Validation of the Frailty-Adjusted Prognosis Tool for 30-Day Mortality in Older Emergency Department Patients

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2025-07-04 DOI:10.1155/ijcp/2048711

A. Z. Szczesna, S. K. Nissen, M. Brabrand, R. Bingisser, C. H. Nickel

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引用次数: 0

Abstract

Aim: Accurate prognostication in the older population in the emergency department (ED) is a crucial but difficult skill. Both frailty and vital signs are independent predictors of mortality, but relying on vital signs alone underestimates risk. The Frailty-adjusted Prognosis tool (FaP-ED) was developed to predict 30-day mortality in older ED patients by combining vital signs with degree of frailty. We aim to validate FaP-ED in an independent ED population for 30-day mortality prediction.

Method: This study is based on a single-centre, observational prospective cohort of undifferentiated consecutive ED patients ≥ 65 years. FaP-ED combines the National Early Warning Score (NEWS) and the Clinical Frailty Scale (CFS) in multivariable logistic regression. We assessed discrimination of FaP-ED with area under the receiver operating characteristic (AUROC) and calibration using slope and intercept.

Results: Among 1166 analysed patients, median age was 78%, and 53.1% were female. In total, 2.7% died within 30 days of presentation to ED. The median NEWS was 1.0 and the median CFS was 3. FaP-ED showed good discrimination with an area under the curve (AUC) of 0.84 in comparison with NEWS (AUC 0.82) and CFS (AUC 0.79) as well as good calibration (slope 1.05; intercept −0.27) compared to NEWS (slope 1.13; intercept −0.24) and CFS (slope 0.95; intercept −0.57).

Conclusion: FaP-ED showed robust prognostic performance in temporal validation, with less biased estimates than NEWS and CFS alone. It could be implemented as an integral adjunct in addition to holistic, pragmatic, patient-centred care of the older population.

Trial Registration: ClinicalTrials.gov identifier: NCT05400707

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高龄急诊科患者30天死亡率虚弱调整预后工具的验证

目的：在急诊科（ED）的老年人群中，准确的预后是一项关键但困难的技能。虚弱和生命体征都是死亡率的独立预测因素，但仅依赖生命体征会低估风险。虚弱调整预后工具（FaP-ED）的开发是通过结合生命体征和虚弱程度来预测老年ED患者的30天死亡率。我们的目标是在独立ED人群中验证FaP-ED对30天死亡率的预测。方法：本研究基于≥65岁未分化连续ED患者的单中心、观察性前瞻性队列研究。FaP-ED在多变量logistic回归中结合了国家预警评分（NEWS）和临床虚弱量表（CFS）。我们用接收器工作特征下面积（AUROC）评估了FaP-ED的鉴别性，并使用斜率和截距进行了校准。结果：1166例患者中位年龄为78%，女性占53.1%。总的来说，2.7%的患者在接受ED治疗后30天内死亡。中位NEWS为1.0，中位CFS为3。与NEWS （AUC 0.82）和CFS （AUC 0.79）相比，FaP-ED具有良好的识别能力，曲线下面积（AUC）为0.84，校准效果良好(斜率1.05；截距- 0.27)，与NEWS(斜率1.13；截距−0.24)和CFS(斜率0.95；拦截−0.57)。结论：FaP-ED在时间验证中表现出强大的预后表现，与单独NEWS和CFS相比，其估计偏差较小。除了对老年人口进行全面、务实、以病人为中心的护理之外，还可以把它作为一个整体的辅助措施加以实施。试验注册：ClinicalTrials.gov标识符：NCT05400707

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来源期刊

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.