Background

Older adults are the most frequent users of emergency services. Comprehensive geriatric assessment (CGA) can help identify high-risk older adults at an early stage. We conducted a systematic review and meta-analysis to identify and evaluate CGA tools used in the emergency department (ED), analyze their predictive validity for adverse outcomes and recommend tools for this particular situation.

Methods

We systematically searched Medline, Web of Science and CENTRAL for eligible articles published in peer-reviewed journals that observed patients ≥65 years admitted to the ED, used at least one assessment tool and reported adverse outcomes of interest. We performed a descriptive analysis and a bivariate meta-analysis of the diagnostic accuracy and predictive validity of the assessment tools for the chosen adverse outcomes.

Results

28 eligible studies were included. The pooled sensitivity (95% CI) of the assessment tools for predicting mortality within short (28–90 days) and long (180–365 days) periods after the first ED visit was 0.77 (0.61–0.89) and 0.79 (0.46–0.96), respectively, with specificity (95% CI) values of 0.45 (0.32–0.59) and 0.37 (0.14–0.65). These findings indicate that the tools used in the included studies had modest predictive accuracy for mortality and were more appropriate for identifying individuals at high risk of readmission in the short term than in the long term.

Conclusions

Early use of assessment tools in the ED might improve clinical decision making and reduce negative outcomes for older adults.

中文翻译：

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急诊科老年患者的老年病评估：系统评价和荟萃分析

背景

老年人是紧急服务的最常使用者。全面的老年医学评估（CGA）有助于在早期阶段识别高危老年人。我们进行了系统的回顾和荟萃分析，以识别和评估急诊科（ED）中使用的CGA工具，分析其对不良后果的预测有效性，并针对这种特殊情况推荐工具。

方法

我们系统地在Medline，Web of Science和CENTRAL中搜索了在同行评审期刊上发表的符合条件的文章，这些文章观察了≥65岁的患者被纳入ED，并使用了至少一种评估工具并报告了所关注的不良结果。我们对所选不良结局的评估工具的诊断准确性和预测有效性进行了描述性分析和双因素荟萃分析。

结果

纳入28项合格研究。评估在首次ED就诊后短（28-90天）和长（180-365天）内死亡率的评估工具的综合敏感性（95％CI）为0.77（0.61-0.89）和0.79（0.46-0.96） ）的特异性（95％CI）值分别为0.45（0.32-0.59）和0.37（0.14-0.65）。这些发现表明，所纳入研究中使用的工具对死亡率的预测准确性不高，因此与长期相比，短期内更适合于识别高再入院风险的个体。

结论

在ED中尽早使用评估工具可能会改善临床决策并减少老年人的不良结果。