Medical care
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This study was designed to determine if comorbidity added more information than knowing only the patient's age in predicting survival and length of hospital stay. ⋯ Patients who died were not significantly older but had higher comorbidity scores. Using patients alive at the end of the follow-up period, linear regression models were fit to the data to determine if comorbidity added more information regarding length of hospital stay than knowing only the patient's age. In the model that included only age as an independent variable, there was a significant relation between age and length of stay (F(1,303) = 5.2; P = 0.012). The R2 value for this model was 0.017. In further models that included age and each of the three comorbidity scores (separately) as the independent variables, the model that included age and the Cumulative Illness Rating Scale yielded the highest R2 value (R2 = 0.062). This study is among the first to compare three different measures of comorbidity and documents that comorbidity provides more information than knowing only the patient's age in relation to survival and length of hospital stay.
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The authors determine whether assessments of effects of rural emergency medical services (EMS) system characteristics on trauma outcomes using patient-level data are biased significantly if the Injury Severity Score (ISS) is not available. ⋯ In rural settings, where a patient's ISS generally is not available, studies of rural EMS system characteristics and trauma outcomes may use Revised Trauma Score, patient age, and type of trauma to control for expected survival. The patient's ISS does not appear to be essential, at least for the rural area analyzed in this study.
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Reliability and validity are as necessary for predrafted advance directive forms as they are for all clinical assessment instruments. Performance of predrafted advance directive forms with both lay persons and clinicians is relevant. Evidence relating to test- retest reliability, content validity, and criterion-related validity of one form, the Medical Directive, has been documented for outpatients. The authors investigated construct validity and external validity among outpatients, physicians, and the general public. ⋯ The Medical Directive has construct validity in relations among specific treatment preferences and between treatment preferences, illness scenarios, and goals for care. External validity is supported by study of separate outpatient, physician, and general public populations. The treatment items constitute a highly reliable scale that can be used in further empirical research regarding life-sustaining treatment.