Kasim Abdulaziz1, Jamie Brehaut1, Monica Taljaard1, Marcel Émond2, Marie-Josée Sirois3, Jacques S Lee4, Laura Wilding5, Jeffrey J Perry1. 1. *Department of Epidemiology and Community Medicine,University of Ottawa,Ottawa,ON. 2. ‡Department of Family and Emergency Medicine,Université Laval,Laval,QC. 3. §Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec,Laval,QC. 4. ǁClinical Epidemiology Unit,Department of Emergency Medicine,University of Toronto,Sunnybrook Health Sciences Center,Toronto,ON. 5. **Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
Abstract
BACKGROUND: There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury. METHODS: After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method. RESULTS: Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks. CONCLUSIONS: A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.
BACKGROUND: There are a number of screening tools to predict return to the emergency department (ED) in elderly traumapatients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury. METHODS: After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method. RESULTS: Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks. CONCLUSIONS: A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly traumapatients.
Entities:
Keywords:
Activities of Daily Living (ADL); Elderly; Emergency Department; Functional Decline; Geriatric Assessment; Minor Injuries; Older Americans Resources and Services (OARS)
Authors: M Elizabeth Wilcox; Elizabeth A Freiheit; Peter Faris; David B Hogan; Scott B Patten; Todd Anderson; William A Ghali; Merril Knudtson; Andrew Demchuk; Colleen J Maxwell Journal: BMC Psychiatry Date: 2016-08-04 Impact factor: 3.630