Volume 56, Issue 10 p. 1926-1931

A Manual of Guidelines to Score the Modified Cumulative Illness Rating Scale and Its Validation in Acute Hospitalized Elderly Patients

Fabio Salvi MD

Fabio Salvi MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Mark D. Miller MD

Mark D. Miller MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Annalisa Grilli MD

Annalisa Grilli MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Raffaella Giorgi MD

Raffaella Giorgi MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Adele L. Towers MD

Adele L. Towers MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Valeria Morichi MD

Valeria Morichi MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Liana Spazzafumo MS

Liana Spazzafumo MS

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Lucia Mancinelli MD

Lucia Mancinelli MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Emma Espinosa MD, PhD

Emma Espinosa MD, PhD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Alessandro Rappelli MD

Alessandro Rappelli MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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Paolo Dessì-Fulgheri MD

Paolo Dessì-Fulgheri MD

From the * Geriatric Rehabilitation Unit, Italian National Institute for Research and Care on Aging, Appignano, Italy Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, Italy Department of Psychiatry § Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Gerontological Research, Statistics and Biometry Center, Italian National Institute for Research and Care on Aging, Ancona, Italy

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First published: 01 October 2008
Citations: 408
Address correspondence to Fabio Salvi, MD, S.O.D. Clinica di Medicina Interna, Azienda Ospedaliero-Universitaria “Ospedali Riuniti,” Via Conca n. 71, 60131 Ancona, Italy. E-mail: [email protected]

Abstract

OBJECTIVES: To update previous guidelines to score the Cumulative Illness Rating Scale (CIRS) and test their usefulness in hospitalized elderly patients.

DESIGN: The CIRS was scored retrospectively in a cohort of elderly patients followed for 18 months.

SETTING: An acute internal medicine ward in an academic tertiary care hospital.

PARTICIPANTS: Three hundred eighty-seven patients aged 65 and older.

MEASUREMENTS: The CIRS was retrospectively scored for the enrolled patients. Intrarater and interrater reliability were calculated. Two illness severity indices (total score (TSC) and severity (SV)) and one comorbidity index (CM) were obtained. Clinical features and comprehensive geriatric assessment (CGA) variables were also used. All patients underwent an 18-month follow-up for mortality and rehospitalization.

RESULTS: Intrarater and interrater reliability of the CIRS scored following the guidelines was good (intraclass correlation coefficients of 0.83 and 0.81, respectively). The TSC, SV, and CM correlated with clinical features (laboratory values, medication usage, and length of in-hospital stay) and CGA variables (cognitive impairment, depression and disability). All three indices were able to predict 18-month mortality and rehospitalization rates.

CONCLUSION: This study confirmed the validity of the CIRS as an indicator of health status and demonstrated its ability to predict 18-month mortality and rehospitalization in hospitalized elderly patients. The availability of detailed guidelines for scoring the CIRS can improve its usefulness and facilitate more-widespread use for research and clinical aims.