scholarly journals SPMSQ for risk stratification of older patients in the emergency department

2019 ◽  
Vol 52 (S4) ◽  
pp. 222-228 ◽  
Author(s):  
A. Schönstein ◽  
H.-W. Wahl ◽  
H. A. Katus ◽  
A. Bahrmann
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Risk Stratification ◽  
Predictive Validity ◽  
Older Patients ◽  
Area Under The Curve ◽  
Composite Endpoint ◽  
Adverse Outcomes ◽  
Nursing Home Admission ◽  
Initial Contact

Abstract Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

Comparison of different risk stratification rules to predict short-term adverse outcomes after syncope in older Chinese adults 

2021 ◽  
Author(s):  
Hong Mu ◽  
Jiexin Liu ◽  
Hefei Tang ◽  
Cheng Huang ◽  
Limin Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Risk Stratification ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Likelihood Ratios ◽  
Short Term ◽  
Predictive Values ◽  
Older Chinese

Abstract Background: Older adults with syncope are commonly treated in the emergency department. Clinical decision rules have been developed to assess syncope patients, but there have been no application or comparative studies in older Chinese cohorts until now. This study aimed to compare the values of five existing rules in predicting the short-term adverse outcomes of older patients. Methods: From September 2018 to February 2021, older Chinese patients (≥60 yr) with syncope admitted to our hospital were investigated and evaluated by the Risk Stratification of Syncope in the Emergency Department (ROSE) rule, the San Francisco Syncope Rule (SFSR), the FAINT rule, the Canadian Syncope Risk Score (CSRS) and the Boston Syncope Criteria (BSC). After a one-month follow-up, the sensitivity, specificity, accuracy, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (PLR), and negative likelihood ratios (NLR) of each aforementioned rule were calculated and compared. Results: A total of 171 patients, with a mean age of 75.65±8.26 years and 48.54% male, were analysed in the study. Fifty-eight patients were reported to have experienced short-term adverse incidents during the month. The neurally mediated syncope group showed a significant sex-specific difference in adverse incidences but the cardiac syncope group did not. There were some factors associated with significant differences in adverse incidences, such as a history of hypertension, congestive heart failure, and chronic obstructive pulmonary disorder, as well as the levels of SpO2, B-type natriuretic peptide (BNP) and troponin T (TnT), while the levels of haemoglobin and creatinine suggested potential significance. In order of the ROSE, SFSR, FAINT, CSRS and BSC rules in the analysis, the sensitivities were 81.03%, 77.59%, 93.10%, 74.14% and 94.83%, the specificities were 86.73%, 84.96%, 38.94%, 60.18% and 56.64%, the NPVs were 89.91%, 88.07%, 91.67%, 81.93% and 95.52%, and the NLRs were 0.22, 0.26, 0.18, 0.43 and 0.09, respectively. Conclusions: This study revealed that the five mentioned rules for syncope risk stratification, with their own characteristics, all showed crucial significance for screening older adults. Therefore, physicians in the emergency department should flexibly understand and judge older patients’ potential risks according to the actual clinical situations.

scholarly journals The Diagnostic Role of Uric Acid to Creatinine Ratio for the Identification of Patients with Adverse Pulmonary Embolism Outcomes

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 193
Author(s):  
Konstantinos Bartziokas ◽  
Christos Kyriakopoulos ◽  
Dimitrios Potonos ◽  
Konstantinos Exarchos ◽  
Athena Gogali ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Uric Acid ◽  
Risk Stratification ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Composite Endpoint ◽  
Severity Index ◽  
Pulmonary Angiography ◽  
Adverse Outcomes ◽  
Creatinine Ratio

