title: Patient risk profiling in acute medicine: the way forward?
abstract: BACKGROUND
  The identification of high-risk patients could form a basis for targetted intervention following an emergency medical admission.
  
  
  METHODS
  All emergency admissions to our institution over 12 years (2002-13) were included. An Illness Severity method based on admission laboratory parameters, previously developed between 2002 and 2007, was investigated for the 2008-13 cohort. We compared the area under the receiver operating characteristic (AUROC) to predict a 30-day in-hospital death between the original and validating cohorts using logistic multiple variable analyses. We defined six risk subgroups, based on admission laboratory data and examined the frequency of 30-day in-hospital mortality within these subgroups.
  
  
  RESULTS
  About 66 933 admissions were recorded in 36 271 patients. Between 2002 and 2007, the 30-day in-hospital mortality was 11.3% but between 2008 and 2013 was 6.7% (P < 0.001). This represented an absolute risk reduction (ARR) of 4.6%, a relative risk reduction (RRR) of 41.0%, and a number needed to treat of 21.6. The laboratory model was similarly predictive in both cohorts-for 2002-07, the AUROC was 0.82 (95% CI 0.81, 0.82) and for 2008-13 was 0.82 (95% CI 0.81, 0.83). Two high-risk subgroups were identified within each cohort; for 2002-07, these contained 15.0 and 30.2% of admitted patients but 95.5% of in-hospital deaths. For 2008-13, these two groups contained 15.7 and 31.0% of admitted patients but 97.0% of in-hospital deaths.
  
  
  CONCLUSIONS
  A previously described laboratory score method, based on admission biochemistry, identified patients at high risk for an in-hospital death. Risk profiling at admission is feasible for emergency medical admissions and could offer a means to outcome improvement.
authors.affiliation: From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Conway
authors.affiliation: From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Byrne
authors.affiliation: From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Riordan
authors.affiliation: From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland bernardsilke@physicians.ie.
authors.forename: B
authors.initials: B
authors.lastname: Silke
mesh_terms: D000208:Acute Disease / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods