Avaliação do perfil de internação com base no instrumento ISAR e identificação do poder preditivo para o óbito em adultos e idosos no Hospital Universitário de Santa Maria

Abstract

Population aging causes an increase in demands for health services, with emphasis on hospitalizations, in many cases in public health systems, causing an overload of care and a greater risk of adverse health outcomes such as death. Objectives: To clarify the hospitalization profile based on the ISAR instrument and to identify its predictive power for death in adults and the elderly. Methodology: This is a prospective cohort, which evaluated 1421 individuals aged between 18 and 97 years, who entered the University Hospital of Santa Maria-Rs (HUSM-EBSERH). Data collection took place between July and December 2019. This study is part of the project “Predictive Validity of an Instrument for Identification of Complex Patients in Hospitalization (IPC)”. Descriptive variables were age and gender, study variables were ISAR (Identifications of Seniors At Risk), ICC (Charlson Comorbidity Index) and CAM (Confusion Assessment Method) scores, and outcomes were length of stay and death. Data were analyzed using the Statistical Package for the Social Sciences (SPSS-21.0). The associations by the chi-square or Fisher's exact test, the prediction of death by multivariate logistic regression (backward method) and the predictive accuracy by the ROC curve (Receiver Operating Characteristics). Statistical significance was considered when p≤ 0.005. Results: It identified that the low-risk profile was of adults, male, married and who entered due to diseases of the circulatory system. Those at high risk were elderly, married, who entered due to diseases of the circulatory system. The predictive accuracy of the ISAR between 18 and 50 years of age was identified (Area under the curve (AUC): 0.719 - Confidence index (CI): 0.633-0.817). Conclusion: It is suggested that the ISAR, despite its initial formulation for the elderly, can be considered a screening instrument in adults. Possibly due to changes in the profile of morbidities, which bring physiological aging to prominence over chronological aging. In this context, there is a need to reformulate the strategies used in patients with multimorbidities, aiming at reducing the functional impact.