223 Risk Factors and Screening Instruments to Predict Adverse Outcomes for Older Emergency Department Patients: A Systematic Review

Carpenter, Christopher R.; Shelton, Erica; Fowler, Susan A.; Suffoletto, B.; Platts-Mills, Tim; Rothman, Richard E.; Hogan, Teresita M.

doi:10.1016/j.annemergmed.2014.07.250

Cited by 2 publications

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“…De fato, as principais ferramentas existentes são em grande parte desatualizadas, apresentam acurácia preditiva de ruim a moderada, e não foram validadas para diferentes ambientes de assistência (38) . (36,39) .…”

Section: Avaliação Prognóstica Do Idoso No Serviço De Pronto Atendimentounclassified

“…Além da ferramenta ISAR, existem ao menos outros seis instrumentos validados de estratificação de risco de eventos adversos após alta hospitalar para pacientes geriátricos (36) . No entanto, segundo metanálise de Carpenter e colaboradores, nenhuma delas teve a habilidade preditiva descrita em suas publicações originais reproduzida em estudos futuros (39) .…”

Section: Identificação De Idosos De Alto Riscounclassified

“…• Alteração mental aguda. A identificação de idosos vulneráveis em serviços de PA é fundamental para alocação adequada de recursos hospitalares e para guiar o plano terapêutico (39) . Consonantes com essa percepção, diretrizes elaboradas em conjunto por sociedades de geriatria, emergência e enfermagem recomendam que os serviços de saúde realizem o rastreio de riscos na avaliação inicial de todo idoso agudamente enfermo (7).…”

Section: Análises De Sensibilidadeunclassified

“…Consonantes com essa percepção, diretrizes elaboradas em conjunto por sociedades de geriatria, emergência e enfermagem recomendam que os serviços de saúde realizem o rastreio de riscos na avaliação inicial de todo idoso agudamente enfermo (7). Apesar disso, os instrumentos de estratificação de risco ou de predição de desfechos atualmente disponíveis para avaliação de idosos nos serviços de PA não possuem acurácia para a distinção satisfatória de pacientes de baixo e alto risco (39) .…”

Section: Análises De Sensibilidadeunclassified

“…Uma diferença do estudo atual para os demais existentes na literatura é a escolha de desfechos de curto prazo, diretamente associados à evolução intra-hospitalar após visita a serviço de PA, incluindo duração de estadia e óbito, enquanto que os principais desfechos analisados em estudos prévios foram mortalidade, institucionalização, revisitas e perda funcional, aferidos em até um ano após a visita a serviço de PA (39) . (75) .…”

Section: Análises De Sensibilidadeunclassified

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Prognóstico de idosos admitidos no serviço de pronto atendimento: desenvolvimento e acurácia de modelo para predição de desfechos intra-hospitalares

Curiati¹

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Section: Avaliação Prognóstica Do Idoso No Serviço De Pronto Atendimentounclassified

Section: Identificação De Idosos De Alto Riscounclassified

Section: Análises De Sensibilidadeunclassified

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Prognóstico de idosos admitidos no serviço de pronto atendimento: desenvolvimento e acurácia de modelo para predição de desfechos intra-hospitalares

Curiati¹

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What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review

Preston

Chambers

Campbell

et al. 2018

Health Serv Deliv Res

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BackgroundEmergency departments (EDs) are facing unprecedented levels of demand. One of the causes of this increased demand is the ageing population. Older people represent a particular challenge to the ED as those older people who are frail will require management that considers their frailty alongside their presenting complaint. How to identify these older people as frail and how best to manage them in the ED is a major challenge for the health service to address.ObjectivesTo systematically map interventions to identify frail and high-risk older people in the ED and interventions to manage older people in the ED and to map the outcomes of these interventions and examine whether or not there is any evidence of the impact of these interventions on patient and health service outcomes.DesignA systematic mapping review.SettingEvidence from developed countries on interventions delivered in the ED.ParticipantsFrail and high-risk older people and general populations of older people (aged > 65 years).InterventionsInterventions to identify older people who are frail or who are at high risk of adverse outcomes and to manage (frail) older people within the ED.Main outcome measuresPatient outcomes (direct and indirect) and health service outcomes.Data sourcesEvidence from 103 peer-reviewed articles and conference abstracts and 17 systematic reviews published from 2005 to 2016.Review methodsA review protocol was drawn up and a systematic database search was undertaken for the years 2005–2016 (using MEDLINE, EMBASE, The Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium and PROSPERO). Studies were included according to predefined criteria. Following data extraction, evidence was classified into interventions relating to the identification of frail/high-risk older people in the ED and interventions relating to their management. A narrative synthesis of interventions/outcomes relating to these categories was undertaken. A quality assessment of individual studies was not undertaken; instead, an assessment of the overall evidence base in this area was made.ResultsOf the 90 included studies, 32 focused on a frail/high-risk population and 60 focused on an older population. These studies reported on interventions to identify (n = 57) and manage (n = 53) older people. The interventions to identify frail and at-risk older people, on admission and at discharge, utilised a number of different tools. There was extensive evidence on these question-based tools, but the evidence was inconclusive and contradictory. Service delivery innovations comprised changes to staffing, infrastructure and care delivery. There was a general trend towards improved outcomes in admissions avoidance, reduced ED reattendance and improved discharge outcomes.LimitationsThis review was a systematic mapping review. Some of the methods adopted differed from those used in a standard systematic review. Mapping the evidence base has led to the inclusion of a wide variety of evidence (in terms of study type and reporting quality). No recommendations on the effectiveness of specific interventions have been made as this was outside the scope of the review.ConclusionsA substantial body of evidence on interventions for frail and high-risk older people was identified and mapped.Future workFuture work in this area needs to determine why interventions work and whether or not they are feasible for the NHS and acceptable to patients.Study registrationThis study is registered as PROSPERO CRD42016043260.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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223 Risk Factors and Screening Instruments to Predict Adverse Outcomes for Older Emergency Department Patients: A Systematic Review

Cited by 2 publications

References 0 publications

Prognóstico de idosos admitidos no serviço de pronto atendimento: desenvolvimento e acurácia de modelo para predição de desfechos intra-hospitalares

Prognóstico de idosos admitidos no serviço de pronto atendimento: desenvolvimento e acurácia de modelo para predição de desfechos intra-hospitalares

What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review

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