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 others Jonas L. Pedersen, Dorothy Breen, John A. Petersen, Birgitte N. Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand

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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.

Original languageEnglish
Pages (from-to)169-174
Number of pages6
JournalArchives of Gerontology and Geriatrics
Volume76
DOIs
Publication statusPublished - 1 May 2018
Externally publishedYes

Fingerprint

Hospital Emergency Service
Cohort Studies
mortality
death
Mortality
Checklist
Uncertainty
uncertainty
Advance Care Planning
Clinical Decision Support Systems
nursing home
hospitalization
Denmark
telephone
caregiver
evidence
Ireland
Internship and Residency
health service
Nursing Homes

Cite this

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. In: Archives of Gerontology and Geriatrics. 2018 ; Vol. 76. pp. 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.",
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 Chang, {Chan Wei} 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",
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doi = "10.1016/j.archger.2018.02.014",
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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, CW, 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, vol. 76, pp. 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.

In: Archives of Gerontology and Geriatrics, Vol. 76, 01.05.2018, p. 169-174.

Research output: Contribution to journalArticleResearchpeer-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.

UR - http://www.scopus.com/inward/record.url?scp=85042933139&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/NHMRC/1054146

U2 - 10.1016/j.archger.2018.02.014

DO - 10.1016/j.archger.2018.02.014

M3 - Article

VL - 76

SP - 169

EP - 174

JO - Archives of Gerontology and Geriatrics

JF - Archives of Gerontology and Geriatrics

SN - 0167-4943

ER -