Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification 英文参考文献.docVIP

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Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification 英文参考文献.doc

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Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification 英文参考文献

PredictionofEmergentHeartFailureDeathbySemi- QuantitativeTriageRiskStratification HarrietteG.C.VanSpall1,ClareAtzema2,3,MichaelJ.Schull3,GaryE.Newton5,6,SusannaMak5,6 ,Alice Chong2,JackV.Tu2,3,The′re`seA.Stukel2,4,DouglasS.Lee2,6 * 1Population Health Research Institute, Hamilton Health Science and McMaster University, Hamilton, Canada, 2Institute for Clinical Evaluative Sciences, University of Toronto,Toronto,Canada,3SunnybrookHealthSciencesCentre,UniversityofToronto,Toronto,Canada,4TheDallaLanaSchoolofPublicHealth,UniversityofToronto, Toronto,Canada,5Mt.SinaiHospital,UniversityofToronto,Toronto,Canada,6TorontoGeneralHospitalandUniversityHealthNetwork,UniversityofToronto,Toronto, Canada Abstract Objectives:Generictriageriskassessmentsarewidelyusedintheemergencydepartment(ED),buthavenotbeenvalidated forpredictionofshort-termriskamongpatientswithacuteheartfailure(HF).OurobjectivewastoevaluatetheCanadian TriageAcuityScale(CTAS)forpredictionofearlydeathamongHFpatients. Methods:WeincludedpatientspresentingwithHFtoanEDinOntariofromApr2003toMar2007.WeusedtheNational AmbulatoryCareReportingSystemandvitalstatisticsdatabasestoexaminecareandoutcomes. Results: Among68,380patients (76612years,49.4%men),earlymortality wasstratifiedwithdeath ratesof9.9%, 1.9%, 0.9%,and0.5%at1-day,and17.2%,5.9%,3.8%,and2.5%at7-days,forCTAS1,2,3,and4–5,respectively.Comparedto loweracuity(CTAS4–5)patients,adjustedoddsratios(aOR)for1-daydeathwere1.32(95%CI;0.93–1.88;p=0.12)forCTAS 3, 2.41(95%CI;1.71–3.40; p,0.001) forCTAS 2, andhighest forCTAS 1: 9.06(95%CI; 6.28–13.06; p,0.001). Predictors of triage-critical (CTAS 1) status included oxygen saturation ,90% (aOR 5.92, 95%CI; 3.09–11.81; p,0.001), respiratory rate .24 breaths/minute (aOR 1.96, 95%CI; 1.05–3.67; p=0.034), and arrival by paramedic (aOR 3.52, 95%CI; 1.70–8.02; p=0.001). While age/sex-adjusted CTAS score provided good discrimination for ED (c-statistic=0.817) and 1-day (c- statistic=0.724) death, mortality prediction was improved fur