Pontificia Universidad Javeriana, Facultad de Medicina, Instituto de Envejecimiento, Bogotá, Colombia.
Pontificia Universidad Javeriana, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia.
Colomb Med (Cali). 2023 Mar 30;54(1):e2005304. doi: 10.25100/cm.v54i1.5304. eCollection 2023 Jan-Mar.
Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge.
This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia.
This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales.
Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60.
This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.
因急性疾病住院的老年人在住院期间和出院后发生医院相关性功能下降的风险更高。
本研究旨在评估医院入院风险谱（HARP）和老年人风险识别（ISAR）量表作为预测哥伦比亚老年急性护理病房患者出院时与医院相关的功能下降的能力，这些患者年龄均在 65 岁以上。
这是对 ISAR 和 HARP 预测模型在老年急性护理病房管理的 65 岁以上患者队列中的外部验证。该研究纳入了入院和出院时测量巴氏指数的患者。评估了两个基本方面：量表的区分能力和校准能力。
在评估的 833 名患者中，有 363 名（43.6%）在出院时出现与医院相关的功能下降。HARP 低估了低风险和中风险类别的患者发生与医院相关的功能下降的风险（观察到的/预期的事件比（ROE）分别为 1.82 和 1.51）。HARP 高估了高风险类别的患者发生与医院相关的功能下降的风险（ROE 为 0.91）。ISAR 低估了低风险和高风险类别的患者发生与医院相关的功能下降的风险（ROE 为 1.59 和 1.11）。两个量表的区分能力都较差，曲线下面积（AUC）在 0.55 到 0.60 之间。
本研究发现，HARP 和 ISAR 量表在预测出院时的 HAFD 方面的区分能力有限。HARP 和 ISAR 量表在哥伦比亚人群中应谨慎使用，因为它们低估了与医院相关的功能下降的风险，并且区分能力较低。
