Study objective

Older adults presenting to the emergency department (ED) are at high risk of adverse health outcomes. This study aimed to evaluate the accuracy of 4 frequently used screening instruments for the prediction of adverse health outcomes among older adults in the ED.

Methods

This was a prospective cohort study in patients ≥70 years of age presenting to the ED in 2 hospitals in the Netherlands. Screening instruments included the acutely presenting older patient screening program (APOP) (providing 2 risk scores—functional decline [APOP1] and mortality [APOP2]), the International Resident Assessment Instrument Emergendy Department screener (InterRAI ED), the Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP), and the safety management system (VMS). The primary outcome measure was a composite outcome encompassing functional decline, institutionalization, and mortality at 3 months after ED presentation. Other follow-up time points were 1 and 6 months. Analyses were performed to assess prognostic accuracy.

Results

In total, 889 patients were included. After 3 months, 267 (31%) patients experienced at least 1 adverse outcome. The positive likelihood ratio ranged from 1.67 (VMS) to 3.33 (APOP1), and the negative likelihood ratio ranged from 0.41 (ISAR-HP) to 0.88 (APOP2). Sensitivity ranged from 17% (APOP2) to 74% (ISAR-HP), and specificity ranged from 63% (ISAR-HP) to 94% (APOP2). The area under the curve ranged from 0.62 (APOP2) to 0.72 (APOP1 and ISAR-HP). Calibration was reasonable for APOP1 and VMS. The prognostic accuracy was comparable across all outcomes and at all follow-up time points.

Conclusion

The frailty screening instruments assessed in this study showed poor to moderate prognostic accuracy, which brings into question their usability in the prediction of adverse health outcomes among older adults who present to the ED.

中文翻译：

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四种常用的虚弱仪器在两个荷兰急诊室预测老年人不良健康结果的准确性：AmsterGEM 研究的结果

学习目标

到急诊科 (ED) 就诊的老年人处于不良健康结果的高风险中。本研究旨在评估 4 种常用筛查工具在预测急诊部老年人不良健康结果方面的准确性。

方法

这是一项前瞻性队列研究，对象为在荷兰 2 家医院就诊的 70 岁以上患者。筛查工具包括急性表现老年患者筛查计划 (APOP)（提供 2 个风险评分——功能下降 [APOP1] 和死亡率 [APOP2]）、国际居民评估工具急诊科筛查器 (InterRAI ED)、高危老年人识别- 住院患者 (ISAR-HP) 和安全管理系统 (VMS)。主要结局指标是综合结局，包括 ED 出现后 3 个月时的功能下降、住院治疗和死亡率。其他随访时间点为 1 个月和 6 个月。进行分析以评估预后准确性。

结果

总共包括889名患者。3 个月后，267 名 (31%) 患者经历了至少 1 种不良结果。正似然比范围从 1.67 (VMS) 到 3.33 (APOP1)，负似然比范围从 0.41 (ISAR-HP) 到 0.88 (APOP2)。灵敏度范围从 17% (APOP2) 到 74% (ISAR-HP)，特异性范围从 63% (ISAR-HP) 到 94% (APOP2)。曲线下面积从 0.62 (APOP2) 到 0.72 (APOP1 和 ISAR-HP)。APOP1 和 VMS 的校准是合理的。所有结果和所有随访时间点的预后准确性均具有可比性。

结论

本研究中评估的虚弱筛查工具显示出较差到中等的预后准确性，这使得它们在预测出现在 ED 的老年人中的不良健康结果方面的可用性受到质疑。