Background: Uric acid (UA) is the final product of purine metabolism and a marker of oxidative stress that may be involved in the pathophysiology of cardiovascular and thromboembolic disease. The aim of the current study is to investigate the potential value of UA to creatinine ratio (UA/Cr) as a diagnostic tool for the outcome of patients admitted with acute pulmonary embolism (PE) and the correlations with other parameters. Methods: We evaluated 116 patients who were admitted for PE in a respiratory medicine department. PE was confirmed with computed tomography pulmonary angiography. Outcomes evaluated were hospitalization duration, mortality or thrombolysis and a composite endpoint (defined as mortality or thrombolysis). Patients were assessed for PE severity with the PE Severity Index (PESI) and the European Society of Cardiology (ESC) 2019 risk stratification. Results: The median (interquartile range) UA/Cr level was 7.59 (6.3–9.3). UA/Cr was significantly associated with PESI (p < 0.001), simplified PESI (p = 0.019), and ESC 2019 risk stratification (p < 0.001). The area under the curve (AUC) for prediction of 30-day mortality by UA/Cr was 0.793 (95% CI: 0.667–0.918). UA/Cr levels ≥7.64 showed 87% specificity and 94% negative predictive value for mortality. In multivariable analysis UA/Cr was an independent predictor of mortality (HR (95% CI): 1.620 (1.245–2.108), p < 0.001) and composite outcome (HR (95% CI): 1.521 (1.211–1.908), p < 0.001). Patients with elevated UA/Cr levels (≥7.64) had longer hospitalization (median (IQR) 7 (5–11) vs. 6 (5–8) days, p = 0.006)), higher mortality (27.3% vs. 3.2%, p = 0.001) and worse composite endpoint (32.7% vs. 3.4%, p < 0.001). Conclusion: Serum UA/Cr ratio levels at the time of PE diagnosis are associated with disease severity and risk stratification, and may be a useful biomarker for the identification of patients at risk of adverse outcomes.

Assessment of the CHA2DS2-VASc Score in Predicting Mortality and Adverse Cardiovascular Outcomes of Patients on Hemodialysis

2020 ◽  
Vol 51 (8) ◽  
pp. 635-640
Author(s):  
Miri Schamroth Pravda ◽  
Keren Cohen Hagai ◽  
Guy Topaz ◽  
Nili Schamroth Pravda ◽  
Nadeen Makhoul ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
High Mortality ◽  
Medical Center ◽  
Composite Endpoint ◽  
Chronic Hemodialysis ◽  
Adverse Outcomes ◽  
First Year ◽  
Increased Risk

Background: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis are at high mortality and cardiovascular risk. This study was aimed to assess whether the CHA2DS2-VASc score may be used for risk stratification of this population. Methods: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA2DS2-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA2DS2-VASc score: 0–3 (low), 4–5 (intermediate), and ≥6 (high). The primary endpoint was the composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis. Results: Of the 457 patients with ESRD, 181 (40%) had low, 193 (42%) intermediate, and 83 (18%) high CHA2DS2-VASc scores. During the first year of hemodialysis, 109 (23.8%) patients died, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA2DS2-VASc score group, those in the intermediate and high score groups had higher risk for the composite endpoint (OR: 2.6, 95% CI: 1.6–4.2, p < 0.01 and OR: 4.2, 95% CI: 2.3–7.5, p < 0.01, respectively). Each 1-point increase in CHA2DS2-VASc score was associated with a 38% increased risk for the composite endpoint, a 19% increased risk for 1-year myocardial infarction, and a 29% increased risk for 1-year stroke. Conclusions: Patients with ESRD are at an extremely high mortality and cardiovascular risk within the first year of hemodialysis. The CHA2DS2-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.

Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?

2009 ◽  
Vol 22 (2) ◽  
pp. 254-263 ◽  
Author(s):  
Carolyn S. Sterke ◽  
Sawadi L. Huisman ◽  
Ed F. van Beeck ◽  
Caspar W. N. Looman ◽  
Tischa J. M. van der Cammen
Keyword(s):  
Regression Analysis ◽  
Nursing Home ◽  
Predictive Validity ◽  
Nursing Home Residents ◽  
Area Under The Curve ◽  
Short Term ◽  
Severe Dementia ◽  
Mobility Assessment ◽  
Specific Objective

