ArticleClinical and experimental emergency medicine2026
Integrating the interpretable machine learning Score for Emergency Risk Prediction (SERP) with emergency department triage to better predict 30-day mortality.
Article in Clinical and experimental emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study integrated a machine learning-based Score for Emergency Risk Prediction (SERP), developed using objective mortality endpoints, with the Patient Acuity Category Scale (PACS) and evaluated its predictive performance in clinical use.
methodsThis single-center, retrospective cohort study included all emergency department (ED) patients from a large tertiary hospital between January 1, 2018, and December 31, 2019. Using a reclassification framework, SERP was incorporated into PACS to derive two enhanced triage models. PACS+ model 1 down-triaged patients with low predicted 30-day mortality risk and up-triaged those with high risk. PACS+ model 2 up-triaged only high-risk patients, whereas lowrisk patients retained their original category. Predictive performance in the test cohort was assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis.
resultsThe derivation cohort included 97,188 ED visits, and the test cohort included 97,212 ED visits. In the derivation set, the mean age of the patients was 58.97±18.41 years, and 47,993 (49.4%) were female. Overall, 19.9%, 57.4%, 22.5%, and 0.2% of patients were triaged to PACS categories P1-P4, respectively. The 30-day mortality rate was 2.8% in the derivation set and 2.7% in the test cohort. For 30-day mortality prediction, PACS+ model 1 (AUC, 0.828; 95% confidence interval [CI], 0.820-0.836) and PACS+ model 2 (AUC, 0.812; 95% CI, 0.805-0.818) outperformed PACS (AUC, 0.722; 95% CI, 0.714-0.729). PACS+ model 1 consistently achieved greater net benefit across the range of clinical thresholds.
conclusionIntegrating machine learning-based SERP with PACS improved 30-day mortality prediction in ED triage.
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