Department of Emergency & Specialist Medicine, University Hospitals of Leicester, Leicester, Leicestershire, UK.
Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK.
Ann Emerg Med. 2021 Jun;77(6):620-627. doi: 10.1016/j.annemergmed.2020.09.006. Epub 2020 Dec 13.
We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes.
We undertook a single-center, retrospective cohort study examining hospital-related outcomes and their associations with frailty scores assessed at ED triage. Participants were aged 65 years or older, registered on their first ED presentation during the study period at a single, centralized ED in the United Kingdom. Baseline data included age, sex, Clinical Frailty Scale score, National Early Warning Score-2 and the Charlson Comorbidity Index score; outcomes included length of stay, readmissions (any future admissions), and mortality (inhospital or out of hospital) up to 2 years after ED presentation. Survival analysis methods (standard and competing risks) were applied to assess associations between ED triage frailty scores and outcomes. Unadjusted incidence curves and adjusted hazard ratios are presented.
A total of 52,562 individuals representing 138,328 ED attendances were included; participants' mean age was 78.0 years, and 55% were women. Initial admission rates generally increased with frailty. Mean length of stay after 30- or 180-day follow-up was relatively low; all Clinical Frailty Scale categories included patients who experienced zero days' length of stay (ie, ambulatory care) and patients with relatively high numbers of inhospital days. Overall, 46% of study participants were readmitted by the 2-year follow-up. Readmissions increased with Clinical Frailty Scale score up until a score of 6 and then attenuated. Mortality rates increased with increasing frailty; the adjusted hazard ratio was 3.6 for Clinical Frailty Scale score 7 to 8 compared with score 1 to 3.
Frailty assessed at ED triage (with the Clinical Frailty Scale) is associated with adverse outcomes in older people. Its use in ED triage might aid immediate clinical decisionmaking and service configuration.
我们确定在急诊科（ED）分诊时应用临床虚弱量表是否与重要的服务和患者相关结局相关。
我们进行了一项单中心、回顾性队列研究，研究了与在英国单一集中的 ED 就诊时进行的 ED 分诊时评估的虚弱评分相关的医院相关结局及其关联。参与者年龄在 65 岁或以上，在研究期间在其第一次 ED 就诊时登记。基线数据包括年龄、性别、临床虚弱量表评分、国家早期预警评分-2 和 Charlson 合并症指数评分；结局包括 ED 就诊后 2 年内的住院时间、再入院（任何未来入院）和死亡率（院内或院外）。应用生存分析方法（标准和竞争风险）评估 ED 分诊虚弱评分与结局之间的关联。呈现未经调整的发病率曲线和调整后的危险比。
共纳入了 52562 名代表 138328 次 ED 就诊的个体；参与者的平均年龄为 78.0 岁，55%为女性。初始入院率通常随着虚弱程度的增加而增加。在 30 天或 180 天随访后，平均住院时间相对较短；所有临床虚弱量表类别均包括经历零天住院时间（即门诊护理）和住院天数相对较高的患者。总体而言，46%的研究参与者在 2 年随访时再次入院。随着临床虚弱量表评分的增加，再入院率增加，直到评分达到 6 分，然后减弱。虚弱程度越高，死亡率越高；与评分 1 到 3 相比，临床虚弱量表评分 7 到 8 的调整后的危险比为 3.6。
在 ED 分诊时评估的虚弱（使用临床虚弱量表）与老年人的不良结局相关。它在 ED 分诊中的使用可能有助于即时临床决策和服务配置。
