The Clinical Frailty Scale offers little utility as part of a prediction model for community-dwelling older fallers at risk of re-presenting to the emergency department.

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care Pub Date : 2024-12-02 DOI:10.1016/j.auec.2024.11.004

Loren Barton, Mark Nelson, Kirsten Strudwick, Corey Scholes

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引用次数: 0

Abstract

Background: There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls' re-presentation in community-dwelling older people.

Methods: A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.

Results: The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.

Conclusions: The CFS cannot be used to prognosticate an individual's risk of ED re-presentation within 6 months of an index extrinsic fall.

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临床虚弱量表作为预测模型的一部分，对社区居住的老年老年人再次出现在急诊科的风险没有多大用处。

背景：目前还没有关于临床虚弱量表（CFS）对急诊科（ED）人群跌倒风险的预测能力的已发表文献。本研究旨在建立一个预后模型，以确定CFS对社区居住老年人ED跌倒再次出现的预测能力。方法：一项回顾性观察队列研究于2019年7月至2022年7月完成，研究对象是75岁及以上的社区居民，他们因外源性跌倒而就诊，并记录了CFS评分。主要结局是与跌倒相关的再次出现ED；次要结局是死亡率。采用随时间变化的灵活参数生存模型，预测6个月内再次跌倒的概率。评估校准并生成决策支持曲线。结果：模型具有合理的大尺度标定（斜率= 0.999），CFS与跌倒再现概率拟合良好。CFS模型在识别有跌倒相关ED在指数表现后6个月内再次表现风险的老年人方面显示出可忽略的判别能力（C-statistic = 0.534）。结论：CFS不能用于预测个体在指数外源性下降后6个月内再次出现ED的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australasian Emergency Care Nursing-Emergency Nursing

CiteScore

3.30

自引率

5.60%

发文量

审稿时长

37 days

期刊介绍： Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.