Kahlon Sharry, Pederson Jenelle, Majumdar Sumit R, Belga Sara, Lau Darren, Fradette Miriam, Boyko Debbie, Bakal Jeffrey A, Johnston Curtis, Padwal Raj S, McAlister Finlay A
Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
CMAJ. 2015 Aug 11;187(11):799-804. doi: 10.1503/cmaj.150100. Epub 2015 May 25.
Readmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. We evaluated the impact of frailty on readmission or death within 30 days after discharge from general internal medicine wards.
We prospectively enrolled patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton. Frailty was defined by means of the previously validated Clinical Frailty Scale. The primary outcome was the composite of readmission or death within 30 days after discharge.
Of the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate, and 11 (2%) had severe frailty. Frail patients were older, had more comorbidities, lower quality of life, and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among nonfrail patients (39 [24.1%] v. 46 [13.8%]). Although frailty added additional prognostic information to predictive models that included age, sex and LACE score, only moderate to severe frailty (31.0% event rate) was an independent risk factor for readmission or death (adjusted odds ratio 2.19, 95% confidence interval 1.12-4.24).
Frailty was common and associated with a substantially increased risk of early readmission or death after discharge from medical wards. The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from general internal medicine wards.
出院后再入院情况常见且费用高昂，但预测模型在识别再入院高风险患者方面效果不佳。我们评估了虚弱对综合内科病房出院后30天内再入院或死亡的影响。
我们前瞻性纳入了埃德蒙顿2家教学医院7个内科病房出院的患者。通过先前验证的临床虚弱量表来定义虚弱。主要结局是出院后30天内再入院或死亡的复合情况。
在纳入研究的495例患者中，162例（33%）符合虚弱定义：91例（18%）为轻度虚弱，60例（12%）为中度虚弱，11例（2%）为重度虚弱。虚弱患者比非虚弱患者年龄更大、合并症更多、生活质量更低且出院时LACE评分更高。虚弱患者30天再入院或死亡的复合情况高于非虚弱患者（39例[24.1%]对46例[13.8%]）。尽管虚弱为包含年龄、性别和LACE评分的预测模型增加了额外的预后信息，但仅中度至重度虚弱（事件发生率31.0%）是再入院或死亡的独立危险因素（调整比值比2.19，95%置信区间1.12 - 4.24）。
虚弱情况常见，且与内科病房出院后早期再入院或死亡风险大幅增加相关。临床虚弱量表可能有助于识别综合内科病房出院的高风险患者。
