Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes

Jesus, Ana Paula Santos de; Okuno, Meiry Fernanda Pinto; Campanharo, Cassia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Batista, Ruth Ester Assayag

doi:10.1590/1980-220X-REEUSP-2020-0162

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2020-0162 copy

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes^* * Extracted from the thesis “Avaliação da classificação de risco em um Serviço de Emergência da Bahia”, Programa de Pós-Graduação em Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, 2020.

Asociación del índice de Charlson con clasificación de riesgo, aspectos clínicos y resultados en urgencias

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department.

Method:

Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses.

Results:

There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital.

Conclusion:

The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

DESCRIPTORS
Triage; Emergency Medical Services; Epidemiology; Comorbidity; Hospital Mortality

	ACCI				p value*
	N	Mean (SD)	Median	Minimum–Maximum	p value*
Risk classification					<0.0001
Red	143	2.06 (2.19)	2	0–10
Orange	769	1.59 (1.89)	1	0–10
Yellow	1.142	1.48 (1.82)	1	0–11
Green	1.004	1.07 (1.46)	0	0–8
Blue	298	1.14 (1.44)	0	0–6
White	268	2.57 (2.09)	2	0–9
Total	3.624	1.47 (1.8)	1	0–11

	ACCI				p value^‡
	N	Mean (SD)*	Median	Minimum–Maximum	p value^‡
Main complaint					<0.0001
Nonspecific	1,904	1 (1.48)	0	0–11
Neurological	487	2.41 (2.05)	2	0–9
Skin and appendages	331	1.74 (1.69)	2	0–7
Digestive	307	1.75 (1.96)	1	0–10
Respiratory	128	1.99 (2)	1	0–8
Genitourinary	127	1.71 (1.79)	2	0–9
Cardiologic	77	2.09 (1.94)	2	0–9
Vascular	76	3.22 (2.04)	3	0–9
Otolaryngological	45	1 (1.65)	0	0–7
Immunological	41	1.07 (1.79)	0	0–6
Endocrine	39	3.05 (1.86)	3	0–7
Dental	32	0.69 (1.51)	0	0–6
Mental	24	1.13 (1.78)	0	0–6
Ophthalmologic	6	0.17 (0.41)	0	0–1
Non-specific complaint					<0.0001
Pain	1,236	1.01 (1.45)	0	0–11
External causes	354	0.71 (1.23)	0	0–6
General malaise	163	1.53 (1.79)	1	0–6
Exogenous intoxication	110	0.38 (0.94)	0	0–7
Device problems^†	21	3.38 (1.99)	4	0–8
Others	20	1.4 (2.01)	0.5	0–6

	ACCI				p value*
	N	Mean (SD)	Median	Minimum–Maximum	p value*
Diagnostic tests
Yes	1,335	1.73 (2)	1	0–11	<0.0001
No	2,289	1.31 (1.65)	1	0–9	<0.0001
Type of test
Electrocardiogram
Yes	174	1.91 (1.95)	1	0–7	0.0024
No	3,450	1.44 (1.79)	1	0–11	0.0024
Radiography
Yes	231	1.68 (2.01)	1	0–10	0.0948
No	3,393	1.45 (1.78)	1	0–11	0.0948
Laboratory
Yes	547	1.7 (2.1)	1	0–11	0.0037
No	3,077	1.43 (1.73)	1	0–9	0.0037
Head CT
Yes	535	2.16 (2.06)	2	0–9	<0.0001
No	3,089	1.35 (1.72)	1	0–11	<0.0001
Endoscopy
Yes	154	1.77 (1.81)	1	0–6	0.0338
No	3,470	1.45 (1.8)	1	0–11	0.0338
Ultrasound
Yes	129	0.84 (1.43)	0	0–7	<0.0001
No	3,495	1.49 (1.81)	1	0–11	<0.0001

	ACCI				p value
	N	Mean (SD)*	Median	Minimum–Maximum	p value
Outcome
Discharge	3171	1.33 (1.71)	1	0–11	<0.0001*
Admission	83	2.51 (2.22)	2	0–8
Transfer	275	2.42 (1.98)	2	0–8
Death	95	2.42 (2.34)	2	0–10
Total	3,624	1.47 (1.8)	1	0–11

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Ana Paula Santos de Jesus Av. Carlos Amaral, 1015, Cajueiro 44574-490 – Santo Antônio de Jesus, BA, Brazil ana_paula@ufrb.edu.br