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Risk Index Critical Score of Evans et al for Identifying an Elderly Patient Requiring Continued Care

Purpose: To evaluate an elderly patient in the hospital for need of continued care using the risk index critical score of Evans.

Description

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%.


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Specialty

Objective

ICD-10