FRAILTY ASSESSMENT IN THE EMERGENCY DEPARTMENT
disability; Emergency Medicine; fractures; functional decline; gait speed; geriatrics; identification; indexes; intervention; mortality; muscle weakness; older-adults; prediction; risk-stratification tool
Background: Frailty (defined as weakness, slowness, weight loss, exhaustion, and physical inactivity) is characterized by increased vulnerability to stressors. Frail older patients are at increased risk of Emergency Department (ED) visits, hospitalization, disability, and death. Objectives: Our aims were to determine the prevalence of frailty (and assess the feasibility of measuring frailty) in older ED patients. We also assessed the correlation of self-reported speed and weakness to measured values and the association between frailty and function. Methods: We performed a study of discharged ED patients aged >= 65 years. We used Fried's frailty definition and a validated activities-of-daily-living (ADL) scale. We measured self-reported and objective weakness and slowness. Data were reported as means and proportions with 95% confidence interval (CI); associations were measured using 95% CI for the differences. Ninety patients provided a 95% CI of +/- 10%. Results: The mean age of the 90 patients was 76 +/- 6.4 SD years; 51% were male. Mean assessment time was 7.4 min (95% CI 6.9-7.9). Twenty percent of patients were frail (18/90, 95% CI 12-30%). Self-report was 18% sensitive and 90% specific for objective weakness; self-report was 42% sensitive and 86% specific for objective slowness. Frail and weak patients were more likely dependent in one or more ADLs (26% difference, 95% CI 1-51% and 20% difference, 95% CI 1-41%, respectively). Conclusions: Frailty is common in discharged older ED patients. Self-reported weakness and slowness are poor predictors of their objective counterparts. Frailty was associated with ADL dependence. These two domains may be reliable markers for elderly ED patients at high risk for adverse outcomes. (C) 2013 Elsevier Inc.
Stiffler K A; Finley A; Midha S; Wilber S T
Journal of Emergency Medicine
2013
2013-08
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2012.11.047" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2012.11.047</a>
The Use Of The Cervilenz Device To Aid In The Diagnosis Of Premature Labor
birth; Cervical length; Cervical length; cervilenz; delivery; epidemiology; fetal fibronectin; intact membranes; Obstetrics & Gynecology; prediction; premature labor; preterm uterine contractions; sonography; transvaginal ultrasonographic measurement
Objective: A short cervix measured by transvaginal ultrasound has been correlated with increased risk for preterm delivery (PTD). Many patients presenting with a complaint of possible premature labor (PL); may not have access to cervical length (CL) screening by ultrasound. Cervilenz is an FDA cleared disposable device for obtaining vaginal CL measurements. This study was conducted to correlate Cervilenz measurements of CL with the occurrence of PTD. Methods: Women presenting with regular uterine contractions at gestational age (GA) >= 22 and <34 weeks with intact membranes and cervical dilation <3 cm were recruited. A speculum examination was performed and Cervilenz measurement of CL was obtained. Patients were treated with tocolytics and/or corticosteroids based upon the attending physician's judgment. The occurrences of PTD as a result of PL or premature rupture of membranes within 7 days, <32 weeks, <34 weeks and <37 weeks, were determined. Patients who were delivered preterm for other maternal or fetal indications were excluded. Negative predictive value (NPV) was calculated. Results: Of the 220 women recruited, 20 were subsequently excluded from analysis because they required PTD for unrelated indications. The mean GA at enrollment was 29.8 +/- 2.8 (SD) weeks. One (0.5%), 2 (1.0%), 4 (2.0%) and 29 (14.5%) women delivered at <= 7 days from enrollment, <= 32 weeks, <= 34 weeks, and <= 37 weeks, inclusively. Seventy-seven (38.5%), 39 (19.5%) and 19 (9.5%) women had Cervilenz measurement of <= 30, <= 25 and <= 20 mm, respectively. The NPV for a Cervilenz measurement of >20 mm for delivery at, <= 32, <= 34 and <= 37 weeks were 99.2%, 98.3% and 86.7%, respectively. Conclusion: Cervilenz measurement >20mm appears to have high NPV for PTD prior to 34 weeks.
Lavin J P; Guy M; Gil K; Crane S
Journal of Maternal-Fetal & Neonatal Medicine
2013
2013-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3109/14767058.2013.811484" target="_blank" rel="noreferrer noopener">10.3109/14767058.2013.811484</a>
Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients.
Opioid dependence; Spine surgery; Prediction; Anterior cervical discectomy and fusion; Lumbar disc herniation; Risk score
BACKGROUND CONTEXT: The opioid epidemic has increased scrutiny of health-care practices and care episodes, such as surgery, that increase the risk of opioid dependence. The Stopping Opioids after Surgery (SOS) score to predict sustained prescription opioid use was previously developed within a population of patients receiving general surgery, orthopedic, and urologic procedures. Notably, the performance for this score has not been assessed in a spine surgical cohort. PURPOSE: We sought to validate the SOS score in a series of patients undergoing cervical and lumbar spine surgery, including inpatient and outpatient cohorts. STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals. OUTCOME MEASURES: Sustained prescription opioid use was defined as opioid prescription without interruption for 90 days or longer following surgery. METHODS: The performance of the SOS score was assessed in the study population by calculating the c-statistic, receiver-operating curve, and observed rates of sustained prescription opioid use. RESULTS: Among 7,027 patients included in this study, 2,374 (33.8%) underwent anterior cervical discectomy and fusion and 4,653 (66.2%) underwent surgery for lumbar disc herniation. The median age was 46 (interquartile range=38.0-53.5). Overall, 604 patients (8.6%) had prolonged opioid prescription. The c-statistic of the risk score was 0.764. The sensitivity of the score at the low risk cutoff of 30 was 0.72. At the high-risk cutoff of 60, the specificity was 0.99. The observed risk (95% confidence interval) of prolonged opioid prescription was 3.6% (3.1-4.2) in the low-risk group (scores <30), 17.2% (15.6-18.7) in the intermediate-risk group (scores 30-60), and 46.0% (36.2-55.9) in the high-risk group (scores >60). CONCLUSIONS: We have validated the use of a clinically relevant bedside risk score for sustained prescription opioid use after spine surgery. The score's ease of use, combined with its exceptional performance, renders it a valuable tool for spine care providers in counseling patients and determining appropriate postdischarge management to prevent sustained opioid use.
Karhade Aditya V; Chaudhary Muhammad Ali; Bono Christopher M; Kang James D; Schwab Joseph H; Schoenfeld Andrew J
The Spine Journal: Official Journal Of The North American Spine Society
2019
2019-10
Journal Article
<a href="http://doi.org/10.1016/j.spinee.2019.05.001" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2019.05.001</a>
PMID: 31078697