Mowbray Fabrice I, Heckman George, Hirdes John P, Costa Andrew P, Beauchet Olivier, Eagles Debra, Perry Jeffrey J, Sinha Samir, Archambault Patrick, Wang Hanting, Jantzi Michaela, Hebert Paul
Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.
School of Public Health Science University of Waterloo Waterloo Ontario Canada.
J Am Coll Emerg Physicians Open. 2023 Jan 13;4(1):e12876. doi: 10.1002/emp2.12876. eCollection 2023 Feb.
We set out to determine the accuracy of the interRAI Emergency Department (ED) Screener in predicting the need for detailed geriatric assessment in the ED. Our secondary objective was to determine the discriminative ability of the interRAI ED Screener for predicting the odds of discharge home and extended ED length of stay (>24 hours).
We conducted a multiprovince prospective cohort study in Canada. The need for detailed geriatric assessment was determined using the interRAI ED Screener and the interRAI ED Contact Assessment as the reference standard. A score of ≥5 was used to classify high-risk patients. Assessments were conducted by emergency and research nurses. We calculated the sensitivity, positive predictive value, and false discovery rate of the interRAI ED Screener. We employed logistic regression to predict ED outcomes while adjusting for age, sex, academic status, and the province of care.
A total of 5629 older ED patients across 11 ED sites were evaluated using the interRAI ED Screener and 1061 were evaluated with the interRAI ED Contact Assessment. Approximately one-third of patients were discharged home or experienced an extended ED length of stay. The interRAI ED Screener had a sensitivity of 93%, a positive predictive value of 82%, and a false discovery rate of 18%. The interRAI ED Screener predicted discharge home and extended ED length of stay with fair accuracy.
The interRAI ED Screener is able to accurately and rapidly identify individuals with medical complexity. The interRAI ED Screener predicts patient-important health outcomes in older ED patients, highlighting its value for vulnerability screening.
我们旨在确定interRAI急诊科筛查工具在预测急诊科详细老年评估需求方面的准确性。我们的次要目标是确定interRAI急诊科筛查工具在预测出院回家几率和急诊科延长住院时间（>24小时）方面的判别能力。
我们在加拿大进行了一项多省份前瞻性队列研究。使用interRAI急诊科筛查工具并以interRAI急诊科接触评估作为参考标准来确定详细老年评估的需求。≥5分用于对高危患者进行分类。评估由急诊和研究护士进行。我们计算了interRAI急诊科筛查工具的敏感性、阳性预测值和假发现率。我们采用逻辑回归来预测急诊科结局，同时对年龄、性别、学术地位和护理省份进行调整。
在11个急诊科站点对总共5629名老年急诊患者使用interRAI急诊科筛查工具进行了评估，1061名患者使用interRAI急诊科接触评估进行了评估。大约三分之一的患者出院回家或经历了急诊科延长住院时间。interRAI急诊科筛查工具的敏感性为93%，阳性预测值为82%，假发现率为18%。interRAI急诊科筛查工具对出院回家和急诊科延长住院时间的预测准确性尚可。
interRAI急诊科筛查工具能够准确、快速地识别患有复杂疾病的个体。interRAI急诊科筛查工具可预测老年急诊患者重要的健康结局，凸显了其在脆弱性筛查方面的价值。
