Frailty and associated prognosis among older emergency department patients with suspected infection: A prospective, observational cohort study

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 687-691 ◽  
Author(s):  
Shannon M. Fernando ◽  
Kevin H. Guo ◽  
Matthew Lukasik ◽  
Bram Rochwerg ◽  
Deborah J. Cook ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Tertiary Care ◽  
Clinical Frailty Scale ◽  
Suspected Infection ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Observational Cohort ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study

ABSTRACTBackgroundPrognosis and disposition among older emergency department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically ill patients; however, its association with clinical outcomes among older ED patients with suspected infection is unknown.MethodsWe conducted a multicenter prospective cohort study at two tertiary care EDs. We included older ED patients (≥75 years) with suspected infection. Frailty at baseline (before index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5–8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty with the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria.ResultsWe enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.08–2.51) and more likely to die within 30 days of ED presentation (aOR 2.05; 95% CI, 1.02–5.24). Sensitivity for mortality was highest among the CFS (73.1%; 95% CI, 52.2–88.4), compared with SIRS ≥ 2 (65.4%; 95% CI, 44.3–82.8) or qSOFA ≥ 2 (38.4; 95% CI, 20.2–59.4).ConclusionsFrailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty to optimize disposition in this population.

scholarly journals LO60: Frailty and associated prognosis among older emergency department patients with suspected infection – a prospective, observational cohort study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S29-S29 ◽  
Author(s):  
S. Fernando ◽  
K. Guo ◽  
M. Lukasik ◽  
B. Rochwerg ◽  
D. Cook ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Clinical Frailty Scale ◽  
Suspected Infection ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Observational Cohort ◽  
Emergency Department Patients

Introduction: Prognostication and disposition among older Emergency Department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically ill patients, however its association with clinical outcomes among older ED patients with suspected infection is unknown. Methods: We conducted a multicentre prospective cohort study at two tertiary care EDs. We included older ED patients (≥ 75 years) presenting with suspected infection. Frailty at baseline (prior to index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5-8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty against the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria. Results: We enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR]: 1.83, 95% confidence interval [CI]: 1.08-2.51) and more likely to die within 30 days of ED presentation (aOR 2.05, 95% CI: 1.02-5.24). Sensitivity for mortality was highest among the CFS (73.1%, 95% CI: 52.2-88.4), as compared to SIRS ≥ 2 (65.4%, 95% CI: 44.3-82.8) or qSOFA ≥ 2 (38.4, 95% CI: 20.2-59.4). Conclusion: Frailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty in order to optimize disposition in this population.

scholarly journals Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection

2019 ◽  
Vol 8 (6) ◽  
pp. 833 ◽  
Author(s):  
Bo-Sun Shim ◽  
Young-Hoon Yoon ◽  
Jung-Youn Kim ◽  
Young-Duck Cho ◽  
Sung-Jun Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Whole Blood ◽  
Predictive Value ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Suspected Infection ◽  
Reactive Protein ◽  
Failure Assessment ◽  
Emergency Department Patients

We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups—those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.

scholarly journals Prognostic accuracy of emergency department triage tools for children with suspected COVID-19: The PRIEST observational cohort study

2020 ◽  
Author(s):  
Katie Biggs ◽  
Ben Thomas ◽  
Steve Goodacre ◽  
Ellen Lee ◽  
Laura Sutton ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Adverse Outcome ◽  
Outcome Data ◽  
Observational Cohort Study ◽  
Swine Flu ◽  
Severe Illness ◽  
Prognostic Accuracy ◽  
Emergency Department Triage ◽  
Observational Cohort

Objectives: Emergency department clinicians can use triage tools to predict adverse outcome and support management decisions for children presenting with suspected COVID-19. We aimed to estimate the accuracy of triage tools for predicting severe illness in children presenting to the emergency department (ED) with suspected COVID-19 infection. Methods: We undertook a mixed prospective and retrospective observational cohort study in 44 EDs across the United Kingdom (UK). We collected data from children attending with suspected COVID-19 between 26 March 2020 and 28 May 2020, and used presenting data to determine the results of assessment using the WHO algorithm, swine flu hospital pathway for children (SFHPC), Paediatric Observation Priority Score (POPS) and Childrens Observation and Severity Tool (COAST). We recorded 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome. Results: We collected data from 1530 children, including 26 (1.7%) with an adverse outcome. C-statistics were 0.80 (95% confidence interval 0.73-0.87) for the WHO algorithm, 0.80 (0.71-0.90) for POPS, 0.76 (0.67-0.85) for COAST, and 0.71 (0.59-0.82) for SFHPC. Using pre-specified thresholds, the WHO algorithm had the highest sensitivity (0.85) and lowest specificity (0.75), but POPS and COAST could optimise sensitivity (0.96 and 0.92 respectively) at the expense of specificity (0.25 and 0.38 respectively) by using a threshold of any score above zero instead of the pre-specified threshold. Conclusion: Existing triage tools have good but not excellent prediction for adverse outcome in children with suspected COVID-19. POPS and COAST could achieve an appropriate balance of sensitivity and specificity for supporting decisions to discharge home by considering any score above zero to be positive.

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