Background

Frailty is considered an emerging syndrome characterized by a decrease in physiological ability to respond to stressors, leading to increased morbidity and mortality rates. Frailty is distinguished from normal age-associated decline because it is a sharp and often rapid decline rather than a gradual slowing down of general functioning. The comprehensive geriatric assessment is currently considered the gold standard for identifying frailty in older adults. The electronic version of this tool is called the eCGA and is commonly included in electronic medical records (EMR) in primary care settings.

Objectives

We explored the adequacy of SNOMED CT to represent frailty concepts by addressing three research questions: 1) What are the defining characteristics of frailty most commonly used in frailty assessment tools? 2) Are these characteristics captured within one or many frailty assessment tools? 3) Which data elements from existing tool(s) can be reliably mapped to existing SNOMED CT terms?

Methods

We conducted a literature search to explore the defining characteristics of frailty and the most commonly used assessment tools. We compared these findings to the components of frailty captured within the eCGA. We then used a descriptive study design to manually map concepts from the eCGA to SNOMED CT.

Results

Our literature review demonstrated that the eCGA contains all common defining characteristics of frailty. Unique assessment questions from the eCGA (n = 133) were manually mapped to SNOMED CT, using expert consensus. Of these, 72 % were direct matches, 17 % were one-to-many matches, and the remaining 11 % were non-matches. Two rounds of expert clinician mapping occurred; inter-rater reliability between the two clinicians was 0.75 (kappa).

Conclusions/Implications

The resulting list of mapped eCGA elements to SNOMED CT terms can inform revisions to existing chronic disease databases to include frailty monitoring and surveillance.

中文翻译：

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将脆弱的概念映射到SNOMED CT

背景

体弱被认为是一种新兴综合征，其特征在于对应激源的生理反应能力降低，从而导致发病率和死亡率增加。衰弱不同于正常的与年龄相关的衰弱，因为衰弱是急剧且通常是迅速的衰弱，而不是总体功能的逐渐减慢。目前，综合的老年医学评估被认为是识别老年人体弱的黄金标准。此工具的电子版本称为eCGA，通常包含在基层医疗机构的电子病历（EMR）中。

目标

通过解决三个研究问题，我们探索了SNOMED CT是否足以代表脆弱性概念：1）脆弱性评估工具中最常使用的脆弱性的定义特征是什么？2）是否在一种或多种脆弱性评估工具中体现了这些特征？3）现有工具中的哪些数据元素可以可靠地映射到现有SNOMED CT术语？

方法

我们进行了文献检索，以探索脆弱性的定义特征和最常用的评估工具。我们将这些发现与eCGA中捕获的虚弱部分进行了比较。然后，我们使用描述性研究设计来手动将概念从eCGA映射到SNOMED CT。

结果

我们的文献综述表明，eCGA包含脆弱的所有常见定义特征。使用专家共识，将来自eCGA（n = 133）的独特评估问题手动映射到SNOMED CT。其中72％为直接比赛，17％为一对多比赛，其余11％为不比赛。进行了两轮专家临床医生制图；两位临床医生之间的评分者间信度为0.75（kappa）。

结论/含义

将eCGA元素映射到SNOMED CT术语的结果列表可以为现有慢性疾病数据库的修订提供信息，以包括脆弱性监测和监视。