Winograd C H, Gerety M B, Chung M, Goldstein M K, Dominguez F, Vallone R
Department of Medicine, Stanford University School of Medicine, California.
J Am Geriatr Soc. 1991 Aug;39(8):778-84. doi: 10.1111/j.1532-5415.1991.tb02700.x.
To determine the reliability of rapid screening by clinically derived geriatric criteria in predicting outcomes of elderly hospitalized patients.
Prospective cohort study of 985 patients screened at the time of hospital admission and followed for 1 year with respect to the outcomes of mortality, hospital readmission, and nursing home utilization.
Palo Alto Veterans Affairs Medical Center, a tertiary care teaching hospital.
Male patients 65 years of age and older admitted to the Medical and Surgical services during the period from October 1, 1985 through September 30, 1986.
Patients were grouped by specific screening criteria into three groups of increasing frailty: Independent, Frail, and Severely Impaired. Each criterion focused on a geriatric condition and was designed to serve as a marker for frailty. Increasing frailty was significantly correlated with increasing length of hospital stay (P less than 0.0001), nursing home utilization (P less than 0.0001), and mortality (P less than 0.0001). Multivariate analyses revealed that the clinical groups were more predictive of mortality and nursing home utilization than were age or Diagnosis-Related Groups (DRGs). Rehospitalization was unrelated to age, clinical group, or DRG, suggesting that utilization may not be driven by the clinical factors measured in this study.
Rapid clinical screening using specific geriatric criteria is effective in identifying frail older subjects at risk for mortality and nursing home utilization. Our findings suggest that geriatric syndromes are more predictive of adverse outcomes than diagnosis per se. This well operationalized screening process is inexpensive as well as effective and could easily be introduced into other hospital settings.
通过临床得出的老年标准来确定快速筛查对预测老年住院患者预后的可靠性。
对985例患者进行前瞻性队列研究，这些患者在入院时接受筛查，并就死亡率、再次住院和疗养院使用情况等预后指标进行为期1年的随访。
帕洛阿尔托退伍军人事务医疗中心，一家三级护理教学医院。
1985年10月1日至1986年9月30日期间入住内科和外科的65岁及以上男性患者。
根据特定筛查标准，患者被分为三组，虚弱程度逐渐增加：独立组、虚弱组和严重受损组。每个标准都聚焦于一种老年疾病，旨在作为虚弱的标志。虚弱程度增加与住院时间延长（P<0.0001）、疗养院使用（P<0.0001）和死亡率（P<0.0001）显著相关。多变量分析显示，与年龄或诊断相关组（DRG）相比，临床分组对死亡率和疗养院使用情况的预测性更强。再次住院与年龄、临床分组或DRG无关，这表明使用情况可能并非由本研究中测量的临床因素驱动。
使用特定老年标准进行快速临床筛查可有效识别有死亡和入住疗养院风险的虚弱老年受试者。我们的研究结果表明，老年综合征对不良预后的预测性比诊断本身更强。这种操作简便的筛查过程既经济又有效，并且可以很容易地引入其他医院环境。
