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Purpose <p>To use simple CT measurements of musculoskeletal and cardiovascular systems to create a CT-based score to predict mortality in patients admitted to the Emergency Department (ED).</p> Methods <p>The study received IRB approval. Non-contrast abdominal CT of &gt;&#xa0;18 year old patients admitted to the ER between January 2019 and January 2020 were evaluated by a team of twelve radiologists to calculate: (1) diameter of the infrarenal aorta in millimeter; (2) cross sectional area and composition (Hounsfield units) of the psoas muscle at the third lumbar vertebra (LV); (3) bone density, as quantified at the first lumbar vertebra (LV); (4) presence or absence of dilated abdominal aorta. Thirty-day all-cause mortality (ACM) was determined through hospital and electronic records.</p> Results <p>N&#xa0;=&#xa0;1920 unique patients were evaluated. The mean age was 65&#xa0;±&#xa0;19&#xa0;years and 46% were female. Death occurred in 7.9% of patients by 30&#xa0;days from admission. The derivation dataset comprised 1462 patients. At multivariable analysis, age (OR 1.02, 95% CI: 1.007–1.04,<i> p</i>&#xa0;=&#xa0;0.005), psoas cross sectional area (OR 0.99, 95% CI: 0.997–0.999,<i> p</i>&#xa0;&lt;&#xa0;0.001) and density (OR 0.96, 95% CI: 0.95–0.98,<i> p</i>&#xa0;&lt;&#xa0;0.001), and dilated infrarenal aorta (OR 1.85, 95% CI: 1–3.28,<i> p</i>&#xa0;=&#xa0;0.04) were predictors of the outcome. We accordingly derived a 4-item risk score. In the derivation dataset, the score yielded moderate–high discrimination, with an AUC of 0.73 and excellent diagnostic agreement. In the validation dataset (N&#xa0;=&#xa0;458), discrimination was high (AUC&#xa0;=&#xa0;0.83).</p> Conclusion <p>Simple measurements gathered during a standard CT may allow determining the risk of mortality in the heterogeneous patient population admitted to the ED in a cost- and time-effective manner.</p>

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Opportunistic prognostication by computerized tomography (CT) in the emergency department: analysis on 1920 patients and creation of a simple and fast scoring system

  • 期刊论文

  • 发表日期：

    2025年4月1日

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  • Alberto Stefano Tagliafico,
  • Stefano Benenati,
  • Italo Porto,
  • Carlo Martinoli,
  • Pietro Ameri,
  • Francesca Bertola,
  • Bianca Bignotti,
  • Lorenzo Bianchi,
  • Sara Carpaneto,
  • Benedetta Conti,
  • Francesco Crupi,
  • Valeria Dorindo,
  • Giulia Francese,
  • Giovanni Guglielmini,
  • Marta Macciò,
  • Ilaria Picone,
  • Simone Rinaldi,
  • Gabriele Rossi,
  • Sara Seitun,
  • Erika Tempo,
  • Caterina Vercelli

摘要

Purpose

To use simple CT measurements of musculoskeletal and cardiovascular systems to create a CT-based score to predict mortality in patients admitted to the Emergency Department (ED).

Methods

The study received IRB approval. Non-contrast abdominal CT of > 18 year old patients admitted to the ER between January 2019 and January 2020 were evaluated by a team of twelve radiologists to calculate: (1) diameter of the infrarenal aorta in millimeter; (2) cross sectional area and composition (Hounsfield units) of the psoas muscle at the third lumbar vertebra (LV); (3) bone density, as quantified at the first lumbar vertebra (LV); (4) presence or absence of dilated abdominal aorta. Thirty-day all-cause mortality (ACM) was determined through hospital and electronic records.

Results

N = 1920 unique patients were evaluated. The mean age was 65 ± 19 years and 46% were female. Death occurred in 7.9% of patients by 30 days from admission. The derivation dataset comprised 1462 patients. At multivariable analysis, age (OR 1.02, 95% CI: 1.007–1.04, p = 0.005), psoas cross sectional area (OR 0.99, 95% CI: 0.997–0.999, p < 0.001) and density (OR 0.96, 95% CI: 0.95–0.98, p < 0.001), and dilated infrarenal aorta (OR 1.85, 95% CI: 1–3.28, p = 0.04) were predictors of the outcome. We accordingly derived a 4-item risk score. In the derivation dataset, the score yielded moderate–high discrimination, with an AUC of 0.73 and excellent diagnostic agreement. In the validation dataset (N = 458), discrimination was high (AUC = 0.83).

Conclusion

Simple measurements gathered during a standard CT may allow determining the risk of mortality in the heterogeneous patient population admitted to the ED in a cost- and time-effective manner.