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The PARIS score can reliably predict 7-day all-cause mortality for both acute medical and surgical patients: an
M Brabrand1,2,3, T Knudsen2,4, J Hallas5
1Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
Insights
The PARIS score, incorporating vital signs and functional capacity, effectively identifies high-risk acutely ill patients. However, its calibration was found to be poor for medical patients in validation studies.
Area of Science:
- Clinical Medicine
- Patient Risk Stratification
- Healthcare Outcomes
Background:
- Existing risk assessments for acutely ill patients often overlook functional capacity, relying solely on vital signs.
- The PARIS score was developed to integrate vital signs with functional capacity for improved risk assessment.
Purpose of the Study:
- To validate the performance of the PARIS score in predicting mortality in acutely ill patients.
- To assess the discriminatory power and calibration of the PARIS score across diverse patient cohorts.
Main Methods:
- A retrospective cohort study involving 14,447 acutely ill patients across Denmark, Ireland, and Uganda.
- Data collected included vital signs, functional capacity (ability to stand, walk, or get into bed unaided), and 7-day mortality or discharge outcomes.
- Discriminatory power was assessed using Area Under the Receiver Operating Characteristics Curve (AUROC), and calibration was evaluated with the Hosmer-Lemeshow goodness of fit test.
Main Results:
- The PARIS score demonstrated good discriminatory power with an overall AUROC of 0.833.
- Seven-day mortality increased significantly with higher PARIS scores, from 0.3% to 26.7%.
- While calibration was adequate for surgical patients, it was poor for medical patients.
Conclusions:
- The PARIS score is a valuable tool for identifying both high- and low-risk acutely admitted medical and surgical patients.
- The poor calibration in medical patients suggests a need for refinement or cautious interpretation in this subgroup.
Background:
We believe errors in the risk assessment of acutely ill patients occur because only vital signs without concurrent functional capacity are considered. We, therefore, developed the PARIS risk score based on blood pressure, age, respiratory rate, loss of independence and oxygen saturation.
Aim:
Validation of the PARIS score in four independent cohorts from three countries.
Methods:
Retrospective cohort study of acutely ill patients admitted to hospitals in Denmark, Ireland and Uganda. Vital signs and functional capacity (registered as ability to stand or walk or get into bed unaided) was recorded upon arrival. Patients were followed up for 7 days (Denmark and Ireland) or until discharge (Uganda) and mortality recorded. The discriminatory power (ability to identify patients at increased risk) was determined using area under the receiver operating characteristics curve (AUROC) and calibration (precision) using Hosmer-Lemeshow goodness of fit test.
Results:
Out of 14 447 patients, 327 (2.3%) died within 7 days: median age was 59 (39-75) years and 7458 (51.8%) were female. Seven-day mortality increased from 0.3% with a score of 0-26.7% with a score of 5. The score's AUROC as 0.833 [95% confidence interval (95% CI) 0.811-0.856], 0.817 (95% CI 0.792-0.842) and 0.894 (95% CI 0.813-0.974) for all patients, medical patients and surgical patients, respectively. However, except for surgical patients, calibration of the score was poor.
Conclusion:
The PARIS score can identify both high and low risk acutely admitted medical and surgical patients, but calibration was poor for medical patients.
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