Zaboli Arian, Sibilio Serena, Brigiari Gloria, Massar Magdalena, Parodi Marta, Magnarelli Gabriele, Brigo Francesco, Turcato Gianni
Innovation, Research and Teaching Service, SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy.
Department Public Health, Institute of Nursing Science, Universitat Basel, Basel, Switzerland.
Intern Emerg Med. 2024 Sep 6. doi: 10.1007/s11739-024-03757-7.
Assessing patient frailty during triage evaluations has become increasingly relevant in Emergency Departments (ED). This study aimed to externally validating the Triage Frailty and Comorbidity (TFC) tool. This prospective study was conducted from June 1 to December 31, 2023. During this period, 12 triage nurses applied the TFC tool during triage evaluation of ED patients. We used receiver operating characteristic (ROC) curves and Decision Curve Analysis to assess the predictive ability of the TFC tool for a 90-day mortality (the same endpoint used during tool development) and a 30-day mortality. 1270 patients were included and 56 of them died within 90 days. The TFC tool had an AUROC of 0.894 (0.858-0.929) for 90-day mortality and 0.885 (0.834-0.938) for 30-day mortality. In Decision Curve Analysis, it yielded higher net benefits up to a threshold probability of 0.30. The externally validated TFC tool appears very effective at identifying patients with increased risk of 90-day mortality after ED attendance. It could be implemented in clinical practice and enhance the predictive ability of standard triage systems.
在急诊科(ED)的分诊评估中评估患者的虚弱程度变得越来越重要。本研究旨在对分诊虚弱与合并症(TFC)工具进行外部验证。这项前瞻性研究于2023年6月1日至12月31日进行。在此期间,12名分诊护士在对ED患者进行分诊评估时应用了TFC工具。我们使用受试者操作特征(ROC)曲线和决策曲线分析来评估TFC工具对90天死亡率(工具开发期间使用的相同终点)和30天死亡率的预测能力。共纳入1270例患者,其中56例在90天内死亡。TFC工具对90天死亡率的曲线下面积(AUROC)为0.894(0.858 - 0.929),对30天死亡率的AUROC为0.885(0.834 - 0.938)。在决策曲线分析中,在阈值概率达到0.30之前,它产生了更高的净效益。经过外部验证的TFC工具在识别急诊就诊后90天死亡风险增加的患者方面似乎非常有效。它可以在临床实践中实施,并提高标准分诊系统的预测能力。