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 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.

scholarly journals Rib fractures following minor trauma in older patients: a not-so-benign injury

CJEM ◽  
2000 ◽  
Vol 2 (01) ◽  
pp. 32-34 ◽  
Author(s):  
Sam G. Campbell ◽  
Margaret A. Dingle
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Rib Fractures ◽  
Minor Trauma ◽  
Emergency Physicians

ABSTRACTTwo older adults presented to the emergency department with rib fractures following minor trauma. Both were discharged on oral analgesics and died within 2 days. Rib fractures more often lead to adverse outcomes in older adults. Emergency physicians should consider admitting any such patient who presents with two or more rib fractures.

scholarly journals Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

2021 ◽  
Vol 18 (5) ◽  
pp. 2237
Author(s):  
Youn-Jung Son ◽  
Da-Young Kim ◽  
Mi Hwa Won
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Older Adults ◽  
Sex Differences ◽  
Older Adult ◽  
Hospital Readmission ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
Male And Female

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

scholarly journals Prospective Validation of a Checklist to Predict Short‐term Death in Older Patients After Emergency Department Admission in Australia and Ireland

2018 ◽  
Vol 26 (6) ◽  
pp. 610-620 ◽  
Author(s):  
Magnolia Cardona ◽  
Michael O'Sullivan ◽  
Ebony T. Lewis ◽  
Robin M. Turner ◽  
Frances Garden ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Short Term ◽  
Emergency Department Admission

scholarly journals Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gijs Hesselink ◽  
Özcan Sir ◽  
Yvonne Schoon
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Older Patients ◽  
Elderly Care ◽  
Rapid Assessment ◽  
Experimental Studies ◽  
Design Quality ◽  
Content Type ◽  
Ed Crowding

Abstract Background The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions. Methods Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects. Results Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician. Conclusion Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention’s effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures. Trial registration The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

scholarly journals National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirsi Kemp ◽  
Janne Alakare ◽  
Veli-Pekka Harjola ◽  
Timo Strandberg ◽  
Jukka Tolonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Hospital Admission ◽  
Early Warning ◽  
Early Warning Score ◽  
Predictive Values ◽  
Frail Older Adults ◽  
High Dependency ◽  
National Early Warning Score ◽  
Risk Predictors

Abstract Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED. Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥ 75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-h and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 h and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU. With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64–0.76) and 0.62 (0.56–0.68); for hospital admission prediction 0.62 (0.60–0.65) and 0.55 (0.52–0.56), and for HDU admission 0.72 (0.61–0.83) and 0.80 (0.70–0.90), respectively. The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p = 0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p < 0.001) but not between the yellow/green groups (p = 0.59). There were 48 and 351 revisits within 72 h and 30 days, respectively. With NEWS2 AUCs for 72-h and 30-day revisit prediction were 0.48 (95% CI 0.40–0.56) and 0.47 (0.44–0.51), respectively; with triage score 0.48 (0.40–0.56) and 0.49 (0.46–0.52), respectively. Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission.

scholarly journals Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Venkatesh Thiruganasambandamoorthy ◽  
Ian G Stiell ◽  
Marco LA Sivilotti ◽  
Heather Murray ◽  
Brian H Rowe ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Short Term

scholarly journals Frailty Predicts Some but Not All Adverse Outcomes in Older Adults Discharged from the Emergency Department

2008 ◽  
Vol 56 (9) ◽  
pp. 1651-1657 ◽  
Author(s):  
S. Nicole Hastings ◽  
Jama L. Purser ◽  
Kimberly S. Johnson ◽  
Richard J. Sloane ◽  
Heather E. Whitson
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Adverse Outcomes

scholarly journals National Early Warning Score 2 (NEWS2) and 3-Level Triage Scale as Risk Predictors in Frail Older Adults in the Emergency Department

2020 ◽  
Author(s):  
Kirsi Kemp ◽  
Janne Alakare ◽  
Veli-Pekka Harjola ◽  
Timo Strandberg ◽  
Jukka Tolonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Hospital Admission ◽  
Early Warning ◽  
Early Warning Score ◽  
Predictive Values ◽  
Frail Older Adults ◽  
High Dependency ◽  
National Early Warning Score ◽  
Risk Predictors

Abstract Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED.Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-hour and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 hours and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU.With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64-0.76) and 0.62 (0.56-0.68); for hospital admission prediction 0.62 (0.60-0.65) and 0.55 (0.52-0.56), and for HDU admission 0.72 (0.61-0.83) and 0.80 (0.70-0.90), respectively.The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p=0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p<0.001) but not between the yellow/green groups (p=0.59).There were 48 and 351 revisits within 72 hours and 30 days, respectively. With NEWS2 AUCs for 72-hour and 30-day revisit prediction were 0.48 (95% CI 0.40-0.56) and 0.47 (0.44-0.51), respectively; with triage score 0.48 (0.40-0.56) and 0.49 (0.46-0.52), respectively.Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission

Geriatric assessment in frail older patients in the emergency department

2013 ◽  
Vol 23 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Cesáreo Fernández-Alonso ◽  
F Javier Martín-Sánchez
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Emergency Care ◽  
Older Patients ◽  
Sufficient Evidence ◽  
Short Term ◽  
Intervention Models ◽  
Patients At Risk ◽  
Geriatric Intervention ◽  
Care Of Elderly

SummaryEmergency care of elderly patients is frequent and complex in the emergency department. Frail older patients have a high risk of poor short-term results following emergency care. There is no practical universal or standardized tool defining frailty. It must be systematically identified in older patients at risk using a screening test, and in those who are positive, a diagnostic scale of frailty or preferably a geriatric scale adapted to emergency care is carried out. An adapted geriatric assessment including brief scales related to clinical, mental, functional and social aspects has been proposed. There are currently no geriatric intervention models with sufficient evidence in frail older patients.

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