Comparative analysis of Glasgow Coma Scale, quick Sepsis-related Organ Failure Assessment, base excess, and lactate for mortality prediction in critically ill emergency department patients

Abstract

OBJECTIVES: It is crucial to promptly identify high-mortality patients in emergency departments and initiate their treatment as soon as possible. Although many parameters have been studied to select patients with high mortality, no comprehensive evaluation exists in previous literature on these parameters in critically ill patients, regardless of patient groups. The aim of this study is to evaluate the Glasgow Coma Scale (GCS), quick Sepsis-related Organ Failure Assessment (qSOFA), blood gas base excess (BE), and blood gas lactate in predicting mortality in critically ill patients admitted to the emergency department. METHODS: This prospective observational cohort study included adult patients with Emergency Severity Index 1-2 (critically ill) admitted to the emergency department. All patients were evaluated by the physician within 10 min, and blood gas samples were taken. The data collection forms recorded the patients' GCS and qSOFA scores at the time of first evaluation by the physician. The qSOFA score assessment was performed in all patients with ESI levels 1 and 2, regardless of whether infective pathology was suspected. Blood gas BE and lactate values were also from laboratory test results. Patients or their relatives were contacted by phone at the end of the 1st month to obtain information about the clinical condition (survival or mortality). RESULTS: A total of 868 patients were included, with 163 deaths observed within 30 days. GCS score, qSOFA score, and lactate value were significant in predicting mortality within 30 days. While the BE value was significant for predicting 30-day mortality for values equal to or below the lower limit of -1.5 (P < 0.001), it was not significant for values equal to or above the upper limit of +3 (P > 0.05). The most successful prediction model for predicting 30-day mortality was found to be qSOFA with a cutoff value of >= 1. CONCLUSION: In emergency departments, each of the GCS, qSOFA scores, BE, and lactate values can be used independently as a practical mortality prediction model in critically ill patients. Among these four models, qSOFA is the most successful practical mortality prediction model in critically ill patients.