Disabling disease codes predict worse outcomes for acute medical admissions. Issue 6 (June 2014)

• Record Type: Journal Article
• Authors: Chotirmall, S. H.; Picardo, S.; Lyons, J.; D'Alton, M.; O'Riordan, D.; Silke, B.
• Is Part Of: Internal medicine journal. Volume 44:Issue 6(2014)
• Page Start: 546
• Page End: 553
• Publication Date: 2014-06
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12440
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12440-sec-0001" sec-type="section"> <title>Background</title> <p>Concurrent with an extension in longevity, a prodrome of ill‐health ('disability' identifiable by certain International Classification of Disease (ICD) 9/ICD10 codes) predates the acute emergency presentation. To date, no study has assessed the effect of such 'disability' on outcomes of emergency medical admissions.</p> </sec> <sec id="imj12440-sec-0002" sec-type="section"> <title>Aim</title> <p>To devise a new method of scoring the burden of 'disability' and assess its relevance to outcomes of acute hospital admissions.</p> </sec> <sec id="imj12440-sec-0003" sec-type="section"> <title>Methods</title> <p>All emergency admissions (67 971 episodes in <italic>n</italic> = 37 828 patients) to St James' Hospital, Dublin, Ireland over an 11‐year period (2002–2012) were studied, and 30‐day in‐hospital mortality and length of stay were assessed as objective end‐points. Patients were classified according to a validated 'disability' classification method and scored from 0 to 4+ (5 classes), dependent on number of ICD9/ICD10 'hits' in hospital episode codes.</p> </sec> <sec id="imj12440-sec-0004" sec-type="section"> <title>Results</title> <p>A disabling score of zero was present in 10.6% of patients. Scores of 1, 2, 3 and 4+ (classified by the number of organ systems involved) occurred with frequencies of 23.3%, 28.7%, 21.9% and 15.5% respectively. The 'disability' score was strongly driven by age. The 30‐day mortality rates were 0.9% (no score), 2.6%, 4.1%, 6.3% and 10.9%. Surviving patients remained in hospital for medians of 1.8 (no score), 3.9, 6.1, 8.1 and 9.7 days respectively. High 'disability' and illness severity predicted a particularly bad outcome.</p> </sec> <sec id="imj12440-sec-0005" sec-type="section"> <title>Conclusion</title> <p>Disability burden, irrespective of organ system at emergency medical admission, independently predicts worse outcomes and a longer in‐hospital stay.</p> </sec> </abstract>