Introduction: Comparing frailty models in different settings that predict inhospital mortality might modify patient disposition and treatment, but models are often complex. Methods: In the following study, we selected all acutely admitted adult patients in 2020–2021 to the three internal medicine departments at a regional 400-bed hospital. We attempt to determine (a) if a new scale (Laniado-4 scale) that includes only three yes/no questions derived from the Norton scale and the presence of a urinary catheter performs as well as the graded Norton scale (including all five domains), in predicting inhospital mortality and (b) to determine the predictive value of a simple frailty index that includes the new scale as well as categories of age, serum albumin, and creatinine values. We calculated odds ratios with 95% confidence intervals and c-statistics for the various models predicting inhospital mortality. Results: The mean patient age was 73 ± 19 years, and 49.1% (5,665/11,542) were males. A Laniado-4 scale performed better than the Norton scale for predicting inhospital mortality. A simple frailty index ranging from 0 to ≥8 points was associated with rates of inhospital mortality that increased from 0 to 37.7%, with an odds ratio of 2.13 (2.03–2.25) per 1 index point. The c-statistic was 0.887 (0.881–0.893). Conclusions: We conclude the Laniado-4 scale performed better than the Norton scale in predicting inhospital mortality and that a simple frailty index that included the 4-question scale and categories of age, serum creatinine, and serum albumin performed as well or better than more complicated models.

1.
Cecil
E
,
Bottle
A
,
Esmail
A
,
Vincent
C
,
Aylin
P
.
What is the relationship between mortality alerts and other indicators of quality of care? A national cross-sectional study
.
J Health Serv Res Policy
.
2020
;
25
(
1
):
13
21
.
2.
Pine
M
,
Norusis
M
,
Jones
B
,
Rosenthal
GE
.
Predictions of hospital mortality rates: a comparison of data sources
.
Ann Intern Med
.
1997
;
126
(
5
):
347
54
.
3.
Sicotte
C
,
Tilquin
C
,
D’Hoore
W
.
Risk adjustment in outcome assessment: the Charlson comorbidity index
.
Methods Inf Med
.
1993
;
32
(
05
):
382
7
.
4.
Marshall
G
,
Shroyer
AL
,
Grover
FL
,
Hammermeister
KE
.
Time series monitors of outcomes. A new dimension for measuring quality of care
.
Med Care
.
1998
;
36
(
3
):
348
56
.
5.
Moreno
R
,
Miranda
DR
,
Fidler
V
,
Van Schilfgaarde
R
.
Evaluation of two outcome prediction models on an independent database
.
Crit Care Med
.
1998
;
26
(
1
):
50
61
.
6.
Prytherch
DR
,
Sirl
JS
,
Schmidt
P
,
Featherstone
PI
,
Weaver
PC
,
Smith
GB
.
The use of routine laboratory data to predict in-hospital death in medical admissions
.
Resuscitation
.
2005
;
66
(
2
):
203
7
.
7.
Hucker
TR
,
Mitchell
GP
,
Blake
LD
,
Cheek
E
,
Bewick
V
,
Grocutt
M
, et al
.
Identifying the sick: can biochemical measurements be used to aid decision making on presentation to the accident and emergency department
.
Br J Anaesth
.
2005
;
94
(
6
):
735
41
.
8.
Jollis
JG
,
Ancukiewicz
M
,
DeLong
ER
,
Pryor
DB
,
Muhlbaier
LH
,
Mark
DB
.
Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research
.
Ann Intern Med
.
1993
;
119
(
8
):
844
50
.
9.
Dans
PE
.
Looking for answers in all the wrong places
.
Ann Intern Med
.
1993
;
119
(
8
):
855
7
.
10.
Knaus
WA
,
Draper
EA
,
Wagner
DP
,
Zimmerman
JE
.
Apache II: a severity of disease classification system
.
Crit Care Med
.
1985
;
13
(
10
):
818
29
.
11.
Shimoni
Z
,
Dusseldorp
N
,
Cohen
Y
,
Barnisan
I
,
Froom
P
.
The Norton scale is an important predictor of in-hospital mortality in internal medicine patients
.
Ir J Med Sci
.
2023
;
192
(
4
):
1947
52
.
12.
Shimoni
Z
,
Froom
P
,
Silke
B
,
Benbassat
J
.
The Presence of a urinary catheter is an important predictor of inhospital mortality in internal medicine patients
.
J Eval Clin Pract
.
2022
;
28
(
6
):
1113
8
.
13.
Norton
D
.
Calculating the risk: reflections on the Norton scale
.
Decubitus
.
1989
;
2
(
3
):
24
31
.
14.
Norton
D
.
Geriatric nursing problems
.
Int Nurs Rev
.
1962
;
9
:
39
41
.
15.
Smolin
B
,
Levy
Y
,
Sabbach-Cohen
E
,
Levi
L
,
Mashiach
T
.
Predicting mortality of elderly patients acutely admitted to the Department of Internal Medicine
.
Int J Clin Pract
.
2015
;
69
(
4
):
501
8
.
You do not currently have access to this content.