Chakroun-Walha Olfa, Walha Adel, Bradai Haifa, Nasri Abdennour, Karray Rim, Jerbi Mouna, Trabelsi Rahma, Rekik Noureddine
Emergency Department, University Hospital Habib Bourguiba, Sfax, Tunisia.
Afr J Emerg Med. 2020 Dec;10(4):229-233. doi: 10.1016/j.afjem.2020.07.014. Epub 2020 Sep 3.
Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Several tools exist for the screening of frailty among these patients. However, no tool has been validated in Tunisia. This study aims to evaluate the usefulness of frailty screening in predicting the outcome of older adults presenting to the ED.
This is a prospective, monocentric study. We evaluated the eligible patients at the ED and after their discharge. Follow-up phone calls were scheduled at 1, 2, 3, and 6 months after the ED visit. All patients aged 65 years or older; and visiting the ED during the inclusion period were involved. We used the ADL index and ISAR scale for assessing frailty.
We enrolled 184 patients; they were living alone in 25% of cases. Half of them had medical care insurance. The ADL index was maximum (6 = total dependency) in 20% of cases. The ISAR score was above 1 point in 38%. Unplanned hospitalizations have accounted for 34%. In univariate analysis, the ADL index and ISAR score were statistically higher in the group of "unplanned hospitalization". In multivariate analysis, the ISAR score and ADL index have not been associated with unplanned hospitalization.
Our results did not demonstrate the relevance of the ISAR or ADL scales in predicting the mortality or the need for unplanned hospitalization in multivariate analysis. This study did indicate an increased mortality in the "frail" patients in the univariate analysis. Further studies with larger samples and different tools are necessary.
体弱的老年人在急诊科就诊后出现不良结局的风险增加。有几种工具可用于筛查这些患者的虚弱情况。然而，尚无工具在突尼斯得到验证。本研究旨在评估虚弱筛查在预测急诊科老年患者结局方面的有用性。
这是一项前瞻性、单中心研究。我们在急诊科对符合条件的患者及其出院后进行了评估。在急诊科就诊后1、2、3和6个月安排了随访电话。纳入所有65岁及以上且在纳入期间到急诊科就诊患者。我们使用日常生活活动（ADL）指数和ISAR量表评估虚弱情况。
我们纳入了184例患者；其中25%的患者独居。他们中有一半拥有医疗保险。20%的病例中ADL指数最高（6 = 完全依赖）。38%的患者ISAR评分高于1分。非计划住院率为34%。在单因素分析中，“非计划住院”组的ADL指数和ISAR评分在统计学上更高。在多因素分析中，ISAR评分和ADL指数与非计划住院无关。
我们的结果在多因素分析中未证明ISAR或ADL量表在预测死亡率或非计划住院需求方面的相关性。本研究在单因素分析中确实表明“虚弱”患者的死亡率有所增加。有必要进行更大样本量和使用不同工具的进一步研究。
