利用扩展的即时检测在有急性疾病迹象的老年患者家中进行评估，以改善诊断：一项前瞻性观察性非随机试点和可行性研究。

Improving diagnostics using extended point-of-care testing during in-home assessments of older adults with signs of emerging acute disease: a prospective observational non-randomised pilot and feasibility study.

机构信息

Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.

Department of Clinical Research, University of Southern Denmark, Kløvervænget 2D, Indgang 112, 7. Sal, Odense, 5000, Denmark.

出版信息

BMC Geriatr. 2024 Apr 25;24(1):373. doi: 10.1186/s12877-024-04914-5.

DOI:10.1186/s12877-024-04914-5

PMID:38664633

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11046810/

Abstract

BACKGROUND

Delayed recognition of acute disease among older adults hinders timely management and increases the risk of hospital admission. Point-of-Care testing, including Focused Lung Ultrasound (FLUS) and in-home analysis of biological material, may support clinical decision-making in suspected acute respiratory disease. The aim of this study was to pilot test the study design for a planned randomised trial, investigate whether in-home extended use of point-of-care testing is feasible, and explore its' potential clinical impact.

METHODS

A non-randomised pilot and feasibility study was conducted during September-November 2021 in Kolding Municipality, Denmark. A FLUS-trained physician accompanied an acute community nurse on home-visits to citizens aged 65 + y with signs of acute respiratory disease. The acute community nurses did a clinical assessment (vital signs, capillary C-reactive protein and haemoglobin) and gave a presumptive diagnosis. Subsequently, the physician performed FLUS, venipuncture with bedside analysis (electrolytes, creatinine, white blood cell differential count), nasopharyngeal swab (PCR for upper respiratory pathogens), and urine samples (flow-cytometry). Primary outcomes were feasibility of study design and extended point-of-care testing; secondary outcome was the potential clinical impact of extended point-of-care testing.

RESULTS

One hundred consecutive individuals were included. Average age was 81.6 (SD ± 8.4). Feasibility of study design was acceptable, FLUS 100%, blood-analyses 81%, PCR for upper respiratory pathogens 79%, and urine flow-cytometry 4%. In addition to the acute community nurse's presumptive diagnosis, extended point-of-care testing identified 34 individuals with a condition in need of further evaluation by a physician.

CONCLUSION

Overall, in-home assessments with extended point-of-care testing are feasible and may aid to identify and handle acute diseases in older adults.

摘要

背景

老年人对急性疾病的认识延迟会阻碍及时的管理，并增加住院的风险。即时检测，包括焦点式肺部超声（FLUS）和对生物材料的家庭分析，可能支持疑似急性呼吸道疾病的临床决策。本研究的目的是对计划中的随机试验进行研究设计的试点测试，调查家庭中是否可以延长使用即时检测，以及探索其潜在的临床影响。

方法

2021 年 9 月至 11 月，在丹麦科灵市进行了一项非随机的试点和可行性研究。一名经过 FLUS 培训的医生陪同急性社区护士对有急性呼吸道疾病迹象的 65 岁及以上的公民进行家访。急性社区护士进行临床评估（生命体征、毛细血管 C 反应蛋白和血红蛋白）并做出初步诊断。随后，医生进行了 FLUS、床边分析的静脉穿刺（电解质、肌酐、白细胞分类计数）、鼻咽拭子（上呼吸道病原体的 PCR）和尿液样本（流式细胞术）。主要结局是研究设计和扩展即时检测的可行性；次要结局是扩展即时检测的潜在临床影响。

结果

共有 100 名连续患者入选。平均年龄为 81.6（标准差±8.4）。研究设计的可行性是可以接受的，FLUS 为 100%，血液分析为 81%，上呼吸道病原体的 PCR 为 79%，尿液流式细胞术为 4%。除了急性社区护士的初步诊断外，扩展即时检测还确定了 34 名有需要进一步由医生评估的疾病患者。