2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort
Abstract Aim Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that...
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| Veröffentlicht in: | Age and ageing 2024-08, Vol.53 (Supplement_3) |
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| creator | Burgess, AJ James, KH Maddock, TB Burberry, DJ Davies, EA |
| description | Abstract
Aim
Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population (1). We have developed a novel, frailty-focused score.
Methods
The Older Person’s Assessment service (OPAS) is ED based, accepting patients with frailty syndromes aged >70 years to provide a comprehensive geriatric assessment (CGA) and is extended into medical SDEC. The databases were retrospectively analysed and interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside NEWS, 4AT, including who with and where the patient resides.
Results
1011 attendances, 414 (40.9%) Male, mean age 82.3(±8.4) years, CFS 5.3(±1.2) and CCI 8.0(±1.8), 701 (69.3%) discharged same-day and 629 (62.2%) fallers. OPAS: 776 attendances, 306 (39.4%) Male, age 82.4(±8.7) years, CFS 5.3(±1.1) and CCI 7.9(±1.9), 540 (69.5%) discharged same-day, 557 (71.8%) fallers. SDEC: 234 attendances, 108 (46.2%) Male, age 81.8(±8.0) years, CFS 5.2(±1.3) and CCI 8.2(±1.7),162 (69.2%) discharged same-day, 72 (30.1%) fallers. There was significant difference between groups with NEWS (p |
| doi_str_mv | 10.1093/ageing/afae139.010 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_3099327264</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ageing/afae139.010</oup_id><sourcerecordid>3099327264</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1094-52857fd8d93f0b172885ff6070985d6f7c93f5ceebb2e0bc1fc6e912e232fedf3</originalsourceid><addsrcrecordid>eNqNkEtOwzAQhi0EEqVwAVaW2MAirR95eVmV8pAqsQDWluOMi6s0DnZaKTsOwQk5CUbpAViNRvP_M_N_CF1TMqNE8LnagG03c2UUUC5mhJITNKFpXias5OkpmhBCWEIKJs7RRQjb2NKMsglyjOUpXuDWHaDBxivb9AMOHWhrrMZB7QDXasCwA7-BVg9YKw_49vV-tbzDQTsPP1_fqsW2tb1VDfbQe_fn7-0B8EE1tla9dS3W7sP5_hKdGdUEuDrWKXp_WL0tn5L1y-PzcrFOdMyTJhkrs8LUZS24IRUtWFlmxuSkIKLM6twUOg4yDVBVDEilqdE5CMqAcWagNnyKbsa9nXefewi93Lq9b-NJyYkQnBUxd1SxUaXjz8GDkZ23O-UHSYn8AytHsPIIVkaw0ZSMJrfv_qP_BYbdfrQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3099327264</pqid></control><display><type>article</type><title>2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Burgess, AJ ; James, KH ; Maddock, TB ; Burberry, DJ ; Davies, EA</creator><creatorcontrib>Burgess, AJ ; James, KH ; Maddock, TB ; Burberry, DJ ; Davies, EA</creatorcontrib><description>Abstract
Aim
Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population (1). We have developed a novel, frailty-focused score.
Methods
The Older Person’s Assessment service (OPAS) is ED based, accepting patients with frailty syndromes aged >70 years to provide a comprehensive geriatric assessment (CGA) and is extended into medical SDEC. The databases were retrospectively analysed and interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside NEWS, 4AT, including who with and where the patient resides.
Results
1011 attendances, 414 (40.9%) Male, mean age 82.3(±8.4) years, CFS 5.3(±1.2) and CCI 8.0(±1.8), 701 (69.3%) discharged same-day and 629 (62.2%) fallers. OPAS: 776 attendances, 306 (39.4%) Male, age 82.4(±8.7) years, CFS 5.3(±1.1) and CCI 7.9(±1.9), 540 (69.5%) discharged same-day, 557 (71.8%) fallers. SDEC: 234 attendances, 108 (46.2%) Male, age 81.8(±8.0) years, CFS 5.2(±1.3) and CCI 8.2(±1.7),162 (69.2%) discharged same-day, 72 (30.1%) fallers. There was significant difference between groups with NEWS (p < 0.02), mortality (P < 0.001) and presenting complaint (p < 0.001). We used a cut-off Score > 6.5 indicating admission (p < 0.0001). Each variable’s weighing was determined using T-tests and Chi-squared analysis. Overall score Sensitivity 0.75, Specificity 0.63, Positive Predictive Value 0.65, Negative Predictive value 0.57, Area under Curve 0.65.
