OBJECTIVES: No prospectively derived or validated decision tools identify @entity341 ( @entity341 ) @entity1 with @entity712 ( @entity712 ) at low risk for 30-day adverse events who are thus potential candidates for safe @entity341 discharge. This study sought to accomplish that goal. BACKGROUND: The nearly 1 million annual @entity341 visits for @entity712 are associated with high proportions of admissions and consume significant resources. METHODS: We prospectively enrolled 1,033 @entity1 diagnosed with @entity712 in the @entity341 from 4 hospitals between July 20, 2007, and February 4, 2011. We used an ordinal outcome hierarchy, defined as the incidence of the most severe adverse event within 30 days of @entity341 evaluation ( @entity1187 , coronary revascularization, emergent dialysis, intubation, mechanical cardiac support, cardiopulmonary resuscitation, and @entity204 ). RESULTS: Of 1,033 @entity1 enrolled, 126 (12%) experienced at least one 30-day adverse event. The decision tool had a C statistic of 0.68 (95% confidence interval: 0.63 to 0.74). Elevated troponin (p  < 0.001) and renal function (p  = 0.01) were significant predictors of adverse events in our multivariable model, whereas B-type natriuretic peptide (p  = 0.09), @entity7405 (p  = 0.09), and @entity1 undergoing dialysis (p  = 0.07) trended toward significance. At risk thresholds of 1%, 3%, and 5%, we found 0%, 1.4%, and 13.0% @entity1 were at low risk, with negative predictive values of 100%, 96%, and 93%, respectively. CONCLUSIONS: The STRATIFY decision tool identifies @entity341 @entity1 with @entity712 who are at low risk for 30-day adverse events and may be candidates for safe @entity341 discharge. After external testing, and perhaps when used as part of a shared decision-making strategy, it may significantly affect disposition strategies. (Improving @entity712 Risk Stratification in the @entity341 [STRATIFY]; NCT00508638).

Identification of Emergency Department @entity1 With XXXX at Low  Risk for 30-Day Adverse Events: The  STRATIFY Decision Tool.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity1187 :: ('MESH:D054058', 'Disease') :: ['acute coronary syndrome'] @entity712 :: ('MESH:D006333', 'Disease') :: ['AHF', 'acute heart failure', 'Heart Failure'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency department', 'ED'] @entity7405 :: ('MESH:D059246', 'Disease') :: ['tachypnea'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity712 :: (MESH:D006333,Disease) :: ['Acute Heart Failure']
