Pulok Mohammad Habibullah, Theou Olga, van der Valk Alexandra M, Rockwood Kenneth
Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada.
Age Ageing. 2020 Oct 23;49(6):1071-1079. doi: 10.1093/ageing/afaa089.
we investigated whether two frailty tools predicted mortality among emergency department (ED) patients referred to internal medicine and how the level of illness acuity influenced any association between frailty and mortality.
two tools, embedded in a Comprehensive Geriatric Assessment (CGA), were the clinical frailty scale (CFS) and a 57-item deficit accumulation frailty index (FI-CGA). Illness acuity was assessed using the Canadian Triage and Acuity Scale (CTAS). We examined all-cause 30-day and 6-month mortality and time to death.
in 808 ED patients (mean age ± SD 80.8 ± 8.8, 54.4% female), the mean FI-CGA score was 0.44 ± 0.14, and the CFS was 5.6 ± 1.6. A minority (307; 38%) were classified as having high acuity (CTAS: 1-2). The 30-day mortality rate was 17%; this increased to 34% at 6 months. Compared to well patients with low acuity, the risk of 30-day mortality was 22.5 times (95% CI: 9.35-62.12) higher for severely frail patients with high acuity; 53% of people with very severe frailty (CFS = 8) and high acuity died within 30 days. When acuity was low, the risk for 30-day mortality was significantly higher only among those with very high levels of frailty (CFS 7-9, FI-CGA > 0.5). When acuity was high, even lower levels of frailty (CFS 5-6, FI-CGA 0.4-0.5) were associated with higher 30-day mortality.
across levels of frailty, higher acuity increased mortality risk. When acuity was low, the risk was significant only when the degree of frailty was high, whereas when acuity was high, even lower levels of frailty were associated with greater mortality risk.
我们研究了两种衰弱评估工具能否预测转诊至内科的急诊科患者的死亡率，以及疾病严重程度如何影响衰弱与死亡率之间的关联。
两种嵌入综合老年评估（CGA）的工具分别是临床衰弱量表（CFS）和包含57个项目的累积缺陷衰弱指数（FI-CGA）。使用加拿大分诊和严重程度量表（CTAS）评估疾病严重程度。我们检查了全因30天和6个月死亡率以及死亡时间。
在808例急诊科患者中（平均年龄±标准差80.8±8.8，54.4%为女性），FI-CGA平均得分为0.44±0.14，CFS为5.6±1.6。少数患者（307例；38%）被归类为高严重程度（CTAS：1 - 2）。30天死亡率为17%；6个月时升至34%。与低严重程度的健康患者相比，高严重程度的严重衰弱患者30天死亡风险高22.5倍（95%置信区间：9.35 - 62.12）；53%的极度衰弱（CFS = 8）且高严重程度的患者在30天内死亡。当严重程度低时，仅在衰弱程度非常高（CFS 7 - 9，FI-CGA>0.5）的患者中30天死亡风险显著更高。当严重程度高时，即使较低水平的衰弱（CFS 5 - 6，FI-CGA 0.4 - 0.5）也与较高的30天死亡率相关。
在不同衰弱水平下，较高的严重程度会增加死亡风险。当严重程度低时，仅在衰弱程度高时风险显著，而当严重程度高时，即使较低水平的衰弱也与更高的死亡风险相关。
