Nagae Masaaki, Umegaki Hiroyuki, Nakashima Hirotaka, Nishiuchi Tatsuya
Department of Emergency Room and General Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan; Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan, Institute of Innovation for Future Society, Nagoya University, Nagoya, Japan.
Arch Gerontol Geriatr. 2025 Feb;129:105649. doi: 10.1016/j.archger.2024.105649. Epub 2024 Oct 1.
The emergency department is treating a growing number of older patients with frailty, which has been linked to poorer outcomes. Urgency is generally emphasized in the emergency department based on indicators such as triage scores and early warning scores for decision-making. However, this approach may not be sufficient for frail older people. The Frailty Index-laboratory (FI-lab) has been used as a simple assessment tool for frailty, but it may also reflect disease severity and predict adverse outcomes in the emergency care setting. Therefore, we aimed to evaluate the association between FI-lab in the emergency room and adverse outcomes during hospitalization through comparison with assessments using triage and early warning scores.
This was a retrospective cohort study conducted in a tertiary hospital. The study included patients aged 65 years or older who were admitted to the general internal medicine ward after being initially evaluated in the emergency department. FI-lab was calculated using 24 laboratory parameters from blood tests. The National Early Warning Score (NEWS), the Japan Triage and Acuity Scale (JTAS), and the modified JTAS were also used as prognostic indicators, and their association with adverse outcomes was compared with that of FI-lab.
In total, 872 patients (mean age, 80.9 years; male, 52.6 %) were analyzed. Patients who died during hospitalization had a higher FI-lab than those who survived. In multiple regression analysis, FI-lab, NEWS, and the modified JTAS were significantly associated with in-hospital death and prolonged length of hospital stay. In contrast, none of these indices were associated with in-hospital falls. The FI-lab was independently associated with the likelihood of discharge to home.
FI-lab evaluated in the emergency department reflected the severity of illness in acutely hospitalized older adults, similarly to NEWS and JTAS, and was a useful indicator for predicting adverse outcomes. These results may indicate the value of FI-lab for older adults in the acute care setting.
急诊科正在治疗越来越多的体弱老年患者，而体弱与较差的预后相关。基于分诊分数和早期预警分数等指标，急诊科在决策时通常强调紧迫性。然而，这种方法可能对体弱的老年人并不足够。衰弱指数-实验室（FI-lab）已被用作一种简单的衰弱评估工具，但它也可能反映疾病严重程度并预测急诊护理环境中的不良结局。因此，我们旨在通过与使用分诊和早期预警分数的评估进行比较，来评估急诊室中的FI-lab与住院期间不良结局之间的关联。
这是一项在三级医院进行的回顾性队列研究。该研究纳入了65岁及以上的患者，这些患者在急诊科经过初步评估后被收入普通内科病房。FI-lab通过血液检测的24项实验室参数计算得出。国家早期预警分数（NEWS）、日本分诊与 acuity 量表（JTAS）以及改良的JTAS也被用作预后指标，并将它们与不良结局的关联与FI-lab的关联进行比较。
总共分析了872例患者（平均年龄80.9岁；男性占52.6%）。住院期间死亡的患者FI-lab高于存活患者。在多元回归分析中，FI-lab、NEWS和改良的JTAS与住院死亡和住院时间延长显著相关。相比之下，这些指标均与住院期间跌倒无关。FI-lab与出院回家的可能性独立相关。
在急诊科评估的FI-lab与NEWS和JTAS类似，反映了急性住院老年人的疾病严重程度，并且是预测不良结局的有用指标。这些结果可能表明FI-lab在急性护理环境中对老年人的价值。
