Eagles Debra, Yadav Krishan, Perry Jeffrey J, Sirois Marie Josée, Emond Marcel
*Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
†Centre de Recherche du CHU de Québec,Hopital de l'Enfant-Jésus,Québec,QC.
CJEM. 2018 May;20(3):353-361. doi: 10.1017/cem.2017.46. Epub 2017 Jul 26.
We wished to determine the impact of emergency department (ED) mobility assessments for older patients on hospitalization, return visits, future falls, and frailty.
We searched MEDLINE, Embase, CINAHL, Cochrane Library, PEDro, and OTseeker (September 2016). Two independent reviewers identified studies of patients ≥65 years with ED physical mobility assessments and outcomes of hospitalization, return to ED, falls, and frailty. Language was not restricted. Only clinical trials and observational studies were included.
We identified 1,365 unique citations. Nine studies (six cohort and three cross-sectional) met full inclusion criteria. Patients (n=2,513) with mean age 75-85 years, admitted to hospital and discharged, underwent these ED evaluations: Timed Up and Go (TUG), Get Up and Go, tandem walk, and a gait assessment. Study quality was moderate to poor. Tandem walk did not predict falls at 90 days. TUG was not associated with return to the ED/hospitalization at 90 days. Get Up and Go was associated with hospital admission but not return to ED visits at 1 or 3 months. Due to clinical heterogeneity in study populations and outcomes, a meta-analysis was not undertaken.
Despite multiple guidelines recommending a mobility assessment prior to ED discharge for older patients, we found that such assessments were neither associated with nor predictive of adverse outcomes. Robust research is required to guide clinicians on the utility of physical mobility assessments in older ED patients.
我们希望确定急诊科对老年患者进行的活动能力评估对住院治疗、复诊、未来跌倒以及衰弱的影响。
我们检索了MEDLINE、Embase、CINAHL、Cochrane图书馆、PEDro和OTseeker（2016年9月）。两名独立评审员确定了关于≥65岁患者进行急诊科身体活动能力评估以及住院治疗、返回急诊科、跌倒和衰弱结局的研究。语言不受限制。仅纳入临床试验和观察性研究。
我们识别出1365条独特的文献引用。九项研究（六项队列研究和三项横断面研究）符合完全纳入标准。平均年龄75 - 85岁、入院并出院的患者（n = 2513）接受了这些急诊科评估：定时起立行走测试（TUG）、起立行走测试、串联行走测试和步态评估。研究质量为中等至较差。串联行走测试不能预测90天内的跌倒。TUG与90天内返回急诊科/住院治疗无关。起立行走测试与住院有关，但与1个月或3个月内返回急诊科就诊无关。由于研究人群和结局存在临床异质性，未进行荟萃分析。
尽管多项指南建议在急诊科对老年患者出院前进行活动能力评估，但我们发现此类评估既不与不良结局相关，也不能预测不良结局。需要开展有力的研究，以指导临床医生了解身体活动能力评估在老年急诊科患者中的效用。
