Mobility Identifies Acutely Ill Patients at Low Risk of In-Hospital Mortality: A Prospective Multicenter Study.

BACKGROUND:A retrospective study has reported that impaired mobility on presentation (IMOP) enhanced the ability of vital signs to predict mortality in acutely ill patients. This study was designed to further examine the association between IMOP and in-hospital mortality. METHODS:Prospective observational study of three different cohorts of acutely ill patients admitted to hospitals in Esbjerg, Denmark (998 patients), Basel, Switzerland (743 patients), and Kitovu, Uganda (1,622 patients). RESULTS:There were significant differences in age, sex, length of stay, proportion of medical and surgical patients, and in-hospital mortality between the three cohorts. Yet in all three cohorts a National Early Warning Score (NEWS) ≥ 3 when first recorded and IMOP increased the risk of in-hospital mortality to approximately the same extent. IMOP and NEWS ≥ 3 when first recorded were, therefore, used for risk categorization: patients with a NEWS < 3 when first recorded and normal mobility on presentation had the lowest in-hospital mortality risk and those with NEWS ≥ 3 when first recorded and IMOP had the highest risk. The number of these low risk patients ranged from 26% in Kitovu to 42% in Esbjerg, and their in-hospital mortality rates did not significantly differ in all three cohorts, ranging from 0.2% in Esbjerg to 0.4% in Basel. CONCLUSIONS:In this prospective multicenter study IMOP enhanced the risk categorization of acutely ill patients from very different clinical settings. The combination normal mobility on presentation and first recorded NEWS identified a substantial proportion of patients in all cohorts with a low risk of dying while in hospital. TRIAL REGISTRY:The Esbjerg data were collected as part of a trial registered with the US National Library of Medicine (ClinicalTrials.gov; No.: NCT03108807; URL: www.clinicaltrials.gov).