Norton scale, hospitalization length, complications, and mortality in elderly patients admitted to internal medicine departments

Background: The Norton scale is used for assessing pressure ulcer risk. The association between admission Norton scale scores (ANSS), hospitalization length, complications, and mortality in elderly patients admitted to internal medicine departments has never been studied. Objective: To determine if ANSS are associated with hospitalization length, complications, in-hospital mortality, and 1-year mortality in elderly patients admitted to an internal medicine department. Methods: Medical charts of consecutive elderly (≥65 years) patients admitted to a single internal medicine department between January and March 2009 were studied for ANSS, demographics, comorbidities, hospitalization length, complications during hospitalization, in-hospital mortality, and 1-year mortality. Complications during hospitalization included acute coronary syndrome, major arrhythmias, major bleeding, stroke, systemic infections, organ failure, thromboembolism, etc. ANSS ≤14 were considered low. Results: The final cohort included 259 elderly patients: 54.4% were women, the mean age was 81.6 years, and the mean hospitalization length was 3.7 days. Overall, 7.3% of the patients had complications other than pressure ulcers, 3.9% died during hospitalization, and 28.6% died within 1 year. The mean ANSS was 15.4, and 37.8% of the patients had low ANSS. Patients with low ANSS had longer hospitalization (4.7 vs. 2.9 days; p = 0.002), a higher incidence of complications during hospitalization (odds ratio: 3.9; p = 0.006), and higher rates of in-hospital mortality (odds ratio: 7.0; p = 0.007) relative to patients with high ANSS. Regression analysis showed that ANSS were independently negatively associated with hospitalization length, complications during hospitalization, and in-hospital mortality (p < 0.0001, p = 0.003, and p = 0.018, respectively) regardless of age, gender, comorbidities, and pressure ulcer appearance. Rates of 1-year mortality were similar in patients with low and high ANSS. Conclusions: The Norton scale may be used for predicting hospitalization length, complications during hospitalization other than pressure ulcers, and in-hospital mortality in elderly patients admitted to an internal medicine department.