One score fits all: not always!
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One score fits all: not always! Paola Sterpone1 · Mauro Molteni1 · Flavio Tangianu1 · Mara Sist1 · Francesco Dentali1 Received: 16 February 2020 / Accepted: 19 February 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Prediction of medical patients’ prognosis can guide healthcare providers in deciding on their management and on planning patients’ priorities. Early identification of patients at high risk of short-term mortality may be helpful to allocate hospital resources and to avoid iatrogenic side effects [1]. Non specific clinical scores are routinely used in specific clinical settings, such as the Acute Physiologic and Chronic Health evaluation (APACHE) score [2, 3] and the Simplified Acute Physiology score (SAPS) [4, 5] in intensive-care units (ICU) or the Modified Early Warning Score (MEWS) [6] in critically ill or surgical patients. On the other hand, other scores have been developed to assess prognosis in specific diseases, such as the MELD or the CHILD–Pugh score for liver disease [7], the DECAF score for acute exacerbation of COPD [8], the 3c-HF score [9], and right-ventricular dimension (RVd) measurements for heart failure [10]. Demographic evolution has resulted in a rising of the number of elderly patients; these types of patients are usually heterogeneous in terms of illness severity, co-morbidity, and cognitive and functional status. Every day, physicians working in Internal Medicine face many different clinical problems and busy internists need simple and easy-to-use instruments to define short- and medium-term prognosis for their patients. Unfortunately, the use of these tools in clinical practice is limited, since most of them are time-consuming and require the application of lengthy formulae or the knowledge of data which are not always available in patients’ records. In addition, the majority of these tools are diseasespecific, and, therefore, inappropriate for patients with multiple comorbidities. The existence of such a large number of scores tends to generate confusion, making them less employed. What prevails in daily clinical practice is physician’s personal judgment and experience (gestalt approach). Development of a universally recognized and validated risk
* Francesco Dentali Francesco.dentali@asst‑settelaghi.it 1
Department of Medicine and Surgery, University of Insubria, Varese, Italy
assessment model (RAM) would ensure a better uniformity in patients’ management, improving accuracy of diagnostic and therapeutic strategies. Very recently, a simple score based on easily and routinely assessed items including bed rest, severely reduced kidney function, recent hospital admission, hypoalbuminemia, and dysphagia (BECLAP-D score) has been derived and validated in non-oncologic medical inpatients. This score showed a good accuracy in predicting 3-month mortality risk, but needs to be externally validated to become widely accept [11]. Padua Prediction Score (PPS) [12] and IMPROVE bleeding score [13] are two risk assessment models (RAMs) widely used in medical
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