception, self-rated health and first clinical impression, including the 30-day surprise question (SQ: "Would I be surprised if this patient died in the next 30 days" of patients, nurses and physicians. Endpoints used to evaluate the discriminatory value of clinical intuition were short-term (30-day) mortality and other adverse outcomes (intensive/medium care admission, prolonged length of hospital stay, loss of independent living or 30-day readmission).MethodsIn this prospective, multicentre cohort study, older medical patients (>= 65 years), nurses and physicians filled in scores regarding severity of illness and their concerns (i.e. disease perception and clinical impression scores) immediately after arrival of the patient in the ED. In addition, patients filled in a self-rated health score and nurses and physicians answered the SQ. Area under the curves (AUCs) of receiver operating characteristics (ROCs) were calculated.ResultsThe median age of the 602 included patients was 79 years and 86.7% were community dwelling. Within 30 days, 66 (11.0%) patients died and 263 (43.7%) patients met the composite endpoint. The severity of concern score of both nurses and physicians yielded the highest AUCs for 30-day mortality (for both 0.75; 95% CI 0.68-0.81). AUCs for the severity of illness score and SQ of nurses and physicians ranged from 0.71 to 0.74 while those for the disease perception and self-rated health of patients ranged from 0.64 to 0.69. The discriminatory value of the scores for the composite endpoint was lower (AUCs ranging from 0.60 to 0.67). We used scores that have not been previously validated which could influence their generalisability.ConclusionClinical intuition,-disease perception, self-rated health and first clinical impression-documented at an early stage after arrival in the ED, is a useful clinical tool to predict mortality and other adverse outcomes in older ED patients. Highest discriminatory values were found for the nurses' and physicians' severity of concern score. Intuition may be helpful for the implementation of personalised medical care in the future.
AB - BackgroundOlder emergency department (ED) patients are at risk for adverse outcomes, however, it is hard to predict these. We aimed to assess the discriminatory value of clinical intuition, operationalized as disease perception, self-rated health and first clinical impression, including the 30-day surprise question (SQ: "Would I be surprised if this patient died in the next 30 days" of patients, nurses and physicians. Endpoints used to evaluate the discriminatory value of clinical intuition were short-term (30-day) mortality and other adverse outcomes (intensive/medium care admission, prolonged length of hospital stay, loss of independent living or 30-day readmission).MethodsIn this prospective, multicentre cohort study, older medical patients (>= 65 years), nurses and physicians filled in scores regarding severity of illness and their concerns (i.e. disease perception and clinical impression scores) immediately after arrival of the patient in the ED. In addition, patients filled in a self-rated health score and nurses and physicians answered the SQ. Area under the curves (AUCs) of receiver operating characteristics (ROCs) were calculated.ResultsThe median age of the 602 included patients was 79 years and 86.7% were community dwelling. Within 30 days, 66 (11.0%) patients died and 263 (43.7%) patients met the composite endpoint. The severity of concern score of both nurses and physicians yielded the highest AUCs for 30-day mortality (for both 0.75; 95% CI 0.68-0.81). AUCs for the severity of illness score and SQ of nurses and physicians ranged from 0.71 to 0.74 while those for the disease perception and self-rated health of patients ranged from 0.64 to 0.69. The discriminatory value of the scores for the composite endpoint was lower (AUCs ranging from 0.60 to 0.67). We used scores that have not been previously validated which could influence their generalisability.ConclusionClinical intuition,-disease perception, self-rated health and first clinical impression-documented at an early stage after arrival in the ED, is a useful clinical tool to predict mortality and other adverse outcomes in older ED patients. Highest discriminatory values were found for the nurses' and physicians' severity of concern score. Intuition may be helpful for the implementation of personalised medical care in the future.
KW - SELF-RATED HEALTH
KW - MORBIDITY
KW - ILLNESS
KW - ADULTS
U2 - 10.1371/journal.pone.0208741
DO - 10.1371/journal.pone.0208741
M3 - Article
C2 - 30601815
SN - 1932-6203
VL - 14
JO - PLOS ONE
JF - PLOS ONE
IS - 1
M1 - 0208741
ER -