Wang Gui-Qun, Gao Yong-Li, Deng Peng
Department of Emergency Medicine, West China Hospital, Sichuan University, China.
Department of Emergency Medicine, West China Hospital, Sichuan University, China.
Am J Emerg Med. 2023 Nov;73:131-136. doi: 10.1016/j.ajem.2023.08.030. Epub 2023 Aug 24.
Older patients arrive at the emergency department (ED) with complex medical challenges, and the current ED triage models frequently undertriage the severity of illness in older adults. There is increasing awareness regarding the importance of identifying frailty in older patients in the context of urgent care. Therefore, this study aimed to assess the predictive accuracy of the seven-question tool of the Program on Research for Integrating Services of the Maintenance of Autonomy (PRISMA-7) in the ED for 28-day mortality among older adults.
A prospective polycentric observational study.
West China Hospital of Sichuan University, Shangjinnanfu of West China Hospital, and People's Hospital of Henan Province.
ED patients aged ≥65 years from the three tertiary care centers over an 8-week period.
The primary outcome, 28-day all-cause mortality, was investigated using a Cox proportional hazards regression model to assess the predictive validity. The secondary endpoints, intensive care unit (ICU) transfer was investigated using multivariable logistic regression, compared with trained study assistants.
The final study population comprised 1043 consecutive patients aged ≥65 years. The area under the receiver operating characteristic (ROC) curve (AUC) for 28-day mortality was 0.80 (95% confidence interval [CI]: 0.76-0.84), 0.73 (95% CI: 0.68-0.77), and 0.78 (95% CI: 0.73-0.83) for PRISMA-7, Emergency Severity Index (ESI), and quick Sepsis Related Organ Failure Assessment (qSOFA), respectively.There was no difference in the AUC between PRISMA-7 and qSOFA(p = 0.374).The AUC for ICU admission was 0.78 (95% CI: 0.75-0.80), 0.62 (95% CI: 0.59-0.66), and 0.68 (95% CI: 0.64-0.72) for PRISMA-7, ESI, and qSOFA, respectively.The AUC for ICU admission between PRISMA-7 and ESI(p<0.001), PRISMA-7 and qSOFA(p<0.001), qSOFA and ESI(p = 0.005) was statistically significant.
Our findings reveal that PRISMA-7 improves the prediction of ICU admission, but there is no significant difference when it comes to all-cause mortality. PRISMA-7 appears to be a reliable and valid instrument for identifying frailty in the ED.
ChiCTR2100046545.
老年患者到急诊科就诊时面临复杂的医疗挑战，而目前的急诊科分诊模式常常对老年患者的疾病严重程度分诊不足。在紧急护理背景下，人们越来越意识到识别老年患者虚弱状态的重要性。因此，本研究旨在评估自主性维持综合服务研究项目（PRISMA - 7）的七问工具在急诊科对老年患者28天死亡率的预测准确性。
一项前瞻性多中心观察性研究。
四川大学华西医院、华西医院上锦南府院区和河南省人民医院。
来自三个三级医疗中心的年龄≥65岁的急诊科患者，为期8周。
主要结局为28天全因死亡率，采用Cox比例风险回归模型进行调查以评估预测有效性。次要终点为重症监护病房（ICU）转入情况，采用多变量逻辑回归进行调查，并与经过培训的研究助理进行比较。
最终研究人群包括1043例连续的年龄≥65岁的患者。PRISMA - 7、急诊严重程度指数（ESI）和快速脓毒症相关器官功能衰竭评估（qSOFA）对28天死亡率的受试者工作特征（ROC）曲线下面积（AUC）分别为0.80（95%置信区间[CI]：0.76 - 0.84）、0.73（95% CI：0.68 - 0.77）和0.78（95% CI：0.73 - 0.83）。PRISMA - 7和qSOFA的AUC无差异（p = 0.374）。PRISMA - 7、ESI和qSOFA对ICU入院的AUC分别为0.78（95% CI：0.75 - 0.80）、0.62（95% CI：0.59 - 0.66）和0.68（95% CI：0.64 - 0.72）。PRISMA - 7与ESI（p<0.001）、PRISMA - 7与qSOFA（p<0.001）、qSOFA与ESI（p = 0.005）之间ICU入院的AUC差异具有统计学意义。
我们的研究结果表明，PRISMA - 7改善了对ICU入院的预测，但在全因死亡率方面没有显著差异。PRISMA - 7似乎是一种在急诊科识别虚弱状态的可靠且有效的工具。
ChiCTR2100046545。
