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Area of Science:

  • Emergency Medicine
  • Clinical Risk Stratification
  • Health Services Research

Background:

  • Emergency department disposition decisions lack objective criteria.
  • Early risk prediction is challenging, hindering timely and appropriate patient management.
  • Current methods often rely on diagnosis, which isn't feasible at initial presentation.

Purpose of the Study:

  • To develop and validate the TRIAL risk score for predicting in-hospital mortality.
  • To support emergency department disposition decisions using routinely collected data.
  • To stratify patients into low, intermediate, and high-risk categories for mortality.

Main Methods:

  • Prospective cohort study of 8687 emergency department patients.
  • Multivariable logistic regression using baseline (triage, age) and laboratory data.
  • Development of the TRIAL risk score to predict mortality.

Main Results:

  • The TRIAL score includes triage level (Emergency Severity Index), age, lactate dehydrogenase, creatinine, albumin, bilirubin, and leukocyte count.
  • The model achieved an area under the ROC curve of 0.93 for in-hospital mortality.
  • Mortality rates were 0.1% (low-risk), 3.5% (intermediate-risk), and 26.2% (high-risk).

Conclusions:

  • The TRIAL risk score effectively stratifies patients based on mortality risk.
  • Routinely available data can provide crucial prognostic information for disposition.
  • The TRIAL score can optimize resource allocation by identifying low-risk patients for potential discharge and high-risk patients for closer observation.