Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score. - Université de Bretagne Occidentale Access content directly
Journal Articles American Journal of Emergency Medicine Year : 2016

Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score.

Abstract

To derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting.
Derivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort.
During the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee.
The score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (-2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9).
This score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergency patients may enable a more rapid and efficient diagnostic process.
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Dates and versions

hal-01561043 , version 1 (12-07-2017)

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Adrien Basset, Emmanuel Nowak, Philippe Castellant, Christophe Gut-Gobert, Grégoire Le Gal, et al.. Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score.. American Journal of Emergency Medicine, 2016, 34 (12), pp.2277-2283. ⟨10.1016/j.ajem.2016.08.023⟩. ⟨hal-01561043⟩
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