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Arch Gerontol Geriatr. 2018 May - Jun;76:169-174. doi: 10.1016/j.archger.2018.02.014. Epub 2018 Mar 6.

Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study.

Author information

1
The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, PO Box 6087, UNSW, NSW, 1466 Australia. Electronic address: magnolia.cardona@unsw.edu.au.
2
The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, PO Box 6087, UNSW, NSW, 1466 Australia. Electronic address: ebony.lewis@unsw.edu.au.
3
Dean's Office Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: robin.turner@otago.ac.nz.
4
Agency for Clinical Innovation, Emergency Care Institute, PO Box 699, Chatswood, NSW, 2057, Australia. Electronic address: Hatem.Alkhouri@health.nsw.gov.au.
5
St George Hospital Emergency Department, Gray St, Kogarah, Sydney, NSW, 2217, Australia. Electronic address: Stephen.Asha@health.nsw.gov.au.
6
Prince of Wales Hospital Emergency Department, Barker St, Randwick, Sydney, NSW, 2031, Australia. Electronic address: John.Mackenzie@health.nsw.gov.au.
7
Campbelltown Hospital Emergency Department, Therry Rd, Sydney, Campbelltown, NSW, 2560, Australia. Electronic address: Margaret.Perkins@sswahs.nsw.gov.au.
8
Campbelltown Hospital Intensive Care Unit, Therry Rd, Sydney, Campbelltown, NSW, 2560, Australia. Electronic address: drsamsuri@gmail.com.
9
Liverpool Hospital Emergency Department, Corner of Elizabeth and Goulburn Streets, Sydney, Liverpool, NSW, 2170, Australia. Electronic address: Anna.Holdgate@health.nsw.gov.au.
10
Sutherland Hospital Emergency Department, The Kingsway, Sydney, Caringbah, NSW, 2229, Australia. Electronic address: luis.winoto@icloud.com.
11
The University of New South Wales, Graduate School of Biomedical Engineering, Library Rd, Sydney, Kensington, NSW, 2033, Australia. Electronic address: davesydney2013@gmail.com.
12
Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2113, Australia. Electronic address: blanca.gallegoluxan@mq.edu.au.
13
Agency for Clinical Innovation, Emergency Care Institute, PO Box 699, Chatswood, NSW, 2057, Australia; Prince of Wales Hospital Emergency Department, Barker St, Randwick, Sydney, NSW, 2031, Australia. Electronic address: Sally.McCarthy@health.nsw.gov.au.
14
Hospital of South West Jutland, Finsensgade, 35, 6700, Esbjerg, Denmark. Electronic address: Mette.Rahbek.Kristensen@rsyd.dk.
15
Cork University Hospital, Wilton, Cork, Ireland. Electronic address: 108661715@umail.ucc.ie.
16
Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. Electronic address: Helene.Skjoet-Arkil@rsyd.dk.
17
Bispebjerg og Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400 NV, Denmark. Electronic address: anette.addy.ekmann@regionh.dk.
18
Bispebjerg og Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400 NV, Denmark. Electronic address: Hanne.Helleskov.Nygaard@regionh.dk.
19
Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. Electronic address: jojen14@student.sdu.dk.
20
Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. Electronic address: runje13@student.sdu.dk.
21
Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. Electronic address: jonas15@student.sdu.dk.
22
Cork University Hospital, Wilton, Cork, Ireland. Electronic address: Dorothy.Breen@hse.ie.
23
Bispebjerg og Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400 NV, Denmark. Electronic address: John.Asger.Petersen.01@regionh.dk.
24
Bispebjerg og Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400 NV, Denmark. Electronic address: Birgitte.Nybo.Jensen@regionh.dk.
25
Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. Electronic address: Christian.Backer.Mogensen@rsyd.dk.
26
The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, PO Box 6087, UNSW, NSW, 1466 Australia; Campbelltown Hospital Intensive Care Unit, Therry Rd, Sydney, Campbelltown, NSW, 2560, Australia; Liverpool Hospital Intensive Care Unit, The Ingham Institute for Applied Medical Research, Corner of Elizabeth and Goulburn Streets, Sydney, Liverpool, NSW, 2170, Australia. Electronic address: k.hillman@unsw.edu.au.
27
Hospital of South West Jutland, Finsensgade, 35, 6700, Esbjerg, Denmark; Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. Electronic address: Mikkel.Brabrand@rsyd.dk.

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

PMID:
29524917
DOI:
10.1016/j.archger.2018.02.014
[Indexed for MEDLINE]

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