A Clinical Deterioration Prediction Tool for Internal Medicine Patients

Lisa L. Kirkland, Michael Malinchoc, Megan O'Byrne, Joanne T. Benson, Deanne T. Kashiwagi, M. Caroline Burton, Prathibha Varkey, Timothy I. Morgenthaler

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Many early warning models for hospitalized patients use variables measured on admission to the hospital ward; few have been rigorously derived and validated. The objective was to create and validate a clinical deterioration prediction tool using routinely collected clinical and nursing measurements. Multivariate regression analysis was used to determine clinical variables statistically associated with clinical deterioration; subsequently, the model tool was retrospectively validated using a different cohort of medical inpatients. The Braden Scale (P = .01; odds ratio [OR] = 0.91; confidence interval [CI] = 0.84-0.98), respiratory rate (P < .01; OR = 1.08; CI = 1.04-1.13), oxygen saturation (P < .01; OR = 0.97; CI = 0.96-0.99), and shock index (P < .01; OR = 2.37; CI = 1.14-3.98) were predictive of clinical deterioration 2-12 hours in the future. When applied to the validation cohort, the tool demonstrated fair concordance with actual outcomes. This tool created using routinely collected clinical measurements can serve as a very early warning system for hospitalized medical patients.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalAmerican Journal of Medical Quality
Issue number2
StatePublished - Mar 2013


  • clinical deterioration
  • early warning systems
  • prediction
  • probability
  • rapid response

ASJC Scopus subject areas

  • Health Policy


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