Predicting Outcomes in Emergency Medical Admissions Using a Laboratory Only Nomogram

Abstract EN

Background.

We describe a nomogram to explain an Acute Illness Severity model, derived from emergency room triage and admission laboratory data, to predict 30-day in-hospital survival following an emergency medical admission.

Methods.

For emergency medical admissions (96,305 episodes in 50,612 patients) between 2002 and 2016, the relationship between 30-day in-hospital mortality and admission laboratory data was determined using logistic regression.

The previously validated Acute Illness Severity model was then transposed to a Kattan-style nomogram with a Stata user-written program.

Results.

The Acute Illness Severity was based on the admission Manchester triage category and biochemical laboratory score; these latter were based on the serum albumin, sodium, potassium, urea, red cell distribution width, and troponin status.

The laboratory admission data was predictive with an AUROC of 0.85 (95% CI: 0.85, 0.86).

The sensitivity was 94.4%, with a specificity of 62.7%.

The positive predictive value was 21.2%, with a negative predictive value of 99.1%.

For the Kattan-style nomogram, the regression coefficients are converted to a 100-point scale with the predictor parameters mapped to a probability axis.

The nomogram would be an easy-to-use tool at the bedside and for educational purposes, illustrating the relative importance of the contribution of each predictor to the overall score.

Conclusion.

A nomogram to illustrate and explain the prognostic factors underlying an Acute Illness Severity Score system is described.