Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments

Protocol for a multi-centre cohort study

Magnolia Cardona, Ebony T Lewis, Robin M Turner, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, Chan-Wei Chang, Blanca Gallego-Luxan, Sally McCarthy, Mette R Kristensen, Michael O'Sullivan, Helene Skjøt-Arkil, Anette A Ekmann, Hanne H Nygaard, Jonas J Jensen, Rune O Jensen & 7 andre Jonas L Pedersen, Dorothy Breen, John A Petersen, Birgitte N Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand

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Resumé

BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments.

METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death.

DISCUSSION: The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices.

OriginalsprogEngelsk
TidsskriftArchives of Gerontology and Geriatrics
Vol/bind76
Sider (fra-til)169-174
ISSN0167-4943
DOI
StatusUdgivet - 1 maj 2018

Fingeraftryk

Hospital Emergency Service
Cohort Studies
Checklist
Uncertainty
Advance Care Planning
Clinical Decision Support Systems
Denmark
Internship and Residency
Nursing Homes
Ireland
Caregivers
Health Services
Intensive Care Units
Electrocardiography
Logistic Models
Prospective Studies
Health

Citer dette

Cardona, Magnolia ; Lewis, Ebony T ; Turner, Robin M ; Alkhouri, Hatem ; Asha, Stephen ; Mackenzie, John ; Perkins, Margaret ; Suri, Sam ; Holdgate, Anna ; Winoto, Luis ; Chang, Chan-Wei ; Gallego-Luxan, Blanca ; McCarthy, Sally ; Kristensen, Mette R ; O'Sullivan, Michael ; Skjøt-Arkil, Helene ; Ekmann, Anette A ; Nygaard, Hanne H ; Jensen, Jonas J ; Jensen, Rune O ; Pedersen, Jonas L ; Breen, Dorothy ; Petersen, John A ; Jensen, Birgitte N ; Mogensen, Christian Backer ; Hillman, Ken ; Brabrand, Mikkel. / Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments : Protocol for a multi-centre cohort study. I: Archives of Gerontology and Geriatrics. 2018 ; Bind 76. s. 169-174.
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title = "Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study",
abstract = "BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments.METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death.DISCUSSION: The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices.",
keywords = "Aged, Clinical decision support, Cohort studies, Emergency departments, Mortality, Risk prediction, Uncertainty, Validation studies",
author = "Magnolia Cardona and Lewis, {Ebony T} and Turner, {Robin M} and Hatem Alkhouri and Stephen Asha and John Mackenzie and Margaret Perkins and Sam Suri and Anna Holdgate and Luis Winoto and Chan-Wei Chang and Blanca Gallego-Luxan and Sally McCarthy and Kristensen, {Mette R} and Michael O'Sullivan and Helene Skj{\o}t-Arkil and Ekmann, {Anette A} and Nygaard, {Hanne H} and Jensen, {Jonas J} and Jensen, {Rune O} and Pedersen, {Jonas L} and Dorothy Breen and Petersen, {John A} and Jensen, {Birgitte N} and Mogensen, {Christian Backer} and Ken Hillman and Mikkel Brabrand",
note = "Copyright {\circledC} 2018 Elsevier B.V. All rights reserved.",
year = "2018",
month = "5",
day = "1",
doi = "10.1016/j.archger.2018.02.014",
language = "English",
volume = "76",
pages = "169--174",
journal = "Archives of Gerontology and Geriatrics",
issn = "0167-4943",
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Cardona, M, Lewis, ET, Turner, RM, Alkhouri, H, Asha, S, Mackenzie, J, Perkins, M, Suri, S, Holdgate, A, Winoto, L, Chang, C-W, Gallego-Luxan, B, McCarthy, S, Kristensen, MR, O'Sullivan, M, Skjøt-Arkil, H, Ekmann, AA, Nygaard, HH, Jensen, JJ, Jensen, RO, Pedersen, JL, Breen, D, Petersen, JA, Jensen, BN, Mogensen, CB, Hillman, K & Brabrand, M 2018, 'Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study', Archives of Gerontology and Geriatrics, bind 76, s. 169-174. https://doi.org/10.1016/j.archger.2018.02.014

Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments : Protocol for a multi-centre cohort study. / Cardona, Magnolia; Lewis, Ebony T; Turner, Robin M; Alkhouri, Hatem; Asha, Stephen; Mackenzie, John; Perkins, Margaret; Suri, Sam; Holdgate, Anna; Winoto, Luis; Chang, Chan-Wei; Gallego-Luxan, Blanca; McCarthy, Sally; Kristensen, Mette R; O'Sullivan, Michael; Skjøt-Arkil, Helene; Ekmann, Anette A; Nygaard, Hanne H; Jensen, Jonas J; Jensen, Rune O; Pedersen, Jonas L; Breen, Dorothy; Petersen, John A; Jensen, Birgitte N; Mogensen, Christian Backer; Hillman, Ken; Brabrand, Mikkel.

I: Archives of Gerontology and Geriatrics, Bind 76, 01.05.2018, s. 169-174.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments

T2 - Protocol for a multi-centre cohort study

AU - Cardona, Magnolia

AU - Lewis, Ebony T

AU - Turner, Robin M

AU - Alkhouri, Hatem

AU - Asha, Stephen

AU - Mackenzie, John

AU - Perkins, Margaret

AU - Suri, Sam

AU - Holdgate, Anna

AU - Winoto, Luis

AU - Chang, Chan-Wei

AU - Gallego-Luxan, Blanca

AU - McCarthy, Sally

AU - Kristensen, Mette R

AU - O'Sullivan, Michael

AU - Skjøt-Arkil, Helene

AU - Ekmann, Anette A

AU - Nygaard, Hanne H

AU - Jensen, Jonas J

AU - Jensen, Rune O

AU - Pedersen, Jonas L

AU - Breen, Dorothy

AU - Petersen, John A

AU - Jensen, Birgitte N

AU - Mogensen, Christian Backer

AU - Hillman, Ken

AU - Brabrand, Mikkel

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments.METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death.DISCUSSION: The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices.

AB - BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments.METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death.DISCUSSION: The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices.

KW - Aged

KW - Clinical decision support

KW - Cohort studies

KW - Emergency departments

KW - Mortality

KW - Risk prediction

KW - Uncertainty

KW - Validation studies

U2 - 10.1016/j.archger.2018.02.014

DO - 10.1016/j.archger.2018.02.014

M3 - Journal article

VL - 76

SP - 169

EP - 174

JO - Archives of Gerontology and Geriatrics

JF - Archives of Gerontology and Geriatrics

SN - 0167-4943

ER -