PDF(Pubmed)
Abstract：
frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy seven item questionnaire (PRISMA-7) and InterRAI-ED at predicting adverse outcomes at 30 days and 6 months amongst older adults presenting to the Emergency Department (ED).
a prospective cohort study of adults ≥65 years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30 days and 6 months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables.
a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes.
older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30 days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention.
a prospective cohort study of adults ≥65 years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30 days and 6 months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables.
a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes.
older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30 days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention.
摘要：
背景：脆弱筛查有助于对不良事件风险最大的老年人进行分层，以便进行紧急评估和后续干预。我们评估了老年人风险识别(ISAR)的有效性，临床虚弱量表（CFS），在向急诊科（ED）提交的老年人中，在30天和6个月时预测不良结果的综合服务研究计划（PRISMA-7）和InterRAI-ED。
方法：对就诊于ED的≥65岁成年人进行前瞻性队列研究。ISAR,CFS,对PRISMA-7和InterRAI-ED进行了评估。在30天和6个月时完成盲随访电话访谈，以评估死亡率。ED重新出席，医院再入院,功能下降和养老院入住。敏感性,特异性，使用2×2表计算筛选工具的阴性预测值和阳性预测值.
结果：共招募了419名患者，其中47%为女性，平均年龄为76.9岁（标准差=7.2）。不同工具的虚弱患病率各不相同(CFS57%对InterRAI-ED70%)。在30天，死亡率为5.1%，ED再出勤率18.1%，医院再入院14%,功能下降47.6%，养老院入院7.1%。所有工具对预测不良后果具有较高的敏感性和阳性预测值。
结论：衰弱筛查阳性的老年人在30天出现不良结局的风险显著增加，而ISAR是最敏感的工具。我们建议在ED设置中实施ISAR，以支持临床医生识别最有可能从专业老年评估和干预中受益的老年人。
方法：对就诊于ED的≥65岁成年人进行前瞻性队列研究。ISAR,CFS,对PRISMA-7和InterRAI-ED进行了评估。在30天和6个月时完成盲随访电话访谈，以评估死亡率。ED重新出席，医院再入院,功能下降和养老院入住。敏感性,特异性，使用2×2表计算筛选工具的阴性预测值和阳性预测值.
结果：共招募了419名患者，其中47%为女性，平均年龄为76.9岁（标准差=7.2）。不同工具的虚弱患病率各不相同(CFS57%对InterRAI-ED70%)。在30天，死亡率为5.1%，ED再出勤率18.1%，医院再入院14%,功能下降47.6%，养老院入院7.1%。所有工具对预测不良后果具有较高的敏感性和阳性预测值。
结论：衰弱筛查阳性的老年人在30天出现不良结局的风险显著增加，而ISAR是最敏感的工具。我们建议在ED设置中实施ISAR，以支持临床医生识别最有可能从专业老年评估和干预中受益的老年人。
