Annals of Emergency Medicine
Volume 57, Issue 1 , Pages 1-12 , January 2011

A Clinical Prediction Model to Estimate Risk for 30-Day Adverse Events in Emergency Department Patients With Symptomatic Atrial Fibrillation

Presented at the 2009 American College of Emergency Physicians Scientific Assembly, October 2009, Boston, MA.

  • Tyler W. Barrett, MD, MSCI

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
    • Corresponding Author InformationAddress for correspondence: Tyler W. Barrett, MD, MSCI, Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232-4700; 615-936-0253, fax 615-936-1316
  • ,
  • Amy R. Martin, MD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
  • ,
  • Alan B. Storrow, MD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
  • ,
  • Cathy A. Jenkins, MS

      Affiliations

    • Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
  • ,
  • Frank E. Harrell Jr, PhD

      Affiliations

    • Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
  • ,
  • Stephan Russ, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
  • ,
  • Dan M. Roden, MD

      Affiliations

    • Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
  • ,
  • Dawood Darbar, MD

      Affiliations

    • Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN

Received 11 February 2010 ,Revised 13 May 2010 ,Accepted 25 May 2010.

  • Image Result

    Thirty-day adverse event prediction rule nomogram. Points are assigned for each of the 12 predictors. The total points correspond to an absolute predicted risk for 30-day adverse events. This nomogram

    Thirty-day adverse event prediction rule nomogram. Points are assigned for each of the 12 predictors. The total points correspond to an absolute predicted risk for 30-day adverse events. This nomogram should not be used in clinical practice until an independent validation is completed.

  • Image Result
    Histogram of predicted probabilities of 30-day adverse events. This figure illustrates the histogram of predicted probabilities from the model and shows that 3.4% of subjects had predicted probabiliti

    Histogram of predicted probabilities of 30-day adverse events. This figure illustrates the histogram of predicted probabilities from the model and shows that 3.4% of subjects had predicted probabilities greater than 0.50 and 5.8% had predicted probabilities less than 0.10.

  • Image Result
    Calibration plot for atrial fibrillation clinical prediction model. This plot illustrates the calibration accuracy of the original model (“Apparent”) and the bootstrap model (“Bias-corrected”) for 30-

    Calibration plot for atrial fibrillation clinical prediction model. This plot illustrates the calibration accuracy of the original model (“Apparent”) and the bootstrap model (“Bias-corrected”) for 30-day adverse events with locally weighted scatterplot smoothing used to model the relationship between actual and predicted probabilities. As can be seen, the model's calibration function estimate is slightly nonlinear, with the corrected calibration showing good agreement with the apparent calibration.

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 Supervising editor: Keith A. Marill, MD

 Author contributions: All authors contributed significantly to the study and the preparation of the article. TWB, ABS, DMD, and DD were responsible for the conception and design of the study. TWB, ARM, and SR were responsible for data acquisition, data entry, and preliminary data analysis. CAJ and FEH performed all statistical analyses. All authors participated in the drafting and multiple revisions of the article and gave final approval to the submitted work. TWB takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The study was entirely funded by the Vanderbilt University Medical Center Physician Scientist Development Program (supported in part by Vanderbilt CTSA grant 1 UL1 RR024975 from NCRR/NIH) and the Department of Emergency Medicine Research Division. Dr. Darbar and Dr. Roden are supported in part by NIH grants U01 HL65962 and R01 HL092217.

 Publication date: Available online August 21, 2010.

 Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.

 Reprints not available from the authors.

 Please see page 2 for the Editor's Capsule Summary of this article.

PII: S0196-0644(10)00556-1

doi: 10.1016/j.annemergmed.2010.05.031

Annals of Emergency Medicine
Volume 57, Issue 1 , Pages 1-12 , January 2011