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.
AffiliationDepartment of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. firstname.lastname@example.org
Aged, 80 and over
Severity of Illness Index
MetadataShow full item record
CitationWho 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.
JournalEuropean journal of internal medicine
AbstractAll 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.
- What diagnoses may make patients more seriously ill than they first appear? Mortality according to the Simple Clinical Score Risk Class at the time of admission compared to the observed mortality of different ICD9 codes identified on death or discharge.
- Authors: Kellett J, Deane B
- Issue date: 2009 Jan
- Assessing the need for hospital admission by the Cape Triage discriminator presentations and the simple clinical score.
- Authors: Emmanuel A, Ismail A, Kellett J
- Issue date: 2010 Nov
- The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores--a pilot study.
- Authors: Kellett J, Rasool S
- Issue date: 2011 Aug
- Simple clinical score is associated with mortality and length of stay of acute general medical admissions to an Australian hospital.
- Authors: Li JY, Yong TY, Hakendorf P, Roberts S, O'Brien L, Sharma Y, Ben-Tovim D, Thompson CH
- Issue date: 2012 Feb
- Prediction of mortality 1 year after hospital admission.
- Authors: Kellett J, Rasool S, McLoughlin B
- Issue date: 2012 Sep