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Donoso-Calero MI, Sanz-García A, Polonio-López B, Maestre Miquel C, Durantez Fernández C, Mordillo-Mateos L, Mohedano-Moriano A, Conty-Serrano R, Otero-Agra M, Jorge-Soto C, Martín-Conty JL, Martín-Rodríguez F. Clinical outcome prediction of acute neurological patients admitted to the emergency department: Sequential Organ Failure Assessment score and modified SOFA score. Front Public Health 2023; 11:1264159. [PMID: 37965516 PMCID: PMC10642972 DOI: 10.3389/fpubh.2023.1264159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Background The aim of this study was to determine the ability of the Sequential Organ Failure Assessment score (SOFA) and modified SOFA score (mSOFA) as predictive tools for 2-day and 28-day mortality and ICU admission in patients with acute neurological pathology treated in hospital emergency departments (EDs). Methods An observational, prospective cohort study in adults with acute neurological disease transferred by ambulance to an ED was conducted from 1 January 2019 to 31 August 2022 in five hospitals in Castilla-León (Spain). Score discrimination was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the score. Results A total of 640 adult patients with neurological disease were included. For the prediction of 2-day mortality (all-cause), mSOFA presented a higher AUC than SOFA (mSOFA = 0.925 vs. SOFA = 0.902). This was not the case for 28-day mortality, for which SOFA was higher than mSOFA (mSOFA = 0.852 vs. SOFA = 0.875). Finally, ICU admission showed that SOFA was higher than mSOFA (mSOFA = 0.834 vs. SOFA = 0.845). Conclusion Both mSOFA and SOFA presented similar predictive ability, with mSOFA being the best predictor for short-term mortality and SOFA being the best predictor for medium-term mortality, as well as for ICU admission. These results in a cohort of patients with acute neurological pathology pave the way for the use of both predictive tools in the ED. The inclusion of these tools could improve the clinical assessment and further treatment of neurological patients, who commonly present the worst outcomes.
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Affiliation(s)
- María I. Donoso-Calero
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Clara Maestre Miquel
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
| | | | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Alicia Mohedano-Moriano
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | | | - Martin Otero-Agra
- School of Nursing from Pontevedra, Universidade de Vigo, Pontevedra, Spain
| | - Cristina Jorge-Soto
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Durantez-Fernández C, Polonio-López B, Martín-Conty JL, Maestre-Miquel C, Viñuela A, López-Izquierdo R, Mordillo-Mateos L, Jorge-Soto C, Otero-Agra M, Dileone M, Rabanales-Sotos J, Martín-Rodríguez F. Comparison of Nine Early Warning Scores for Identification of Short-Term Mortality in Acute Neurological Disease in Emergency Department. J Pers Med 2022; 12:630. [PMID: 35455748 PMCID: PMC9024907 DOI: 10.3390/jpm12040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, as well as to track the 2-, 7-, 14-, and 28-day mortality in a cohort of patients diagnosed with an acute neurological condition. (2) Methods: We conducted a prospective, longitudinal, observational study, calculating the EWS [Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), Early Warning Score (EWS), Hamilton Early Warning Score (HEWS), Standardised Early Warning Score (SEWS), WHO Prognostic Scored System (WPSS), and Rapid Acute Physiology Score (RAPS)] upon the arrival of patients to the emergency department. (3) Results: In all, 1160 patients were included: 808 patients were hospitalized, 199 cases (17%) required ICU care, and 6% of patients died (64 cases) within 2 days, which rose to 16% (183 cases) within 28 days. The highest area under the curve for predicting the need for ICU admissions was obtained by RAPS and MEWS. For predicting mortality, MREMS obtained the best scores for 2- and 28-day mortality. (4) Conclusions: This is the first study to explore whether several EWS accurately identify the risk of ICU admissions and mortality, at different time points, in patients with acute neurological disorders. Every score analyzed obtained good results, but it is suggested that the use of RAPS, MEWS, and MREMS should be preferred in the acute setting, for patients with neurological impairment.
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Affiliation(s)
- Carlos Durantez-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Begoña Polonio-López
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - José L. Martín-Conty
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Clara Maestre-Miquel
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
| | - Antonio Viñuela
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Raúl López-Izquierdo
- Department of Emergency, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain;
- Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain;
- Prehospital Early Warning Scoring-System Investigation Group, 47005 Valladolid, Spain
| | - Laura Mordillo-Mateos
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Cristina Jorge-Soto
- Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
- SICRUS Research Group, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- CLINURSID Research Group, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Martín Otero-Agra
- University School of Nursing, University of Vigo, 36001 Pontevedra, Spain;
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Michele Dileone
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
- Hospital Virgen del Puerto, Servicio Extremeño de Salud (SES), 10600 Plasencia, Spain
| | - Joseba Rabanales-Sotos
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, 02006 Albacete, Spain;
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain;
- Prehospital Early Warning Scoring-System Investigation Group, 47005 Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
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