Wilson et al reported the NaURSE (sodium, urea, respiratiory rate and shock index in the elderly) for evaluating a very old person who has been admitted with acute illness to the hospital. This can help to identify a patient at risk for in-hospital mortality who may benefit from more aggressive management. The authors are from Norfolk and Norwich University Hospital, University of South Manchester, Woodend Hospital and University of Aberdeen in the UK.
Patient selection: age >= 90 years of age, in-hospital, acutely ill
Outcome: in-hospital mortality
Parameters:
(1) serum sodium in mmol/L
(2) urea in mmol/L
(3) respiratory rate in breaths per minute
(4) shock index (heart rate in beats per minute divided by systolic blood pressure in mm Hg)
Parameter
Finding
Points
serum sodium
<= 145 mmol/L
0
> 145 mmol/L
1
serum urea
< 14 mmol/L
0
>= 14 mmol/L
1
respiratory rate
<= 20 breaths per minute
0
> 20 breaths per minute
1
shock index
<= 1.0
0
> 1.0
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4 (range from 0 to 4 is referred to as "5-point").
• The higher the score the greater the in-hospital morality
Score
In-Hospital Mortality
0
9.5%
1
20%
2
34%
3
67%
4
100%
Performance:
• The area under the ROC curve was 0.69.
• A cut-off >= 2 had a sensitivity of 39% and specificity of 87% for in-hospital mortality.
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