Modified Shock Index as a Predictor for Mortality and Hospitalization Among Patients With Dementia

Re'em Sadeh, Sagi Shashar, Ela Shaer, Tzachi Slutsky, Iftach Sagy, Victor Novack, Vladimir Zeldetz

    Research output: Contribution to journalArticlepeer-review

    1 Scopus citations


    Background: One in four older adults in the Emergency Department (ED) suffers from severe cognitive impairment, creating great difficulty for the emergency physicians who determine the urgency of their patients’ condition, which informs decisions regarding discharge or hospitalization. Objective: Our objective was to determine whether modified shock index (MSI) can be a clinical mortality and hospitalization predictor when applied to older patients with dementia in the ED. Methods: Included in the research were all patients with dementia, > 65 years old, who arrived at the Soroka University Medical Center ED during 2014–2017. The population was divided into three groups according to their MSI score, calculated as heart rate/mean arterial pressure: MSI < 0.7; 0.7 > MSI < 1.3; and MSI > 1.3. We performed multivariable logistic regression as a predictor of death within 30 days, Cox analysis for number of days to death, and a negative binominal regression for predicting the number of admission days. Results: Included were 1437 patients diagnosed with dementia. Patients with an MSI > 1.3 vs. those with MSI < 0.7 had an odds ratio of 8.23 (95% confidence interval [CI] 4.64–4.54) for mortality within 30 days, increased mortality risk within 180 days (hazard ratio 4.42; 95% CI 2.64–7.41), and longer hospitalization duration (incidence rate ratio 1.8; 95% CI 1.32–2.45). Conclusions: High MSI scores were associated with high mortality rates and longer hospitalization duration for patients diagnosed with dementia who were > 65 years old. We suggest performing prospective studies utilizing the MSI score as an indicator in ED triage settings to classify patients with dementia by their severity of risk, to determine if this benefits health, minimizes expenses, and prevents unnecessary hospitalizations.

    Original languageEnglish
    Pages (from-to)590-599
    Number of pages10
    JournalJournal of Emergency Medicine
    Issue number5
    StatePublished - 1 May 2022


    • Modified shock index
    • dementia
    • emergency department

    ASJC Scopus subject areas

    • Emergency Medicine


    Dive into the research topics of 'Modified Shock Index as a Predictor for Mortality and Hospitalization Among Patients With Dementia'. Together they form a unique fingerprint.

    Cite this