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- Title
A simple 5-point scoring system, NaURSE (Na+, Urea, Respiratory Rate and Shock Index in the Elderly), predicts in-hospital mortality in oldest old.
- Authors
Wilson, Alexander H.; Kidd, Andrew C.; Skinner, Jane; Musonda, Patrick; Pai, Yogish; Lunt, Claire J.; Butchart, Catherine; Soiza, Roy L.; Potter, John F.; Myint, Phyo Kyaw
- Abstract
Background: the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions.Methods: we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011.Results: a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1–90.3) and sensitivity of 39% (28.5–50.0), with an AUC value of 0.69 (0.63–0.76). An external independent validation study (n = 121) showed similar results.Conclusions: the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.
- Subjects
UNITED Kingdom; RISK assessment; CHI-squared test; CONFIDENCE intervals; HOSPITALS; DEATH rate; PROGNOSIS; RESPIRATORY measurements; SODIUM; T-test (Statistics); U-statistics; LOGISTIC regression analysis; DATA analysis software; DESCRIPTIVE statistics
- Publication
Age & Ageing, 2014, Vol 43, Issue 3, p352
- ISSN
0002-0729
- Publication type
Article
- DOI
10.1093/ageing/afu002