Patrizio Enrica, Bergamaschini Luigi C, Cesari Matteo
Fellowship program in Geriatrics and Gerontology, University of Milan, via Pace 9, 20122, Milan, Italy.
Internal Medicine Unit, Ospedale di Busto Arsizio, Busto Arsizio, Italy.
Eur Geriatr Med. 2019 Oct;10(5):727-732. doi: 10.1007/s41999-019-00225-w. Epub 2019 Aug 19.
The number of frail patients admitted to Emergency Departments is increasing. The so-called Frailty Index based on the age-related accumulation of deficits models is often perceived as excessively burdening or not feasible in busy clinical settings due to its quantitative nature. We wanted to prove the possibility of generating a Frailty Index in the Emergency Department from data that are routinely collected during the standard clinical practice in this setting and to test its predictive capacity for adverse events.
A retrospective analysis of the medical records of 110 hospitalized patients (mean age = 67.4 ± 18.9 years; women 41.8%) admitted to our Emergency Department during 6 days of 2017. A 41-item Frailty Index was computed from vital signs, physical examination, anamnestic diseases, and blood tests routinely collected by Emergency Department physicians. The length of the subsequent hospital stay and the institutionalization of the patient at the hospital discharge were the dependent variables of interest.
Median length of stay was 11.0 (interquartile range, IQR = 6.0-16.0) days. Institutionalization rate at discharge was 18.2%. The median Frailty Index was 0.22 (IQR = 0.17-0.30). The Frailty Index was significantly correlated with age (Spearman's r = 0.44, p < 0.001) and resulted significantly associated with length of stay and institutionalization. The receiver operating characteristics areas under the curve were 0.731 (Confidence Interval, 95%CI 0.601-0.860, p = 0.001) and 0.726 (95%CI 0.610-0.841, p < 0.001) in the prediction of institutionalization and prolonged hospital stay, respectively. No statistically significant association of age with a length of stay (p = 0.75) nor institutionalization (p = 0.09) was reported.
The standard multidimensional assessment conducted at the Emergency Department admission has all the necessary features to generate a meaningful clinical Frailty Index, potentially supporting decisions since the first contact of the individual with the hospital system.
入住急诊科的虚弱患者数量正在增加。基于与年龄相关的缺陷积累模型的所谓虚弱指数，由于其定量性质，在繁忙的临床环境中常被认为负担过重或不可行。我们想证明，根据急诊科标准临床实践中常规收集的数据生成急诊科虚弱指数的可能性，并测试其对不良事件的预测能力。
对2017年6天内入住我院急诊科的110例住院患者（平均年龄=67.4±18.9岁；女性占41.8%）的病历进行回顾性分析。根据急诊科医生常规收集的生命体征、体格检查、既往疾病和血液检查结果，计算出一个包含41项指标的虚弱指数。随后的住院时间和出院时患者的机构化情况是感兴趣的因变量。
中位住院时间为11.0天（四分位间距，IQR=6.0-16.0）。出院时的机构化率为18.2%。中位虚弱指数为0.22（IQR=0.17-0.30）。虚弱指数与年龄显著相关（Spearman相关系数r=0.44，p<0.001），并与住院时间和机构化显著相关。在预测机构化和延长住院时间方面，曲线下的受试者工作特征面积分别为0.731（置信区间，95%CI 0.601-0.860，p=0.001）和0.726（95%CI 0.610-0.841，p<0.001）。未报告年龄与住院时间（p=...
