Performance of the PATHOS score in predicting in-hospital mortality in patients aged 65 years and older admitted to the intensive care unit from the emergency department

Year 2025, Volume: 50 Issue: 1, 99 - 105, 31.03.2025

Ekrem Taha Sert , Kamil Kokulu

https://doi.org/10.17826/cumj.1567918

Abstract

Purpose: The aim of this study was to investigate the performance of the platelets, age, troponin, heart rate, oxygenation, and systolic blood pressure (PATHOS) score in predicting in-hospital mortality among patients aged 65 years and older admitted to the intensive care unit (ICU) from the emergency department (ED).
Materials and Methods: This single-center, retrospective observational study included patients aged 65 years and older who presented to the ED and were admitted to the ICU between 2018 and 2024. The PATHOS score was calculated using routine vital signs and blood parameters obtained at ED admission. The patients were divided into two groups: survivors and non-survivors. The predictive power of the PATHOS score for in-hospital mortality was evaluated by comparing these groups.
Results: The study included a total of 1,131 patients. The number of survivors was 889 (78.6%), while that of non-survivors was 242 (21.4%). Multivariate logistic regression analysis revealed that the PATHOS score (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 3.07–4.70, p<0.001) independently predicted in-hospital mortality. According to the receiver operating characteristic analysis, the area under the curve of the PATHOS score was 0.827 (0.804–0.849). A PATHOS score greater than 2 predicted in-hospital mortality with a specificity of 75.9% and a sensitivity of 77.6%.
Conclusion: The PATHOS score may serve as a valuable tool for predicting in-hospital mortality in geriatric patients admitted to the ICU from the ED. By effectively identifying critically ill elderly patients, this score may facilitate timely ICU transfers and contribute to the more efficient use of limited resources.

Keywords

Emergency department, geriatric patient, mortality, PATHOS score

Ethical Statement

This study protocol was approved by Scientific Research Ethics Committee of Aksaray University Health Sciences with a protocol number of 2024/022 and conducted in accordance with the Declaration of Helsinki and Good Clinical Practices

Supporting Institution

Aksaray University Medical School

Project Number

2024/022

Acil servisten yoğun bakım ünitesine yatırılan 65 yaş ve üzeri hastalarda hastane içi mortaliteyi tahmin etmede PATHOS skorunun performansı

Abstract

Amaç: Bu çalışmanın amacı, acil servisten (AS) yoğun bakım ünitesine (YBÜ) yatırılan 65 yaş ve üzeri hastalarda hastane içi mortaliteyi tahmin etmede PATHOS (trombositler, yaş, troponin, kalp hızı, oksijenasyon ve sistolik kan basıncı) skorunun etkinliğini araştırmaktır.
Gereç ve Yöntem: Bu tek merkezli, retrospektif gözlemsel çalışmaya 2018 ile 2024 tarihleri arasında AS’ye başvuran ve YBÜ’ye yatırılan 65 yaş ve üzeri hastalar dahil edildi. Hastaların PATHOS skoru AS’ye kabulünde alınan rutin vital bulgular ve kan parametrelerinden hesaplandı. Hastalar yaşayanlar ve ölenler olmak üzere iki gruba ayrıldı. Gruplar arasında PATHOS skorunun hastane içi mortaliteyi öngörebilme gücü değerlendirildi.
Bulgular: Çalışmaya 1131 hasta dahil edildi. Hayatta kalanların sayısı 889 (78.6%), ölenlerin sayısı ise 242 (21.4%) idi. Çok değişkenli lojistik regresyon analizi, PATHOS skorunun (olasılık oranı [OR]: 3.80, %95 güven aralığı [GA]: 3.07-4.70, p<0.001) hastane içi mortaliteyi bağımsız olarak öngördüğünü göstermiştir. Alıcı işlem karakteristik (ROC) analizinde PATHOS skorunun eğri altında kalan alanı (AUC) 0.827 (0.804-.0849) olarak tespit edildi. PATHOS skoru 2’nin üzerinde olmasının hastane içi mortaliteyi %75.9 özgüllük ve %77.6 duyarlılıkla öngördüğünü saptadık.
Sonuç: PATHOS skoru, AS’den YBÜ’ye kabul edilen geriatrik hastalarda hastane içi mortaliteyi tahmin etmede değerli bir araç olarak kullanılabilir. Bu skor, kritik durumdaki yaşlı hastaları etkili bir şekilde belirleyerek YBÜ’ye zamanında transferi kolaylaştırabilir ve sınırlı kaynakların daha verimli kullanılmasına katkı sağlayabilir.

