Kwok et al developed the Targeted Risk Prediction Score for evaluating very elderly patients undergoing emergency colon surgery. The authors are from Brigham and Women’s Hospital in Boston.
Patient selection: age >= 80 and emergency colon surgery
Parameters:
(1) age group
(2) dependency status
(3) history of chronic obstructive pulmonary disease (COPD)
(4) history of congestive heart failure (CHF)
(5) history of metastatic cancer
(6) history of preoperative steroid use
(7) systemic inflammatory response syndrome (SIRS) response
(8) serum creatinine
|
Parameter |
Finding |
Points |
|
age group |
80 to 89 years of age age |
-0.4850 |
|
|
>= 90 years of age |
0 |
|
dependency status |
totally dependent |
0.9317 |
|
|
not totally dependent |
0 |
|
history of COPD |
no |
0 |
|
|
yes |
0.5840 |
|
history of CHF |
no |
0 |
|
|
yes |
0.6271 |
|
history of metastatic cancer |
no |
0 |
|
|
yes |
0.6931 |
|
history of preoperative steroids |
no |
0 |
|
|
yes |
0.4764 |
|
SIRS response |
absent |
0 |
|
|
present |
0.7538 |
|
serum creatinine |
<= 1.5 mg/dL |
0 |
|
|
> 1.5 mg/dL |
0.9447 |
where:
• Patients with sepsis or septic shock were included with SIRS.
• SIRS was diagnosed if at least 2 features were present within the same time frame: temperature < 36°C OR > 38°C, pulse > 90 beats per minute, respiratory rate > 20 breaths per minute OR PaCO2 < 32 mm Hg, WBC count < 4,000 OR > 12,000 per µL OR > 10% band forms, anion gap acidosis.
targeted risk prediction score =
= SUM(points for all 8 parameters) – 1.768
probability of mortality =
= 1 / (1 + EXP((-1) * (score)))
Performance:
• The authors reported a c-statistic (area under the ROC curve) 0.77.
• The cumulative residual goodness-of-fit p value was 0.51.
Specialty: Anesthesiology
ICD-10: ,
