TY - JOUR
T1 - A novel early risk assessment tool for detecting clinical outcomes in patients with heat-related illness (J-ERATO score)
T2 - Development and validation in independent cohorts in Japan
AU - Hayashida, Kei
AU - Kondo, Yutaka
AU - Hifumi, Toru
AU - Shimazaki, Junya
AU - Oda, Yasutaka
AU - Shiraishi, Shinichiro
AU - Fukuda, Tatsuma
AU - Sasaki, Junichi
AU - Shimizu, Keiki
N1 - Funding Information:
This study was supported by Japanese Association for Acute Medicine.
PY - 2018/5
Y1 - 2018/5
N2 - Background We sought to develop a novel risk assessment tool to predict the clinical outcomes after heat-related illness. Methods Prospective, multicenter observational study. Patients who transferred to emergency hospitals in Japan with heat-related illness were registered. The sample was divided into two parts: 60% to construct the score and 40% to validate it. A binary logistic regression model was used to predict hospital admission as a primary outcome. The resulting model was transformed into a scoring system. Results A total of 3,001 eligible patients were analyzed. There was no difference in variables between development and validation cohorts. Based on the result of a logistic regression model in the development phase (n = 1,805), the J-ERATO score was defined as the sum of the six binary components in the prehospital setting (respiratory rate22 /min, Glasgow coma scale<15, systolic blood pressure100 mmHg, heart rate100 bpm, body temperature38C, and age65 y), for a total score ranging from 0 to 6. In the validation phase (n = 1,196), the score had excellent discrimination (C-statistic 0.84; 95% CI 0.79–0.89, p<0.0001) and calibration (P>0.2 by Hosmer-Lemeshow test). The observed proportion of hospital admission increased with increasing J-ERATO score (score = 0, 5.0%; score = 1, 15.0%; score = 2, 24.6%; score = 3, 38.6%; score = 4, 68.0%; score = 5, 85.2%; score = 6, 96.4%). Multivariate analyses showed that the J-ERATO score was an independent positive predictor of hospital admission (adjusted OR, 2.43; 95% CI, 2.06–2.87; P<0.001), intensive care unit (ICU) admission (3.73; 2.95–4.72; P<0.001) and in-hospital mortality (1.65; 1.18–2.32; P = 0.004). Conclusions The J-ERATO score is simply assessed and can facilitate the identification of patients with higher risk of heat-related hospitalization. This scoring system is also significantly associated with the higher likelihood of ICU admission and in-hospital mortality after heat-related hospitalization.
AB - Background We sought to develop a novel risk assessment tool to predict the clinical outcomes after heat-related illness. Methods Prospective, multicenter observational study. Patients who transferred to emergency hospitals in Japan with heat-related illness were registered. The sample was divided into two parts: 60% to construct the score and 40% to validate it. A binary logistic regression model was used to predict hospital admission as a primary outcome. The resulting model was transformed into a scoring system. Results A total of 3,001 eligible patients were analyzed. There was no difference in variables between development and validation cohorts. Based on the result of a logistic regression model in the development phase (n = 1,805), the J-ERATO score was defined as the sum of the six binary components in the prehospital setting (respiratory rate22 /min, Glasgow coma scale<15, systolic blood pressure100 mmHg, heart rate100 bpm, body temperature38C, and age65 y), for a total score ranging from 0 to 6. In the validation phase (n = 1,196), the score had excellent discrimination (C-statistic 0.84; 95% CI 0.79–0.89, p<0.0001) and calibration (P>0.2 by Hosmer-Lemeshow test). The observed proportion of hospital admission increased with increasing J-ERATO score (score = 0, 5.0%; score = 1, 15.0%; score = 2, 24.6%; score = 3, 38.6%; score = 4, 68.0%; score = 5, 85.2%; score = 6, 96.4%). Multivariate analyses showed that the J-ERATO score was an independent positive predictor of hospital admission (adjusted OR, 2.43; 95% CI, 2.06–2.87; P<0.001), intensive care unit (ICU) admission (3.73; 2.95–4.72; P<0.001) and in-hospital mortality (1.65; 1.18–2.32; P = 0.004). Conclusions The J-ERATO score is simply assessed and can facilitate the identification of patients with higher risk of heat-related hospitalization. This scoring system is also significantly associated with the higher likelihood of ICU admission and in-hospital mortality after heat-related hospitalization.
UR - http://www.scopus.com/inward/record.url?scp=85046763874&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046763874&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0197032
DO - 10.1371/journal.pone.0197032
M3 - Article
C2 - 29742138
AN - SCOPUS:85046763874
VL - 13
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 5
M1 - e0197032
ER -