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首页> 外文期刊>BMC Geriatrics >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
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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

机译：回顾性队列研究表明，与中年人相比，急诊科中潜在使用的风险评估模型的预测能力较中年人低

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Older 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. Cohort 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). The 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. The 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.
机译：与年轻患者相比，老年患者是不良后果风险增加的复杂人群，应在急诊科进行的风险评估中考虑这一点。我们评估了不同风险评估模型对急性入院患者的预测能力是否受年龄影响。中老年患者的队列研究。我们调查了在使用不同风险评估模型的7天内区分幸存者和非幸存者的准确性;传统的分类算法，具有临床评估，生命体征，常规生物标志物和预后生物标志物可溶性尿激酶纤溶酶原激活物受体（suPAR）的分类算法。该队列包括22,653（53.2％）名中年患者（40-69岁）和19,889（46.8％）名老年患者（70岁以上）。 139例患者（0.6％）发生在7天之内，其中中年患者死亡，596例（3.0％）发生在老年患者中。基于生命体征和常规生物标志物的模型的曲线下面积（AUC）最高，与老年患者相比，这两种模型在区分中年患者7天死亡率方面均明显更好。 AUC（95％CI）：0.88（0.84-0.91），0.75（0.72-0.78），P 0.01和0.86（0.82-0.90），0.76（0.73-0.78），P 0.001。在整个队列的一个亚组（6.400例患者，15.0％）中，有suPAR水平可用。 suPAR在所有个体预测因子中的AUC最高，年龄组之间无显着差异，但是在使用此生物标记之前，需要对其进行进一步研究。在所有研究模型中，老年患者的预测价值均低于中年患者。生命体征或常规生物标志物是预测7天死亡率的最佳模型，并且优于传统的分类法模型。因此，可以加强当前的短期死亡率风险评估，但是在急诊科中建立新的风险评估模型时，应考虑年龄的变化。

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