Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in olderadults after non-traumatic emergency department (ED) intubations.

Methods: We used Vizient administrative data from hospitalizations of 22,374 adults >75 years whounderwent non-traumatic ED intubation from 2008-2015 at nearly 300 U.S. hospitals to develop andvalidate an index to predict in-hospital mortality. We randomly selected one half of participants for thedevelopment cohort and one half for the validation cohort. Considering 25 potential predictors, wedeveloped a multivariable logistic regression model using least absolute shrinkage and selection operatormethod to determine factors associated with in-hospital mortality. We calculated risk scores using pointsderived from the final model’s beta coefficients. To evaluate calibration and discrimination of the finalmodel, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis andcompared mortality by risk groups in the development and validation cohorts.

Results: Death during the index hospitalization occurred in 40% of cases. The final model included sixvariables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer,age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Thosewith low-risk scores (<6) had 31% risk of in-hospital mortality while those with high-risk scores (>10) had58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09), andthe c-statistic was 0.62 in the validation cohort.

Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.