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    Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions

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    Publication date
    2013-11
    Author
    Jarvis, S.W.
    Kovacs, C.
    Badriyah, T.
    Briggs, J.
    Mohammed, Mohammed A.
    Meredith, P.
    Schmidt, P.E.
    Featherstone, P.I.
    Prytherch, D.R.
    Smith, G.B.
    Keyword
    Adolescent
    ; Adult
    ; Aged
    ; Algorithms
    ; Decision trees
    ; Diagnostic tests
    ; Emergencies
    ; Female
    ; Hospital mortality
    ; Humans
    ; Male
    ; Middle aged
    ; Patient admission
    ; Predictive value of tests
    ; Biochemistry
    ; Early warning scores
    ; Haematology
    ; Illness severity score
    ; Risk prediction
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    Peer-Reviewed
    Yes
    
    Metadata
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    Abstract
    To build an early warning score (EWS) based exclusively on routinely undertaken laboratory tests that might provide early discrimination of in-hospital death and could be easily implemented on paper. Using a database of combined haematology and biochemistry results for 86,472 discharged adult patients for whom the admission specialty was Medicine, we used decision tree (DT) analysis to generate a laboratory decision tree early warning score (LDT-EWS) for each gender. LDT-EWS was developed for a single set (n=3496) (Q1) and validated in 22 other discrete sets each of three months long (Q2, Q3...Q23) (total n=82,976; range of n=3428 to 4093) by testing its ability to discriminate in-hospital death using the area under the receiver-operating characteristic (AUROC) curve. The data generated slightly different models for male and female patients. The ranges of AUROC values (95% CI) for LDT-EWS with in-hospital death as the outcome for the validation sets Q2-Q23 were: 0.755 (0.727-0.783) (Q16) to 0.801 (0.776-0.826) [all patients combined, n=82,976]; 0.744 (0.704-0.784, Q16) to 0.824 (0.792-0.856, Q2) [39,591 males]; and 0.742 (0.707-0.777, Q10) to 0.826 (0.796-0.856, Q12) [43,385 females]. CONCLUSIONS: This study provides evidence that the results of commonly measured laboratory tests collected soon after hospital admission can be represented in a simple, paper-based EWS (LDT-EWS) to discriminate in-hospital mortality. We hypothesise that, with appropriate modification, it might be possible to extend the use of LDT-EWS throughout the patient's hospital stay.
    URI
    http://hdl.handle.net/10454/9783
    Version
    No full-text available in the repository
    Citation
    Jarvis SW, Kovacs C, Badriyah T, Briggs J, Mohammed MA et al (2013) Development and validation of a decision tree early warning score based on routing laboratory test results for the discrimination of hospital mortality in emergency medical admissions. Resuscitation. 84(11): 1494-1499.
    Link to publisher’s version
    http://dx.doi.org/10.1016/j.resuscitation.2013.05.018
    Type
    Article
    Collections
    Health Studies Publications

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