Hustey Fredric M, Mion Lorraine C, Connor Jason T, Emerman Charles L, Campbell James, Palmer Robert M
Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Am Geriatr Soc. 2007 Aug;55(8):1269-74. doi: 10.1111/j.1532-5415.2007.01272.x.
To determine the effectiveness of the six-item Triage Risk Screening Tool (TRST) to assess baseline functional status and predict subsequent functional decline in older community-dwelling adults discharged home from the emergency department (ED).
Secondary data analysis of a randomized, controlled trial.
EDs of two urban academic hospitals.
Six hundred fifty community-dwelling adults aged 65 and older presenting to the ED and discharged home. Patients were categorized a priori as "high risk" if they had cognitive impairment or two or more risk factors on the TRST.
Functional status: summed activity of daily living (ADL) and instrumental activity of daily living (IADL) scores at baseline, 30 days, and 120 days. Self-perceived physical health: standardized physical health component of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Functional decline: loss of one or more ADLs and one or more IADLs from ED baseline at 30 and 120 days. Decline in self-perceived physical health: follow-up SF-36 standardized physical health component scores four or more points lower than baseline.
TRST scores correlated with baseline ADL impairments, IADL impairments, and self-perceived physical health at all endpoints (P<.001). A TRST score of two or more was moderately predictive of decline in ADLs or IADLs (30-day ADL area under the receiver operating characteristic curve (AUC)=0.64; 95% confidence interval (CI)=0.56-0.72; 120-day ADL AUC=0.66; 95% CI=0.58-0.74) but not perceived physical health.
The TRST identifies baseline functional impairment in older ED patients and is moderately predictive of subsequent functional decline after an initial ED visit. The TRST provides a valid proxy measure for assessing functional status in the ED and may be useful in identifying high-risk patients who would benefit from referrals for further evaluation or surveillance upon ED discharge.
确定六项分诊风险筛查工具（TRST）在评估老年社区居住成年人从急诊科（ED）出院回家时的基线功能状态及预测其随后功能衰退方面的有效性。
一项随机对照试验的二次数据分析。
两家城市学术医院的急诊科。
65岁及以上前往急诊科并出院回家的650名社区居住成年人。如果患者有认知障碍或在TRST上有两个或更多风险因素，则预先被归类为“高风险”。
功能状态：基线、30天和120天时日常生活活动（ADL）和工具性日常生活活动（IADL）得分总和。自我感知的身体健康状况：医学结局研究36项简短健康调查（SF - 36）的标准化身体健康分量表。功能衰退：在30天和120天时，与ED基线相比，一项或多项ADL和一项或多项IADL丧失。自我感知的身体健康状况下降：随访时SF - 36标准化身体健康分量表得分比基线低4分或更多。
在所有终点，TRST得分与基线ADL损伤、IADL损伤及自我感知的身体健康状况相关（P <.001）。TRST得分为两分或更高对ADL或IADL衰退具有中度预测性（30天ADL受试者工作特征曲线下面积（AUC）= 0.64；95%置信区间（CI）= 0.56 - 0.72；120天ADL AUC = 0.66；95% CI = 0.58 - 0.74），但对自我感知的身体健康状况无预测性。
TRST可识别老年ED患者的基线功能损伤，并对首次ED就诊后的后续功能衰退具有中度预测性。TRST为评估ED中的功能状态提供了一种有效的替代指标，可能有助于识别那些在ED出院后通过转诊进行进一步评估或监测会受益的高风险患者。
