Mortality prediction upon hospital admission - the value of clinical assessment: A retrospective, matched cohort study

Abstract

Accurate prediction of mortality upon hospital admission is of great value, both for the sake of patients and appropriate resources' allocation. A myriad of assessment tools exists for this purpose. The evidence relating to the comparative value of clinical assessment versus established indexes are scarce. We analyzed the accuracy of a senior physician's clinical assessment in a retrospective cohort of patients in a crude, general patients' population and later on a propensity matched patients' population. In one department of internal medicine in a tertiary hospital, of 9891 admitted patients, 973 (10%) were categorized as prone to death in a 6-months' duration by a senior physician. The risk of death was significantly higher for these patients [73.1% vs 14.1% mortality within 180 days; hazard ratio (HR) = 7.58; confidence intervals (CI) 7.02-8.19, P < .001]. After accounting for multiple, other patients' variables associated with increased risk of mortality, the correlation remained significant (HR = 3.25; CI 2.85-3.71, P < .001). We further performed a propensity matching analysis (a subgroup of 710 patients, subdivided to two groups with 355 patients each): survival rates were as low as 45% for patients categorized as prone to death compared to 78% in patients who weren't categorized as such (P < .001). Reliance on clinical evaluation, done by an experienced senior physician, is an appropriate tool for mortality prediction upon hospital admission, achieving high accuracy rates.