Jeuris Anthony, Van Grootven Bastiaan, Geyskens Lisa, Milisen Koen, Flamaing Johan, Deschodt Mieke
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Department of Geriatric Medicine, Jessa Hospital, Hasselt, Belgium.
Acta Clin Belg. 2023 Feb;78(1):44-50. doi: 10.1080/17843286.2022.2031374. Epub 2022 Jan 25.
To determine whether routine screening with the Flemish version of the Triage Risk Screening Tool (fTRST) is a valid approach to determine which patients on cardiac care wards are at risk for inhospital functional decline and would benefit from geriatric expertise consultation.
A secondary data-analysis of the G-COACH before-cohort, describing patient profiles and routine care processes, in 189 older adults on two cardiac care wards in the University Hospitals Leuven between September 2016 and June 2017. Inhospital functional decline was defined as an increase of at least one point on the Katz Index of Activities of Daily Living or death between hospital admission and discharge.
Nine in 10 patients had at least one geriatric syndrome and one-third developed functional decline. Based on the fTRST proposed cut-off of ≥2, 156 (82.5%) patients were at risk for functional decline (sensitivity of 95.2%, specificity of 23.8%, negative predictive value of 90.9% and Area Under the Curve of 0.60). Of the 156 'at risk' patients, 43 (27.6%) received a consultation by the geriatric consultation team after a median of four hospitalization days. A positive fTRST was not significantly related to geriatric consultations (x = 0.57; p = 0.45).
The fTRST has a low discriminative value in identifying older cardiology patients at risk for functional decline. Given the high prevalence of geriatric syndromes, we propose a new paradigm were all older adults on cardiac care wards undergo a needs assessment upon hospital admission.
确定使用佛兰芒语版分诊风险筛查工具（fTRST）进行常规筛查是否是一种有效的方法，以确定心脏护理病房中的哪些患者存在住院期间功能衰退的风险，并将从老年医学专家咨询中受益。
对2016年9月至2017年6月期间鲁汶大学医院两个心脏护理病房的189名老年人进行G-COACH队列前的二次数据分析，描述患者概况和常规护理流程。住院期间功能衰退定义为住院期间至出院时日常生活活动能力的 Katz 指数至少增加1分或死亡。
十分之九的患者至少有一种老年综合征，三分之一出现功能衰退。根据fTRST建议的≥2 的临界值，156名（82.5%）患者存在功能衰退风险（敏感性为95.2%，特异性为23.8%，阴性预测值为90.9%，曲线下面积为0.60）。在这156名“有风险”的患者中，43名（27.6%）在住院中位数4天后接受了老年咨询团队的咨询。fTRST呈阳性与老年咨询无显著相关性（x = 0.57；p = 0.45）。
fTRST在识别有功能衰退风险的老年心脏病患者方面具有较低的判别价值。鉴于老年综合征的高患病率，我们提出一种新的模式，即心脏护理病房中的所有老年人在入院时都要进行需求评估。
