The inter-rater reliability of emergency department and paramedic frailty screening in older patients following a fall.

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE Australasian Emergency Care Pub Date : 2024-10-24 DOI:10.1016/j.auec.2024.10.002

Nikita Indrawan, Jason Ellis, Judith Finn, Glenn Arendts

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Abstract

Background: Screening for frailty in the emergency setting may be useful in directing patients to appropriate management pathways. The main aim of this study was to assess the inter-rater reliability of the Clinical Frailty Scale between paramedics and emergency department staff (doctors and allied heath) for patients after a fall. Secondarily, to assess how these scores correlate with patient outcomes.

Methods: A prospective study of older patients arriving by ambulance to a single hospital in Western Australia following a fall. The inter-rater reliability was assessed using a weighted Cohen's κ. The relationship between Clinical Frailty Scale and secondary outcomes were assessed using chi-squared and Kruskal-Wallis tests.

Results: Data from 94 patients were included, the mean age was 82 years and 64 % were female. The inter-rater reliability between paramedics and emergency department staff using the Clinical Frailty Scale was moderate (κ 0.48 (95 % CI 0.36-0.59)).

Conclusions: There is only moderate agreement between emergency department staff and paramedics when screening for frailty in patients who present after a fall. The findings indicate the need to improve reliability as a pre-requisite to the use of frailty screening in emergency settings.

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急诊科和护理人员对跌倒后老年患者进行虚弱程度筛查的互评可靠性。

背景：在急诊环境中筛查虚弱程度可能有助于将患者引导至适当的治疗途径。本研究的主要目的是评估辅助医务人员和急诊科工作人员（医生和专职医疗人员）对跌倒患者进行临床虚弱量表评分的互评可靠性。其次，评估这些评分与患者预后的相关性：一项前瞻性研究，对象是摔倒后乘坐救护车来到西澳大利亚一家医院的老年患者。使用加权科恩κ评估了评分者之间的可靠性。临床虚弱量表与次要结果之间的关系采用秩方检验和 Kruskal-Wallis 检验进行评估：共纳入了 94 名患者的数据，平均年龄为 82 岁，64% 为女性。医护人员和急诊科工作人员使用临床虚弱量表的评分者间可靠性为中等（κ 0.48 (95 % CI 0.36-0.59)）：急诊科医护人员和护理人员在对跌倒后就诊的患者进行体弱筛查时仅有中等程度的一致性。研究结果表明，在急诊环境中使用虚弱筛查的前提条件是需要提高可靠性。

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来源期刊

Australasian Emergency Care Nursing-Emergency Nursing

CiteScore

3.30

自引率

5.60%

发文量

审稿时长

37 days

期刊介绍： Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.