Mohamed Abdirahman, McCormack Claire, Sooknarine-Rajpatty Aditi, Barry Louise, Gabr Ahmed, Leahy Aoife, Carroll Ida, Cunnigham Nora, Prendiville Tadhg, Shanahan Elaine, Higginbotham Owen, Hembrecht Sandra, Walsh Mary, Barry Kevin, O'Connor Margaret, Galvin Rose
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.
BMC Geriatr. 2025 Jun 9;25(1):420. doi: 10.1186/s12877-025-06094-2.
Frailty is associated with adverse outcomes in older adults across healthcare settings. Frailty screening tools can serve to identify older adults living with frailty and direct resources to high-risk older adults. This systematic review and meta-analysis examined the diagnostic and predictive accuracy of the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7) frailty screening tool.
A systematic literature search was conducted in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library. Prospective or retrospective cohort and cross-sectional studies that explored the diagnostic and/or predictive accuracy of the PRISMA-7 tool in older adults were included across all healthcare settings. Study quality was assessed using the QUADAS-2 tool. Statistical analysis was completed using Stata version 12 (StataCorp, TX, USA). A bivariate random effects model was used to generate pooled estimates of sensitivity and specificity. RevMan5 was used to pool data comparing older adults living with frailty versus those without frailty.
Thirty-six studies were included in the review. The overall quality of the studies included was moderate. Meta-analysis of diagnostic accuracy (regardless of reference standard used) showed a pooled sensitivity and specificity of 72% (95% CI 54-84%) and 87% (95% CI 76-93%), respectively. Sub-analysis of the six studies that used Frailty Phenotype as a reference standard demonstrated pooled sensitivity and specificity of 82% (95% CI 73.8-88.2) and 79% (95% CI 72-85.6%), respectively. Meta-analysis of the predictive accuracy of the PRISMA-7 showed that older adults living with frailty spent significantly more time in the emergency department (FEM MD 2.66 h, 95% CI 2.15-3.16 h, I = 25%) and stayed longer in hospital, (REM MD 1.89 days, 95% CI 0.18-3.6 days, I = 86%), respectively.
The PRISMA-7 has a moderate sensitivity and high specificity for frailty identification. It has good predictive accuracy for multiple adverse outcomes among older adults, supporting its potential utilization across healthcare settings.
在各类医疗环境中，衰弱与老年人的不良结局相关。衰弱筛查工具可用于识别衰弱的老年人，并将资源导向高危老年人。本系统评价和荟萃分析考察了整合维持自主性服务研究项目7（PRISMA - 7）衰弱筛查工具的诊断和预测准确性。
在PubMed、EMBASE、CINAHL、EBSCO和Cochrane图书馆进行系统文献检索。纳入所有医疗环境中探讨PRISMA - 7工具在老年人中的诊断和/或预测准确性的前瞻性或回顾性队列研究及横断面研究。使用QUADAS - 2工具评估研究质量。使用Stata 12版本（美国德克萨斯州StataCorp公司）完成统计分析。采用双变量随机效应模型生成敏感性和特异性的合并估计值。使用RevMan5汇总比较衰弱老年人与非衰弱老年人的数据。
本评价纳入36项研究。纳入研究的总体质量中等。诊断准确性的荟萃分析（无论使用何种参考标准）显示，合并敏感性和特异性分别为72%（95%可信区间54 - 84%）和87%（95%可信区间76 - 93%）。以衰弱表型作为参考标准的6项研究的亚组分析显示，合并敏感性和特异性分别为82%（95%可信区间73.8 - 88.2）和79%（95%可信区间72 - 85.6%）。PRISMA - 7预测准确性的荟萃分析表明，衰弱老年人在急诊科停留的时间显著更长（固定效应模型均数差2.66小时，95%可信区间2.15 - 3.16小时，I² = 25%），住院时间也更长（随机效应模型均数差1.89天，95%可信区间0.18 - 3.6天，I² = 86%）。
PRISMA - 7在识别衰弱方面具有中等敏感性和高特异性。它对老年人的多种不良结局具有良好的预测准确性，支持其在各类医疗环境中的潜在应用。
