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. 2019 May 3:7:27.
doi: 10.1186/s40560-019-0384-2. eCollection 2019.

The development and validation of a "5A" severity scale for predicting in-hospital mortality after accidental hypothermia from J-point registry data

Yohei Okada  1   2 , Tasuku Matsuyama  3 , Sachiko Morita  4 , Naoki Ehara  5 , Nobuhiro Miyamae  6 , Takaaki Jo  7 , Yasuyuki Sumida  8 , Nobunaga Okada  3   9 , Makoto Watanabe  3 , Masahiro Nozawa  10 , Ayumu Tsuruoka  11 , Yoshihiro Fujimoto  12 , Yoshiki Okumura  13 , Tetsuhisa Kitamura  14 , Shungo Yamamoto  15 , Ryoji Iiduka  2 , Kaoru Koike  1
Affiliations

The development and validation of a "5A" severity scale for predicting in-hospital mortality after accidental hypothermia from J-point registry data

Yohei Okada et al. J Intensive Care. .

Erratum in

Abstract

Background: Accidental hypothermia is a serious condition that requires immediate and accurate assessment to determine severity and treatment. Currently, accidental hypothermia is evaluated using the Swiss grading system which uses core body temperature and clinical findings; however, research has shown that core body temperature is not associated with in-hospital mortality in urban settings. Therefore, we developed and validated a severity scale for predicting in-hospital mortality among urban Japanese patients with accidental hypothermia.

Methods: Data for this multi-center retrospective cohort study were obtained from the J-point registry. We included patients with accidental hypothermia who were admitted to an emergency department. The total cohort was divided into a development cohort and validation cohort, based on the location of each institution. We developed a logistic regression model for predicting in-hospital mortality using the development cohort and assessed its internal validity using bootstrapping. The model was then subjected to external validation using the validation cohorts.

Results: Among the 572 patients in the J-point registry, 532 were ultimately included and divided into the development cohort (N = 288, six hospitals, in-hospital mortality 22.0%) and the validation cohort (N = 244, six hospitals, in-hospital mortality 27.0%). The 5 "A" scoring system based on age, activities-of-daily-living status, near arrest, acidemia, and serum albumin level was developed based on the variables' coefficients in the development cohort. In the validation cohort, the prediction performance was validated.

Conclusion: Our "5A" severity scoring system could accurately predict the risk of in-hospital mortality among patients with accidental hypothermia.

Keywords: Accidental hypothermia; Cardiac arrest; Environmental emergency.

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Conflict of interest statement

The ethics committee of each center approved the registry protocol and retrospective analysis of the de-identified data.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Calibration plot for each cohort. In the development cohort, the ideal dashed line reflects perfect calibration between the predicted and observed mortality. The apparent performance, indicated by the dotted line, reflects the calibrated performance of the model. The solid line reflects the bias-corrected performance based on bootstrapping. The validation cohort also has ideal dashed lines. The solid lines reflect the fitted logistic calibration curve. The dotted lines reflect a smooth nonparametric fit using a locally weighted scatter plot for smoothing
Fig. 3
Fig. 3
Predicted and observed mortality based on the 5A scoring system. The median predicted mortality rate is shown for the quartile-based sums of the risk scores in each cohort. The observed mortality rate reflected the proportion of in-hospital mortality. The predictions were well calibrated with the observations. The 5A scoring system provided a simple and rapid prediction of post-accidental hypothermia prognosis. ADL activities of daily living, SBP systolic blood pressure. Arrest was defined as SBP of ≤ 60 mmHg, unmeasurable values, and confirmed arrest
See this image and copyright information in PMC

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