Alassaad et al developed a model for predicting rehospitalisation and death of an elderly patient in hospital. This can help to identify a patient who may benefit from more aggressive management. The authors are from Uppsala University in Sweden.
Patient selection: elderly adult in the hospital, age >= 80 years
Outcome: rehospitalisation or death in the year after hospital discharge
Parameters:
(1) estimated GFR in mL per minute (based on Cockcroft-Gault score)
(2) social support after discharge
(3) pulmonary disease (asthma, COPD)
(4) malignant disease (past or present)
(5) prescription of drug for peptic ulcer disease or GERD
(6) prescription for an opioid analgesic
(7) prescription of an antidepressant other than tricyclic antidepressant (TCA)
|
Parameter |
Finding |
Points |
|
estimated GFR |
> 90 mL per minute |
0 |
|
|
60 to 89 mL per minute |
1 |
|
|
30 to 59 mL per minute |
2 |
|
|
< 30 mL per minute |
3 |
|
social support |
lives alone or with spouse |
0 |
|
|
nursing home |
1 |
|
pulmonary disease |
no |
0 |
|
|
yes |
2 |
|
malignant disease |
no |
0 |
|
|
yes |
1 |
|
drug for peptic ulcer or GERD |
no |
0 |
|
|
yes |
1 |
|
opioid analgesic |
no |
0 |
|
|
yes |
2 |
|
non-TCA antidepressant |
no |
0 |
|
|
yes |
-2 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -2
• maximum score: 10
• The higher the score the greater the risk.
|
Score |
Percent Outcome |
|
-2 |
16% |
|
-1 |
22% |
|
0 |
30% |
|
1 |
40% |
|
2 |
52% |
|
3 |
65% |
|
4 |
78% |
|
5 |
89% |
|
6 |
96% |
|
7 |
>=99% |
Performance:
• The area under the ROC curve was 0.71.
