Derivation and validation of a score based on Hypotension, Oxygen saturation, low Temperature, ECG changes and Loss of independence (HOTEL) that predicts early mortality between 15 min and 24 h after admission to an acute medical unit.
BACKGROUND
Predictive scores such as APACHE II have been used to assess patients in intensive care units, but few scores have been used to assess acutely ill general medical patients.


METHODS
Examination of the ability of clinical variables documented at the time of admission to predict early mortality between 15 min and 24 h after admission.


METHODS
An Irish rural hospital.


METHODS
10,290 consecutive patients admitted as acute medical emergencies, divided into a derivation cohort of 6947 patients and a validation cohort of 3343 patients.


RESULTS
40 patients of the derivation cohort (0.6%) died within 24h of hospital admission. Multivariate analysis revealed 11 independent predictors of early death from which a simplified model with minimal loss of predictive ability was derived. Since this model contained only the five variables of Hypotension (systolic blood pressure<100 mm Hg), low Oxygen saturation (<90%), low Temperature (<35 degrees C, abnormal ECG and Loss of independence (unable to stand unaided) it was named the HOTEL score (one point for each variable). There were no differences in the early mortality predicted by this score between the derivation and validation cohorts-the area under the receiver operator characteristic curves for the derivation and validation cohorts were 86.5% and 85.4%, respectively. None of the patients with a score of zero died within 15 min and 24 h and a score of one had an early mortality of 0.3% in both cohorts. A score of two had an early mortality of 0.9% in the derivation cohort and 1.7% in the validation cohort, while a score of three or greater had an early mortality of 10.2% in the derivation and 5.6% the validation cohort.


CONCLUSIONS
The HOTEL score quickly identifies patients at a low and high risk of death between 15 min and 24 h after admission, thus enabling prompt triage and placement within a health care facility.
Kellett
John
J
Nenagh Hospital, Nenagh, County Tipperary, Ireland. jgkellett@eircom.net
Deane
Breda
B
Gleeson
Margaret
M
D000367:Age Factors; D001831:Body Temperature / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006780:Hospitals, Rural; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007494:Ireland; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
D010100:Oxygen