Dissertação
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
Fecha
2022-10-21Autor
Brittes, Eduardo Dornelles
Institución
Resumen
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.