title: The Appropriateness Evaluation Protocol is a poor predictor of in-hospital mortality.
abstract: BACKGROUND
  The Appropriateness Evaluation Protocol (AEP) proposes admission criteria based only on physiological and laboratory parameters and has recently informed an Irish national bed utilisation review. Severity of illness tools can be poorly predictive of outcomes, particularly in older patients.
  
  
  OBJECTIVE
  To assess the clinical utility of the AEP in moribund older and younger patients.
  
  
  METHODS
  The study was conducted in four acute hospitals in South Munster, Ireland, and was of retrospective analytical cohort study design. The Hospital In-Patient Enquiry Scheme was used to ascertain patients who died within 10 days of hospital admission, over a 2-year period. Proximate death was used as a robust measure of validity of admission. Emergency department (ED) records were screened retrospectively to allocate the AEP criteria.
  
  
  RESULTS
  There were 803 eligible in-hospital deaths. Establishment of AEP criteria was available in 72.9 % (585 patients, 50.8 % female). The median length of stay until death was 4 days. Just over 30 % (179/585) of patients did not meet AEP criteria, two-fifths (72/179) of whom had been coded as severely unwell on arrival to the ED. There was no significant difference in AEP identification rates between older and younger age groups.
  
  
  CONCLUSIONS
  Our study illustrates that the AEP is a poor predictor of mortality in all age groups, having failed to identify approximately one-third of our cohort. Based on our findings, we feel that this tool should not be used to assess the appropriateness of admission.
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland, niamh.oregan@ucc.ie.
authors.forename: N A
authors.initials: NA
authors.lastname: O'Regan
authors.forename: L
authors.initials: L
authors.lastname: Healy
authors.forename: M
authors.initials: M
authors.lastname: O Cathail
authors.forename: T W
authors.initials: TW
authors.lastname: Law
authors.forename: G
authors.initials: G
authors.lastname: O'Carroll
authors.forename: J
authors.initials: J
authors.lastname: Clare
authors.forename: S
authors.initials: S
authors.lastname: Timmons
authors.forename: K A
authors.initials: KA
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007494:Ireland; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000592:standards*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014600:Utilization Review