ABSTRACT
OBJECTIVE: To identify the most relevant clinical characteristics of the nursing diagnosis frail elderly syndrome (FES) in hospitalized patients aged 65 or older and analyze their impact on 9-month mortality and hospital readmission. METHODS: A prospective and prognostic accuracy study was conducted in patients aged 65 or older, who were admitted to hospital more than 24 h. A consecutive convenience sampling process was used. Assessment included defining characteristics (DCs) of FES, clinical fraility scale (CFS), frail scale (FS), and 9-month mortality and hospital readmission. Statistical tests were used to verify associations between variables. Binary logistic regression analysis and area under the curve were used, to identify significant predictors for the outcomes and evaluate the prognostic accuracy of the DCs. FINDINGS: This study involved 150 patients. CFS scored 65 patients (43.3%, confidence interval 95% 35.2% a 51.6) as frail and proved a prognostic value of mortality at 9 month from pre-frail state (p = 0.020). The mean number of DCs for FES nursing diagnosis was 6.35 (SD = 3.14). Validated tools for measuring frailty were associated with all DCs, excepting nutritional imbalance: below body needs. The hospital readmission during the following 9 months was only statistically related to memory impairment (p = 0.07). CONCLUSION: Clinical frailty scale showed good results as a predictor of mortality. The study suggests exploring including it, in clinical manifestations of elderly frail syndrome. This study found that only memory impairment defining characteristic was predictive of hospital readmission. Further research should identify other relevant and prognostic clinical manifestations. IMPLICATION FOR NURSING PRACTICE: These findings highlight the importance of being vigilant on cognitive decline during hospital admissions. The most prevalent and determinant DCs identified in this study indicate that clinical should focus on preserving functional and mental abilities as well as mobility.
ABSTRACT
Introducción: A pesar de su importancia, la existencia de falsos negativos (pacientes a los que se les dice que oyen bien, pero en realidad son hipoacúsicos) no suele ser evaluada en los programas de detección precoz de hipoacusia. El objetivo de este estudio es determinar las variables que pueden a llevar a un retraso diagnóstico, en especial la existencia de falsos negativos así como la falta de registro de factores de riesgo. Métodos: Se ha realizado un estudio observacional retrospectivo de prevalencia, analizando las historias clínicas de los pacientes con hipoacusia neurosensorial nacidos entre 2005 y 2012 en las áreas de salud del estudio. Resultados: De 32 niños con hipoacusia neurosensorial, 16 pasaron las OEA, 12 no pasaron las OEA y a 4 no se les realizaron. De los pacientes con hipoacusia pero que pasaron las OEA, el 57% tiene una hipoacusia severa y/o profunda. El 66% de los niños con hipoacusia presentaban algún factor de riesgo de hipoacusia, siendo los antecedentes familiares de hipoacusia el más frecuente, pero solo el 7% de los que tenían antecedentes familiares fueron incluidos en el grupo de riesgo. La tasa de pacientes falsos negativos en el estudio es muy elevada. Conclusiones: Los resultados del estudio indican que el diagnóstico tardío de las hipoacusias infantiles en las áreas estudiadas está relacionado con la presencia de falsos negativos a las OEA y con la falta de registro de los factores de riesgo (AU)
Introduction: Despite its importance, the existence of false negatives (patients who are told they hear well, but they have some degree of hipacusia) is rarely evaluated in programs for early detection of hearing loss. The aim of this study is to determine the variables that can lead to a delayed diagnosis, especially the existence of false negatives and the lack of registration of risk factors. Methods: A retrospective study of prevalence has been carried out, in which the medical records of children diagnosed with sensorineural hearing loss born within 2005 and 2012 in the health centers of study have been analyzed. Results: Of the 32 children with sensorineural hearing loss, 16 passed the OAE, 12 did not passed the OAE, and in four they were not carried out. Of the children who passed the OAE, 57% have severe hearing loss. 66% of children with hearing loss presented a risk factor for hearing loss at birth, being the most frecuent family history of hearing loss, but only 7% of those with family history of hearing loss were included in the risk group. Conclusions: The results of the study indicate that the late diagnosis of hearing loss is related to the presence of false negatives to the OAE and the non-registration of risk factors (AU)
Subject(s)
Humans , Male , Female , Child , Deafness/diagnosis , Hearing Tests/methods , Hearing Loss, Sensorineural/diagnosis , Deafness/epidemiology , Neonatal Screening/methods , Delayed Diagnosis/statistics & numerical data , False Negative Reactions , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Despite its importance, the existence of false negatives (patients who are told they hear well, but they have some degree of hipacusia) is rarely evaluated in programs for early detection of hearing loss. The aim of this study is to determine the variables that can lead to a delayed diagnosis, especially the existence of false negatives and the lack of registration of risk factors. METHODS: A retrospective study of prevalence has been carried out, in which the medical records of children diagnosed with sensorineural hearing loss born within 2005 and 2012 in the health centers of study have been analyzed. RESULTS: Of the 32 children with sensorineural hearing loss, 16 passed the OAE, 12 did not passed the OAE, and in four they were not carried out. Of the children who passed the OAE, 57% have severe hearing loss. 66% of children with hearing loss presented a risk factor for hearing loss at birth, being the most frecuent family history of hearing loss, but only 7% of those with family history of hearing loss were included in the risk group. CONCLUSIONS: The results of the study indicate that the late diagnosis of hearing loss is related to the presence of false negatives to the OAE and the non-registration of risk factors.