title: Disabling disease codes predict worse outcomes for acute medical admissions.
abstract: BACKGROUND
  Concurrent with an extension in longevity, a prodrome of ill-health ('disability' identifiable by certain International Classification of Disease (ICD) 9/ICD10 codes) predates the acute emergency presentation. To date, no study has assessed the effect of such 'disability' on outcomes of emergency medical admissions.
  
  
  OBJECTIVE
  To devise a new method of scoring the burden of 'disability' and assess its relevance to outcomes of acute hospital admissions.
  
  
  METHODS
  All emergency admissions (67 971 episodes in n = 37 828 patients) to St James' Hospital, Dublin, Ireland over an 11-year period (2002-2012) were studied, and 30-day in-hospital mortality and length of stay were assessed as objective end-points. Patients were classified according to a validated 'disability' classification method and scored from 0 to 4+ (5 classes), dependent on number of ICD9/ICD10 'hits' in hospital episode codes.
  
  
  RESULTS
  A disabling score of zero was present in 10.6% of patients. Scores of 1, 2, 3 and 4+ (classified by the number of organ systems involved) occurred with frequencies of 23.3%, 28.7%, 21.9% and 15.5% respectively. The 'disability' score was strongly driven by age. The 30-day mortality rates were 0.9% (no score), 2.6%, 4.1%, 6.3% and 10.9%. Surviving patients remained in hospital for medians of 1.8 (no score), 3.9, 6.1, 8.1 and 9.7 days respectively. High 'disability' and illness severity predicted a particularly bad outcome.
  
  
  CONCLUSIONS
  Disability burden, irrespective of organ system at emergency medical admission, independently predicts worse outcomes and a longer in-hospital stay.
authors.affiliation: Department of Internal Medicine, Saint James's Hospital, Dublin, Ireland.
authors.forename: S H
authors.initials: SH
authors.lastname: Chotirmall
authors.forename: S
authors.initials: S
authors.lastname: Picardo
authors.forename: J
authors.initials: J
authors.lastname: Lyons
authors.forename: M
authors.initials: M
authors.lastname: D'Alton
authors.forename: D
authors.initials: D
authors.lastname: O'Riordan
authors.forename: B
authors.initials: B
authors.lastname: Silke
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health; D003953:Diagnosis-Related Groups; D004185:Disability Evaluation; D004630:Emergencies / Q000145:classification / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014505:Urban Population
keywords: comorbidity; disability; emergency; mortality; patient admission