Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score.
OBJECTIVE
To derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting.


METHODS
Derivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort.
During the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee.


RESULTS
The score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (-2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9).


CONCLUSIONS
This score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergency patients may enable a more rapid and efficient diagnostic process.
Urgences adultes, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France.
Adrien
A
Basset
Centre d'investigation clinique, INSERM CIC 1412, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France.
Emmanuel
E
Nowak
Pneumologie, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France.
Philippe
P
Castellant
Cardiologie, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France.
Christophe
C
Gut-Gobert
Centre d'investigation clinique, INSERM CIC 1412, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Grégoire
G
Le Gal
Urgences adultes, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; LATIM, INSERM UMR 1101, Université de Bretagne Occidentale, 29200 Brest, France. Electronic address: erwan.lher@chu-brest.fr.
Erwan
E
L'Her
D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors