Evidence map›Paper›PMID 31727661›Full record

Observational studyBMJ open2019

Can Waterlow score predict 30-day mortality and length of stay in acutely admitted medical patients (aged ≥65 years)? Evidence from a single centre prospective cohort study.

James Wei Wang, Phillip Smith, Shah-Jalal Sarker, Sophie Elands, Amelia Oliveira, Claire Barratt, Chris Thorn, Tom Holme, Mary Lynch

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Waterlow score for risk assessment in surgical patients: a systematic review.Annals of the Royal College of Surgeons of England · 2021
    Pooled it
  2. Observational
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

James Wei WangCardiology, Lister Hospital, Stevenage, UK james.wang@nhs.net.ORCID 0000-0002-1530-1055
Phillip SmithLee Haynes Research Institute, Lister Hospital, Stevenage, UK.
Shah-Jalal SarkerResearch Department of Medical Education, University College London, London, UK.
Sophie ElandsRespiratory Medicine, Lister Hospital, Stevenage, UK.
Amelia OliveiraRespiratory Medicine, Lister Hospital, Stevenage, UK.
Claire BarrattBorthwick Research Centre, Lister Hospital, Stevenage, UK.
Chris ThornGeneral Surgery, Lister Hospital, Stevenage, UK.
Tom HolmeGeneral Surgery, Lister Hospital, Stevenage, UK.
Mary LynchCardiology, Lister Hospital, Stevenage, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis study aimed to explore the potential for the Waterlow score (WS) to be used as a predictor of 30-day mortality and length of hospital stay (LHS) in acutely admitted medical patients aged 65 years and older.

designProspective observational cohort study.

settingUK District General Hospital. SUBJECTS: 834 consecutive patients aged 65 years and older admitted acutely to medical specialties between 30 May and 22 July 2014.

methodsAdmission WS (range 4-64) assessment paired with the patient's status at 30 days in terms of mortality and their LHS. PRIMARY OUTCOMES: 30-day mortality and length of inpatient stay.

results834 consecutive acute medical admissions had their WS recorded. 30-day mortality was 13.1% (109 deaths). A significant difference in the distribution of WS (p<0.001) was seen between those who survived (median 12) and those who died (median 16) within 30 days, particularly within respiratory (p<0.001), stroke (p<0.001), cardiology (p<0.016), non-respiratory infections (p<0.018) and trauma (p<0.044) subgroups. Odds of dying within 30 days increased threefold for every 10-unit increase in the WS (p<0.001, 95% CI 2.1 to 4.3). LHS was also positively linearly associated with the WS in those who survived 30 days (median=5, IQR=10; r=0.32, p<0.01). A five-unit increase in WS was associated with approximately 5 days increase in LHS. On the other hand, quadratic regression showed this relationship was curvilinear and negative (concave) for those who died within 30 days where a five-unit increase in WS was associated with an approximately 10 days decrease in LHS.

conclusionThis study demonstrates an association between a high WS and both 30-day mortality and LHS. This is particularly significant for mortality in patients in the respiratory, stroke and cardiac subcategories. The WS, a nursing-led screening tool that is carried out on virtually all admissions to UK hospitals, could have additional use at the time of patient admission as a risk assessment tool for 30-day mortality as well as a predictor of LHS.

Indexed as

Hospital MortalitySeverity of Illness IndexAgedAged, 80 and overCause of DeathFemaleHumansLength of StayLinear ModelsLogistic ModelsMaleProspective StudiesRisk AssessmentRisk FactorsTime FactorsUnited Kingdom30-day mortalitylength of stayWaterlow Score

Identifiers

PMID31727661
PMCPMC6886901

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.