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Disabling disease codes predict worse outcomes for acute medical admissions
Author(s) -
Chotirmall S. H.,
Picardo S.,
Lyons J.,
D'Alton M.,
O'Riordan D.,
Silke B.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12440
Subject(s) - medicine , prodrome , icd 10 , diagnosis code , disease , emergency department , emergency medicine , pediatrics , population , psychiatry , environmental health , psychosis
Background Concurrent with an extension in longevity, a prodrome of ill‐health (‘disability’ identifiable by certain International Classification of Disease ( ICD ) 9/ ICD 10 codes) predates the acute emergency presentation. To date, no study has assessed the effect of such ‘disability’ on outcomes of emergency medical admissions. Aim To devise a new method of scoring the burden of ‘disability’ and assess its relevance to outcomes of acute hospital admissions. Methods All emergency admissions (67 971 episodes in n = 37 828 patients) to S t J ames' H ospital, D ublin, I reland 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 ICD 9/ ICD 10 ‘hits’ in hospital episode codes. Results 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. Conclusion Disability burden, irrespective of organ system at emergency medical admission, independently predicts worse outcomes and a longer in‐hospital stay.