ABSTRACTBackground:The feasibility and predictive validity of balance and gait measures in more severe stages of dementia have been understudied. We evaluated the clinimetric properties of the Tinetti Performance Oriented Mobility Assessment (POMA) in nursing home residents with dementia with a specific objective of predicting falls in the short term.Methods:Seventy-five ambulatory nursing home residents with dementia, mean age 81 ± 8 years, participated in a prospective cohort study. All participants underwent the full POMA-test. Fall statistics were retrieved from incident reports during a three-months follow-up period. The predictive validity was expressed in terms of sensitivity and specificity. Loglinear regression analysis was used to examine the relationship between POMA scores and the occurrence of a fall.Results:The POMA showed several feasibility problems, with 41% of patients having problems in understanding one or more instructions. The inter-rater reliability of the instrument was good. The predictive validity was acceptable, with a sensitivity of 70–85% and a specificity of 51–61% for the POMA and its subtests, and an area under the curve (AUC) of 0.70 for POMA-Total (95% CI: 0.53–0.81), 0.67 for POMA-Balance (95% CI: 0.52–0.81), and 0.67 for POMA-Gait (95% CI: 0.53–0.81). After loglinear regression analysis, only POMA-T was significant in predicting a fall (adjusted HR = 1.08 per point lower; 95% CI 1.00–1.17).Conclusions:Application of the POMA in populations with moderate to severe dementia is hampered by feasibility problems. Its implementation in clinical practice cannot therefore be recommended, despite an acceptable predictive validity. To refine our findings, large prospective studies on the predictive validity of the POMA in populations with mild, moderate and severe dementia are needed. In addition, the performance of mobility assessment methods that are less dependent on cognition should be evaluated.

Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes

2011 ◽  
Vol 7 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Susan N. Hastings ◽  
Amanda Barrett ◽  
Morris Weinberger ◽  
Eugene Z. Oddone ◽  
Luna Ragsdale ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Emergency Department Discharge

O-029: Association of impaired cognition and adverse outcomes in older patients presenting to the emergency department; the APOP study

2015 ◽  
Vol 6 ◽  
pp. S13
Author(s):  
J. Lucke ◽  
J. de Gelder ◽  
B. de Groot ◽  
A.J. Fogteloo ◽  
C. Heringhaus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Impaired Cognition

scholarly journals NUTRITIONAL RISK PREDICTS HEALTH SERVICES UTILIZATION AND DEATH OVER 1 YEAR: RESULTS FROM THE UAB STUDY OF AGING II

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S347-S347
Author(s):  
David R Buys ◽  
Richard E Kennedy ◽  
Yue Zhang ◽  
Julie Locher ◽  
Cynthia J Brown
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Nursing Home ◽  
Health Services ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Nutritional Risk ◽  
Nursing Home Admission ◽  
Services Utilization

Abstract Nutritional risk has been demonstrated to be associated with poor health outcomes, increased risk of health services utilization (HSU), and mortality among older adults. The aim of this study was to assess the prospective relationship between nutritional risk; HSU focusing separately on emergency department visits, hospitalization, and nursing home admission; and mortality. Using the University of Alabama-Birmingham Study of Aging II, we examined this relationship among 419 community-dwelling older Alabamians (75+years). We used the Mini-Nutrition Assessment (MNA), a well-validated nutritional risk assessment, which classifies individuals as either well-nourished, at-risk or malnourished, collected at baseline. We assessed HSU by asking about healthcare encounters since the last monthly follow-up call for 12 months and verified death with family reports and official documents. We completed univariate, bivariate, and Cox proportional hazards regression analyses with one-year of follow-up data, adjusting for social support, social isolation, comorbidities, and demographic variables. Accounting for covariates, being either at-risk or malnourished, relative to well-nourished, was associated with emergency department visits (HR: 1.30, 95% CI:1.14,1.48), hospitalization (HR: 1.58, 95% CI:1.37,1.82), nursing home admission (HR: 8.94, 95% CI:3.99,20.02), and mortality (HR: 1.90, 95% CI:1.25,2.88). These findings underscore the growing awareness that nutritional risk, particularly for older adults, is a significant factor affecting their well-being and particularly their ability to continue living in the community. Nutrition assessment, interventions, and services for community-dwelling older adults may lead to a reduction in health care utilization, particularly nursing home placement, and ultimately to reduced healthcare costs to families and taxpayers.

scholarly journals 296 Risk-prediction in the Emergency Department: Comparing the Accuracy of Short Frailty Screens to Identify Adverse Healthcare Outcomes among Older Adults

