三种用于筛查老年住院患者衰弱的工具的灵敏度和特异性。

Sensitivity and specificity of three screening tools for frailty in hospitalized older adults.

机构信息

Division of Nursing, Nursing Research, Singapore General Hospital, Singapore.

Health Services and Systems Research (HSSR), and Deputy Director and Head of Research, Centre for Ageing Research and Education (CARE) at the Duke-NUS Medical School, Singapore.

出版信息

Int J Nurs Stud. 2023 Mar;139:104435. doi: 10.1016/j.ijnurstu.2022.104435. Epub 2023 Jan 5.

DOI:10.1016/j.ijnurstu.2022.104435

PMID:36640700

Abstract

AIM

To determine the test accuracy, including sensitivity, specificity, positive predictive value, negative predictive value and area under curve, of three frailty screening tools in identifying the risk of frail outcomes among hospitalized older patients.

DESIGN

Prospective longitudinal study.

METHODS

The screening tools [Frail-PPS (Frail-Physical, Psychological and Social), Frailty Assessment Measure (FAM), and Identification of seniors at-risk hospitalized patients (ISAR-HP)] were administered by ward nurses to patients aged 65 years and older within 24 h of admission to an acute hospital. Sensitivity, specificity, positive predictive value, negative predictive value and area under curve analysis of the three tools in the context of three frail outcomes, (a) functional decline at three months after discharge-defined as a decline of at least one point on the Katz Index, (ii) requiring a full-time caregiver upon discharge, and (iii) death by three months after discharge, was assessed.

RESULTS

Of 366 patients enrolled in the study, 78 (21.3%) experienced one or more frail outcomes, with 65 (17.76%) experiencing functional decline, 61 (16.67%) requiring a full-time caregiver upon discharge and 8 (2.19%) dying by three months. Frail-PPS had sensitivity 12.5% to 31.4% and specificity 91.2% to 94.8%, varying by the considered frail outcome. Similarly, FAM had sensitivity 12.5% to 29.4% and specificity 90.9% to 94.1%, and ISAR-HP had sensitivity 2.9% to 19.2% and specificity 92.2% to 99.1%. positive predictive value of the FAM, Frail-PPS and ISAR-HP ranged from 3.0 to 45.5%, 3.1 to 50.0% and 3.9 to 23.6% respectively, while their negative predictive value ranged from 87.1% to 97.9%, 87.7% to 97.9% and 92.2% to 99.4% respectively. The area under curve values were moderate for the Frail-PPS (0.56 to 0.75), FAM (0.58 to 0.70) and ISAR-HP (0.71 to 0.77) for the three outcomes.

CONCLUSIONS

With high specificity and negative predictive values, as well as low sensitivity, FAM and Frail-PPS may be beneficial in identifying older individuals who are not frail, minimizing unnecessary further assessment and intervention.

摘要

目的

确定三种虚弱筛查工具在识别住院老年患者虚弱结局风险方面的测试准确性，包括敏感性、特异性、阳性预测值、阴性预测值和曲线下面积。

设计

前瞻性纵向研究。

方法

在急性医院入院后 24 小时内，病房护士对 65 岁及以上的患者使用三种筛查工具[虚弱综合评价计划-物理、心理和社会（Frail-PPS）、虚弱评估量表（FAM）和识别高危住院患者（ISAR-HP）]进行评估。在三种虚弱结局的情况下，评估三种工具的敏感性、特异性、阳性预测值、阴性预测值和曲线下面积分析，（a）出院后三个月的功能下降定义为 Katz 指数至少下降一个点，（ii）出院时需要全职护理人员，（iii）出院后三个月内死亡。

结果

在纳入研究的 366 名患者中，78 名（21.3%）经历了一种或多种虚弱结局，其中 65 名（17.76%）经历了功能下降，61 名（16.67%）出院时需要全职护理人员，8 名（2.19%）在出院后三个月内死亡。Frail-PPS 的敏感性为 12.5%至 31.4%，特异性为 91.2%至 94.8%，因考虑的虚弱结局而异。同样，FAM 的敏感性为 12.5%至 29.4%，特异性为 90.9%至 94.1%，ISAR-HP 的敏感性为 2.9%至 19.2%，特异性为 92.2%至 99.1%。FAM、Frail-PPS 和 ISAR-HP 的阳性预测值分别为 3.0%至 45.5%、3.1%至 50.0%和 3.9%至 23.6%，而其阴性预测值分别为 87.1%至 97.9%、87.7%至 97.9%和 92.2%至 99.4%。Frail-PPS（0.56 至 0.75）、FAM（0.58 至 0.70）和 ISAR-HP（0.71 至 0.77）对三种结局的曲线下面积值均为中度。