Low Norton scale scores are associated with medical complications other than pressure ulcers during rehabilitation in the elderly

PurposeTo determine if low admission Norton scale scores (ANSS) are associated with medical complications other than pressure ulcers during rehabilitation in the elderly.MethodsA retrospective cohort study conducted in a department of geriatric rehabilitation during 2009. The medical charts of consecutive elderly (≥ 65 years) patients admitted for rehabilitation following hip arthroplasty (n = 221), stroke (n = 111), and due to hospital-associated deconditioning (HAD) (n = 98), were studied for the following measurements: ANSS, demographics, co-morbidities, the appearance of pressure ulcers, and medical complications. Medical complications included: urinary tract infection, soft tissue infection, respiratory tract infection, gastrointestinal infection, arthritis, falls, venous thromboembolism, gastrointestinal bleeding, urinary retention, heart failure exacerbation, acute renal failure, and transient confusion.ResultsFour hundred and thirty patients were included: 289 (67.2%) females; mean age 82.3 ± 6.7 years. Overall, 132 (30.7%) patients had medical complications, and the three most common were: urinary tract infection, respiratory tract infection, and urinary retention. Mean ANSS was 14.6 ± 2.2, and 208 (48.4%) patients had low (≤ 14) ANSS. Patients with medical complications had significantly lower ANSS relative to patients without medical complications (13.7 ± 2.1 vs. 14.9 ± 2.1; P < 0.0001). Regression analysis showed that medical complications were independently associated with ANSS as a continuous variable (P = 0.022) and with low ANSS as a categorical variable (P = 0.034), regardless of age, gender, cause of rehabilitation, co-morbidities, admission albumin serum levels, mini-mental status examination scores, and the appearance of pressure ulcers.ConclusionsThe Norton scoring system may be used for predicting medical complications other than pressure ulcers during rehabilitation in the elderly following hip arthroplasty, stroke, and with HAD.