• Feng Xie, Nan Liu, Stella Xinzi Wu, Yukai Ang, Lian Leng Low, Ho Andrew Fu Wah AFW Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore., Lam Sean Shao Wei SSW Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. H, David Bruce Matchar, Ong Marcus Eng Hock MEH Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. , and Bibhas Chakraborty.
• Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
• BMJ Open. 2019 Sep 26; 9 (9): e031382.

ObjectivesTo identify risk factors for inpatient mortality after patients' emergency admission and to create a novel model predicting inpatient mortality risk.DesignThis was a retrospective observational study using data extracted from electronic health records (EHRs). The data were randomly split into a derivation set and a validation set. The stepwise model selection was employed. We compared our model with one of the current clinical scores, Cardiac Arrest Risk Triage (CART) score.SettingA single tertiary hospital in Singapore.ParticipantsAll adult hospitalised patients, admitted via emergency department (ED) from 1 January 2008 to 31 October 2017 (n=433 187 by admission episodes).Main Outcome MeasureThe primary outcome of interest was inpatient mortality following this admission episode. The area under the curve (AUC) of the receiver operating characteristic curve of the predictive model with sensitivity and specificity for optimised cut-offs.Results15 758 (3.64%) of the episodes were observed inpatient mortality. 19 variables were observed as significant predictors and were included in our final regression model. Our predictive model outperformed the CART score in terms of predictive power. The AUC of CART score and our final model was 0.705 (95% CI 0.697 to 0.714) and 0.817 (95% CI 0.810 to 0.824), respectively.ConclusionWe developed and validated a model for inpatient mortality using EHR data collected in the ED. The performance of our model was more accurate than the CART score. Implementation of our model in the hospital can potentially predict imminent adverse events and institute appropriate clinical management.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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