Prediction admission in the older population in the Emergency Department: the CLEARED tool

被引:0
作者
Brink, A. [1 ]
Alsma, J. [1 ]
Brink, H. S. [2 ]
de Gelder, J. [3 ]
Lucke, J. A. [4 ]
Mooijaart, S. P. [3 ]
Zietse, R. [1 ]
Schuit, S. C. E. [1 ,5 ]
Lingsma, H. F. [6 ]
机构
[1] Erasmus MC, Dept Internal Med, Rotterdam, Netherlands
[2] Med Spectrum Twente, Dept Internal Med, Enschede, Netherlands
[3] Leiden Univ, Dept Gerontol & Geriatr, Med Ctr, Leiden, Netherlands
[4] Leiden Univ, Dept Emergency Med, Med Ctr, Leiden, Netherlands
[5] Erasmus MC, Dept Emergency Med, Rotterdam, Netherlands
[6] Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands
关键词
Aging patient population; crowding; emergency department; prediction model; triage; LENGTH-OF-STAY; ELDERLY-PATIENTS; RISK-STRATIFICATION; GERIATRIC-PATIENTS; TRIAGE; ADULTS; CARE; VALIDATION; OUTCOMES; IDENTIFICATION;
D O I
暂无
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Length of stay (LOS) in the Emergency Department (ED) is correlated with an extended in-hospital LOS and may even increase 30-day mortality. Older patients represent a growing population in the ED and they are especially at risk of adverse outcomes. Screening tools that adequately predict admission could help reduce waiting times in the ED and reduce time to treatment. We aimed to develop and validate a clinical prediction tool for admission, applicable to the aged patient population in the ED. Methods: Data from 7,606 ED visits of patients aged 70 years and older between 2012 and 2014 were used to develop the CLEARED tool. Model performance was assessed with discrimination using logistic regression and calibration. The model was internally validated by bootstrap resampling in Erasmus Medical Center and externally validated at two other hospitals, Medisch Spectrum Twente (MST) and Leiden University Medical Centre (LUMC). Results: CLEARED contains 10 predictors: body temperature, heart rate, diastolic blood pressure, systolic blood pressure, oxygen saturation, respiratory rate, referral status, the Manchester Triage System category, and the need for laboratory or radiology testing. The internally validated area under the curve (AUC) was 0.766 (95% CI [0759; 0.780. External validation in MST showed an AUC of o.797 and in LUMC, an AUC of 0.725. Conclusions: The developed CLEARED tool reliably predicts admission in elderly patients visiting the ED. It is a promising prompt, although further research is needed to implement the tool and to investigate the benefits in terms of reduction of crowding and LOS in the ED.
引用
收藏
页码:357 / 367
页数:11
相关论文
共 45 条
[1]  
Alexander RH, 1993, ADV TRAUMA LIFE SUPP
[2]   Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions [J].
Aminzadeh, F ;
Dalziel, WB .
ANNALS OF EMERGENCY MEDICINE, 2002, 39 (03) :238-247
[3]   A conceptual model of emergency department crowding [J].
Asplin, BR ;
Magid, DJ ;
Rhodes, KV ;
Solberg, LI ;
Lurie, N ;
Camargo, CA .
ANNALS OF EMERGENCY MEDICINE, 2003, 42 (02) :173-180
[4]   Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study [J].
Barfod, Charlotte ;
Lauritzen, Marlene Mauson Pankoke ;
Danker, Jakob Klim ;
Soeletormos, Gyoergy ;
Forberg, Jakob Lundager ;
Berlac, Peter Anthony ;
Lippert, Freddy ;
Lundstrom, Lars Hyldborg ;
Antonsen, Kristian ;
Lange, Kai Henrik Wiborg .
SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE, 2012, 20
[5]   Delirium within the emergency care setting, occurrence and detection: a systematic review [J].
Barron, Ewan Alexander ;
Holmes, John .
EMERGENCY MEDICINE JOURNAL, 2013, 30 (04) :263-268
[6]   OLD-PEOPLE IN THE EMERGENCY ROOM - AGE-RELATED DIFFERENCES IN EMERGENCY DEPARTMENT USE AND CARE [J].
BAUM, SA ;
RUBENSTEIN, LZ .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1987, 35 (05) :398-404
[7]   Triage of geriatric patients in the emergency department: Validity and survival with the Emergency Severity Index [J].
Baumann, Michael R. ;
Strout, Tania D. .
ANNALS OF EMERGENCY MEDICINE, 2007, 49 (02) :234-240
[8]   Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients [J].
Bo, Mario ;
Bonetto, Martina ;
Bottignole, Giuliana ;
Porrino, Paola ;
Coppo, Eleonora ;
Tibaldi, Michela ;
Ceci, Giacomo ;
Raspo, Silvio ;
Cappa, Giorgetta ;
Bellelli, Giuseppe .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2016, 64 (05) :1114-1119
[9]   Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact of age, patient's clinical acuity and complexity, and care pathways [J].
Casalino, Enrique ;
Wargon, Mathias ;
Peroziello, Anne ;
Choquet, Christophe ;
Leroy, Christophe ;
Beaune, Sebastien ;
Pereira, Laurent ;
Bernard, Julien ;
Buzzi, Jean-Claude .
EMERGENCY MEDICINE JOURNAL, 2014, 31 (05) :361-368
[10]  
Centers for Disease Control and Prevention, 2014, NAT HOSP AMB MED CAR