急诊科分诊时 Rockwood 临床虚弱量表的一致性和预测价值。

Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage.

机构信息

Emergency Department, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK

Emergency Department, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK.

出版信息

Emerg Med J. 2021 Dec;38(12):868-873. doi: 10.1136/emermed-2019-208633. Epub 2020 Nov 10.

DOI:10.1136/emermed-2019-208633

PMID:33172880

Abstract

AIM

To determine the agreement and predictive value of emergency department (ED) triage nurse scoring of frailty using the Rockwood Clinical Frailty Scale (CFS) when compared with inpatient medical assessment using the same scale.

METHODS

Prospective, dual-centre UK-based study over a 1-year period (1 April 2017 to 31 March 2018) of CFS recorded digitally at nursing triage on ED arrival and on hospital admission by a medical doctor. Inclusion criteria were emergency medical admission in those aged ≥65 staying at least one night in hospital with a CFS completed in both ED and at hospital admission. Agreement between ED triage nurse and inpatient hospital physician was assessed using a weighted Kappa statistic and Spearman's correlation coefficient. The ability of the ED to diagnose frailty (defined by a CFS ≥5) was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curves. At both time points the ability of the CFS to predict inpatient mortality was also assessed.

RESULTS

From 29 211 admissions aged ≥65 who stayed at least one night in hospital, 12 385 (42.3%) were referred from the ED. Of the ED referrals, 8568 cases (69.2%) were included with paired CFS performed. Median age was 84 (IQR 77 to 89) with an inpatient mortality of 6%. Median CFS in ED was 4 (3 to 5) and on hospital admission 5 (4 to 6). Agreement between the ED CFS and admission CFS was weak (Kappa 0.21, 95% CI 0.19 to 0.22, r 0.366). The area under the ROC curve (AUC) was 0.67 (95% CI 0.66 to 0.68) for the ED CFS ability to predict an admission CFS ≥5. To predict inpatient mortality the ED CFS AUC was 0.56 (0.53 to 0.59) and admission CFS AUC 0.70 (0.68 to 0.73).

CONCLUSION

Agreement between ED CFS and inpatient CFS was found to be weak. In addition the ability of ED CFS to predict clinically important outcomes was limited. NPV and PPV for ED CFS cut-off value of ≥5 were found to be low. Further work is required on the feasibility, clinical impact and appropriate tools for screening of frailty in EDs.

摘要

目的

通过比较急诊分诊护士使用 Rockwood 临床虚弱量表（CFS）对虚弱的评分与住院医生使用相同量表进行的住院评估，确定急诊分诊护士对虚弱的评分与住院医生评估的一致性和预测价值。

方法

这是一项前瞻性、英国双中心研究，在 1 年期间（2017 年 4 月 1 日至 2018 年 3 月 31 日），在急诊室到达时和住院时，由护士使用数字方式记录 CFS，由医生进行评估。纳入标准为年龄≥65 岁的急诊医疗入院，至少在医院住院一晚，并且在急诊室和入院时均完成了 CFS。使用加权 Kappa 统计量和斯皮尔曼等级相关系数评估急诊分诊护士和住院医生之间的一致性。使用灵敏度、特异性、阳性预测值（PPV）、阴性预测值（NPV）和受试者工作特征（ROC）曲线评估 ED 诊断虚弱（定义为 CFS≥5）的能力。在这两个时间点，还评估了 CFS 预测住院死亡率的能力。

结果

在≥65 岁、至少住院一晚的 29211 名入院患者中，有 12385 名（42.3%）从急诊室转来。在急诊室转来的患者中，有 8568 例（69.2%）进行了配对 CFS 检查。中位年龄为 84 岁（IQR 77 至 89），住院死亡率为 6%。急诊室 CFS 的中位数为 4（3 至 5），入院时为 5（4 至 6）。ED 的 CFS 与入院 CFS 的一致性较差（Kappa 值为 0.21，95%CI 为 0.19 至 0.22，r 值为 0.366）。ED CFS 预测入院 CFS≥5 的 ROC 曲线下面积（AUC）为 0.67（95%CI 0.66 至 0.68）。预测住院死亡率时，ED CFS AUC 为 0.56（0.53 至 0.59），入院 CFS AUC 为 0.70（0.68 至 0.73）。