Introduction: Observation visits have been increasing. McKesson’s InterQual criteria are widely used in hospitals and emergency departments (EDs) to determine if hospitalized patients should be classified as observation or inpatient status. The accuracy of these criteria in predicting lengths of stay (LOS) for patients with syncope has not been studied.
Methods: We conducted a secondary analysis of a large, multicenter, prospective cohort study of adults >60 years of age with unexplained syncope. We calculated InterQual criteria for each patient and classified the patient as qualifying for observation or inpatient hospitalization status. Outcomes were whether patient LOS ≤48 hours or >48 hours.. We derived sensitivity, specificity, positive predictive value and negative predictive value for LOS.
Results: We analyzed 2,358 patients. Overall, 1,224 (51.9%) patients were male and 1,942 (82.8%) were white, with a mean age of 73.2 +/- 9.0 years. The median LOS was 32.6 hours (IQR 24.2-71.8). Using InterQual criteria, 1,326 (56.2%) of patients would meet criteria for inpatient hospitalization. InterQual criteria did predict increased LOS (odds ratio 1.36; 95% CI 1.15-1.61). The sensitivity of InterQual criteria was 60.7% (95% CI 57.6-63.8%); specificity 46.8% (95% CI 44.2-49.4%); positive predictive value 43.6% (40.9-46.3%); negative predictive value 63.8% (60.8-66.7%).
Conclusion: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared to those who did not; however, the accuracy of the criteria is modest. Future research should identify criteria to improve the accuracy of tools used to assist with determinations of patient status while hospitalized.