Conclusion
Frailty is an important determinant in identifying whether ambulatory care is appropriate. The efficacy of the score is comparable to the results derived in validation cohorts of existing and recommended scores. We are currently prospectively testing the score but clinical judgement, alongside a MDT providing a CGA is gold standard care.</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afae139.010</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Age ; Ambulatory health care ; Clinical decision making ; Efficacy ; Emergency medical care ; Emergency services ; Frailty ; Geriatric assessment ; Males ; Morbidity ; Older people ; Overcrowding ; Patients ; Same day ; Triage ; Weighing</subject><ispartof>Age and ageing, 2024-08, Vol.53 (Supplement_3)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904,30978</link.rule.ids></links><search><creatorcontrib>Burgess, AJ</creatorcontrib><creatorcontrib>James, KH</creatorcontrib><creatorcontrib>Maddock, TB</creatorcontrib><creatorcontrib>Burberry, DJ</creatorcontrib><creatorcontrib>Davies, EA</creatorcontrib><title>2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort</title><title>Age and ageing</title><description>Abstract
Aim
Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population (1). We have developed a novel, frailty-focused score.
Methods
The Older Person’s Assessment service (OPAS) is ED based, accepting patients with frailty syndromes aged >70 years to provide a comprehensive geriatric assessment (CGA) and is extended into medical SDEC. The databases were retrospectively analysed and interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside NEWS, 4AT, including who with and where the patient resides.
Results
1011 attendances, 414 (40.9%) Male, mean age 82.3(±8.4) years, CFS 5.3(±1.2) and CCI 8.0(±1.8), 701 (69.3%) discharged same-day and 629 (62.2%) fallers. OPAS: 776 attendances, 306 (39.4%) Male, age 82.4(±8.7) years, CFS 5.3(±1.1) and CCI 7.9(±1.9), 540 (69.5%) discharged same-day, 557 (71.8%) fallers. SDEC: 234 attendances, 108 (46.2%) Male, age 81.8(±8.0) years, CFS 5.2(±1.3) and CCI 8.2(±1.7),162 (69.2%) discharged same-day, 72 (30.1%) fallers. There was significant difference between groups with NEWS (p < 0.02), mortality (P < 0.001) and presenting complaint (p < 0.001). We used a cut-off Score > 6.5 indicating admission (p < 0.0001). Each variable’s weighing was determined using T-tests and Chi-squared analysis. Overall score Sensitivity 0.75, Specificity 0.63, Positive Predictive Value 0.65, Negative Predictive value 0.57, Area under Curve 0.65.
Conclusion
Frailty is an important determinant in identifying whether ambulatory care is appropriate. The efficacy of the score is comparable to the results derived in validation cohorts of existing and recommended scores. We are currently prospectively testing the score but clinical judgement, alongside a MDT providing a CGA is gold standard care.</description><subject>Age</subject><subject>Ambulatory health care</subject><subject>Clinical decision making</subject><subject>Efficacy</subject><subject>Emergency medical care</subject><subject>Emergency services</subject><subject>Frailty</subject><subject>Geriatric assessment</subject><subject>Males</subject><subject>Morbidity</subject><subject>Older people</subject><subject>Overcrowding</subject><subject>Patients</subject><subject>Same day</subject><subject>Triage</subject><subject>Weighing</subject><issn>0002-0729</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqNkEtOwzAQhi0EEqVwAVaW2MAirR95eVmV8pAqsQDWluOMi6s0DnZaKTsOwQk5CUbpAViNRvP_M_N_CF1TMqNE8LnagG03c2UUUC5mhJITNKFpXias5OkpmhBCWEIKJs7RRQjb2NKMsglyjOUpXuDWHaDBxivb9AMOHWhrrMZB7QDXasCwA7-BVg9YKw_49vV-tbzDQTsPP1_fqsW2tb1VDfbQe_fn7-0B8EE1tla9dS3W7sP5_hKdGdUEuDrWKXp_WL0tn5L1y-PzcrFOdMyTJhkrs8LUZS24IRUtWFlmxuSkIKLM6twUOg4yDVBVDEilqdE5CMqAcWagNnyKbsa9nXefewi93Lq9b-NJyYkQnBUxd1SxUaXjz8GDkZ23O-UHSYn8AytHsPIIVkaw0ZSMJrfv_qP_BYbdfrQ</recordid><startdate>20240808</startdate><enddate>20240808</enddate><creator>Burgess, AJ</creator><creator>James, KH</creator><creator>Maddock, TB</creator><creator>Burberry, DJ</creator><creator>Davies, EA</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20240808</creationdate><title>2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort</title><author>Burgess, AJ ; James, KH ; Maddock, TB ; Burberry, DJ ; Davies, EA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1094-52857fd8d93f0b172885ff6070985d6f7c93f5ceebb2e0bc1fc6e912e232fedf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Age</topic><topic>Ambulatory health care</topic><topic>Clinical decision making</topic><topic>Efficacy</topic><topic>Emergency medical care</topic><topic>Emergency services</topic><topic>Frailty</topic><topic>Geriatric assessment</topic><topic>Males</topic><topic>Morbidity</topic><topic>Older people</topic><topic>Overcrowding</topic><topic>Patients</topic><topic>Same day</topic><topic>Triage</topic><topic>Weighing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burgess, AJ</creatorcontrib><creatorcontrib>James, KH</creatorcontrib><creatorcontrib>Maddock, TB</creatorcontrib><creatorcontrib>Burberry, DJ</creatorcontrib><creatorcontrib>Davies, EA</creatorcontrib><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burgess, AJ</au><au>James, KH</au><au>Maddock, TB</au><au>Burberry, DJ</au><au>Davies, EA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort</atitle><jtitle>Age and ageing</jtitle><date>2024-08-08</date><risdate>2024</risdate><volume>53</volume><issue>Supplement_3</issue><issn>0002-0729</issn><eissn>1468-2834</eissn><abstract>Abstract
Aim
Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population (1). We have developed a novel, frailty-focused score.
Methods
The Older Person’s Assessment service (OPAS) is ED based, accepting patients with frailty syndromes aged >70 years to provide a comprehensive geriatric assessment (CGA) and is extended into medical SDEC. The databases were retrospectively analysed and interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside NEWS, 4AT, including who with and where the patient resides.
Results
1011 attendances, 414 (40.9%) Male, mean age 82.3(±8.4) years, CFS 5.3(±1.2) and CCI 8.0(±1.8), 701 (69.3%) discharged same-day and 629 (62.2%) fallers. OPAS: 776 attendances, 306 (39.4%) Male, age 82.4(±8.7) years, CFS 5.3(±1.1) and CCI 7.9(±1.9), 540 (69.5%) discharged same-day, 557 (71.8%) fallers. SDEC: 234 attendances, 108 (46.2%) Male, age 81.8(±8.0) years, CFS 5.2(±1.3) and CCI 8.2(±1.7),162 (69.2%) discharged same-day, 72 (30.1%) fallers. There was significant difference between groups with NEWS (p < 0.02), mortality (P < 0.001) and presenting complaint (p < 0.001). We used a cut-off Score > 6.5 indicating admission (p < 0.0001). Each variable’s weighing was determined using T-tests and Chi-squared analysis. Overall score Sensitivity 0.75, Specificity 0.63, Positive Predictive Value 0.65, Negative Predictive value 0.57, Area under Curve 0.65.
Conclusion
Frailty is an important determinant in identifying whether ambulatory care is appropriate. The efficacy of the score is comparable to the results derived in validation cohorts of existing and recommended scores. We are currently prospectively testing the score but clinical judgement, alongside a MDT providing a CGA is gold standard care.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><doi>10.1093/ageing/afae139.010</doi></addata></record> |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Oxford University Press Journals All Titles (1996-Current) |
| subjects | Age Ambulatory health care Clinical decision making Efficacy Emergency medical care Emergency services Frailty Geriatric assessment Males Morbidity Older people Overcrowding Patients Same day Triage Weighing |
| title | 2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort |
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