The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, PO Box 6087, UNSW, NSW, 1466 Australia.
Dean's Office Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Arch Gerontol Geriatr. 2018 May-Jun;76:169-174. doi: 10.1016/j.archger.2018.02.014. Epub 2018 Mar 6.
Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments.
Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death.
The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices.
预后的不确定性阻碍了临床医生及时开展临终讨论和预先医疗指示。本研究评估了 CriSTAL（筛选和分诊标准以提供适当替代护理）检查表在急诊科的疗效。
这是一项在澳大利亚、丹麦和爱尔兰的 10 家医院急诊科就诊的≥65 岁、任何诊断的患者的前瞻性队列研究。将使用电子和纸质临床记录来提取风险因素，如养老院居住、需要快速响应电话的生理恶化、既往活动期慢性疾病个人史、过去一年的住院或重症监护病房入院史、蛋白尿或心电图异常的证据，以及与 Fried 评分和临床虚弱量表同时测量的虚弱证据。将在初始评估后约三个月通过电话联系患者或其非正式护理者，以确定存活、自我报告的健康状况、出院后虚弱和出院后卫生服务利用情况。将使用逻辑回归和引导技术以及 AUROC 曲线来测试 CriSTAL 在入院后 90 天内和院内死亡的短期死亡预测准确性。
CriSTAL 检查表是一种用于急诊科老年患者的客观实用工具，用于确定个体短期死亡的概率。预计该检查表在该队列中的验证将降低临床医生对患者死亡时间的预后不确定性，并鼓励及时进行临终讨论，以支持对老年体弱患者及其家属进行关于其即将到来或未来护理选择的临床决策。