Keywords

Acil servis, geriatrik hasta, mortalite, PATHOS skoru

Ethical Statement

Bu araştırma protokolü Aksaray Üniversitesi Sağlık Bilimleri Bilimsel Araştırma Etik Kurulu tarafından 2024/022 protokol numarası ile onaylanmış olup Helsinki Bildirgesi ve İyi Klinik Uygulamaları'na uygun olarak yürütülmüştür.

Supporting Institution

Aksaray Üniversitesi Tıp Fakültesi

Project Number

2024/022

Thanks

Yazarlar bu çalışmaya katılan tüm katılımcılara teşekkürlerini sunarlar.

References

• Cetınkaya HB, Koksal O, Sigirli D, Leylek EH, Karasu O. The predictive value of the modified early warning score with rapid lactate level (ViEWS-L) for mortality in patients of age 65 or older visiting the emergency department. Intern Emerg Med. 2017;12:1253-7.
• Hu T, Dattani ND, Cox KA, Au B, Xu L, Melady D et al. Effect of comorbidities and medications on frequency of primary care visits among older patients. Can Fam Physician. 2017;63:45-50.
• Groenland CNL, Termorshuizen F, Rietdijk WJR, van den Brule J, Dongelmans DA, de Jonge E et al. Emergency department to ICU time is associated with hospital mortality: a registry analysis of 14,788 patients from six university hospitals in the Netherlands. Crit Care Med. 2019;47:1564-71.
• Blomaard LC, Speksnijder C, Lucke JA, de Gelder J, Anten S, Schuit SCE et al. Geriatric screening, triage urgency, and 30-day mortality in older emergency department patients. J Am Geriatr Soc. 2020;68:1755-62.
• Kemp K, Alakare J, Harjola VP, Strandberg T, Tolonen J, Lehtonen L et al. National early warning score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department. BMC Emerg Med. 2020;20:83.
• Jeong S. Scoring systems for the patients of intensive care unit. Acute Crit Care. 2018;33:102–4.
• Vincent J-L, Moreno R. Clinical review: scoring systems in the critically ill. Crit Care. 2010;14:207
• Spampinato MD, Covino M, Passaro A, Benedetto M, D'Angelo L, Galizia G et al. Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score. Clin Exp Emerg Med. 2023;10:26-36.
• Vallet H, Schwarz GL, Flaatten H, de Lange DW, Guidet B, Dechartres A. Mortality of older patients admitted to an ICU: a systematic review. Crit Care Med. 2021;49:324-34.
• American college of emergency physicians; american geriatrics society; emergency nurses association; society for academic emergency medicine; geriatric emergency department guidelines task force. Geriatric emergency department guidelines. Ann Emerg Med. 2014;63: e7-25.
• Brouns SHA, Mignot-Evers L, Derkx F, Lambooij SL, Dieleman JP, Haak HR. Performance of the manchester triage system in older emergency department patients: a retrospective cohort study. BMC Emerg Med. 2019;19:3.
• Ginsburg AD, Oliveira J E Silva L, Mullan A, Mhayamaguru KM, Bower S, Jeffery MM et al. Should age be incorporated into the adult triage algorithm in the emergency department? Am J Emerg Med. 2021;46:508-14.
• Kemp K, Alakare J, Harjola VP, Strandberg T, Tolonen J, Lehtonen L et al. National early warning score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department. BMC Emerg Med. 2020;20:83.
• Soykan Sert Z, Bertizlioğlu M. Predictive value of the HALP score for pre-eclampsia with severe features. Postgrad Med. 2024;136:468-73.
• Lee JY, Oh SH, Peck EH, Lee JM, Park KN, Kim SH et al. The validity of the Canadian triage and acuity scale in predicting resource utilization and the need for immediate life-saving interventions in elderly emergency department patients. Scand J Trauma Resusc Emerg Med. 2011;19:68.
• Vardy ER, Lasserson D, Barker RO, Hanratty B. NEWS2 and the older person. Clin Med (Lond). 2022;22:522-4.
• Alışkan H, Kılıç M. A new model for estimating in-hospital mortality in patients with pulmonary embolism: PATHOS score. Anatolian Curr Med J. 2023;5:237-41.
• Spampinato MD, Covino M, Passaro A, Benedetto M, D'Angelo L, Galizia G et al. Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score. Clin Exp Emerg Med. 2023;10:26-36.