Who’s really sick?

File:Digital Blood Pressure Monitor.jpg

Risk stratification is difficult – two people with the same symptoms can have entirely different outcomes, and the difficulty comes when choosing which patient is safe to send straight to the ward, and who needs to stay in ED – how do you know which patient is going to be really sick, right from the start?

Using a score to predict critical illness isn’t new – the MEWS score has been around since 2001, using the initial observations to determine the risk of mortality. These scores aren’t foolproof – they’re designed to give a brief idea of critical illness to assist with triaging patients from basic numbers. 

This month’s JAMA brings us a new score to predict critical illness as an inpatient, using the following variables taken before you come into hospital:

  • age
  • systolic BP
  • respiratory rate
  • heart rate
  • GCS
  • oxygen saturation
  • nursing home residence

Not too difficult to calculate in the field or at triage (at least compared with an APACHE or similar), and it seems that at least on this study, it does help to predict outcomes.

These kind of scores are only going to get more popular, but you have to be aware of their limitations. Read the article here – note that it does get pretty stats-heavy in the middle. 

IMAGE: Solaris2006


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