Risk assessment models for potential use in the emergency department have lower predictive ability in older patients compared to the middle-aged for short-term mortality – a retrospective cohort study

BMC Geriatrics

Jesper Eugen-Olsen¹  Line Jee Hartmann Rasmussen¹  Lars Simon Rasmussen²  Rasmus Bo Hasselbalch³  Kasper Karmark Iversen³  Martin Schultz⁴  Birgitte Nybo Jensen⁵  Lotte Usinger⁶  Christian Torp-Pedersen⁷  Nicolas Carlson⁸ 

[1] 0000 0001 0674 042X, grid.5254.6, Clinical Research Centre, Amager and Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark;0000 0001 0674 042X, grid.5254.6, Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;0000 0001 0674 042X, grid.5254.6, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark;0000 0001 0674 042X, grid.5254.6, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark;0000 0001 0674 042X, grid.5254.6, Department of Internal Medicine and Geriatrics, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark;0000 0001 0674 042X, grid.5254.6, Department of Emergency Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark;0000 0001 0674 042X, grid.5254.6, Department of Internal Medicine and Geriatrics, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark;0000 0004 0646 7349, grid.27530.33, Department of Health, Science and Technology, Aalborg University Hospital, Aalborg, Denmark;0000 0004 0646 7349, grid.27530.33, Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark;0000 0004 0646 9598, grid.453951.f, The Danish Heart Foundation, Copenhagen, Denmark;

关键词: Emergency department;    Older patients;    Risk assessment;    Triage;   

DOI  :  10.1186/s12877-019-1154-7

来源: publisher

【 摘 要 】

BackgroundOlder patients is a complex group at increased risk of adverse outcomes compared to younger patients, which should be considered in the risk assessment performed in emergency departments. We evaluated whether the predictive ability of different risk assessment models for acutely admitted patients is affected by age.MethodsCohort study of middle-aged and older patients. We investigated the accuracy in discriminating between survivors and non-survivors within 7 days of different risk assessment models; a traditional triage algorithm, a triage algorithm with clinical assessment, vital signs, routine biomarkers, and the prognostic biomarker soluble urokinase plasminogen activator receptor (suPAR).ResultsThe cohort included 22,653 (53.2%) middle-aged patients (age 40–69 years), and 19,889 (46.8%) older patients (aged 70+ years). Death within 7 days occurred in 139 patients (0.6%) in middle-aged patients and 596 (3.0%) of the older patients. The models based on vital signs and routine biomarkers had the highest area under the curve (AUC), and both were significantly better at discriminating 7-day mortality in middle-aged patients compared to older patients; AUC (95% CI): 0.88 (0.84–0.91), 0.75 (0.72–0.78), P < 0.01, and 0.86 (0.82–0.90), 0.76 (0.73–0.78), P < 0.001. In a subgroup of the total cohort (6.400 patients, 15.0%), the suPAR level was available. suPAR had the highest AUC of all individual predictors with no significant difference between the age groups, but further research in this biomarker is required before it can be used.ConclusionThe predictive value was lower in older patients compared to middle-aged patients for all investigated models. Vital signs or routine biomarkers constituted the best models for predicting 7-day mortality and were better than the traditional triage model. Hence, the current risk assessment for short-term mortality can be strengthened, but modifications for age should be considered when constructing new risk assessment models in the emergency department.

【 授权许可】

CC BY