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A modified Elixhauser score for predicting in-hospital mortality in internal medicine admissions

Published:February 08, 2017DOI:https://doi.org/10.1016/j.ejim.2017.02.002

      Highlights

      • Multimorbid older adults are frequently admitted.
      • Data on in-hospital mortality are heterogeneous.
      • A specific score for internal medicine wars could better classify cases.
      • Evaluation by a score could help in the identification of high risk patients.
      • A score could help communication between physicians and patients' family.

      Abstract

      Background

      In-hospital mortality (IHM) is an indicator of the quality of care provided. The two most widely used scores for predicting IHM by International Classification of Diseases (ICD) codes are the Elixhauser (EI) and the Charlson Comorbidity indexes. Our aim was to obtain new measures based on internal medicine ICD codes for the original EI, to detect risk for IHM.

      Material and methods

      This single-center retrospective study included hospital admissions for any cause in the department of internal medicine between January 1, 2000, and December 31, 2013, recorded in the hospital database. The EI was calculated for evaluation of comorbidity, then we added age, gender and diagnosis of ischemic heart disease. IHM was our outcome. Only predictors positively associated with IHM were taken into consideration and the Sullivan's method was applied in order to modify the parameter estimates of the regression model into an index.

      Results

      We analyzed 75,586 admissions (53.4% females) and mean age was 72.7 ± 16.3 years. IHM was 7.9% and mean score was 12.1 ± 7.6. The points assigned to each condition ranged from 0 to 16, and the possible range of the score varied between 0 and 89. In our population the score ranged from 0 to 54, and it was higher in the deceased group. Receiver operating characteristic curve of the new score was 0.721 (95% CI 0.714–0.727, p < 0.001).

      Conclusions

      In order to make prognostic assessment, the use of a score could be of help in targeting interventions in older adults, identifying subjects at high risk for IHM.

      Abbreviations:

      ADL (activities of daily living), CGA (comprehensive geriatric assessment), CI (confidence interval), CIRS (Cumulative Illness Rating Scale), EI (Elixhauser index), ED (emergency department), HDR (hospital discharge records), HIV (Human Immunodeficiency Virus), IHM (in-hospital mortality), ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification), IHD (ischemic heart disease), MPI (Multidimensional Prognostic Index), NEWS (National Early Warning Score), PCPs (primary care physicians), ROC (receiver operating characteristic), SD (Standard deviation)

      Keywords

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