Launay Cyrille P, de Decker Laure, Kabeshova Anastasiia, Annweiler Cédric, Beauchet Olivier
Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
Department of Geriatrics, EA 1156-12, Nantes University Hospital, Nantes, France.
PLoS One. 2014 Oct 15;9(10):e110135. doi: 10.1371/journal.pone.0110135. eCollection 2014.
The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS.
Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry.
Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6.
Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.
本研究的目的是：1）确认在急诊科（ED）就诊后入住急性医疗科的老年患者中，简短老年评估（BGA）项目的组合是长期住院时间（LHS）延长的显著危险因素；2）确定这些BGA项目的组合是否可作为长期LHS的预后工具。
基于前瞻性观察队列设计，本研究选取了1254名在法国昂热大学医院急诊科就诊并在急性医疗科出院的住院患者（平均年龄±标准差，84.9±5.9岁；59.3%为女性）。在基线评估时，进行了一次BGA，包括以下6个项目：年龄≥85岁、男性、多重用药（即每天≥5种药物）、使用家庭帮助服务、过去6个月内有跌倒史以及时间定向障碍（即无法说出月份和/或年份）。使用医院登记册前瞻性计算急性医疗科的LHS天数。
BGA项目不同组合的长期LHS的受试者工作特征（ROC）曲线下面积在0.50至0.57之间。Cox回归模型显示，从ROC曲线确定的定义长期LHS高风险的组合是长期LHS的显著危险因素（风险比>1.16，P>0.010）。出院的Kaplan-Meier分布显示，被分类为长期LHS高风险组的住院患者出院时间比低风险组晚（P<0.003）。所有组合对长期LHS的预后价值较差，敏感性低于77%，特异性变化较大（从26.6到97.4），阳性试验的似然比低，低于5.6。
6项BGA工具的组合是长期LHS延长的显著危险因素，但在本研究的老年住院患者样本中其预后价值较差。
