A Novel Algorithm

Rapid risk stratification of getriatric patients with non-specific complaints

The combination of MR-proADM and ITT

The subsequent combination of MR-proADM cut-offs with the initial intention to transfer (ITT) score has been shown in a multi-centre observational study to result in an extensive reclassification of patient disposition (n=497)19, where initial ITT disposition decisions can be modified by MR-proADM values by a maximum of one severity level. For example, patients presenting to the ED with a low ITT score, and therefore considered to be of low potential risk, can subsequently be found to have high MR-proADM levels, indicating a more severe underlying condition than previously thought. The patient can subsequently be reclassified as an intermediate risk, and admitted to either a geriatric ward or community hospital, as opposed to being discharged.

 

The combination of MR-proADM and ITT: A novel algorithm for improved accuracy

The combination of MR-proADM and ITTCombined MR-proADM and ITT algorithm for an improved risk assessment score for patients suffering from non-specific complaints (adapted from Nickel et al, 2013)19

 

Safe and established cut-offs for non-specific complaints

The combination of MR-proADM with existing risk assessment scores has previously been shown to significantly increase risk assessment accuracy without compromising patient safety25, 26. Indeed, using similar MR-proADM cut-offs for CAP25 and COPD27, patients can be divided into three risk categories according to their MR-proADM concentration, with cut-offs of 0.75 and 1.5 nmol/L. When MR-proADM values fall below 0.75 nmol/L, 98.4 % of patients suffering from non-specific complaints were shown to survive after 30 days, in contrast to 94.6 % and 86.4 % for intermediate (MR-proADM values between and including 0.75 and 1.5 nmol/L) and high risk (MR-proADM values above 1.5 nmol/L) groups19.

 

 

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