评估在急诊科就诊的老年低视力患者中，将虚弱程度纳入分诊评估的预后价值。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-06-01 DOI:10.1016/j.jemermed.2024.12.005

Gamze Nur Taş MD, Murat Pekdemir MD, İbrahim Ulaş Özturan MD, Nurettin Özgür Doğan MD, Elif Yaka MD, Serkan Yılmaz MD

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引用次数: 0

摘要

背景：在急诊科（ED）就诊的老年患者中，虚弱与不良健康结果相关。评估到急诊科就诊的老年人的虚弱，以及分诊，可以预测不良的健康结果。目的：本研究的目的是探讨弱视分诊水平低的患者在分诊评估中加入虚弱评估的预后表现。方法：这是一项于2022年11月至2023年8月进行的单中心前瞻性队列研究。年龄≥65岁的急诊科住院患者分为紧急和非紧急分类。采用临床虚弱量表对患者的虚弱程度进行分级。确定了分诊、虚弱以及分诊和虚弱联合使用在预测30天死亡率、住院、急诊科复诊、重症监护病房（ICU）入院和急诊科处置方面的预后表现。结果：纳入1143例患者，其中急诊分诊837例（73.2%）。体弱患者组618例（54.1%）。在预测30天死亡率时，分诊的相对危险度（RR）为2.22 (95%CI: 1.19-4.15)，灵敏度为86% (95%CI: 76-93)，特异性为28% (95%CI: 35-30)，虚弱的相对危险度（RR）为3.88 (95%CI: 2.20-6.84)，灵敏度为82% (95%CI: 71-89)，特异性为48% (95%CI: 45-51)，分诊和虚弱相结合的相对危险度为7.08 (95%CI: 2.24-22.37)，灵敏度为95% (95%CI: 86-99)，特异性为30% （95%CI: 26-33）。结论：在分诊中加入虚弱评估可以提高在急诊科就诊的低度分诊老年人30天死亡率的预测效果。

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Evaluating the Prognostic Value of Adding Frailty to Triage Assessment in Elderly Patients With Lower Acuity Presentations in the Emergency Department

Background

Frailty is associated with adverse health outcomes in elderly patients presenting to the emergency department (ED). Assessing frailty in the elderly presenting to the ED, alongside triage, can predict adverse health outcomes.

Objectives

The aim of this study was to investigate the prognostic performance of frailty assessment added to triage evaluation in patients with low acuity triage level.

Methods

This was a single-center, prospective cohort study conducted between November 2022 and August 2023. Patients ≥65 years old admitted to ED with urgent and nonurgent triage levels were included. The patients were categorized by triage level and frailty status classified by the Clinical Frailty Scale. The prognostic performance of triage, frailty, and the combined use of triage and frailty in predicting 30-day mortality, hospitalization, ED revisit, intensive care unit (ICU) admission, and ED disposition were determined.

Results

The study included 1143 patients, of whom 837 (73.2%) were in the urgent triage category. There were 618 (54.1%) in the frail patient group. In predicting 30-day mortality, triage had a relative risk (RR) of 2.22 (95% CI: 1.19–4.15), sensitivity 86% (95% CI: 76–93), specificity 28% (95% CI: 35–30), frailty had an RR of 3.88 (95% CI: 2.20–6.84), sensitivity 82% (95% CI: 71–89), specificity, 48% (95% CI: 45–51), and combined triage and frailty these values were RR 7.08 (95%CI: 2.24–22.37), sensitivity 95% (95% CI: 86–99), specificity 30% (95% CI: 26–33).

Conclusion

Adding assessment of frailty to triage may enhance the prognostic performance in predicting 30-day mortality among older adults presenting to the ED with lower acuity triage level.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine