Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes.

Ana Paula Santos De Jesus,Cassia Regina Vancini Campanharo,Maria Carolina Barbosa Teixeira Lopes,Meiry Fernanda Pinto Okuno,Ruth Ester Assayag Batista

doi:10.1590/1980-220x-reeusp-2020-0162

Ana Paula Santos De Jesus, Cassia Regina Vancini Campanharo + Show 3 more

Open Access

https://doi.org/10.1590/1980-220x-reeusp-2020-0162

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Abstract

To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department. Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses. There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital. The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

Highlights

The higher prevalence of Chronic Non-Communicable Diseases (CNCDs) can be explained by the increase in the elderly population or by improvements taking place in health care and in the development of society(1)
1,227 (33.9%) had comorbidities according to the Charlson classification, 919 (25.4%) had clinical condition weight 1, with 414 (11.4%) having uncomplicated diabetes, 249 (6.9%) cerebrovascular disease, 90 (2.5%) peripheral vascular and aortic disease, 50 (1.4%) ulcer disease, 30 (0.8%) dementia/Alzheimer, 25 (0.7%) acute myocardial infarction, 24 (0.7%) congestive heart failure, 20 (0.5%) c hronic lung disease, 15 (0.4%) mild liver disease, and two (0.1%) rheumatologic disease
The results found in this investigation demonstrate that the use of adjusted CCI (ACCI), despite lacking validation studies for patients classified by the Manchester Triage System (MTS), was able to predict mortality and detect patients with more urgent conditions

Summary

Introduction

The higher prevalence of Chronic Non-Communicable Diseases (CNCDs) can be explained by the increase in the elderly population or by improvements taking place in health care and in the development of society(1). The increase in CNCD(2) and urban violence leads to greater demand for health services, which have become increasingly saturated and insufficient to meet the needs of the population(3). Inserted in this context and due to the low resolution of the Health Care Network, the emergency department (ED) has been used as one of the main gateways to the health system, both for urgent and emergency care, and for diseases with less clinical severity, including some CNCD(3–4). One of the main instruments used for this purpose is the risk classification system (CR), internationally known as screening(3). The priority assessment tool most used worldwide, which demonstrated the possibility of predicting the patient’s risk level and the mortality in the short term, is the Manchester Triage System (MTS)(6–7)

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