Service Pharmacie, Hôpital européen Georges Pompidou - Assistance Publique Hôpitaux de Paris, Paris, France.
Equipe 6, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Paris, France.
BMJ Open. 2019 Jul 29;9(7):e028302. doi: 10.1136/bmjopen-2018-028302.
The aim of this systematic review was to describe and analyse the performance statistics of validated risk scores identifying elderly inpatients at risk of early unplanned readmission.
We identified potentially eligible studies by searching MEDLINE, EMBASE, COCHRANE and Web of Science. Our search was restricted to original studies, between 1966 and 2018.
Original studies, which internally or externally validated the clinical scores of hospital readmissions in elderly inpatients.
A data extraction grid based on Strengthening the Reporting of Observational Studies in Epidemiology and Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis statements was developed and completed by two reviewers to collect general data. The same process was used to extract metrological data of the selected scores.
Assessment of the quality and risk of bias in individual studies was performed by two reviewers, using the validated Effective Public Health Practice Project quality assessment tool.
Elderly inpatients discharged to home from hospital or returning home after an accident and emergency department visit.
A total of 12 studies and five different scores were included in the review. The five scores present area under the receiving operating characteristic curve between 0.445 and 0.69. Identification of Senior At Risk (ISAR) and Triage Risk Screening Tool (TRST) scores were the more frequently validated scores with ISAR being more sensitive and TRST more specific.
The TRST and ISAR scores have been extensively studied and validated. The choice of the most suitable score relies on available patient data, patient characteristics and the foreseen clinical care intervention. In order to pair the intervention with the appropriate clinical score, further studies of external validation of clinical scores, identifying elderly patients at risk of early unplanned readmission, are needed.
CRD42017054516.
本系统评价旨在描述和分析经验证的风险评分在识别有早期非计划性再入院风险的老年住院患者方面的性能统计数据。
我们通过搜索 MEDLINE、EMBASE、COCHRANE 和 Web of Science 来确定潜在的合格研究。我们的搜索仅限于原始研究，时间范围为 1966 年至 2018 年。
内部或外部验证老年住院患者住院再入院临床评分的原始研究。
我们制定了一个基于观察性研究的流行病学强化报告和多变量预测个体预后或诊断模型透明报告的研究数据提取网格，并由两名评审员完成，以收集一般数据。同样的过程用于提取所选评分的计量学数据。
两名评审员使用经过验证的有效公共卫生实践项目质量评估工具对个体研究的质量和偏倚风险进行评估。
从医院出院回家或从急症部门返回的老年住院患者。
共有 12 项研究和 5 种不同的评分纳入了本次评价。这 5 种评分的接收者操作特征曲线下面积在 0.445 至 0.69 之间。识别高危老年人（ISAR）和分诊风险筛查工具（TRST）评分是经过更广泛验证的评分，ISAR 更敏感，TRST 更特异。
TRST 和 ISAR 评分已经得到了广泛的研究和验证。最合适评分的选择取决于可用的患者数据、患者特征和预期的临床护理干预措施。为了将干预措施与适当的临床评分相匹配，需要进一步进行外部验证识别有早期非计划性再入院风险的老年患者的临床评分的研究。
PROSPERO 注册号：CRD42017054516。
