title: Prediction of en-route complications during interfacility transport by outcome predictive scores in ED.
abstract: OBJECTIVE
  The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure.
  
  
  CONCLUSIONS
  None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital.
authors.forename: Y K
authors.initials: YK
authors.lastname: Wong
authors.affiliation: Department of Accident and Emergency Medicine, Tuen Mun Hospital. Electronic address: ectlui@yahoo.com.hk.
authors.forename: C T
authors.initials: CT
authors.lastname: Lui
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital.
authors.forename: K K
authors.initials: KK
authors.lastname: Li
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital.
authors.forename: C Y
authors.initials: CY
authors.lastname: Wong
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital.
authors.forename: M M
authors.initials: MM
authors.lastname: Lee
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital.
authors.forename: W L
authors.initials: WL
authors.lastname: Tong
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital.
authors.forename: K L
authors.initials: KL
authors.lastname: Ong
authors.affiliation: Department of Accident and Emergency Medicine, Tuen Mun Hospital.
authors.forename: S Y H
authors.initials: SY
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014218:Triage; D055815:Young Adult