Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
J Am Geriatr Soc. 2020 Jul;68(7):1454-1461. doi: 10.1111/jgs.16503. Epub 2020 May 13.
To compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department Screener for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged ≥70 years) community-dwelling adults admitted to the ED.
Single-center, prospective, observation study.
ED with embedded observation unit in University Hospitals Leuven (Belgium).
A total of 794 patients (median age = 80 years; 55% female) were included.
Study nurses collected data using semistructured interviews and patient record review during ED admission. Outcome data were collected with patient record review.
Hospitalization (following index ED stay) and unplanned ED readmission at 30 and 90 days occurred in 67% (527/787) of patients and in 12.2% (93/761) and 22.1% (168/761) of patients, respectively. For all outcomes at cutoff 2, the three screening tools had moderate to high sensitivity (range = 0.71-0.90) combined with (very) low specificity (range = 0.14-0.32) and low accuracy (range = 0.21-0.67). At all cutoffs, likelihood ratios and interval likelihood ratios had no or small impact (range = 0.46-3.95; zero was not included) on the posttest probability of the outcomes. For all outcomes, area under the receiver operating characteristics curve varied in the range of 0.49 to 0.62.
Diagnostic characteristics of all screening tools were comparable. None of the tools accurately predicted the outcomes as a stand-alone index. Future studies should explore the clinical effectiveness and implementation aspects of ED-specific minimum geriatric assessment and intervention strategies. J Am Geriatr Soc 68:1454-1461, 2020.
比较老年人风险识别（Identification of Seniors at Risk）、弗拉芒版分诊风险筛查工具（Triage Risk Screening Tool）和 interRAI 急诊部筛查器在预测老年（年龄≥70 岁）社区居住成年人在急诊部（ED）延长住院时间、住院（在 ED 住院后）和 30 和 90 天非计划性 ED 再入院方面的诊断准确性。
单中心、前瞻性、观察性研究。
比利时鲁汶大学医院（University Hospitals Leuven）的 ED 内嵌入观察单元。
共纳入 794 例患者（中位数年龄=80 岁；55%为女性）。
在 ED 入院期间，研究护士使用半结构化访谈和患者病历回顾收集数据。通过病历回顾收集结局数据。
在 787 例患者中，67%（527/787）在 30 天和 90 天出现住院（在 ED 住院后）和非计划性 ED 再入院，12.2%（93/761）和 22.1%（168/761）的患者在 90 天出现住院（在 ED 住院后）和非计划性 ED 再入院。对于所有结局在截止值 2 时，三种筛查工具均具有中等至高的敏感性（范围=0.71-0.90），特异性（范围=0.14-0.32）和准确性（范围=0.21-0.67）均非常低。在所有截止值时，似然比和区间似然比对结局的后验概率没有或仅有较小影响（范围=0.46-3.95；不包括 0）。对于所有结局，受试者工作特征曲线下面积在 0.49 到 0.62 之间。
所有筛查工具的诊断特征相当。作为单独的指标，这些工具均无法准确预测结局。未来的研究应探讨 ED 特定的最低老年综合评估和干预策略的临床效果和实施方面。美国老年学会杂志 68:1454-1461, 2020。
