TY - JOUR
T1 - Modified Shock Index as a Predictor for Mortality and Hospitalization Among Patients With Dementia
AU - Sadeh, Re'em
AU - Shashar, Sagi
AU - Shaer, Ela
AU - Slutsky, Tzachi
AU - Sagy, Iftach
AU - Novack, Victor
AU - Zeldetz, Vladimir
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - 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.
AB - 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.
KW - Modified shock index
KW - dementia
KW - emergency department
UR - http://www.scopus.com/inward/record.url?scp=85124653797&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2021.12.023
DO - 10.1016/j.jemermed.2021.12.023
M3 - Article
C2 - 35181187
AN - SCOPUS:85124653797
SN - 0736-4679
VL - 62
SP - 590
EP - 599
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 5
ER -