"General deterioration": a diagnosis that is a marker for risk of mortality upon re-admission.
BACKGROUND
Predicting mortality is important in treatment planning and professional duty towards patients and their families.


OBJECTIVE
To evaluate the predictive value regarding patients' survival once the diagnosis of "general deterioration" replaces an ICD-9 diagnosis upon re-admission.


METHODS
In this retrospective cohort case-control study, we screened the records of patients re-admitted at least three times during the past 2 years. For each patient's death during the third hospitalization, we matched (for age and gender) a patient who survived the third hospitalization. We evaluated 14 parameters potentially accountable for increased risk of mortality, e.g., length of stay at each admission, interval to re-admission, etc. We applied a multifactorial analysis using logistic regression to predict the risk of mortality during the third hospitalization as potentially affected by the aforementioned parameters.


RESULTS
The study included 81 study patients and 81 controls. Of the 14 parameters potentially explaining an increased risk of mortality during the third hospitalization, several were found to be statistically significant. The most significant was the diagnostic switch from a specific ICD-9 diagnosis on first admission to the non-specific diagnosis of "general deterioration" at the second hospitalization. In such cases, the risk of death during the third hospitalization was increased by 5300% (odds ratio = 54, P = 0.008). The increased risk of mortality was not restricted to patients with malignancy as their background diagnosis.


CONCLUSIONS
At re-admission a switch from disease-specific diagnosis to the obscure diagnosis "general deterioration" increases the subsequent risk of mortality.
Department of Internal Medicine T, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel. gad.segal@sheba.health.gov.il
Gad
G
Segal
Inna
I
Alperson
Yoram
Y
Levo
Rami
R
Hershkovitz
D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors