Internal and Emergency Medicine

, Volume 12, Issue 1, pp 127–128 | Cite as

Lack of correlation between physician and nurses’ ability to predict worse hospital outcomes of older medical patients

  • Marco CeiEmail author
  • Barbara Marini
  • Nicola Mumoli

Dear Editor,

It is well known that older adults are at increased risk of worse outcomes when admitted to the hospital for acute medical conditions. To identify and to stratify this risk at admission may lead to various benefits (like proper allocation and more precise treatment plans), but this task is a really difficult one. Indeed, patients might be evaluated with risk assessment models (RAMs) that are specific for a single disease (i.e., the Ranson score for acute pancreatitis), or with physiologic indexes like the Modified Early Warning Score (MEWS), or with even complex scores as the Sequential Organ Failure Assessment (SOFA) or the Acute Physiology and Chronic Health Evaluation II (APACHE II). Physicians are historically confident with this kind of RAMs. However, older medical patients are usually frail and heavily comorbid, and multicomponent, comprehensive evaluation is recommended, because poor functional status is associated with adverse hospital outcomes [1, 2]. Conversely,...


Acute Pancreatitis Sequential Organ Failure Assessment Pressure Ulcer Hospital Outcome Internal Medicine Ward 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with ethical standards

Conflict of interest


Statement of human and animal rights

The Institutional Review Board approved the study, which was carried out and is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies.

Informed consent



  1. 1.
    Avelino-Silva TJ, Farfel JM, Curiati JAE, Amaral JRG, Campora F, Jacob-Filho W (2014) Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults. BMC Geriatr 14:129CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    De Buyser SL, Petrovic M, Taes YE, Vetrano DL, Onder G (2014) A multicomponent approach to identify predictors of hospital outcomes in older in-patients: a multicentre, observational study. PLoS One 9(12):e115413CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Di Bari M, Balzi D, Roberts AT, Barchielli A, Fumagalli S, Ungar A, Bandinelli S, De Alfieri W, Gabbani L, Marchionni N (2010) Prognostic stratification of older persons based on simple administrative data: development and validation of the “Silver Code,” to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 65(2):159–164. doi: 10.1093/gerona/glp043 CrossRefPubMedGoogle Scholar
  4. 4.
    Cei M, Mumoli N, Vitale J, Dentali F (2015) A prognostic index for 1-year mortality can also predict in-hospital mortality of elderly medical patients. Intern Emerg Med 10:575–579CrossRefPubMedGoogle Scholar
  5. 5.
    Ayello EA, Braden B (2002) How and why to do pressure ulcer risk assessment. Adv Skin Wound Care 15:125–132CrossRefPubMedGoogle Scholar
  6. 6.
    Mistiaen P, Duijnhower E, Prins-Hoekstra A, Ros W, Blaylock A (1999) Predictive validity of the Brass index in screening patients with post-discharge problems. J Adv Nurs 30:1050–1056CrossRefPubMedGoogle Scholar

Copyright information

© SIMI 2016

Authors and Affiliations

  1. 1.Department of Internal MedicineOspedale Civile di CecinaCecinaItaly
  2. 2.Department of Internal MedicineOspedale Civile di LivornoLeghornItaly

Personalised recommendations