Buurman Bianca M, van Munster Barbara C, Korevaar Johanna C, Abu-Hanna Ameen, Levi Marcel, de Rooij Sophia E
Department of Internal Medicine, Geriatric section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
J Gen Intern Med. 2008 Nov;23(11):1883-9. doi: 10.1007/s11606-008-0741-7. Epub 2008 Sep 4.
The process of prognostication has not been described for acutely hospitalized older patients.
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.
Prospective cohort study.
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.
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.
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.
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.
尚未对急性住院老年患者的预后评估过程进行描述。
调查（1）一组急性住院老年内科患者中哪些因素与90天死亡风险相关，以及（2）添加护士或医生的临床印象评分是否能提高死亡预测的辨别能力。
前瞻性队列研究。
2002年11月1日至2005年7月1日期间，463名65岁及以上的内科患者急性入住一家拥有1024张床位的三级大学教学医院。
入院时，要求主治护士和医生对患者入院所患疾病给出临床印象评分。该评分范围从1分（预后良好可能性高）到10分（预后不良可能性高，包括死亡）。收集所有患者的基线特征和临床参数。记录入院后90天内的死亡率。
共有23.8%（n = 110）的患者在入院90天内死亡。四个参数与死亡风险显著相关：功能障碍、诊断为恶性肿瘤、合并症和高血清尿素氮水平。包含这些风险因素的基线模型（模型1）的曲线下面积（AUC）为0.76（95%置信区间0.71至0.82）。使用风险因素和医生临床印象评分的模型（模型2）的AUC为0.77（0.71至0.82）。使用风险因素和护士临床印象评分的模型（模型3）的AUC为0.76（0.71至0.82），包含基线协变量以及护士和医生临床印象评分的模型的AUC为0.77（0.72至0.82）。在模型1中添加临床印象评分并未显著提高其准确性。
一组四个临床变量能很好地预测急性住院老年患者的死亡风险。添加护士、医生或两者的临床印象评分并未提高模型的辨别能力。
