Abstract：
BACKGROUND: There is a lack of data about adverse events (AE) in intermediate and long-term care centers (ILCC). We aimed to synthesize the available scientific evidence on instruments used to identify and characterize AEs. We also aimed to describe the most common adverse events in ILCCs.
METHODS: A narrative systematic review of the literature was conducted according to Prisma recommendations. The PubMed database was searched for articles published between 2000 and 2021. Two reviewers independently screened and reviewed the studies through blind and independent review. We evaluated bias risk with Cochrane\'s risk of bias tool. Disagreements were resolved by consensus. Discrepancies that were not resolved by discussion were discussed with a third reviewer. Descriptive data was extracted and qualitative content analysis was performed.
RESULTS: We found 2191 articles. Based on the inclusion and exclusion criteria, 272 papers were screened by title and abstract, and 66 studies were selected for full review. The instruments used to identify AEs were mostly tools to identify specific AEs or risks of AEs (94%), the remaining 6% were multidimensional. The most frequent categories detected medication-related AEs (n=26, 40%); falls (n=7, 11%); psychiatric AEs (6.9%); malnutrition (4.6%), and infections (4.6%). The studies that used multidimensional tools refer to frailty, dependency, or lack of energy as predictors of AEs. However, they do not take into account the importance of detecting AEs. We found 2-11 adverse drug events (ADE) per resident/month. We found a prevalence of falls (12.5%), delirium (9.6-89%), pain (68%), malnutrition (2-83%), and pressure ulcers (3-30%). Urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and gastroenteritis were the most common infections in this setting. Transitions between different care settings (from hospitals to ILCC and vice versa) expose AE risk.
CONCLUSIONS: There are many instruments to detect AEs in ILCC, and most have a specific approach. Adverse events affect a significant proportion of patients in ILCC, the nurse-sensitive outcomes, nosocomial infections, and adverse drug events are among the most common. The systematic review was registered with Prospero, ID: CRD42022348168.
METHODS: A narrative systematic review of the literature was conducted according to Prisma recommendations. The PubMed database was searched for articles published between 2000 and 2021. Two reviewers independently screened and reviewed the studies through blind and independent review. We evaluated bias risk with Cochrane\'s risk of bias tool. Disagreements were resolved by consensus. Discrepancies that were not resolved by discussion were discussed with a third reviewer. Descriptive data was extracted and qualitative content analysis was performed.
RESULTS: We found 2191 articles. Based on the inclusion and exclusion criteria, 272 papers were screened by title and abstract, and 66 studies were selected for full review. The instruments used to identify AEs were mostly tools to identify specific AEs or risks of AEs (94%), the remaining 6% were multidimensional. The most frequent categories detected medication-related AEs (n=26, 40%); falls (n=7, 11%); psychiatric AEs (6.9%); malnutrition (4.6%), and infections (4.6%). The studies that used multidimensional tools refer to frailty, dependency, or lack of energy as predictors of AEs. However, they do not take into account the importance of detecting AEs. We found 2-11 adverse drug events (ADE) per resident/month. We found a prevalence of falls (12.5%), delirium (9.6-89%), pain (68%), malnutrition (2-83%), and pressure ulcers (3-30%). Urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and gastroenteritis were the most common infections in this setting. Transitions between different care settings (from hospitals to ILCC and vice versa) expose AE risk.
CONCLUSIONS: There are many instruments to detect AEs in ILCC, and most have a specific approach. Adverse events affect a significant proportion of patients in ILCC, the nurse-sensitive outcomes, nosocomial infections, and adverse drug events are among the most common. The systematic review was registered with Prospero, ID: CRD42022348168.
摘要：
背景：缺乏有关中期和长期护理中心（ILCC）不良事件（AE）的数据。我们旨在综合用于识别和表征AE的仪器的现有科学证据。我们还旨在描述ILCC中最常见的不良事件。
方法：根据Prisma建议对文献进行叙述性系统综述。在PubMed数据库中搜索了2000年至2021年之间发表的文章。两名审稿人通过盲目和独立审查独立筛选和审查研究。我们使用Cochrane的偏倚风险工具评估偏倚风险。分歧通过协商一致解决。与第三位审阅者讨论了未通过讨论解决的差异。提取描述性数据并进行定性内容分析。
结果：我们发现了2191篇文章。根据纳入和排除标准，通过标题和摘要筛选了272篇论文，选择66项研究进行全面审查.用于识别AE的工具大多是识别特定AE或AE风险的工具(94%)，其余6%是多维的。最常见的类别检测到药物相关的不良事件（n=26，40％）;跌倒（n=7，11％）;精神病不良事件（6.9％）;营养不良（4.6％），和感染(4.6%)。使用多维工具的研究指的是脆弱，依赖性，或缺乏能量作为AE的预测因子。然而,他们没有考虑到检测AE的重要性。我们发现每个居民/月有2-11起药物不良事件（ADE）。我们发现跌倒的患病率（12.5％），谵妄（9.6-89%），疼痛（68%），营养不良（2-83％），和压疮（3-30％）。尿路感染,下呼吸道感染,皮肤和软组织感染，胃肠炎是这种情况下最常见的感染。不同护理环境之间的转换(从医院到ILCC,反之亦然)暴露AE风险。
结论：有许多仪器可以检测ILCC中的AE，大多数都有特定的方法。不良事件影响ILCC患者的显著比例，护士敏感的结果，医院感染，药物不良事件是最常见的。系统审查已在Prospero注册，ID：CRD42022348168。
方法：根据Prisma建议对文献进行叙述性系统综述。在PubMed数据库中搜索了2000年至2021年之间发表的文章。两名审稿人通过盲目和独立审查独立筛选和审查研究。我们使用Cochrane的偏倚风险工具评估偏倚风险。分歧通过协商一致解决。与第三位审阅者讨论了未通过讨论解决的差异。提取描述性数据并进行定性内容分析。
结果：我们发现了2191篇文章。根据纳入和排除标准，通过标题和摘要筛选了272篇论文，选择66项研究进行全面审查.用于识别AE的工具大多是识别特定AE或AE风险的工具(94%)，其余6%是多维的。最常见的类别检测到药物相关的不良事件（n=26，40％）;跌倒（n=7，11％）;精神病不良事件（6.9％）;营养不良（4.6％），和感染(4.6%)。使用多维工具的研究指的是脆弱，依赖性，或缺乏能量作为AE的预测因子。然而,他们没有考虑到检测AE的重要性。我们发现每个居民/月有2-11起药物不良事件（ADE）。我们发现跌倒的患病率（12.5％），谵妄（9.6-89%），疼痛（68%），营养不良（2-83％），和压疮（3-30％）。尿路感染,下呼吸道感染,皮肤和软组织感染，胃肠炎是这种情况下最常见的感染。不同护理环境之间的转换(从医院到ILCC,反之亦然)暴露AE风险。
结论：有许多仪器可以检测ILCC中的AE，大多数都有特定的方法。不良事件影响ILCC患者的显著比例，护士敏感的结果，医院感染，药物不良事件是最常见的。系统审查已在Prospero注册，ID：CRD42022348168。
