title: Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care.
abstract: BACKGROUND
  We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups.
  
  
  METHODS
  This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets-the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint.
  
  
  RESULTS
  We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits (25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set.
  
  
  CONCLUSIONS
  The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises.
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Kuo
authors.forename: Tsair-Wei
authors.initials: TW
authors.lastname: Chien
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.forename: Wei-Lung
authors.initials: WL
authors.lastname: Chen
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.forename: Su-Hen
authors.initials: SH
authors.lastname: Chang
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method