Comparing the effectiveness of early warning scores in predicting adult patient outcomes in the emergency department

Objective@#This study compared the effectiveness of the Modified Early Warning Score, the National Early Warning Score, the VitalPAC Early Warning Score (ViEWS), the Rapid Acute Physiology Score, the Rapid Emergency Medicine Score (REMS), and the Worthing Physiological Scoring system for predicting hospitalization, intensive care unit (ICU) admission and in-hospital mortality. @*Methods@#Our study was performed on all the patients admitted to the emergency department, except those who were pregnant, dead on arrival or self-discharge patients between 1 January 2019 and 31 March 2019. The outcomes of the study were hospitalization, ICU admission, and in-hospital mortality. Receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare the six scores. @*Results@#REMS was found to have the greatest efficacy for the prediction of hospitalization. The area under the ROC curve (AUROC) was 0.705. ViEWS was found to have the greatest efficacy for prediction of ICU admission and in-hospital mortality (include the 2-day and 7-day mortality). AUROC was 0.727 in ICU admission, 0.918 in 2-day mortality, 0.813 in 7-day mortality, and 0.775 in in-hospital mortality. @*Conclusion@#The efficiency of ViEWS was better than other scores for predicting the patients’ severity. For predicting hospitalization, REMS could be the best predictor because of the age variable.

Differential diagnostic factors of type 1 and type 2 myocardial infarction in patients with elevated cardiac troponin levels

Objective@#Emergency physicians experience difficulty in determining the disposition of patients with elevated troponin I levels using emergency room tests. In this study, we aimed to investigate factors that could discriminate between the occurrence of type 1 myocardial infarction (T1MI) and type 2 myocardial infarction (T2MI) in patients with elevated troponin I levels. @*Methods@#Patients admitted to the emergency department between January 1, 2017 and June 30, 2017 with elevated troponin I levels who underwent subsequent cardiac biomarker testing were included. Samples for baseline blood tests, such as cardiac biomarker levels, were collected within approximately 10 minutes of admission. Electrocardiogram, transthoracic echocardiography, and percutaneous coronary intervention results were retrospectively examined via patient report and chart reviews. @*Results@#During the study period, 169 of 234 (72%) patients were diagnosed with T2MI and 65 (28%) were diagnosed with T1MI. Among various factors, typical chest pain (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.46 to 13.24; P=0.008), high troponin I levels (OR, 1.50; 95% CI, 1.19 to 1.90; P<0.001), high cholesterol (OR, 1.01; 95% CI, 1.00 to 1.02; P=0.008), and low D-dimer levels (OR, 0.87; 95% CI, 0.77 to 0.98; P=0.027) were significantly associated with T1MI incidence. @*Conclusion@#Our findings in this study indicate that typical chest pain, high levels of troponin I and cholesterol, and low levels of D-dimer were associated with the diagnosis of T1MI. Further studies are suggested to determine the cut-off values for accurate diagnosis of T1MI in the ED.