Validation and reclassification of MGAP and GAP in hospital settings using data from the XXXX Audit and Research Network.

@entity1 @entity204 @entity772 @entity130
BACKGROUND: Recently, two simple clinical scores were published to predict survival in @entity130 @entity1 . Both scores may successfully guide major @entity130 triage, but neither has been independently validated in a hospital setting. METHODS: This is a cohort study with 30-day mortality as the primary outcome to validate two new @entity130 scores-Mechanism, Glasgow @entity772 Scale (GCS), Age, and Pressure (MGAP) score and GCS, Age and Pressure (GAP) score-using data from the UK @entity130 Audit and Research Network. First, an assessment of discrimination, using the area under the receiver operating characteristic (ROC) curve, and calibration, comparing mortality rates with those originally published, were performed. Second, we calculated sensitivity, specificity, predictive values, and likelihood ratios for prognostic score performance. Third, we propose new cutoffs for the risk categories. RESULTS: A total of 79,807 adult (>= 16 years) major @entity130 @entity1 (2000-2010) were included; 5,474 (6.9%) died. Mean (SD) age was 51.5 (22.4) years, median GCS score was 15 (interquartile range, 15-15), and median Injury Severity Score (ISS) was 9 (interquartile range, 9-16). More than 50% of the @entity1 had a low-risk GAP or MGAP score (1% mortality). With regard to discrimination, areas under the ROC curve were 87.2% for GAP score (95% confidence interval, 86.7-87.7) and 86.8% for MGAP score (95% confidence interval, 86.2-87.3). With regard to calibration, 2,390 (3.3%), 1,900 (28.5%), and 1,184 (72.2%) @entity1 died in the low, medium, and high GAP risk categories, respectively. In the low- and medium-risk groups, these were almost double the previously published rates. For MGAP, 1,861 (2.8%), 1,455 (15.2%), and 2,158 (58.6%) @entity1 died in the low-, medium-, and high-risk categories, consonant with results originally published. Reclassifying score point cutoffs improved likelihood ratios, sensitivity and specificity, as well as areas under the ROC curve. CONCLUSION: We found both scores to be valid triage tools to stratify emergency department @entity1 , according to their risk of @entity204 . MGAP calibrated better, but GAP slightly improved discrimination. The newly proposed cutoffs better differentiate risk classification and may therefore facilitate hospital resource allocation. LEVEL OF EVIDENCE: Prognostic study, level II.
