Emergency Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
BMC Geriatr. 2024 Sep 14;24(1):758. doi: 10.1186/s12877-024-05346-x.
Emergency physicians are always faced with the challenge of choosing the appropriate disposition for elderly patients in order to ensure an acceptable care plan and effective use of resources. A clinical decision rule, Geriatric Fever Score (GFS) has been proposed but not validated to help ED physicians with decision-making. This rule employs leukocytosis, severe coma, and thrombocytopenia as predictors of 30-day mortality. Through our study determines the performance of this clinical prediction rule in a prospective study in a setting different from where it was developed.
In this prospective cohort study in a 1200-bed tertiary care, patients older than 65 years old who visited the ED with fever were enrolled. All elements of the rule were collected and the total score was calculated for each patient. Patients were also categorized as low risk (score 0-1) or high risk (score ≥ 2). Thirty-day follow-up was performed to determine the patient outcome (survival or mortality).
A total of 296 patients were included in our final analysis. The mortality rate was 33.1% for patients with a Score of 0, 42.1% for a score of 1, 57.1% for a score of 2, and 100% for a score of 3. When divided into two risk groups, patients' mortality rates were as follows: low risk group 37.9% and high-risk group 40.5%.
Our study showed that elderly patients who present to ED with fever and have a score of 2 or higher on the Geriatric Fever Score are at higher risk of mortality at 30 days.
为了确保可接受的护理计划和资源的有效利用，急诊医师经常面临为老年患者选择适当处置方法的挑战。已经提出了一种临床决策规则，即老年发热评分（GFS），但尚未对其进行验证以帮助 ED 医师进行决策。该规则使用白细胞增多、严重昏迷和血小板减少症作为 30 天死亡率的预测指标。通过我们的研究，确定了在与制定该规则的地点不同的环境中进行前瞻性研究时，该临床预测规则的表现。
在这项针对 1200 张病床的三级保健急诊 65 岁以上发热患者的前瞻性队列研究中，招募了前往 ED 的患者。收集了规则的所有要素，并为每位患者计算了总评分。患者还分为低危（评分 0-1）或高危（评分≥2）。进行 30 天随访以确定患者结局（存活或死亡）。
共有 296 例患者纳入我们的最终分析。评分 0 分患者的死亡率为 33.1%，评分 1 分患者的死亡率为 42.1%，评分 2 分患者的死亡率为 57.1%，评分 3 分患者的死亡率为 100%。当分为两个风险组时，患者的死亡率如下：低危组为 37.9%，高危组为 40.5%。
我们的研究表明，因发热而到 ED 就诊且老年发热评分达到 2 分或更高的老年患者在 30 天时的死亡率更高。
