The emergency department (ED) serves as our society's medical safety-net, especially for those patients with critical illnesses. An accurate and reliable clinical prediction instrument applied to a broad range of seriously-ill ED patients to estimate mortality would be extremely useful. An instrument of this nature may also be used to compare quality of care, improve resource allocation, and select patients for aggressive hemodynamic monitoring and therapy. Currently, there is a paucity of effective tools used for predicting mortality in seriously-ill ED patients. The Mortality in Emergency Department Sepsis (MEDS) Score attempted to fill this gap, but has several limitations and thus does not effectively translate into clinical practice. The first hypothesis of the investigations proposed here is that ED patient and laboratory data will be used to derive a novel mortality risk score among patients admitted to the hospital with systemic inflammatory response syndrome (SIRS). The second hypothesis is that the resultant mortality risk score will stratify ED patients into distinct risk strata corresponding to increasing levels of mortality. The third hypothesis is that the resultant mortality risk score will be superior to the MEDS Score when applied to ED patients admitted to the hospital with SIRS. The fourth hypothesis is that the mortality risk score and its individual components will be highly reliable when applied by physicians.
The Specific Aims therefore include: (1) performing a multi-center prospective ED cohort study to derive a mortality risk score using multivariable logistic regression analysis;(2) performing a multi-center prospective ED cohort study to validate the mortality risk score derived in Specific Aim 1 and to compare its performance with that of the MEDS Score in the same ED population;and (3) performing a multi-center prospective ED cohort study to assess the inter-rater reliability of the mortality risk score derived in Specific Aim 1.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Postdoctoral Individual National Research Service Award (F32)
Project #
5F32HS018123-02
Application #
7993096
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Benjamin, Shelley
Project Start
2009-11-09
Project End
2011-11-08
Budget Start
2010-11-09
Budget End
2011-11-08
Support Year
2
Fiscal Year
2011
Total Cost
Indirect Cost
Name
Denver Health and Hospital Authority
Department
Type
DUNS #
093564180
City
Denver
State
CO
Country
United States
Zip Code
80204
Vogel, Jody A; Liao, Michael M; Hopkins, Emily et al. (2014) Prediction of postinjury multiple-organ failure in the emergency department: development of the Denver Emergency Department Trauma Organ Failure score. J Trauma Acute Care Surg 76:140-5
Otten, David; Liao, Michael M; Wolken, Robert et al. (2014) Comparison of bag-valve-mask hand-sealing techniques in a simulated model. Ann Emerg Med 63:6-12.e3
Kim, Daniel J; Theoret, Jonathan; Liao, Michael M et al. (2012) The current state of ultrasound training in canadian emergency medicine programs: perspectives from program directors. Acad Emerg Med 19:E1073-8
Soriya, Gina C; McVaney, Kevin E; Liao, Michael M et al. (2012) Safety of prehospital intravenous fentanyl for adult trauma patients. J Trauma Acute Care Surg 72:755-9
Shy, Bradley D (2012) Path dependence and the persistence of the Glasgow Coma Scale. Ann Emerg Med 59:559; author reply 559-60
Thompson, David O; Hurtado, Timothy R; Liao, Michael M et al. (2011) Validation of the Simplified Motor Score in the out-of-hospital setting for the prediction of outcomes after traumatic brain injury. Ann Emerg Med 58:417-25
Liao, Michael M; Ginde, Adit A; Clark, Sunday et al. (2010) Salmeterol use and risk of hospitalization among emergency department patients with acute asthma. Ann Allergy Asthma Immunol 104:478-84