Research paper| Volume 25, ISSUE 4, P316-320, December 2022

The utility of the Barthel index as an outcome predictor in older patients with acute infection attending the emergency department

Published:April 06, 2022DOI:



      Functional decline and frailty are common in older adults and influence the risk of adverse outcomes. We aimed to assess the value of a Barthel index at the Emergency Department (ED-BI) score in predicting 30-day mortality and ED reconsultation among older patients with acute infection.


      We performed a prospective multicentre cohort study of older patients (≥75 years) diagnosed with acute infection in 69 Spanish EDs. Demographic, comorbidities, functional status, clinical and analytical data were collected. Unadjusted and adjusted logistic regression models were used to assess the association between ED-BI score, mortality and ED reconsultation.


      In total 1596 patients with a mean age of 84.7 years were included in the study and 51.7% female. The most frequent focus of infection was respiratory in 918 patients (57.5%). Patients with an ED-BI< 60 points were significantly older, predominantly female, more likely institutionalized and more urinary infections. When comparing patients with an ED-BI score ≥ 60 points with those< 60 points no differences were found in ED reconsultation but in the latter group mortality at 30-days was higher (p < 0.001).


      An ED-BI score< 60 points appears to be a strong predictor of mortality at the 30-day follow up in older patients with acute infection.

      Data availability

      The data used to support the findings of this study are included within the article.


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        • Puig M.
        • Blázquez M.
        • Ris J.
        Learn, unlearn, and learn again: the secret to changing how elderly patients are attended in the emergency department.
        Emergencias. 2020; 32: 122-130
        • Albert M.
        • McCaig L.F.
        • Ashman J.J.
        Emergency department visits by persons aged 65 and over: United States, 2009–2010.
        NCHS Data Brief. 2013; : 1-8
        • Salvi F.
        • Morichi V.
        • Grilli A.
        • et al.
        The elderly in the emergency department: a critical review of problems and solutions.
        Intern Emerg Med. 2007; 4: 292-301
        • O’Caoimh R.
        • Gao Y.
        • Svendrovski A.
        • et al.
        Screening for markers of frailty and perceived risk of adverse outcomes using the risk instrument for screening in the community (RISC).
        BMC Geriatr. 2014; 14
        • Ryg J.
        • Engberg H.
        • Mariadas P.
        • et al.
        Barthel index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study.
        Clin Epidemiol. 2018; : 1789-1800
        • Chivite D.
        • Formiga F.
        • Corbella X.
        • et al.
        Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients. The RICA prospective study.
        Int J Cardiol. 2018; : 182-188
        • Rosselló X.
        • Miró O.
        • Llorens P.
        • et al.
        Effect of barthel index on the risk of thirty-day mortality in patients with acute heart failure attending the emergency department: a cohort study of nine thousand ninety-eight patients from the epidemiology of acute heart failure in emergency departments registry.
        Ann Emerg Med. 2019; 6: 589-598
        • Murcia J.
        • Llorens P.
        • Sánchez-Payá J.
        • et al.
        Functional status determined by Barthel Index predicts community-acquired pneumonia mortality in general population.
        J Infect. 2010; 6: 458-464
        • González J.
        • Jiménez J.
        • González-Martínez F.
        • et al.
        Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department.
        Eur J Clin Microbiol Infect Dis. 2017; 12: 2361-2369
        • Hwang U.
        • Carpenter C.
        Assessing geriatric vulnerability for post emergency department adverse outcomes: challenges abound while progress is low.
        Emerg Med J. 2016; 1: 2-3
        • Michalski-Monnerat C.
        • Carron P.N.
        • Nguyen S.
        • Büla C.
        • Mabire C.
        Assessing older patients vulnerability in the emergency department: a study of InterRAI ED screener accuracy.
        J Am Geriatr Soc. 2020; 12: 2914-2920
        • Taylor A.
        • Broadbent M.
        • Wallis M.
        • Marsden E.
        The predictive validity of the InterRAI ED screener for predicting re-presentation within 28 days for older adults at a regional hospital emergency department.
        Austral Emerg Care. 2019; 3: 149-155
        • Wilber S.T.
        • Blanda M.
        • Gerson L.W.
        Does functional decline prompt emergency department visits and admission in older patients ?.
        Acad Emerg Med. 2006; 6: 680-682
        • Hepper H.J.
        • Sieber C.
        • Walger P.
        • et al.
        Infections in the elderly.
        Crit Care Clin. 2013; : 757-774
        • Martin-Sánchez F.J.
        • Gil V.
        • Llorens P.
        • et al.
        Barthel Index-enhanced feedback for effective cardiac treatment (BI-EFFECT) study: contribution of the barthel index to the heart risk scoring system model in elderly adults with acute heart failure in the emergency department.
        J Am Geriatr Soc. 2012; 3: 493-498
        • Matzen L.E.
        • Jepsen D.B.
        • Ryg J.
        • et al.
        Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit.
        BMC Geriatr. 2012; 32
        • Martín-Sánchez F.J.
        • Rodríguez-Andrada E.
        • Vidan M.T.
        • et al.
        Impact of frailty and disability on 30-day mortality in older patients with acute heart failure.
        Am J Cardiol. 2017; 7: 1151-1157
        • Torres O.H.
        • Muñoz J.
        • Ruiz D.
        • et al.
        Outcome predictors of pneumonia in elderly patients: importance of functional assessment.
        J Am Geriatr Soc. 2004; 10: 1603-1609
        • Sligl W.I.
        • Eurich D.T.
        • Marrie T.J.
        • et al.
        Only severely limited, premorbid functional status is associated with short and long-term mortality in patients with pneumonia who are critically ill: a prospective observational study.
        Chest. 2011; : 88-94
        • Chih-Chung S.
        • Hsiu-Chuan H.
        • I-Ling C.
        • et al.
        Lower barthel index is associated with higher risk of hospitalization-requiring pneumonia in long-term care facilities.
        Tohoku J Exp Med. 2015; : 281-288
        • Jeon K.
        • Yoo H.
        • Jeong B.H.
        • et al.
        Functional status and mortality prediction in community-acquired pneumonia.
        Respirology. 2017; 7: 1400-1406
        • Formiga F.
        • Chivite D.
        • Conde A.
        • Ruiz-Laiglesia F.
        • et al.
        Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients – the prospective RIVA study.
        Int J Cardiol. 2014; 1: 127-131
        • Miró O.
        • Llorens P.
        • Martín-Sánchez F.J.
        • et al.
        Short-term prognostic factors in elderly patients seen in emergency departments for acute heart failure.
        Rev Esp Cardiol. 2009; 7: 757-764
        • Gips E.
        • Spilsbury K.
        • Boecker C.
        • Ng R.
        • Arendts G.
        Do frailty and comorbidity indices improve risk prediction of 28-day ED reattendance ? Reanalysis of an ED discharge nomogram for older people.
        Aging Clin Exp Res. 2019; 10: 1401-1406
        • Mion L.C.
        • Palmer R.M.
        • Meldon S.W.
        • et al.
        Case finding and referral model for emergency department elders: a randomized clinical trial.
        Ann Emerg Med. 2003; : 57-68
        • Caplan G.A.
        • Williams A.J.
        • Daly B.
        • et al.
        A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department – the DEED II study.
        J Am Geriatr Soc. 2004; : 1417-1423