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Predictive scoring in non-trauma emergency patients: a scoping review
  1. Kirsty Challen,
  2. Steve W Goodacre
  1. Health Services Research, ScHARR, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Challen, 84 Whitbarrow Road, Lymm, WA13 9BA; kirstychallen{at}


This study is an inclusive scoping review of the literature relating to outcome prediction in adult non-trauma emergency patients, in order to identify the number and range of risk scores developed for acutely ill adults and to identify the outcomes these scores predict. The data source used was Medline 1950–2009. To be eligible for inclusion, papers had to detail an assessment tool, wholly or predominantly clinical, applied at the point of patient presentation to unscheduled healthcare services with outcome measures up to 30 days after presentation. Papers detailing trauma, paediatrics, purely obstetric or psychiatric presentations, tools wholly applied in a critical care setting, tools requiring an algorithm not freely available, biomarkers or tests not routinely available in an Emergency Department (ED) setting were excluded. 192 papers were reviewed. Within 17 broad disease categories, 80 inclusion criteria were used, 119 tools were assessed (25 of which were non-disease specific), and 51 outcome measures were used (30 of which were disease-specific). The areas under the receiver-operator characteristic curve (AUROCs) varied from 0.44 to 0.984. The multiplicity of tools available presents a challenge in itself to the acute clinician. Many tools require a specific diagnosis, which is not immediately available, and the authors advocate ED development of tools for case-mix adjustment and clinical risk stratification.

  • Clinical assessment
  • major incidents
  • clinical care
  • prehospital care
  • clinical management

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  • Data sharing Dataset available from KC at kirstychallen{at}

  • Funding SG is an employee of the University of Sheffield. KC is funded by a Medical Research Council PhD studentship. Neither body had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

  • Competing interests All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that (1) no authors have support from any commercial company for the submitted work; (2) no authors have relationships with any commercial company that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) no authors have non-financial interests that may be relevant to the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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