title: Lung injury prediction score for the emergency department: first step towards prevention in patients at risk.
abstract: BACKGROUND
  Early identification of patients at risk of developing acute lung injury (ALI) is critical for potential preventive strategies. We aimed to derive and validate an acute lung injury prediction score (EDLIPS) in a multicenter sample of emergency department (ED) patients.
  
  
  METHODS
  We performed a subgroup analysis of 4,361 ED patients enrolled in the previously reported multicenter observational study. ED risk factors and conditions associated with subsequent ALI development were identified and included in the EDLIPS model. Scores were derived and validated using logistic regression analyses. The model was assessed with the area under the receiver-operating curve (AUC) and compared to the original LIPS model (derived from a population of elective high-risk surgical and ED patients) and the Acute Physiology and Chronic Health Evaluation (APACHE II) score.
  
  
  RESULTS
  The incidence of ALI was 7.0% (303/4361). EDLIPS discriminated patients who developed ALI from those who did not with an AUC of 0.78 (95% CI 0.75, 0.82), better than the APACHE II AUC 0.70 (p ≤ 0.001) and similar to the original LIPS score AUC 0.80 (p = 0.07). At an EDLIPS cutoff of 5 (range -0.5, 15) positive and negative likelihood ratios (95% CI) for ALI development were 2.74 (2.43, 3.07) and 0.39 (0.30, 0.49), respectively, with a sensitivity 0.72(0.64, 0.78), specificity 0.74 (0.72, 0.76), and positive and negative predictive value of 0.18 (0.15, 0.21) and 0.97 (0.96, 0.98).
  
  
  CONCLUSIONS
  EDLIPS may help identify patients at risk for ALI development early in the course of their ED presentation. This novel model may detect at-risk patients for treatment optimization and identify potential patients for ALI prevention trials.
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine, PO Box 100186, 1329 SW 16th Street, Gainesville, FL 32610, USA. elie@ufl.edu.
authors.forename: Marie-Carmelle
authors.initials: MC
authors.lastname: Elie-Turenne
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hou
authors.forename: Aya
authors.initials: A
authors.lastname: Mitani
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Barry
authors.forename: Erica Y
authors.initials: EY
authors.lastname: Kao
authors.forename: Jason E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Frendl
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Nina T
authors.initials: NT
authors.lastname: Gentile