Norton Scale, Hospitalization Length, Complications, and Mortality in Elderly Patients Admitted to Internal Medicine Departments

Abstract

Background: The Norton scale is used for assessing pressure ulcer risk. The association between admission Norton scale scores (ANSS), hospitalization length, complications, and mortality in elderly patients admitted to internal medicine departments has never been studied. Objective: To determine if ANSS are associated with hospitalization length, complications, in-hospital mortality, and 1-year mortality in elderly patients admitted to an internal medicine department. Methods: Medical charts of consecutive elderly (≥65 years) patients admitted to a single internal medicine department between January and March 2009 were studied for ANSS, demographics, comorbidities, hospitalization length, complications during hospitalization, in-hospital mortality, and 1-year mortality. Complications during hospitalization included acute coronary syndrome, major arrhythmias, major bleeding, stroke, systemic infections, organ failure, thromboembolism, etc. ANSS ≤14 were considered low. Results: The final cohort included 259 elderly patients: 54.4% were women, the mean age was 81.6 years, and the mean hospitalization length was 3.7 days. Overall, 7.3% of the patients had complications other than pressure ulcers, 3.9% died during hospitalization, and 28.6% died within 1 year. The mean ANSS was 15.4, and 37.8% of the patients had low ANSS. Patients with low ANSS had longer hospitalization (4.7 vs. 2.9 days; p = 0.002), a higher incidence of complications during hospitalization (odds ratio: 3.9; p = 0.006), and higher rates of in-hospital mortality (odds ratio: 7.0; p = 0.007) relative to patients with high ANSS. Regression analysis showed that ANSS were independently negatively associated with hospitalization length, complications during hospitalization, and in-hospital mortality (p < 0.0001, p = 0.003, and p = 0.018, respectively) regardless of age, gender, comorbidities, and pressure ulcer appearance. Rates of 1-year mortality were similar in patients with low and high ANSS. Conclusions: The Norton scale may be used for predicting hospitalization length, complications during hospitalization other than pressure ulcers, and in-hospital mortality in elderly patients admitted to an internal medicine department.

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

“…In addition, increased one-year mortality rate was observed in subjects with low Norton scale in our study. Similar to prior studies, patients with lower Norton scale score were associated with higher mortality rate in elderly patients (34) (35).…”

Evaluating the Validity of the Braden Scale Using Longitudinal Electronic Medical Records

“…For example, an increase in sensitivity may result in a decrease in specificity, depending on the cut‐off score that is used (Larson, ). Because pressure ulcers are associated with high rates of morbidity and mortality (Cox, ; Allen, ; Leshem‐Rubinow et al, ), as well as longer hospital stays (Cho & Noh, 2010; Cox, ; Leshem‐Rubinow et al, ), higher medical costs (Allen, ), and physical and mental stress for patients and their families, it is desirable to increase the number of true positive cases and decrease the number of false negative cases. Although a false positive result does not increase the patient's risk of pressure ulcers, it may lead to investment of healthcare resources in unnecessary preventive care, thereby lowering the overall efficiency of the healthcare system.…”

“…Pressure ulcers are associated with high rates of morbidity and mortality (Cox, ; Allen, ; Leshem‐Rubinow, Vaknin, Sherman, & Justo, ), as well as longer hospital stays (Cho & Noh, 2010; Cox, ; Leshem‐Rubinow et al, ) and higher medical costs (Allen, ). The incidence of pressure ulcers among hospitalized patients ranges from 6% to 31% in Korea (Cho & Noh, 2010; K. S. Choi & Song, 1991; S. J. Choi, Bae, Choi, & Bang, ; E. K. Kim, Lee, Lee, & Eom, ), from 4.5% to 15.5% in the USA (Bergquist & Frantz, 2001; Bergstrom & Braden, 2002; Lyder et al, ), and from 1.8% to 34% in other countries (Cremasco, Wenzel, Zanei, & Whitaker, ; Lahmann, Kottner, Dassen, & Tannen, ; Moore, Johanssen, & van Etten, ; Nijs et al, ; Sayar et al, ).…”

Study of Factors Affecting Deaths in Medicine Ward Patients Including MICU at a Teaching and Tertiary Care Hospital Located in Central India during Period 2013 to 2016

“…[9] Thereafter many such studies have done. [10,11,12] Most of these studies utilized retrospective study design. Few of the studies conducted in Western countries were of prospective design, wherein factors like length of hospital stay, side effects of medication, and polypharmacy were analyzed in relation to death rates.…”