Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care

doi:10.1016/j.ajem.2013.02.010

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Title:	Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care
Authors:	Huang, Chien-Cheng Kuo, Shu-Chun Chien, Tsair-Wei Lin, Hung-Jung Guo, How-Ran Chen, Wei-Lung Chen, Jiann-Hwa Chang, Su-Hen Su, Shih-Bin
Contributors:	醫務管理系
Keywords:	Diabetic-Ketoacidosis Methodological Standards Adult Patients Experience Management Mortality Severity Mellitus Model Coma
Date:	2013-05
Issue Date:	2014-05-26 10:48:27 (UTC+8)
Publisher:	W B Saunders Co-Elsevier Inc
Abstract:	Background: We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups.Methods: This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets-the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint.Results: We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits (25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set.Conclusions: The PHD score is a simple and rapid rule for predicting 30-daymortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises. (C) 2013 Elsevier Inc. All rights reserved.
Relation:	American Journal of Emergency Medicine, v.31 n.5, pp.830-834
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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