Rauh et al reported a model for predicting mortality of a nursing home resident with dementia and pneumonia. This is based on the model of van der Steen et al and can help to identify a patient who may benefit from more aggressive management. The authors are from Vrije Universiteit Amsterdam, National Institute for Public Health and Environment, University of Missouri, Leiden University Medical Center and Radboud University Medical Center.
Patient selection: nursing home resident with pneumonia and dementia
Outcome: 14-day mortality
Parameters:
(1) sex
(2) respiratory rate in breaths per minute
(3) respiratory difficulty
(4) heart rate in beats per minute
(5) decreased alertness
(6) fluid intake
(7) dehydration
(8) eating dependency
(9) increase in eating dependency in the 2 weeks before diagnosis
(10) bowel incontinence
(11) history of cardiovascular disease
Parameters
Findings
Points
sex
female
0
male
2
respiratory rate
< 21 breaths per minute
0
21 to 30
1
31 to 40
2
> 40
4
respiratory difficulty
absent
0
present
3
heart rate
<= 75 beats per minute
0
76 to 95
1
96 to 115
3
> 115
5
alertness
decreased
3
normal
0
fluid intake
sufficient
0
insufficient
2
dehydration
absent
0
present
4
eating
independent
0
needs assistance
3
fully dependent
6
increase in eating dependency
no
0
yes
3
bowel incontinence
absent
0
present
5
history of cardiovascular disease
absent
0
present
3
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 40
• The higher the score the greater the mortality.
Total Score
14-Day Mortality
0 to 14
2%
15 to 18
7%
19 to 22
15%
23 to 26
27%
>= 27
50%
Performance:
• The area under the ROC curve was 0.80.
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