• Al-Deen SaidSayfSQuality Improvement & Patient Safety, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH., Corey K Gentle, Abby Gross, Kelly Nimylowycz, Mir Shanaz Hossain, Allison Weathers, R Matthew Walsh, Scott R Steele, Miguel Regueiro, and Toms Augustin.
• Quality Improvement & Patient Safety, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
• Ann. Surg. 2024 May 10.

ObjectiveDevelop and validate a mortality risk calculator that could be utilized at the time of transfer, leveraging routinely collected variables that could be obtained by trained non-clinical transfer personnel.Summary Background DataThere are no objective tools to predict mortality at the time of inter-hospital transfer for Emergency General Surgery (EGS) patients that are "unseen" by the accepting system.MethodsPatients transferred to general or colorectal surgery services from January 2016 through August 2022 were retrospectively identified and randomly divided into training and validation cohorts (3:1 ratio). The primary outcome was admission-related mortality, defined as death during the index admission or within 30 days post-discharge. Multiple predictive models were developed and validated.ResultsAmong 4,664 transferred patients, 280 (6.0%) experienced mortality. Predictive models were generated utilizing 19 routinely collected variables; the penalized regression model was selected over other models due to excellent performance using only 12 variables. The model performance on the validating set resulted in an area under the receiver operating characteristic curve, sensitivity, specificity, and balanced accuracy of 0.851, 0.90, 0.67, and 0.79, respectively. After bias correction, Brier score was 0.04, indicating a strong association between the assigned risk and the observed frequency of mortality.ConclusionA risk calculator using twelve variables has excellent predictive ability for mortality at the time of interhospital transfer among "unseen" EGS patients. Quantifying a patient's mortality risk at the time of transfer could improve patient triage, bed and resource allocation, and standardize care.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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