Emergency Triage to Intensive Care: Can We Use Prognosis and Patient Preferences?

Hanson, Laura C.; Danis, Marion; Lazorick, Suzanne

doi:10.1111/j.1532-5415.1994.tb06511.x

Cited by 15 publications

(5 citation statements)

References 47 publications

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“…These findings are consistent with previous studies that have found that cognitive impairment is a predictor of in-hospital and long-term mortality 2,6,14,31 and is associated with longer length of stay in the hospital and worse functional outcome. 2,14,22,25,32 Similar to other studies, 16,23 it was found that low BMI values are also predictive of in-hospital mortality.…”

Section: Discussionsupporting

confidence: 93%

Predictive Factors of In‐Hospital Mortality in Older Patients Admitted to a Medical Intensive Care Unit

Massaia

Raspo

et al. 2003

J American Geriatrics Society

181

108

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OBJECTIVES: To identify prognostic factors that are independently predictive of in‐hospital mortality in older patients hospitalized in a medical intensive care unit (MICU). DESIGN: Prospective cohort study. SETTING: A MICU in an Italian university hospital. PARTICIPANTS: Patients aged 65 and older consecutively admitted to the MICU directly from the first‐aid unit. MEASUREMENTS: Upon admission, the following variables were examined: demographics, clinical history (diabetes mellitus, active neoplasm, cognitive impairment, immobilization, pressure ulcers, use of nutritional support, home oxygen therapy), physiopathology (Acute Physiology and Chronic Health Evaluation (APACHE) II), and cognition/function (activity of daily living (ADL), instrumental activity of daily living (IADL), Short Portable Mental Status Questionnaire (SPMSQ)). The vital status of the patient at the end of hospitalization was recorded. RESULTS: Over a period of 10 months, 659 patients were recruited (mean age ± standard deviation = 76.6 ± 7.5; 352 men and 307 women). There were 97 deaths (14.71%). The following factors proved to be significantly associated with in‐hospital mortality: old age, low body mass index (BMI) values, low values of albumin, high scores on APACHE II, functional impairment (ADL, IADL), cognitive impairment (SPMSQ), history of cognitive deterioration, history of confinement to bed, and presence of pressure ulcers. Using multivariate analysis, the following variables were independently predictive of in‐hospital mortality: lack of independence in ADLs (P < .001), moderate‐to‐severe cognitive impairment on SPMSQ (P < .001), score on APACHE II (P = .002), and low BMI values (P = .031). CONCLUSION: The prognosis of older patients hospitalized in medical intensive care units depends not only on the acute physiological impairments, but also on a series of preexisting conditions, such as loss of functional independence, severe and moderate cognitive impairment, and low BMI.

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Section: Discussionsupporting

confidence: 93%

Predictive Factors of In‐Hospital Mortality in Older Patients Admitted to a Medical Intensive Care Unit

Massaia

Raspo

et al. 2003

J American Geriatrics Society

181

108

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“…The clinical risk factors for mortality we found were in concordance with the literature. A high score on the Charlson co-morbidity index, 15 , 18 , 25 , 26 more functional impairment, 17 , 18 , 25 , 27 diagnosed malignancy 18 , 25 , 28 and high urea nitrogen serum levels 29 were all factors identified in literature as risk factors for mortality in this population. We did, however, not find age and delirium as risk factors for mortality in our study.…”

Section: Discussionmentioning

confidence: 76%

“…However, the short-term mortality rate we found of acutely hospitalized elderly (23%) was within the range reported by other studies, between 15% and 48%. 2 , 15 , 18 In our study we only interviewed nurses and physicians separately from each other, but it would be interesting to know how discussions would affect the opinion of both disciplines, especially in patients where opinions diverge extensively. This might improve prognostication.…”

Section: Discussionmentioning

confidence: 99%

Prognostication in Acutely Admitted Older Patients by Nurses and Physicians

et al. 2008

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BACKGROUND:The process of prognostication has not been described for acutely hospitalized older patients.OBJECTIVE: To investigate (1) which factors are associated with 90-day mortality risk in a group of acutely hospitalized older medical patients, and (2) whether adding a clinical impression score of nurses or physicians improves the discriminatory ability of mortality prediction. DESIGN: Prospective cohort study.PARTICIPANTS: Four hundred and sixty-three medical patients 65 years or older acutely admitted from November 1, 2002, through July 1, 2005, to a 1024-bed tertiary university teaching hospital. MEASUREMENTS:At admission, the attending nurse and physician were asked to give a clinical impression score for the illness the patient was admitted for. This score ranged from 1 (high possibility of a good outcome) until 10 (high possibility of a bad outcome, including mortality). Of all patients baseline characteristics and clinical parameters were collected. Mortality was registered up to 90 days after admission. MAIN RESULTS:In total, 23.8% (n=110) of patients died within 90 days of admission. Four parameters were significantly associated with mortality risk: functional impairment, diagnosis malignancy, co-morbidities and high urea nitrogen serum levels. The AUC for the baseline model which included these risk factors (model 1) was 0.76 (95% CI 0.71 to 0.82). The AUC for the model using the risk factors and the clinical impression score of the physician (model 2) was 0.77 (0.71 to 0.82). The AUC for the model using the risk factors and the clinical impression score of the nurse (model 3) was 0.76 (0.71 to 0.82) and the AUC for the model, including the baseline covariates and the clinical impression score of both nurses and physicians was 0.77 (0.72 to 0.82). Adding clinical impression scores to model 1 did not significantly improve its accuracy. CONCLUSION:A set of four clinical variables predicted mortality risk in acutely hospitalized older patients quite well. Adding clinical impression scores of nurses, physicians or both did not improve the discriminating ability of the model.

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“…Y luego, además, no se apreciaron diferencias significativas entre los tratamientos de quienes rellenaron el TV de y quienes no lo hicieron 45 . La frecuencia de documentos de TV en pacientes hospitalizados aumentó del 1 al 40% en unos pocos años 46 , si bien de los pacientes ingresados en UCI sólo el 5% tenía algún tipo de TV, y además la mayoría de los médicos de éstos desconocía si sus pacientes los tenían 47 . Continúa siendo una realidad que muchos médicos no aceptan los TV como algo clínico y no los integran en su práctica clínica.…”

Section: El Testamento Vitalunclassified

Reflexiones sobre el testamento vital (I)

Urionabarrenetxea¹

2003

Aten Primaria

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Emergency Triage to Intensive Care: Can We Use Prognosis and Patient Preferences?

Cited by 15 publications

References 47 publications

Predictive Factors of In‐Hospital Mortality in Older Patients Admitted to a Medical Intensive Care Unit

Predictive Factors of In‐Hospital Mortality in Older Patients Admitted to a Medical Intensive Care Unit

Prognostication in Acutely Admitted Older Patients by Nurses and Physicians

Reflexiones sobre el testamento vital (I)

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