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Communication Effort Score (CES) in patients hospitalized in internal medicine ward

Aims: There are more than thirty prognostic scoring systems defined in the literature for emergency patients up to now. The purpose of this study is to develop communication effort score (CES) to be used in internal medicine ward by considering it from a different angle, and also to examine the relation of this index with prognosis. Methods: The study had a prospective-observational study design, and was conducted on patients followed-up in the ward due to acute diseases. The patients were graded under 4 categories according to communication effort within the first 8 hours after referring to emergency department, between exhibiting active communication effort and being closed to communication.The prognostic performance of CES was tested comparatively with other scoring systems by using AUROC analysis. Results: Data were collected on 308 consecutive acute medical admissions, 55.2% of whom were men, with the mean age of 65.4 ± 15.6 years The mortality rate of the patients in hospital was 2% in CES-1, 4.8% in CES-2, 27.2% in CES-3; and 51.6% in CES-4.The CES model showed a good discrimination power for in-hospital mortality as 0.813 AUC(95% CI, 0.77–0.85). These results were better than the prognostic scoring systems (RAPS, MEWS, REMS, WPS, GAP, and NEWS) and the other specific and general descriptive scoring systems (ECOG, GCS, qSOFA, CCL). The sensitivity and specificity of CES for the optimal cut-off point (2.5) in predicting in-hospital mortality were 0.957 and 0.632, respectively. Conclusions: The present study showed that CES, which is a new definitive score, is a strong predictor of both inhospital mortality and short-term mortality.