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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.

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    Authors
    Kellett, John
    Emmanuel, Andrew
    Deane, Breda
    Affiliation
    Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. jgkellett@eircom.net
    Issue Date
    2011-08
    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
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    Citation
    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. 2011, 22 (4):375-81 Eur. J. Intern. Med.
    Journal
    European journal of internal medicine
    URI
    http://hdl.handle.net/10147/205031
    DOI
    10.1016/j.ejim.2011.03.005
    PubMed ID
    21767755
    Additional Links
    http://www.sciencedirect.com/science/article/pii/S0953620511000616
    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.
    Item Type
    Article
    Language
    en
    ISSN
    1879-0828
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ejim.2011.03.005
    Scopus Count
    Collections
    Nenagh General Hospital

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