Jakub Kenig1, Beata Zychiewicz2, Urszula Olszewska3, Marcin Barczynski4, Wojciech Nowak5. 1. 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: jkenig@cm-uj.krakow.pl. 2. 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: betiz@interia.eu. 3. 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: urszula.olszewska@szeptem.pl. 4. 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: marbar@mp.pl. 5. 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: chirurgia@narutowicz.krakow.pl.
Abstract
INTRODUCTION: The literature on geriatric assessment in emergency admitted patients is scarce, particularly there are no studies regarding the efficacy of frailty screening tests among patients qualified for emergency abdominal surgery. Therefore, the aim of this study was to compare the diagnostic accuracy of six screening instruments in this group of patients. MATERIAL AND METHODS: The diagnostic accuracy of the Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric-8 (G8), Groningen Frailty Index (GFI), Rockwood, Balducci score was evaluated in a prospective group of 184 consecutive patients ≥65 years of age. Outcome measure was sensitivity, specificity, positive and negative predictive values of these tests in prediciting 30-day postoperative outcome. RESULTS: Patients mean age was 76.9±5.8 (65-100) years. The prevalence of frailty, as diagnosed by screening methods, was: 50-79.9% (Balducci/Rockwood-G8). Multivariate analyses have identified all screening tests apart from Rockwood and TRST as independent factors that predict postoperative outcome. The sensitivity and negative predictive value in case of postoperative mortality were 60-91% (Rockwood-VES-13) and 30-93% (GFI-VES13). In case of postoperative morbidity they were 52-85% (Rockwood-VES-13 and G8) and 44-70% (Rockwood-VES-13), respectively. CONCLUSION: Considering these results, it is possible to perform safely and efficiently screening test for frailty in older patients qualified for emergency abdominal surgery. The VES-13 was the best screening instrument; it had the highest sensitivity and negative predictive value both for the postoperative mortality and morbidity. This instrument may offer physicians additional information that can be used in the postoperative optimisation of the treatment of these high-risk group of patients.
INTRODUCTION: The literature on geriatric assessment in emergency admitted patients is scarce, particularly there are no studies regarding the efficacy of frailty screening tests among patients qualified for emergency abdominal surgery. Therefore, the aim of this study was to compare the diagnostic accuracy of six screening instruments in this group of patients. MATERIAL AND METHODS: The diagnostic accuracy of the Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric-8 (G8), Groningen Frailty Index (GFI), Rockwood, Balducci score was evaluated in a prospective group of 184 consecutive patients ≥65 years of age. Outcome measure was sensitivity, specificity, positive and negative predictive values of these tests in prediciting 30-day postoperative outcome. RESULTS:Patients mean age was 76.9±5.8 (65-100) years. The prevalence of frailty, as diagnosed by screening methods, was: 50-79.9% (Balducci/Rockwood-G8). Multivariate analyses have identified all screening tests apart from Rockwood and TRST as independent factors that predict postoperative outcome. The sensitivity and negative predictive value in case of postoperative mortality were 60-91% (Rockwood-VES-13) and 30-93% (GFI-VES13). In case of postoperative morbidity they were 52-85% (Rockwood-VES-13 and G8) and 44-70% (Rockwood-VES-13), respectively. CONCLUSION: Considering these results, it is possible to perform safely and efficiently screening test for frailty in older patients qualified for emergency abdominal surgery. The VES-13 was the best screening instrument; it had the highest sensitivity and negative predictive value both for the postoperative mortality and morbidity. This instrument may offer physicians additional information that can be used in the postoperative optimisation of the treatment of these high-risk group of patients.
Authors: Massimo Sartelli; Fausto Catena; Fikri M Abu-Zidan; Luca Ansaloni; Walter L Biffl; Marja A Boermeester; Marco Ceresoli; Osvaldo Chiara; Federico Coccolini; Jan J De Waele; Salomone Di Saverio; Christian Eckmann; Gustavo P Fraga; Maddalena Giannella; Massimo Girardis; Ewen A Griffiths; Jeffry Kashuk; Andrew W Kirkpatrick; Vladimir Khokha; Yoram Kluger; Francesco M Labricciosa; Ari Leppaniemi; Ronald V Maier; Addison K May; Mark Malangoni; Ignacio Martin-Loeches; John Mazuski; Philippe Montravers; Andrew Peitzman; Bruno M Pereira; Tarcisio Reis; Boris Sakakushev; Gabriele Sganga; Kjetil Soreide; Michael Sugrue; Jan Ulrych; Jean-Louis Vincent; Pierluigi Viale; Ernest E Moore Journal: World J Emerg Surg Date: 2017-05-04 Impact factor: 5.469
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Authors: Itziar Vergara; Maider Mateo-Abad; María Carmen Saucedo-Figueredo; Mónica Machón; Alonso Montiel-Luque; Kalliopi Vrotsou; María Antonia Nava Del Val; Ana Díez-Ruiz; Carolina Güell; Ander Matheu; Antonio Bueno; Jazmina Núñez; Francisco Rivas-Ruiz Journal: BMC Geriatr Date: 2019-12-03 Impact factor: 3.921