Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark.
Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
Eur J Intern Med. 2017 Nov;45:71-73. doi: 10.1016/j.ejim.2017.09.036. Epub 2017 Oct 3.
Several frailty rating scales have been developed to detect and screen for the level of frailty. It is uncertain what diagnostic value screening of frailty level have in the emergency department.
To assess the accuracy of the screening tools used in the emergency department to detect frailty in patients≥65years by their ability to identify the risk of adverse outcomes.
An extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department. Data was subsequently extracted and evaluated from the results of the included studies.
Four studies met the exact inclusion criteria. Four different frailty screening scales: Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk and The Study of Osteoporotic Fracture frailty index used in the emergency department were described and compared. Predictive values for various outcomes are represented and discussed.
The results suggest that frailty successfully predicts increased risk of hospitalization, nursing home admission, mortality and prolonged length of stay after an initial emergency department visit. Frailty does however not predict increased risk of 30day emergency department revisit. Further research highlighting the value of screening for frailty level in elderly emergency department patients is needed.
Although frail elders in need of further geriatric assessment should be identified as soon as possible, this systematic review only identified four cohort studies of frailty assessment in emergency departments. Although frailty screening appeared to predict the risk of mortality and of admission to hospital/nursing home, these four studies did not show that it could predict return visits to emergency departments within 30days. Randomized clinical trials of frailty screening tools compared to usual care or other methods of assessment are clearly needed.
已经开发出几种虚弱评分量表来检测和筛查虚弱程度。目前尚不确定在急诊科筛查虚弱程度有什么诊断价值。
评估急诊科使用的虚弱筛查工具在识别 65 岁以上患者不良结局风险方面检测虚弱的准确性。
对 Embase 和 PubMed 进行了广泛的医学文献检索，以确定在急诊科使用虚弱筛查量表的研究。随后从纳入研究的结果中提取和评估数据。
四项研究完全符合纳入标准。描述并比较了在急诊科使用的四种不同的虚弱筛查量表：临床虚弱量表、缺陷累积指数、识别高危老年人和骨质疏松性骨折虚弱指数。代表并讨论了各种结局的预测值。
结果表明，虚弱成功预测了初始急诊科就诊后住院、入住养老院、死亡和延长住院时间的风险增加。然而，虚弱并不能预测 30 天内急诊科再次就诊的风险增加。需要进一步研究强调在老年急诊科患者中筛查虚弱程度的价值。
虽然需要进一步老年评估的虚弱老年人应尽快识别，但本系统评价仅确定了四项急诊科虚弱评估的队列研究。虽然虚弱筛查似乎可以预测死亡率和住院/养老院入院的风险，但这四项研究并未表明它可以预测 30 天内返回急诊科就诊的情况。显然需要对虚弱筛查工具进行随机临床试验，与常规护理或其他评估方法进行比较。
