Clinical paperDerivation and validation of a score based on Hypotension, Oxygen saturation, low Temperature, ECG changes and Loss of independence (HOTEL) that predicts early mortality between 15 min and 24 h after admission to an acute medical unit☆
Section snippets
Background
Although the measurement of vital signs has been standard practice for over a century there have been few attempts to quantify their clinical performance. Nevertheless changes in the vital signs have been used by various “track and trigger” systems such as the Early Warning Scoring System (EWSS),1 the Modified Early Warning Score (MEWS),2 Patient At-Risk Teams (PARTs)3 and others.4, 5 Most of these calling criteria were determined empirically by expert opinion. The Rapid Emergency Medicine
Methods
As previously reported8 Nenagh Hospital is small general hospital in rural Ireland serving a population of 60,000. It has a 36 bed acute medical unit with 2800 admissions per year almost all of which are unplanned emergencies. It is served by three consultant physicians each assisted by a team of three physicians in training—each team is on-call every third day. From February 17, 2000 to January 29, 2004 all medical patients admitted to Nenagh Hospital had their history and physical data
Results
The continuous variables of age, oxygen saturation and vital signs were partitioned into categorical variables either by identifying cut-points associated with the highest odds ratio for early mortality, or by placing them into groups that were then bar graphed against early mortality. The pattern for systolic blood pressure is shown in Figure 1.
In the case of pulse rate the traditionally accepted normal ranges were used.17 A Shock Index >1.4, a temperature <35 °C, systolic blood pressures <77
Discussion
The HOTEL score uses five easily available clinical variables that divide acutely ill medical patients into four fifths at a very low risk and one fifth at a markedly increased risk of death within 24 h. Unlike other scores HOTEL requires almost no computational ability and can be determined easily, quickly and at no cost by any competent health care worker. Although there were several statistically significant differences between the derivation and validation cohorts these differences were of
Conflict of interest
This study was entirely funded by our employers the Mid-Western Health Board—now re-named the Health Service Executive. None of the authors have any other potential conflict of interest, financial or otherwise.
Acknowledgements
The authors would like to acknowledge the help of all the medical, nursing and administrative staff of Nenagh Hospital in the collection of data that made this paper possible. In particular we would like to thank Mrs. Marie Kennedy for her meticulous help. This study was entirely funded by the authors’ employers the Mid-Western Health Board.
References (24)
- et al.
Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study
Br J Anaesth
(2007) - et al.
Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene triphosphoramide
J Chron Dis
(1960) - et al.
An early warning scoring system for detecting developing critical illness
Clin Intensive Care
(1997) - et al.
Validation of a modified early warning score in medical admissions
Q J Med
(2001) - et al.
Early detection of patients at risk (PART)
Anaesthesia
(2000) - et al.
Using algorithms in critical care outreach: UCLH Trust Patient Emergency Response Team (PERT) algorithm for heart rate >125
Care Crit Ill
(2002) - et al.
ASSIST: a screening tool for critically ill patients on general medical wards
Intensive Care Med
(2002) - et al.
Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients
Acad Emerg Med
(2003) - et al.
The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit
Q J Med
(2006) - et al.
Shockindex
Dtsch Med Wochenschr
(1967)
Clarifying confusion: the confusion assessment method
Ann Int Med
LOGISTIC: a conditional logistic regression program for the IBM-PC
Am Stat
Cited by (0)
- ☆
A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.02.011.