title: Geriatric Fever Score: a new decision rule for geriatric care.
abstract: BACKGROUND
  Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups.
  
  
  METHODS
  Consecutive geriatric patients (≥65 years old) visiting the emergency department (ED) of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done.
  
  
  RESULTS
  Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3), Severe coma (GCS ≤ 8), and Thrombocytopenia (platelets <150 10(3)/mm3) (LST). After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0%) (95% CI: 2.3-6.9%): a general ward or treatment in the ED then discharge and high (30.3%) (95% CI: 17.4-47.3%): consider the intensive care unit. The area under the curve for the rule was 0.73.
  
  
  CONCLUSIONS
  We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need.
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Min-Hsien
authors.initials: MH
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Si-Chon
authors.initials: SC
authors.lastname: Vong
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Tzu-Meng
authors.initials: TM
authors.lastname: Yang
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Kuo-Tai
authors.initials: KT
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan; Fu Jen Catholic University School of Medicine, Taipei, Taiwan.
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005334:Fever / Q000175:diagnosis*; D005853:Geriatrics / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013624:Taiwan