Defining XXXX severity on presentation to hospital: an international derivation and validation study.

@entity1 @entity1133 @entity55 @entity1514 @entity497 @entity911
BACKGROUND: In the assessment of severity in @entity497 ( @entity497 ), the modified British @entity1514 Society (mBTS) rule identifies @entity1 with severe @entity55 but not @entity1 who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with @entity497 into different management groups. METHODS: Data from three prospective studies of @entity497 conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort. RESULTS: 1068 @entity1 were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age >/=65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin <30 g/dl (OR 4.7, 95% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule (OR 5.2, 95% CI 2.7 to 10). A six point score, one point for each of @entity911 , Urea >7 mmol/l, Respiratory rate >/=30/min, low systolic(<90 mm Hg) or diastolic (</=60 mm Hg) Blood pressure), age >/=65 years (CURB-65 score) based on information available at initial hospital assessment, enabled @entity1 to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern. CONCLUSIONS: A simple six point score based on @entity911 , @entity1133 , respiratory rate, blood pressure, and age can be used to stratify @entity1 with @entity497 into different management groups.
