The use of Charlson comorbidity index for patients revisiting the emergency department within 72 hours.

ABSTRACT

BACKGROUND: To validate the use of the Charlson Comorbidity Index (CCI) for predicting admission of patients revisiting the Emergency Department (ED) within 72 hours. METHODS: Non-trauma patients aged above 17 years old who revisited an urban ED within 72 hours during January of 2004 were included in this retrospective observational study. Demographic data, diagnosis, CCI, in-hospital mortality rate and length of hospital stay were reviewed, and comparisons were made between the patients who were admitted or discharged on their return visits. RESULTS: Of the 168 enrolled patients, 60 were admitted to a ward and 108 were discharged. Revisiting patients with high CCIs (> or = 2) had a higher admission rate (67.3% vs. 22.7%; p < 0.001) and an increased adjusted odds ratio of admission (odds ratio (OR) 2.06; 95% confidence interval (CI) 1.14-3.75) than low CCI patients. Admitted revisiting patients with high CCIs had poorer prognoses, longer hospital stays (11.79 +/- 8.92 days vs. 6.78 +/- 5.17 days; p < 0.05) and a higher in-hospital mortality rate (15.2% vs. 3.7%; p = 0.209). CONCLUSION: CCI was well correlated with the admission possibility of patients revisiting the ED within 72 hours. More clinical management and discharge strategies should target those revisiting patients who have more comorbidities.