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The association of clinical frailty with outcomes of patients reviewed by rapid response teams: an international prospective observational cohort study.
So, Ralph K L; Bannard-Smith, Jonathan; Subbe, Chris P; Jones, Daryl A; van Rosmalen, Joost; Lighthall, Geoffrey K.
Afiliação
  • So RKL; Department of Intensive Care, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, the Netherlands. ralphklso@gmail.com.
  • Bannard-Smith J; Department of Critical Care, Manchester Royal Infirmary, Central Manchester University NHS Hospitals, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.
  • Subbe CP; Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, UK.
  • Jones DA; Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, VIC, Australia.
  • van Rosmalen J; Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands.
  • Lighthall GK; Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr. H3580, Stanford, CA, 94305, USA.
Crit Care ; 22(1): 227, 2018 09 22.
Article em En | MEDLINE | ID: mdl-30241490
ABSTRACT

BACKGROUND:

Frailty is a state of vulnerability to poor resolution of homeostasis after a stressor event and is strongly associated with adverse outcomes. Therefore, the assessment of frailty may be an essential part of evaluation in any healthcare encounter that might result in an escalation of care. The purpose of the study was to assess the frequency and association of frailty with clinical outcomes in patients subject to rapid response team (RRT) review.

METHODS:

In this multi-national prospective observational cohort study, centres with existing RRTs collected data over a 7-day period, with follow up of all patients at 24 h following their RRT call and at hospital discharge or 30 days following the event trigger (whichever came sooner). Investigators also collected data on the triggers and interventions provided and a bedside assessment on the level of patients' frailty using a clinical frailty scale.

RESULTS:

Amongst 1133 patients, 40% were screened as frail, which was associated with older age (p < 0.001), admission under a medical speciality (p < 0.001), increased severity of illness at the time of the RRT review (p = 0.0047), and substantially higher frequency of limitations of care (p < 0.001). Importantly, 72% of patients screened as frail were either dead or dependent on hospital care by 30 days (p < 0.001). In the multivariable analysis, the significant risk factors for the composite endpoint "poor recovery" (died or were hospital-dependent by 30 days) were age (odds ratio (OR), 1.04; 95% confidence interval (CI), 1.03-1.05; p < 0.001), frailty level (p < 0.001), existing limitation of care (OR, 2.0; 95% CI, 1.3-3.0; p < 0.001), and the quick sequential organ failure assessment (qSOFA) score (p < 0.001).

CONCLUSIONS:

Higher frailty scores were associated with increased mortality and dependence on health care at 30 days. Our results indicate that frailty has an influence on the clinical trajectory of deteriorating patients and that such assessment should be included in discussion of goals and expectations of care. TRIAL REGISTRATION Netherlands Trial Registry, NTR5535 . Registered on 23 December 2015.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Avaliação de Resultados em Cuidados de Saúde / Equipe de Respostas Rápidas de Hospitais / Fragilidade Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Avaliação de Resultados em Cuidados de Saúde / Equipe de Respostas Rápidas de Hospitais / Fragilidade Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article