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首页> 外文期刊>Canadian Journal of Emergency Medicine >Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule
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Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

机译：评估专长患有独立损失（PERIL）的危险的参数：临床预测规则的衍生，可靠性和比较效果

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We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics’ observations.We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression.We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) “Problems in the home contributing to adverse outcomes?” (OR 1.43); 2) “Called 911 in the last 30 days?” (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR.The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
机译：我们进行了一项研究计划，促进了临床预测规则的可靠性，以识别高风险的老年人使用有护理人员的观察。我们制定了在43是或否问题的独立损失（Peril）清单中评估长老的护理人员。 ，包括识别风险（ISAR）工具项目的老年人。我们从三个安大略省服务培训了1,185名护理人员，以使用此清单，并在方便的样本中评估观察者间可靠性。使用省级数据库进行评估在一个月内返回ed，住院或死亡的主要结果。我们使用多变量逻辑回归来源的预测规则。我们注册了1,065个科目，其中764（71.7％）有完整的数据。观察者间可靠性好或优秀40/43问题。我们派生了四项规则：1）“家庭问题导致不利的结果？” （或1.43）; 2）“在过去30天内称为911？” （或1.72）; 3）男性（或1.38）和4）缺乏社会支持（或1.4）。危险规则表现优于临床判断的代理度量（AUC 0.62与0.56，p = 0.02），并且粘附更好地对危险而言比Isar更好。四项危险规则具有良好的观察者间可靠性和依从性，并且拥有与临床判断的代理衡量标准相比的优点。 ISAR是可接受的替代方案，但依从性可能会更低。如果未来的研究验证了危险规则，它可以由紧急医生和护理人员服务用于针对被确定为高风险的老年人的预防性干预措施。

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