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Rónán O'Caoimh
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Risk Prediction ◽  
Predictive Validity ◽  
Nursing Home Admission ◽  
Healthcare Outcomes ◽  
Term Care ◽  
Significant Difference ◽  
One Year

Abstract Background Multiple instruments are available to screen for frailty in the Emergency Department (ED). Despite this, few studies have compared their predictive validity among older adults attending ED. This study aimed to investigate the diagnostic accuracy of a variety of different short frailty and risk-prediction instruments to predict 30-day readmission, length of stay (LOS), one-year mortality and institutionalisation. Methods Consecutive patients aged ≥70 attending a university hospital ED were screened and assessed for frailty. Outcomes were obtained from hospital records. The following instruments were compared: the Clinical Frailty Scale (CFS), PRISMA-7, Identification of Seniors at Risk tool, FRAIL scale, Groningen Frailty Indicator (GFI) and Risk Instrument for Screening in the Community (RISC). Results In all, 193 patients were included, median age 79+/-9; 55% were female. Based upon a CGA, 60% (116/193) were classified as frail. Those identified as frail were significantly older (p=0.03) and reported lower quality of life scores (p<0.001). There was no significant difference in co-morbidity using the Charlson Index (p=0.15). The ED conversion rate was 77%, median LOS 8+/-9 days and 20% were re-admitted within 30 days. At one-year, 13.5% were accepted for long-term care and 17% had died. Comparing instruments, the combined RISC was had the highest accuracy based on the area under the ROC curve (AUC) scores for predicting mortality and nursing home admission at one year, AUC 0.77 (95% CI:0.68-0.87) and 0.73 (95% CI:0.64-0.82), respectively. The GFI, CFS and PRISMA-7 had statistically similar, albeit lower scores. No instrument was accurate in predicting 30-day readmission after discharge (AUC <0.70). Conclusion Short frailty screening instruments applied in ED have poor-modest predictive validity for important healthcare outcomes, particularly hospital re-admission. The RISC score had the highest diagnostic accuracy for institutionalisation and death but this was fair at best, suggesting that instrument selection should be pragmatic with the expectation of identifying frailty.

The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection

2018 ◽  
Vol 35 (10) ◽  
pp. 619-622 ◽  
Author(s):  
Mats Warmerdam ◽  
Lucia Baris ◽  
Margo van Liebergen ◽  
Annemieke Ansems ◽  
Laura Esteve Cuevas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Older Patients ◽  
Tissue Perfusion ◽  
Case Mix ◽  
Suspected Infection ◽  
Resuscitation Guidelines

ObjectiveIn existing risk stratification and resuscitation guidelines for sepsis, a hypotension threshold of systolic blood pressure (SBP) below 90–100 mmHg is typically used. However, for older patients, the clinical relevance of a SBP in a seemingly ‘normal’ range (>100 mmHg) is still poorly understood, as they may need higher SBP for adequate tissue perfusion due to arterial stiffening. We therefore investigated the association between SBP and mortality in older emergency department (ED) patients hospitalised with a suspected infection.MethodsIn this observational multicentre study in the Netherlands, we interrogated an existing prospective database of consecutive ED patients hospitalised with a suspected infection between 2011 and 2016. We investigated the association between SBP categories (≤100, 101–120, 121–139, ≥140 mmHg) and in-hospital mortality in patients of 70 years and older. We adjusted for demographics, comorbidity, disease severity and admission to ward/intensive care using multivariable logistic regression.ResultsIn the 833 included older patients, unadjusted in-hospital mortality increased from 4.7% (n=359) in SBP ≥140 mmHg to 20.8% (n=96) in SBP ≤100 mmHg. SBP categories were linearly associated with case-mix-adjusted in-hospital mortality. The adjusted ORs (95% CI) for ≤100, 101–120 and 121–139 mmHgcompared with the reference of ≥140 mmHg were 3.8 (1.8 to 7.8), 2.8 (1.4 to 5.5) and 1.9 (0.9 to 3.7), respectively.ConclusionIn older ED patients hospitalised with a suspected infection, we found an inverse linear association between SBP and case-mix-adjusted in-hospital mortality. Our data suggest that the commonly used threshold for hypotension is not clinically meaningful for risk stratification of older ED patients with a suspected infection.

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