Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada.
Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada.
BMC Geriatr. 2021 Jan 22;21(1):73. doi: 10.1186/s12877-020-01999-6.
The "Program of Research on the Integration of Services for the Maintenance of Autonomy" (PRISMA-7) and "Emergency room evaluation and recommendations" (ER) are both clinical tools used in Québec Emergency Departments (EDs) for screening of older ED users at higher risk of poor outcomes, such as prolonged length of stay (LOS) in EDs and in hospital. The study aimed to: 1) examine whether the PRISMA-7 and ER risk levels were associated with length of stays in ED and hospital, as well as hospital admission; and 2) compare the criteria performance (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under receiver operating characteristic curve) of the PRISMA-7 and ER2 high-risk levels for these three ED adverse events in Québec older patients visiting ED on a stretcher.
A total of 1905 older patients who visited the ED of the Jewish General Hospital (Montreal, Québec, Canada) on stretchers were recruited in this prospective observational cohort. Upon their ED arrival, PRISMA-7 and ER were performed. The outcomes were LOS in ED and in hospital, and hospital admission.
The PRISMA-7 and ER risk levels were associated with length of stay in ED and hospital as well as with hospital admission. Prolonged stays and higher hospitalization rates were associated with high-risk levels, whereas those in low-risk level groups had significantly shorter LOS and a lower rate of hospital admission (P < 0.006). While performance measures were poor for both assessment tools, ER had a greater prognostic testing accuracy compared with PRISMA-7.
PRISMA-7 and ER were both associated with incidental short-term ED adverse events but their overall prognostic testing accuracy was low, suggesting that they cannot be used as prognostic tools for this purpose.
“维持自主服务整合研究计划”（PRISMA-7）和“急诊室评估和建议”（ER）都是魁北克省急诊部（ED）用于筛查预后较差风险较高的老年 ED 使用者的临床工具，例如 ED 和医院的住院时间延长（LOS）。该研究旨在：1）检查 PRISMA-7 和 ER 风险水平是否与 ED 和医院的住院时间以及住院有关；2）比较 PRISMA-7 和 ER2 高风险水平对这三个 ED 不良事件的标准性能（即敏感性、特异性、阳性预测值、阴性预测值、似然比和接收者操作特征曲线下的面积）在魁北克省担架上就诊的老年患者。
共招募了 1905 名在加拿大蒙特利尔犹太总医院 ED 担架上就诊的老年患者进行前瞻性观察队列研究。在他们到达 ED 时，进行了 PRISMA-7 和 ER 检查。结果是 ED 和医院的 LOS 以及住院。
PRISMA-7 和 ER 风险水平与 ED 和医院的住院时间以及住院有关。长时间停留和更高的住院率与高风险水平有关，而低风险水平组的 LOS 明显缩短，住院率也较低（P<0.006）。虽然两种评估工具的性能指标都较差，但 ER 的预后测试准确性大于 PRISMA-7。
PRISMA-7 和 ER 均与偶然的短期 ED 不良事件有关，但总体预后测试准确性较低，表明它们不能用于此目的的预后工具。
