Prognostic value for mortality of the new FADOI-COMPLIMED score(s) in patients hospitalized in medical wards.

BACKGROUND: Recently we defined a user-friendly tool (FADOI-COMPLIMED scores-FCS) to assess complexity of patients hospitalized in medical wards. FCS-1 is an average between the Barthel Index and the Exton-Smith score, while FCS-2 is obtained by using the Charlson score. The aim of this paper is to assess the ability of the FCS to predict mortality in-hospital and after 1-3-6-12-months. In this perspective, we performed comparisons with the validated Multidimensional Prognostic Index (MPI). METHODS: It is a multicenter, prospective observational study, enrolling patients aged over 40, suffering from at least two chronic diseases and consecutively admitted to Internal Medicine departments. For each patient, data from 13 questionnaires were collected. Survival follow-up was conducted at 1-3-6-12 months after discharge. The relationships between cumulative incidences of death with FCS were investigated with logistic regression analyses. ROC curve analyses were performed in order to compare the predictiveness of the logistic models based on FCS with respect to those with MPI taken as reference. RESULTS: A cohort of 541 patients was evaluated. A 10-point higher value for FCS-1 and FCS-2 leads to an increased risk of 1-year death equal to 25.0% and 27.1%, respectively. In case of in-hospital mortality, the relevant percentages were 63.1% and 15.3%. The logistic model based on FCS is significantly more predictive than the model based on MPI (which requires an almost doubled number of items) for all the time-points considered. CONCLUSIONS: Assessment of prognosis of patients has the potential to guide clinical decision-making and lead to better care. We propose a new, efficient and easy-to-use instrument based on FCS, which demonstrated a good predictive power for mortality in patients hospitalized in medical wards. This tool may be of interest for clinical practice, since it well balances feasibility (requiring the compilation of 34 items, taking around 10 minutes) and performance.

Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN).

BACKGROUND AND AIMS: Although pain in the elderly is a common and important problem, it is frequently underestimated and undertreated. Pain assessment in elderly people is often more difficult than in the general population, because of the occurrence of dementia and other cognitive impairments that may compromise the ability to communicate the presence and the intensity of pain to hospital staff. Recently, several observational tools have been developed in order to assess pain behaviors in non-communicative patients. The aim of the present study was to verify if the Italian version of the Non- Communicative Patient's Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting. METHODS: Sixty severely demented patients (MMSE /=23, language test score >/=4) were selected on the basis of their cognitive status and language skills. NOPPAIN forms were filled in at the same time by two nursing staff members after patients' daily care activities; behavioral indicators of the affective state and communicative patients' reports of pain were also collected. RESULTS: Significant interrater agreement was found in the subscores of the four main sections of the NOPPAIN and also in the total score. In addition, in cognitively intact patients there was a moderate (about 0.50) but significant correlation between NOPPAIN ratings and pain self-reports. A positive correlation between pain scores and negative affective state scores was also found, especially in cognitively impaired patients. CONCLUSIONS: The preliminary data of the present study support the reliability and validity of the Italian version of the NOPPAIN, which appears to be an easy-to-use tool in the assessment of pain in hospitalized non-communicative patients.