Vital signs as determinants of immediate and longer term mortality outcome of patients admitted from Nursing Homes
Phyo K. Myint1,2, Nicola J.B. Trepte3, Richard A. Parker4, Sayed J. Sultanzadeh5, Jasmine Patel3, Robert Mallinson3 and John F. Potter1,2
1Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, 2Ageing and Stroke Medicine Section, Health and Social Sciences Research Institute, Faculty of Health, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, 3Department of Acute Medicine, Ipswich Hospital, Ipswich, 4Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, 5Acute Medical Unit, Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, South Yorkshire, United Kingdom

Abstract

Background and aims: Hospital admissions from Nursing Homes (NHs) are associated with high mortality. Identifying people with a poor prognosis admitted from NHs is essential to inform appropriate clinical decision making. Methods: We identified all consecutive admissions from NHs (all ages) to an Acute Medical Assessment Unit (AMU) of a large District General Hospital in UK with a catchment population of ~360,000 between January 2005-December 2007 and reviewed their outcome to end of March 2009 (median follow-up=133 days). The relation between admission vital signs (systolic blood pressure, pulse rate, respiratory rate, body temperature and Glasgow Coma Scale-GCS) and outcomes including in-patient mortality, hospital length of stay and mortality at follow-up were examined using logistic and Cox regression models. Results: The cohort consisted of 316 patients (32% male), mean age at admission was 83.8 years (SD 8.36 yrs; range=49-99 yrs). Sixty-seven (21%) had at least two admissions during the study period; the maximum number of readmissions was five. We found strong evidence that lower systolic blood pressure and higher respiratory rate at the time of admission were associated with increased probability of in-patient death and reduced survival time but not with length of stay. Older age and lower admission GCS were additionally associated with overall poor prognosis. Conclusion: Simple and readily available hospital admission parameters predict not only the in-patient mortality but also longer term outcome for NH residents who require acute hospital admission. Further studies are required to examine whether opportunities exist to intervene and improve outcome in this patient population. (Aging Clin Exp Res 2011; 23: 309-315) ©2011, Editrice Kurtis

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