scholarly journals Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

2017 ◽  
Vol 10 (1) ◽  
Author(s):  
Kinda Ibrahim ◽  
Charlotte Owen ◽  
Harnish P. Patel ◽  
Carl May ◽  
Mark Baxter ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Data ◽  
Older Patients ◽  
Healthcare Outcomes ◽  
Patients At Risk

scholarly journals Real-time utilisation of administrative data in the ED to identify older patients at risk: development and validation of the Dynamic Silver Code

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033374 ◽  
Author(s):  
Daniela Balzi ◽  
Giulia Carreras ◽  
Francesco Tonarelli ◽  
Luca Degli Esposti ◽  
Paola Michelozzi ◽  
...  
Keyword(s):  
At Risk ◽  
Cohort Study ◽  
Real Time ◽  
Administrative Data ◽  
Older Patients ◽  
Clinical Decision Making ◽  
External Validation ◽  
Clinical Decision ◽  
Patients At Risk ◽  
Ed Visits

ObjectiveIdentification of older patients at risk, among those accessing the emergency department (ED), may support clinical decision-making. To this purpose, we developed and validated the Dynamic Silver Code (DSC), a score based on real-time linkage of administrative data.Design and settingThe ‘Silver Code National Project (SCNP)’, a non-concurrent cohort study, was used for retrospective development and internal validation of the DSC. External validation was obtained in the ‘Anziani in DEA (AIDEA)’ concurrent cohort study, where the DSC was generated by the software routinely used in the ED.ParticipantsThe SCNP contained 281 321 records of 180 079 residents aged 75+ years from Tuscany and Lazio, Italy, admitted via the ED to Internal Medicine or Geriatrics units. The AIDEA study enrolled 4425 subjects aged 75+ years (5217 records) accessing two EDs in the area of Florence, Italy.InterventionsNone.Outcome measuresPrimary outcome: 1-year mortality. Secondary outcomes: 7 and 30-day mortality and 1-year recurrent ED visits.ResultsAdvancing age, male gender, previous hospital admission, discharge diagnosis, time from discharge and polypharmacy predicted 1-year mortality and contributed to the DSC in the development subsample of the SCNP cohort. Based on score quartiles, participants were classified into low, medium, high and very high-risk classes. In the SCNP validation sample, mortality increased progressively from 144 to 367 per 1000 person-years, across DSC classes, with HR (95% CI) of 1.92 (1.85 to 1.99), 2.71 (2.61 to 2.81) and 5.40 (5.21 to 5.59) in class II, III and IV, respectively versus class I (p<0.001). Findings were similar in AIDEA, where the DSC predicted also recurrent ED visits in 1 year. In both databases, the DSC predicted 7 and 30-day mortality.ConclusionsThe DSC, based on administrative data available in real time, predicts prognosis of older patients and might improve their management in the ED.

scholarly journals The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Laurien E. Zijlstra ◽  
Stella Trompet ◽  
Simon P. Mooijaart ◽  
Marjolijn van Buren ◽  
Naveed Sattar ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
At Risk ◽  
Data Analysis ◽  
Longitudinal Data ◽  
Cognitive Decline ◽  
Kidney Function ◽  
Older Patients ◽  
Longitudinal Data Analysis ◽  
Patients At Risk

scholarly journals Nutritional Advice in Older Patients at Risk of Malnutrition during Treatment for Chemotherapy: A Two-Year Randomized Controlled Trial

PLoS ONE ◽  
2014 ◽  
Vol 9 (9) ◽  
pp. e108687 ◽  
Author(s):  
Isabelle Bourdel-Marchasson ◽  
Christelle Blanc-Bisson ◽  
Adélaïde Doussau ◽  
Christine Germain ◽  
Jean-Frédéric Blanc ◽  
...  
Keyword(s):  
At Risk ◽  
Randomized Controlled Trial ◽  
Older Patients ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Nutritional Advice ◽  
Patients At Risk

scholarly journals Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne-Carina Scharf ◽  
Janine Gronewold ◽  
Christian Dahlmann ◽  
Jeanina Schlitzer ◽  
Andreas Kribben ◽  
...  
Keyword(s):  
At Risk ◽  
Older Patients ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Medical Needs ◽  
Patients At Risk

Identifying Patients at Risk for Diaphragm Atrophy During Mechanical Ventilation Using Routinely Available Clinical Data

2020 ◽  
pp. respcare.08223
Author(s):  
Martin Urner ◽  
Nicholas Mitsakakis ◽  
Stefannie Vorona ◽  
Lu Chen ◽  
Michael C Sklar ◽  
...  
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Clinical Data ◽  
Patients At Risk ◽  
Diaphragm Atrophy

Delirium in Older Patients after Combined Epidural–General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial

2021 ◽  
Author(s):  
Ya-Wei Li ◽  
Huai-Jin Li ◽  
Hui-Juan Li ◽  
Bin-Jiang Zhao ◽  
Xiang-Yang Guo ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Risk ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Number Needed To Treat ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Patients At Risk

Background Delirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural–general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery. Methods Patients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days. Results Between November 2011 and May 2015, 1,802 patients were randomized to combined epidural–general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural–general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P &lt; 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P &lt; 0.001), and more epidural patients were given vasopressors (495 [58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P &lt; 0.001). Conclusions Older patients randomized to combined epidural–general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Changes in Mental Status

2004 ◽  
Vol 94 (2) ◽  
pp. 118-125
Author(s):  
Alicia J. Curtin
Keyword(s):  
At Risk ◽  
Mental Status ◽  
Clinical Assessment ◽  
Older Patients ◽  
Medical Condition ◽  
Hospital Setting ◽  
Common Symptom ◽  
Patients At Risk ◽  
Hospitalized Patient ◽  
High Level

Change in mental status is a common symptom in the older, hospitalized patient. Often referred to as delirium, it may be the first indication of a serious medical condition. If delirium is not identified and treated promptly, it may lead to severe complications. The podiatric physician can prevent many cases of delirium by maintaining a high level of suspicion, performing a thorough clinical assessment, and identifying older patients at risk in the hospital setting. (J Am Podiatr Med Assoc 94(2): 118-125, 2004)

Sign in / Sign up

Export Citation Format

Share Document