title: External validation of the simple clinical score and the HOTEL score, two scores for predicting short-term mortality after admission to an acute medical unit.
abstract: BACKGROUND
  Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs.
  
  
  METHODS
  Pre-planned prospective observational cohort study.
  
  
  METHODS
  Danish 460-bed regional teaching hospital.
  
  
  RESULTS
  We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ(2) = 2.68 (10 degrees of freedom), P = 0.998 and χ(2) = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ(2) = 5.56 (10 degrees of freedom), P = 0.234.
  
  
  CONCLUSIONS
  We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision.
authors.affiliation: Department of Anaesthesiology, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark.
authors.forename: Mia
authors.initials: M
authors.lastname: Stræde
authors.affiliation: Department of Medicine, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark; Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results