NDLI: Measures of acute physiology, comorbidity and functional status to differentiate illness severity and length of stay among acute general medical admissions: a prospective cohort study.

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Measures of acute physiology, comorbidity and functional status to differentiate illness severity and length of stay among acute general medical admissions: a prospective cohort study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Huggan, P. J. Akram, F. Er, B. H. D. Christen, L. S. J. Weixian, L. Lim, V. Huang, Y. Merchant, R. A.
Description	Country affiliation: New Zealand Author Affiliation: Huggan PJ ( Waikato Clinical School, University of Auckland, Hamilton, New Zealand.); Akram F ( University Medicine Cluster, National University Health System, Singapore.); Er BH ( Yong Loo Lin School of Medicine, National University of Singapore, Singapore.); Christen LS ( Saw Swee Hock School of Public Health Singapore, Singapore.); Weixian L ( Yong Loo Lin School of Medicine, National University of Singapore, Singapore.); Lim V ( Yong Loo Lin School of Medicine, National University of Singapore, Singapore.); Huang Y ( Yong Loo Lin School of Medicine, National University of Singapore, Singapore.); Merchant RA ( Yong Loo Lin School of Medicine, National University of Singapore, Singapore.)
Abstract	BACKGROUND: Simple measures of acute physiologic compromise, functional status and comorbidity may help clinicians to make decisions relating to clinical care and resource utilisation. AIMS: To explore the usefulness of common assessment tools in predicting outcomes of (i) death or intensive care unit (ICU) admission and (ii) length of hospital stay at a busy tertiary hospital in Singapore. METHODS: Three hundred and ninety-eight consecutive admissions to two general medicine teams were prospectively assessed during 2 months in 2011. Patients were followed until discharge or transfer to ICU/high dependency unit (HDU). Data collected included routine demographic data, final diagnosis, comorbid conditions including a weighted prognostic comorbidity index (the updated Charlson index) and the modified Early Warning Score (MEWS) at presentation to the emergency department. The admission modified Barthel Index was recorded for patients aged 65 and over. Death and total length of hospital stay were recorded in all cases. RESULTS: Of 398 patients, 16 (4 %) died or were transferred to ICU and 99 (25%) stayed for more than 7 days. Medical early warning (MEW) scores of ≥5 were significantly associated with death or ICU admission (hazard ratio 5.50, 95% confidence interval 1.77-17.07, P = 0.003). There was no independent association between this outcome and the Charlson score or admission Barthel Index. Excess length of stay was associated with a modified Barthel Index ≤17 and altered mental status at presentation. CONCLUSION: Among unselected general medical patients, MEW scores of ≥5 were significantly associated with death or ICU admissions and only functional status and altered mental status were independent predictors of excess length of stay.
File Format	HTM / HTML
ISSN	14440903
Issue Number	7
Volume Number	45
e-ISSN	14455994
Journal	Internal Medicine Journal
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2015-07-01
Publisher Place	Australia
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Geriatric Assessment Intensive Care Units Emergency Medicine Prospective Studies Comorbidity Patient Admission Humans Middle Aged Mortality Discipline Internal Medicine Length Of Stay Male Aged, 80 And Over Journal Article Adult Female Organ Dysfunction Scores Statistics & Numerical Data Aged Severity Of Illness Index Observational Study
Content Type	Text
Resource Type	Article
Subject	Internal Medicine

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