Dataset Information

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.

ABSTRACT:

Abstract

To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients.

Methods

Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy.

Results

2493 patients, with median age 78-80 years (DK-Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7-8.6 vs. 5.8 95% CI 5.6-5.9) and Danish mean 7.1 (95% CI 6.6-7.5 vs. 5.5 95% CI 5.4-5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL's accuracy was only modest for in-hospital death prediction in either setting.

Conclusions

The modified CriSTAL tool (with CFS instead of Fried's frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician's confidence in initiating earlier end-of-life discussions.

SUBMITTER: Cardona M

PROVIDER: S-EPMC6267649 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.

Cardona Magnolia M Lewis Ebony T ET Kristensen Mette R MR Skjøt-Arkil Helene H Ekmann Anette Addy AA Nygaard Hanne H HH Jensen Jonas J JJ Jensen Rune O RO Pedersen Jonas L JL Turner Robin M RM Garden Frances F Alkhouri Hatem H Asha Stephen S Mackenzie John J Perkins Margaret M Suri Sam S Holdgate Anna A Winoto Luis L Chang David C W DCW Gallego-Luxan Blanca B McCarthy Sally S Petersen John A JA Jensen Birgitte N BN Backer Mogensen Christian C Hillman Ken K Brabrand Mikkel M

European geriatric medicine 20181031 6

<h4>Abstract</h4>To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients.<h4>Methods</h4>Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death pr ...[more]

PMID: 30574216

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Dataset Information

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.

Abstract

Methods

Results

Conclusions

Publications

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.

Similar Datasets

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