Clinical decision-making in older adults following emergency admission to hospital. Derivation and validation of a risk stratification score: OPERA

Autor: Lui G. Forni, David Hunt, Khushal Arjan, Richard M. Venn, Luke Hodgson
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Resuscitation
Palliative care
Critical Care and Emergency Medicine
Epidemiology
Elderly
Mathematical and Statistical Techniques
Patient Admission
Medicine and Health Sciences
Medicine
Hospital Mortality
Prospective Studies
Aged
80 and over
Multidisciplinary
Framingham Risk Score
Frailty
Palliative Care
Statistics
Regression analysis
Acute Kidney Injury
Early warning score
Hospitals
Cohort
Physical Sciences
Female
Anatomy
Risk assessment
Emergency Service
Hospital
Research Article
medicine.medical_specialty
Critical Illness
Science
Clinical Decision-Making
Research and Analysis Methods
Risk Assessment
Adults
Humans
Derivation
Statistical Methods
Aged
business.industry
Biology and Life Sciences
Kidneys
Renal System
United Kingdom
Health Care
Health Care Facilities
Geriatrics
Age Groups
Early Warning Score
Medical Risk Factors
Emergency medicine
People and Places
Population Groupings
business
Mathematics
Forecasting
Zdroj: PLoS ONE, Vol 16, Iss 3, p e0248477 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: Objectives of the studyDemographic changes alongside medical advances have resulted in older adults accounting for an increasing proportion of emergency hospital admissions. Current measures of illness severity, limited to physiological parameters, have shortcomings in this cohort, partly due to patient complexity. This study aimed to derive and validate a risk score for acutely unwell older adults which may enhance risk stratification and support clinical decision-making.MethodsData was collected from emergency admissions in patients ≥65 years from two UK general hospitals (April 2017- April 2018). Variables underwent regression analysis for in-hospital mortality and independent predictors were used to create a risk score. Performance was assessed on external validation. Secondary outcomes included seven-day mortality and extended hospital stay.ResultsDerivation (n = 8,974) and validation (n = 8,391) cohorts were analysed. The model included the National Early Warning Score 2 (NEWS2), clinical frailty scale (CFS), acute kidney injury, age, sex, and Malnutrition Universal Screening Tool. For mortality, area under the curve for the model was 0.79 (95% CI 0.78–0.80), superior to NEWS2 0.65 (0.62–0.67) and CFS 0.76 (0.74–0.77) (P30 days.ConclusionsOur simple validated model (Older Persons’ Emergency Risk Assessment [OPERA] score) predicts in-hospital mortality and prolonged length of stay and could be easily integrated into electronic hospital systems, enabling automatic digital generation of risk stratification within hours of admission. Future studies may validate the OPERA score in external populations and consider an impact analysis.
Databáze: OpenAIRE
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