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[A score to predict medical emergencies in hospitalized patients].

BACKGROUND
The medical alert system (MAS) was created for the timely handling of clinical decompensations, experienced by patients hospitalized at the Medical Surgical Service (MSS) in a private clinic. It is activated by the nurse when hemodynamic, respiratory, neurological, infectious or metabolic alterations appear, when a patient falls or complains of pain. A physician assesses the patient and decides further therapy.


AIM
To analyze the clinical and demographic characteristics of patients who activated or not the MAS and develop a score to identify patients who will potentially activate MAS.


MATERIAL AND METHODS
Data from 13,933 patients discharged from the clinic in a period of one year was analyzed.


RESULTS
MAS was activated by 472 patients (3.4%). Twenty two of these patients died during hospital stay compared to 68 patients who did not activate the alert (0.5%, p < 0.01). The predictive score developed considered age, diagnosis (based on the tenth international classification of diseases) and whether the patient was medical or surgical. The score ranges from 0 to 9 and a cutoff ≥ 6 provides a sensitivity and specificity of 37 and 81% respectively and a positive likelihood ratio (LR+) of 1.9 to predict the activation of MAS. The same cutoff value predicts death with a sensitivity and specificity of 80% and a negative predictive value of 99.8%.


CONCLUSIONS
This score may be useful to identify hospitalized patients who may have complications during their hospital stay.