急诊科老年患者的复诊和虚弱状况——一项前瞻性观察性多中心研究。

Revisits and frailty in older patients in the emergency department - a prospective observational multicenter study.

机构信息

Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

Falck Emergency Östergötland, Linköping, Sweden.

出版信息

BMC Emerg Med. 2024 Oct 29;24(1):205. doi: 10.1186/s12873-024-01123-6.

DOI:10.1186/s12873-024-01123-6

PMID:39468432

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11520878/

Abstract

BACKGROUND

An increased number of revisits may signal that the immediate medical needs of patients seeking care at Emergency Departments (EDs) are not being met. The prevalence and characteristics of revisits to the EDs in Sweden among older patients, and its association to frailty, are unknown. We aimed to investigate the prevalence of ED revisits among patients over 65 years of age, living with or without frailty, and its association with rate of admission, and mortality; in the Swedish ED setting.

METHODS

This was a prospective, multicentre study of patients over 65 years of age with an index visit to one of three Swedish EDs during May-Nov 2021. Frailty was assessed in conjunction with standard triage, using the 9-level Clinical Frailty Scale (CFS) with a CFS score of 5 to 8 as cut-off for identifying frailty. For all patients who made a revisit within 90 days of their index visit, we collected information about the revisit, admission, and mortality.

RESULTS

A total of 1835 patients made an index visit which were included, and out of those, 595 patients made a revisit within 90 days of the index visit. Patients living with frailty (CFS 5 to 8) were more likely to make a revisit to the ED at 8 to 30 days (17% vs. 11%, diff 6%, 95% CI 2-10%, p < 0.001) and at 31 to 90 days (19% vs. 12%, diff 7%, 95% CI 3-10%, p < 0.001) and be admitted to in-hospital care during their revisit (57% vs. 47%, diff 10%, 95% CI, 1-18%, p < 0.05), compared to patients living without frailty. Results also show that patients living with frailty had a higher overall mortality rate (17% vs. 5%, diff 12%, 95% CI 7-18%, p < 0.001). However, among patients living without frailty, making a revisit slightly increased the mortality rate compared to those who did not (5% vs. 2%, diff 3%, 95% CI 1-10%, p < 0.05).

CONCLUSIONS

Patients living with frailty make more revisits, are more often admitted to in-hospital care, and have a higher overall mortality rate than patients not living with frailty. Frailty, assessed with the CFS may be a simple and useful indicator of increased risk of adverse events, including revisits, in the ED.

摘要

背景

就诊于急诊科（ED）的患者复诊次数增加可能表明他们的即时医疗需求未得到满足。瑞典老年患者 ED 复诊的发生率及其与虚弱的关系尚不清楚。本研究旨在调查瑞典年龄在 65 岁以上、有或无虚弱的患者的 ED 复诊发生率，并分析其与住院率和死亡率的关系。

方法

这是一项前瞻性、多中心研究，纳入了 2021 年 5 月至 11 月期间在瑞典 3 家 ED 就诊的年龄在 65 岁以上的患者。采用 9 级临床虚弱量表（CFS）结合标准分诊评估虚弱，以 CFS 评分为 5 至 8 作为识别虚弱的切点。对于所有在就诊后 90 天内复诊的患者，我们收集了其复诊、住院和死亡信息。

结果

共纳入 1835 例就诊患者，其中 595 例在就诊后 90 天内复诊。患有虚弱（CFS 5 至 8）的患者在就诊后 8 至 30 天（17%比 11%，差异 6%，95%CI 2%至 10%，p<0.001）和就诊后 31 至 90 天（19%比 12%，差异 7%，95%CI 3%至 10%，p<0.001）更有可能再次就诊于 ED，且在复诊时更有可能接受住院治疗（57%比 47%，差异 10%，95%CI 1%至 18%，p<0.05），而与无虚弱的患者相比。结果还表明，患有虚弱的患者总体死亡率更高（17%比 5%，差异 12%，95%CI 7%至 18%，p<0.001）。然而，与无虚弱的患者相比，有虚弱的患者在复诊时死亡率略有增加（5%比 2%，差异 3%，95%CI 1%至 10%，p<0.05）。