Ability of combined soluble urokinase plasminogen activator receptor to predict preventable emergency attendance in older patients in Japan: a prospective pilot study

PeerJ

article

Toshiya Mitsunaga¹  Yuhei Ohtaki¹  Wataru Yajima¹  Kei Sugiura¹  Yutaka Seki²  Kunihiro Mashiko²  Masahiko Uzura¹  Satoshi Takeda¹ 

[1] Department of Emergency Medicine, Jikei University School of Medicine;Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital

关键词: suPAR;    Home medical care;    Triage;    Preventable emergency attendance;    Older patients;   

DOI  :  10.7717/peerj.14322

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

65 years) without trauma who presented to the emergency department (ED). This single-center prospective pilot study was conducted in the ED of the Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, in Hachiouji City, Tokyo, Japan, from September 16, 2020, to June 21, 2022. The study included all patients without trauma aged 65 years or older who were living in their home or a facility and presented to the ED when medical professionals decided an emergency consultation was required. Discrimination was assessed by plotting the receiver-operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). During the study period, 49 eligible older patients were included, and thirteen (26.5%) PEA cases were detected. The median suPAR was significantly lower in the PEA group than in the non-PEA group (p < 0.05). For suPAR, the AUC for the prediction of PEA was 0.678 (95% CI 0.499–0.842, p < 0.05), and there was no significant difference from other variables as follows: 0.801 (95% CI 0.673–0.906, p < 0.001) for WBC, 0.833 (95% CI 0.717–0.934, p < 0.001) for CRP, and 0.693 (95% CI 0.495–0.862, p < 0.05) for NEWS. Furthermore, the AUC for predicting PEA was 0.867 (95% CI 0.741–0.959, p < 0.001) for suPAR + WBC + CRP + NEWS, which was significantly higher than that of the original suPAR (p < 0.01). The cutoff values, sensitivity, specificity, and odds ratio of suPAR and suPAR + WBC + CRP + NEWS were 7.5 and 22.88, 80.6% and 83.3%, 53.8% and 76.9%, and 4.83 and 16.67, respectively. This study has several limitations. First, this was pilot study, and we included a small number of older patients. Second, the COVID-19 pandemic occurred during the study period, so that there may be selection bias in the study population. Third, our hospital is a secondary emergency medical institution, and as such, we did not treat very fatal cases, which could be another cause of selection bias. Our single-center study has demonstrated the moderate utility of the combined suPAR as a triage tool for predicting PEA in older patients without trauma receiving home medical care. Before introducing suPAR to the prehospital setting, evidence from multicenter studies is needed.

【 授权许可】

CC BY