Seymour et al developed a score to help to identify a patient requiring critical care following out-of-hospital emergency care. The authors are from the University of Washington Seattle, University of Pennsylvania, and the University of Michigan.
Patient selection: adult with out of hospital emergency care
Outcome: critical illness in hospital (severe sepsis, mechanical ventilation, death), any occurrence
Parameters:
(1) age in years
(2) respiratory rate in breaths per minute
(3) systolic blood pressure in mm Hg
(4) heart rate in beats per minute
(5) percent saturation on pulse oximetry
(6) Glasgow Coma Scale (GCS)
Parameter
Finding
Points
age in years
< 45 years of age
0
>= 45 years of age
1
respiratory rate
< 12 breaths per minute
1
12 to 23
0
24 to 35
1
>= 36 breaths per minute
2
systolic blood pressure
<= 90 mm Hg
1
> 90 mm Hg
0
heart rate
< 120 beats per minute
0
>= 120 beats per minute
1
pulse oximetry
>= 88 percent
0
< 88 percnet
1
Glasgow coma score
15
0
8 to 14
1
< 8
2
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the risk of critical illness.
Score
Percent Critically Ill
0
0%
1
3%
2
7%
3
17%
4
32%
5
48%
6
68%
7
86%
8
100%
Performance:
• The maximum Youden index (0.43) is seen with a score >= 2. This had a sensitivity of 73% and specificity of 70%. The positive likelihood ratio is 2.4 and negative likelihood ratio 0.38.
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