| چکیده انگلیسی مقاله |
Evaluating of clinical judgment versus APACHE II and REMS for predicting Mortality in Emergency Department: A Prospective Evaluation Study Authors: Zahra Rahmatinejad1, Fatemeh Rahmatinejad2, , Ali Atashi3, Saeid Eslami4,* Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. zahra.rahmatinejad@gmail.com Student Research Committee, Department of Health Information Technology, Faculty of Paramedical, Mashhad University of Medical Sciences, Mashhad, Iran. rahmatif82@gmail.com E-health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran smatashii@gmail.com Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. s.eslami.h@gmail.com Abstract Introduction Physician in emergency department (ED) are always in a tense situation. Primary judgment of physician plays a decisive role in future patient care because of scoring systems can play an effective and useful role in determining prognosis and taking clinical decisions. THE REMS and APACHEII models were used as an example of these systems and were compared with clinical judgment of emergency medical practitioners. Method A prospective cohort study was conducted in the largest emergency referral center in eastern Iran. Patients over 18 years of age with triage levels 1, 2 and 3 to be entered into a study. Evaluation of models from several aspects, overall performance, distinguishing Power and calibration were investigated. Result A total of 3064 patients only 2205 patients had full details of study and including 53% of men with an average age of 61.8 ± 18.5. Area under curve in THE REMS, APACHEII model and clinical judgment of physician were 0.67 (0.70-0.64), 0.68 (0.71-0.65) and 0.75 (0.78-0.72) respectively. Brier score were 0.179,0.141 and 0.154 respectively. number of observed deaths were 426. Predicted death rates in APACHEII, clinical judgment and THE REMS model were 303, 507, and 619, respectively (13.7%, 22.9% and 28% respectively). Average age of emergency medical residents was 37 and number of Physicians participating in this study was 10. using R studio. Conclusion In general, APACHEII model was more versatile than other models, However, poor calibration of these models highlights the need for recalibration or modification process before clinical use at individual level. Our study showed that physicians similar to THE REMS model had a conservative behavior in predicting outcome of patients. Key words: REMS, APACHE II, predicting Mortality, Emergency Department Correspond Email: zahra.rahmatinejad@gmail.com Tel:09158006654 Zahra.rahmatinejad@gmail.com |
| نویسندگان مقاله |
zahara rahmatinejad - student research committee, department of medical informatics, faculty of medicine, mashhad university of medical sciences, mashhad, iran.
fatemeh rahmatinejad - student research committee, department of health information technology, faculty of paramedical, mashhad university of medical sciences, mashhad, iran.
alireza atashi - گروه سلامت الکترونیک، دانشکده مجازی، دانشگاه علوم پزشکی تهران، تهران، ایران
hamidreza reihani - department of emergency medicine, faculty of medicine, mashhad university of medical sciences, mashhad, iran.
saeid eslami - department of medical informatics, faculty of medicine, mashhad university of medical sciences, mashhad, iran.
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