Inability to walk (IATW) has predicted mortality in emergency units in low-income settings, but its value among inpatients in high-income countries is unknown. To evaluate the predictive accuracy of IATW for 30-day in-hospital mortality among inpatients in a high-income country, compare its performance with NEWS CRITICAL (the threshold for urgent review), and assess whether IATW provides complementary risk stratification when combined with NEWS. All adult inpatients in four Swedish hospitals were prospectively examined in a multicenter point-prevalence assessment. IATW was defined as inability to walk five steps without physical assistance or walking aids. NEWS was calculated from contemporaneous vital signs. The primary outcome was 30-day in-hospital mortality. We computed sensitivity, specificity, predictive values, and likelihood ratios. Multivariable logistic regression assessed the association between IATW and mortality, adjusted for NEWS, age, and sex. Of 1842 patients, 59.9% were IATW-positive and 22.3% met NEWS CRITICAL (≥5 or any single-parameter score of 3). Mortality was 4.6%. IATW had higher sensitivity (86.9% vs 66.7%) but lower specificity (41.4% vs 79.8%) than NEWS CRITICAL; NPV was high for both (98.5% vs 98.0%). IATW was independently associated with mortality after adjustment for NEWS (OR 2.43, 95% CI 1.24–4.76; p = 0.009). Those both IATW-negative and with NEWS <5 (35.2% of the cohort) had 1.1% mortality. Inability to walk (IATW) is a bedside assessment that when negative identifies patients with low 30-day in-hospital mortality and provides complementary information to NEWS. Its low complexity, high sensitivity and low negative likelihood ratios support its use in clinical risk assessments. • IATW identified 87% of inpatients who died within 30 days in hospital. • IATW was independently associated with mortality after adjustment for NEWS. • Combining IATW and NEWS stratified mortality from 1.1% to 16.2%. • A negative IATW result reduced the odds of death by approximately 68%. • IATW provides complementary risk information beyond physiological scoring.
Sjöstedt et al. (Sun,) studied this question.