目的:探讨老年人预测死亡率的预测工具的准确性和精确性,住院治疗,以及不同设置和时间的疗养院入住。
方法:前瞻性和回顾性研究的系统评价和荟萃分析。
方法:在Medline进行了从数据库开始到2023年2月1日的系统搜索,Embase,Cinhal,科克伦图书馆。
方法:如果研究报告了与以下任何结果相关的预后指数的准确性(曲线下面积[AUC])和/或准确性(C指数),则符合研究条件:死亡率,住院治疗,和养老院入院。
方法:两个独立的审阅者提取数据。使用随机效应模型汇集数据。使用预后研究质量(QUIPS)工具评估偏倚风险。如果针对相同设置和时间的三项以上研究可用,我们使用GRADE工具进行了荟萃分析,并对其他数据进行了描述性报道.
结果:在最初考虑的16,082项研究中,共纳入159项研究,共2,398,856名老年人(平均年龄:78岁)。大多数研究是在医院或病房进行的。在社区环境中,只有两个工具(健康评估工具和多维预后指数,MPI)对长期死亡率具有良好的准确性。在急诊科设置中,Barthel指数在预测短期死亡率方面具有出色的准确性。在医疗病房里,MPI对预测短期死亡率的证据具有中等确定性(13项研究;11,787例患者;AUC=0.79,4项研究;3,915例患者;C指数=0.82).当考虑更长的随访期时,MPI也有类似的发现。当考虑疗养院和手术室时,文献有限。偏见的风险通常是可以接受的;观察到的偏见主要是由于减员和混淆。
结论:一些工具用于预测老年患者的不良预后,但是只有从多维评估中得出的评估才具有精度和准确性的特征。
To explore the accuracy and
precision of prognostic tools used in older people in predicting mortality, hospitalization, and nursing home admission across different settings and timings.
Systematic
review and meta-analysis of prospective and retrospective studies.
A systematic search from database inception until 01st February 2023 was run in Medline, Embase, Cinhal, Cochrane Library.
Studies were eligible if they reported accuracy (area under the curve [AUC]) and/or
precision (C-index) for the prognostic index in relation to any of the following outcomes: mortality, hospitalization, and nursing home admission.
Two independent reviewers extracted data. Data were pooled using a random effects model. The risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. If more than three studies for the same setting and time were available, a meta-analysis was performed and evaluated using the GRADE tool; other data were reported descriptively.
Among 16,082 studies initially considered, 159 studies with a total of 2398856 older people (mean age: 78 years) were included. The majority of the studies was carried out in hospital or medical wards. In the community setting, only two tools (Health Assessment Tool and the Multidimensional Prognostic Index, MPI) had good
precision for long-term mortality. In emergency department setting, Barthel Index had an excellent accuracy in predicting short-term mortality. In medical wards, the MPI had a moderate certainty of the evidence in predicting short-term mortality (13 studies; 11,787 patients; AUC=0.79 and 4 studies; 3915 patients; C-index=0.82). Similar findings were available for MPI when considering longer follow-up periods. When considering nursing home and surgical wards, the literature was limited. The risk of bias was generally acceptable; observed bias was mainly owing to attrition and confounding.
Several tools are used to predict poor prognosis in geriatric patients, but only those derived from a multidimensional evaluation have the characteristics of
precision and accuracy.