Prediction Rule of Hak et al for Hospitalization or Death of an Elderly Patient During an Influenza Epidemic

Description

Hak et al developed a prediction rule for evaluating the risks faced by an elderly patient during an influenza epidemic. This can help identify those patients who should be targeted to receive influenza vaccination. The authors are from Utrecht (The Netherlands), University of Minnesota, Portland (Oregon) and New York City.

Subjects: > 65 years of age

Outcomes:

(1) admission for pneumonia

(2) admission for influenza

(3) death due to any cause

Parameters:

(1) age of the patient in years

(2) gender

(3) number of outpatient visits during the past year

(4) previous hospitalization for pneumonia or influenza

(5) comorbid states (5)

Parameter	Findings	Points
age of the patient in years	< 70 years of age	0
	70 - 74	14
	75 - 79	28
	80 - 89	42
	>= 90	56
gender of the patient	female	0
	male	9
number of outpatient visits	0	0
	1 to 6	11
	7 to 12	22
	>= 13	33
previous hospitalization	none	0
	1 or more	63
pulmonary disease	absent	0
	present	18
heart disease	absent	0
	present	6
renal disease, including transplant	absent	0
	present	12
dementia or stroke	absent	0
	present	22
cancer, hematologic or nonhematologic	absent	0
	present	48

score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0

• maximum score: 267

• A score >= 50 was used as the cutoff to identify the high risk group.

• A list of relative risks for different scores is given in Table 4.

Performance:

• Sensitivity 89%. I could not find the specificity, but using the ROC curve (Figure 1, page 454) it appears to be about 50%. This may be acceptable since you are trying to identify patients to be vaccinated, which has a much lower morbidity than influenza in the elderly.

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Prediction Rule of Hak et al for Hospitalization or Death of an Elderly Patient During an Influenza Epidemic

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