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Who will be sicker in the morning? Changes in the Simple Clinical Score the day after admission and the subsequent outcomes of acutely ill unselected medical patients.
Kellett, John Emmanuel, Andrew Deane, Breda
Kellett, John
Emmanuel, Andrew
Deane, Breda
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Date
2011-08
Date Submitted
Keywords
Other Subjects
Subject Mesh
Acute Disease
Aged
Aged, 80 and over
Disease Progression
Female
Follow-Up Studies
Hospital Mortality
Humans
Ireland
Male
Middle Aged
Patient Admission
Prognosis
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Aged
Aged, 80 and over
Disease Progression
Female
Follow-Up Studies
Hospital Mortality
Humans
Ireland
Male
Middle Aged
Patient Admission
Prognosis
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
All doctors are haunted by the possibility that a patient they reassured yesterday will return seriously ill tomorrow. We examined changes in the Simple Clinical Score (SCS) the day after admission, factors that might influence these changes and the relationship of these changes to subsequent clinical outcome.
The SCS was recorded in 1165 patients on admission and again the following day (i.e. 25.0±15.8 h later). The abilities of 51 variables that might predict changes in the SCS were examined.
The day after admission 16.1% of patients had been discharged home, 31.4% had decreased their SCS by 2.4±1.6 points, 38.6% had an unchanged SCS, 12.0% had increased their SCS by 2.1±1.7 points and 1.2% had died. Patients with an increased SCS had higher in-hospital mortality (10% vs. 1.1%, OR 10.1, p<.001) and a longer length of stay (9.4±9.6 vs. 5.6±7.0 days, p<.001). There was no consistent association between the SCS recorded at admission and SCS increase. Only nursing home residence, heart failure and a Medical Admission Risk System laboratory data score>0.09 were found to be independent predictors of SCS increase.
The SCS of 12% of patients increases the day after admission to hospital, which is associated with a ten-fold increase of in-hospital mortality. Low SCS risk patients are just as likely to have a SCS increase as high risk patients.
The SCS was recorded in 1165 patients on admission and again the following day (i.e. 25.0±15.8 h later). The abilities of 51 variables that might predict changes in the SCS were examined.
The day after admission 16.1% of patients had been discharged home, 31.4% had decreased their SCS by 2.4±1.6 points, 38.6% had an unchanged SCS, 12.0% had increased their SCS by 2.1±1.7 points and 1.2% had died. Patients with an increased SCS had higher in-hospital mortality (10% vs. 1.1%, OR 10.1, p<.001) and a longer length of stay (9.4±9.6 vs. 5.6±7.0 days, p<.001). There was no consistent association between the SCS recorded at admission and SCS increase. Only nursing home residence, heart failure and a Medical Admission Risk System laboratory data score>0.09 were found to be independent predictors of SCS increase.
The SCS of 12% of patients increases the day after admission to hospital, which is associated with a ten-fold increase of in-hospital mortality. Low SCS risk patients are just as likely to have a SCS increase as high risk patients.
Language
en
ISSN
1879-0828
eISSN
ISBN
DOI
10.1016/j.ejim.2011.03.005
PMID
21767755