Kajsa Eklund, Katarina Wilhelmson, Sten Landahl, Synneve Ivanoff-Dahlin
Vårdalinstitutet, The Swedish Institute for Health Sciences, University of Gothenburg, Lund, Sweden.
Department of Health and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
BMC Emerg Med. 2016 Jul 22;16(1):27. doi: 10.1186/s12873-016-0087-0.
The identification of frail older persons in different health care settings is widely seen as an important step in improving the healthcare system. Screening at an emergency department (ED) should be handled in just a few minutes without the use of tests or measurements. The FRESH-screening was developed for this purpose. This study's aim was to evaluate the FRESH-screening and its construct validity; also assessed were the sensitivity, specificity, and predictive values for frailty screening.
The study had a cross-sectional design. A total of 161 elderly people who sought care at the emergency department at Mölndal Hospital were included. Inclusion criteria were ages ≥80 years or ages 65-79 with at least one chronic disease and dependence in at least one daily living activity. Sensitivity, specificity, and predictive values were calculated to describe the accuracy of the FRESH-screening in identifying those with frailty, as assessed by eight frailty indicators. Sensitivity and specificity were both set at a minimum of 80 %, and a percentage sum ≥150 of the sensitivity and positive prediction was considered a measure of excellent value.
Both sensitivity and specificity were high (81 % and 80 %, respectively) when comparing the four questions of the FRESH-screening against the eight frailty indicators. The percentage sum of sensitivity and positive prediction was 173 (81 % + 92 %), thus exceeding the 150 cutoff.
This study shows the FRESH-screening to be of excellent clinical value. Additionally, the clinical experience is that the instrument is simple and rapid to use, takes only a few minutes to administer, and requires minimal energy input by older persons.
在不同医疗环境中识别体弱老年人被广泛视为改善医疗体系的重要一步。急诊科的筛查应在几分钟内完成，无需进行检测或测量。为此开发了FRESH筛查法。本研究旨在评估FRESH筛查法及其结构效度；同时还评估了体弱筛查的敏感性、特异性和预测值。
本研究采用横断面设计。共纳入了161名在莫恩达尔医院急诊科就诊的老年人。纳入标准为年龄≥80岁或65 - 79岁且患有至少一种慢性病并在至少一项日常生活活动中存在依赖。计算敏感性、特异性和预测值，以描述FRESH筛查法在识别体弱患者方面的准确性，该准确性由八项体弱指标评估。敏感性和特异性均设定为至少80%，敏感性和阳性预测值的百分比总和≥150被视为具有优异价值的衡量标准。
将FRESH筛查法的四个问题与八项体弱指标进行比较时，敏感性和特异性均较高（分别为81%和80%）。敏感性和阳性预测值的百分比总和为173（81% + 92%），因此超过了150的临界值。
本研究表明FRESH筛查法具有优异的临床价值。此外，临床经验表明该工具使用简单快捷，只需几分钟即可完成，且老年人所需的精力投入极少。
