Evans et al used the risk index critical score to help identify a hospitalized elderly patient who may require continued medical care. The authors are from the Veterans Administration Medical Center in Seattle, Washington, and Brown University in Providence, Rhode Island.
Patient selection: hospitalized adult patient
Outcome: nursing home replacement, prolonged hospital stay or hospital readmission
Parameters:
(1) number of chronic conditions
(2) mental status
(3) psychiatric comorbidity
(4) history of previous hospital admission
(5) age in years
(6) residence
(7) ambulation
(8) marital status
Parameter |
Finding |
Points |
---|---|---|
number of chronic conditions |
0 to 1 |
0 |
|
>= 2 |
1 |
mental status |
excellent to fair |
0 |
|
poor |
1 |
psychiatric comorbidity |
none |
0 |
|
present |
1 |
history of previous admission |
no |
0 |
|
yes |
1 |
age in years |
<= 75 years of age |
0 |
|
> 75 years of age |
1 |
residence |
lives with someone |
0 |
|
lives alone |
1 |
|
lives in a nursing home |
1 |
ambulation |
independent |
0 |
|
dependent (impaired) |
1 |
marital status |
married |
0 |
|
unmarried |
1 |
where:
• Control status of the comorbid conditions was not included.
risk index critical score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score >= 4 was at high risk for continued care.
Performance:
• The sensitivity was 36% with specificity 98%. If the score is positive, then the patient will probably need continued care. If the score is negative then the patient may or may not need continued care.
• Using a cutoff of >= 3 had a sensitivity of 52% and specificity 64%.
Purpose: To evaluate an elderly patient in the hospital for need of continued care using the risk index critical score of Evans.
Specialty: Sports Medicine & Rehabilitation
Objective: risk factors, severity, prognosis, stage
ICD-10: R41.8, R54,