Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments

a prospective study

Magnolia Cardona*, Ebony T. Lewis, Mette R. Kristensen, Helene Skjøt-Arkil, Anette Addy Ekmann, Hanne H. Nygaard, Jonas J. Jensen, Rune O. Jensen, Jonas L. Pedersen, Robin M. Turner, Frances Garden, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, David C.W. Chang, Blanca Gallego-Luxan & 6 andre Sally McCarthy, John A. Petersen, Birgitte N. Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand

*Kontaktforfatter for dette arbejde

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Resumé

Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7–8.6 vs. 5.8 95% CI 5.6–5.9) and Danish mean 7.1 (95% CI 6.6–7.5 vs. 5.5 95% CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions.

OriginalsprogEngelsk
TidsskriftEuropean Geriatric Medicine
Vol/bind9
Udgave nummer6
Sider (fra-til)891-901
ISSN1878-7649
DOI
StatusUdgivet - 1. dec. 2018

Fingeraftryk

Hospital Emergency Service
Prospective Studies
ROC Curve
Area Under Curve
Logistic Models
Regression Analysis
Physicians
Health
Neoplasms

Citer dette

Cardona, Magnolia ; Lewis, Ebony T. ; Kristensen, Mette R. ; Skjøt-Arkil, Helene ; Ekmann, Anette Addy ; Nygaard, Hanne H. ; Jensen, Jonas J. ; Jensen, Rune O. ; Pedersen, Jonas L. ; Turner, Robin M. ; Garden, Frances ; Alkhouri, Hatem ; Asha, Stephen ; Mackenzie, John ; Perkins, Margaret ; Suri, Sam ; Holdgate, Anna ; Winoto, Luis ; Chang, David C.W. ; Gallego-Luxan, Blanca ; McCarthy, Sally ; Petersen, John A. ; Jensen, Birgitte N. ; Backer Mogensen, Christian ; Hillman, Ken ; Brabrand, Mikkel. / Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments : a prospective study. I: European Geriatric Medicine. 2018 ; Bind 9, Nr. 6. s. 891-901.
@article{70fd349c324c4f9cbf6ac6746367b726,
title = "Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study",
abstract = "Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95{\%} CI 7.7–8.6 vs. 5.8 95{\%} CI 5.6–5.9) and Danish mean 7.1 (95{\%} CI 6.6–7.5 vs. 5.5 95{\%} CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions.",
keywords = "Aged, Frail, Prognosis, Prospective studies, Risk assessment, Uncertainty",
author = "Magnolia Cardona and Lewis, {Ebony T.} and Kristensen, {Mette R.} and Helene Skj{\o}t-Arkil and Ekmann, {Anette Addy} and Nygaard, {Hanne H.} and Jensen, {Jonas J.} and Jensen, {Rune O.} and Pedersen, {Jonas L.} and Turner, {Robin M.} and Frances Garden and Hatem Alkhouri and Stephen Asha and John Mackenzie and Margaret Perkins and Sam Suri and Anna Holdgate and Luis Winoto and Chang, {David C.W.} and Blanca Gallego-Luxan and Sally McCarthy and Petersen, {John A.} and Jensen, {Birgitte N.} and {Backer Mogensen}, Christian and Ken Hillman and Mikkel Brabrand",
year = "2018",
month = "12",
day = "1",
doi = "10.1007/s41999-018-0123-6",
language = "English",
volume = "9",
pages = "891--901",
journal = "European Geriatric Medicine",
issn = "1878-7649",
publisher = "Elsevier",
number = "6",

}

Cardona, M, Lewis, ET, Kristensen, MR, Skjøt-Arkil, H, Ekmann, AA, Nygaard, HH, Jensen, JJ, Jensen, RO, Pedersen, JL, Turner, RM, Garden, F, Alkhouri, H, Asha, S, Mackenzie, J, Perkins, M, Suri, S, Holdgate, A, Winoto, L, Chang, DCW, Gallego-Luxan, B, McCarthy, S, Petersen, JA, Jensen, BN, Backer Mogensen, C, Hillman, K & Brabrand, M 2018, 'Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study', European Geriatric Medicine, bind 9, nr. 6, s. 891-901. https://doi.org/10.1007/s41999-018-0123-6

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments : a prospective study. / Cardona, Magnolia; Lewis, Ebony T.; Kristensen, Mette R.; Skjøt-Arkil, Helene; Ekmann, Anette Addy; Nygaard, Hanne H.; Jensen, Jonas J.; Jensen, Rune O.; Pedersen, Jonas L.; Turner, Robin M.; Garden, Frances; Alkhouri, Hatem; Asha, Stephen; Mackenzie, John; Perkins, Margaret; Suri, Sam; Holdgate, Anna; Winoto, Luis; Chang, David C.W.; Gallego-Luxan, Blanca; McCarthy, Sally; Petersen, John A.; Jensen, Birgitte N.; Backer Mogensen, Christian; Hillman, Ken; Brabrand, Mikkel.

I: European Geriatric Medicine, Bind 9, Nr. 6, 01.12.2018, s. 891-901.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments

T2 - a prospective study

AU - Cardona, Magnolia

AU - Lewis, Ebony T.

AU - Kristensen, Mette R.

AU - Skjøt-Arkil, Helene

AU - Ekmann, Anette Addy

AU - Nygaard, Hanne H.

AU - Jensen, Jonas J.

AU - Jensen, Rune O.

AU - Pedersen, Jonas L.

AU - Turner, Robin M.

AU - Garden, Frances

AU - Alkhouri, Hatem

AU - Asha, Stephen

AU - Mackenzie, John

AU - Perkins, Margaret

AU - Suri, Sam

AU - Holdgate, Anna

AU - Winoto, Luis

AU - Chang, David C.W.

AU - Gallego-Luxan, Blanca

AU - McCarthy, Sally

AU - Petersen, John A.

AU - Jensen, Birgitte N.

AU - Backer Mogensen, Christian

AU - Hillman, Ken

AU - Brabrand, Mikkel

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7–8.6 vs. 5.8 95% CI 5.6–5.9) and Danish mean 7.1 (95% CI 6.6–7.5 vs. 5.5 95% CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions.

AB - Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7–8.6 vs. 5.8 95% CI 5.6–5.9) and Danish mean 7.1 (95% CI 6.6–7.5 vs. 5.5 95% CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions.

KW - Aged

KW - Frail

KW - Prognosis

KW - Prospective studies

KW - Risk assessment

KW - Uncertainty

U2 - 10.1007/s41999-018-0123-6

DO - 10.1007/s41999-018-0123-6

M3 - Journal article

VL - 9

SP - 891

EP - 901

JO - European Geriatric Medicine

JF - European Geriatric Medicine

SN - 1878-7649

IS - 6

ER -