Outcome prediction in dogs admitted through the emergency room: Accuracy of staff prediction and comparison with an illness severity stratification system for hospitalized dogs

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care Pub Date : 2023-11-21 DOI:10.1111/vec.13350

Alice Le Gal DVM, MVetMed, DACVECC, DECVECC, Dominic Martin Barfield BSc, BVSc, MVetMed, DACVECC, DECVECC, Roseanne Helen Wignall RVN, Simon David Cook BSc, BVSc, MVetMed, DACVECC, DECVECC

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引用次数: 0

Abstract

Objective

To determine whether emergency staff and students can predict patient outcome within 24 hours of admission, comparing the accuracy of clinician prognostication with outcome prediction by Acute Patient Physiologic and Laboratory Evaluation (APPLE)_fast scoring and identifying whether experience or mood would be associated with accuracy.

Design

Prospective observational study between April 2020 and March 2021.

Setting

University teaching hospital.

Animals

One hundred and sixty-one dogs admitted through an Emergency Service were assessed. Where data were available, an APPLE_fast score was calculated per patient. An APPLE_fast score of >25 was deemed a predictor for mortality.

Interventions

None.

Measurements and Main Results

Emergency staff and students were asked to complete surveys about dogs admitted to the emergency room. All clinicopathological data were available for review, and the animals were available for examination. Data collected included opinions on whether the patient would be discharged from hospital, a mood score, position, and experience in Emergency and Critical Care. One-hundred and twenty-five dogs (77.6%) were discharged; 36 dogs (22.4%) died or were euthanized. Two hundred and sixty-six responses were obtained; 202 responses (75.9%) predicted the correct outcome. Students, interns, residents, faculty, and nurses predicted the correct outcome in 81.4%, 58.3%, 83.3%, 82.1%, and 65.5% of cases, respectively. Of 64 incorrect predictions, 43 (67.2%) predicted death in hospital. APPLE_fast scores were obtained in 121 cases, predicting the correct outcome in 83 cases (68.6%). Of 38 cases in which APPLE_fast was incorrect, 27 (71.1%) were dogs surviving to discharge. Mean APPLE_fast score was 22.9 (± 6.2). There was no difference in outcome prediction accuracy between staff and APPLE_fast scores (P = 0.13). Neither experience nor mood score was associated with outcome prediction ability (P = 0.55 and P = 0.74, respectively).

Conclusions

Outcome prediction accuracy by staff is not significantly different to APPLE_fast scoring where a cutoff of >25 is used to predict mortality. When predictions were incorrect, they often predicted nonsurvival.

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通过急诊室入院犬的预后预测:工作人员预测的准确性以及与住院犬疾病严重程度分层系统的比较

目的:确定急诊人员和学生是否能够在入院24小时内预测患者的预后，比较临床医生预测的准确性与急性患者生理和实验室评估(APPLE)快速评分预测的结果，并确定经验或情绪是否与准确性相关。设计:2020年4月至2021年3月的前瞻性观察研究。单位:大学教学医院。动物:对通过紧急服务接收的161只狗进行了评估。在数据可用的情况下，对每位患者计算APPLEfast评分。APPLEfast评分为bbbb25被认为是死亡率的预测指标。干预措施:没有。测量和主要结果:要求急救人员和学生完成关于被送往急诊室的狗的调查。所有的临床病理资料都可以查阅，动物也可以进行检查。收集的数据包括对患者是否出院、情绪评分、体位以及急诊和重症监护经验的意见。出院125只，占77.6%;36只(22.4%)死亡或被安乐死。共获得266份答复;202个回答(75.9%)预测正确。学生、实习生、住院医师、教师和护士的预测正确率分别为81.4%、58.3%、83.3%、82.1%和65.5%。在64个错误预测中，43个(67.2%)预测了院内死亡。121例获得APPLEfast评分，正确预测83例(68.6%)。在APPLEfast错误的38例中，有27例(71.1%)是存活出院的狗。APPLEfast平均评分为22.9(±6.2)分。工作人员与APPLEfast评分结果预测准确率无差异(P = 0.13)。经验和情绪评分与预后预测能力均无相关性(P分别为0.55和0.74)。结论:工作人员预测结果的准确性与APPLEfast评分无显著差异，APPLEfast评分采用bbbb25作为预测死亡率的截止点。当预测不正确时，他们通常预测无法存活。

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来源期刊

Journal of veterinary emergency and critical care 农林科学-兽医学

CiteScore

2.50

自引率

15.40%

发文量

121

审稿时长

18-36 weeks

期刊介绍： The Journal of Veterinary Emergency and Critical Care’s primary aim is to advance the international clinical standard of care for emergency/critical care patients of all species. The journal’s content is relevant to specialist and non-specialist veterinarians practicing emergency/critical care medicine. The journal achieves it aims by publishing descriptions of unique presentation or management; retrospective and prospective evaluations of prognosis, novel diagnosis, or therapy; translational basic science studies with clinical relevance; in depth reviews of pertinent topics; topical news and letters; and regular themed issues. The journal is the official publication of the Veterinary Emergency and Critical Care Society, the American College of Veterinary Emergency and Critical Care, the European Veterinary Emergency and Critical Care Society, and the European College of Veterinary Emergency and Critical Care. It is a bimonthly publication with international impact and adheres to currently accepted ethical standards.