A new approach to scoring systems to improve identification of acute medical admissions that will require critical care

Carmichael, H.A., Robertson, E., Austin, J., McCruden, D., Messow, C.M. and Belcher, P.R. (2011) A new approach to scoring systems to improve identification of acute medical admissions that will require critical care. Scottish Medical Journal, 56(4), pp. 195-202. (doi: 10.1258/smj.2011.011157)

Abstract

Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92·4%) than PREAMBLE-1 (88·1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years.

• Item Type: Articles (Other)
• Additional Information: Carmichael, H.A., Robertson, E., Austin, J., McCruden, D., Messow, C.M., and Belcher, P.R. (2011) A new approach to scoring systems to improve identification of acute medical admissions that will require critical care. Scottish Medical Journal, 56 (4). pp. 195-202. ISSN 0036-9330. DOI: 10.1258/smj.2011.011157. This is the final draft, after peer-review, of a manuscript published in RSM journals: www.rsmpress.com
• Keywords: Early warning scores, triaging scores, acute medical admissions, intensive care, high dependency care
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Messow, Dr Martina
• Authors: Carmichael, H.A., Robertson, E., Austin, J., McCruden, D., Messow, C.M., and Belcher, P.R.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Scottish Medical Journal
• Publisher: Royal Society of Medicine Press
• ISSN: 0036-9330
• ISSN (Online): 2045-6441
• Copyright Holders: Copyright © 2011 Royal Society of Medicine Press
• First Published: First published in Scottish Medical Journal 56(4):195-202
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher