Australasian Emergency Care最新文献_第7页

Enhancing end-of-life care for advanced heart failure patients in Saudi Arabian emergency departments (EDs): Perspectives of ED staff on challenges 加强沙特阿拉伯急诊科（ED）晚期心力衰竭患者的临终关怀：ED工作人员对挑战的看法。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-02-05 DOI: 10.1016/j.auec.2025.01.004

Ali Jaber Alqahtani , Geoffrey Keith Mitchell , Lisa Crossland , Hanan Mesfer Alyami

Background

Providing care for patients nearing the end of life who have advanced heart failure presents significant challenges, especially in emergency settings where the primary focus is on life-saving interventions. Exploring the perceptions of emergency department staff is essential for identifying barriers and improving care delivery in this critical context.

Methods

A qualitative study was conducted in two hospitals in Saudi Arabia. Semi-structured interviews were completed with thirty emergency staff. A thematic analysis was used to identify the challenges in delivering care for patients nearing the end of life.

Results

Seven themes were identified: current practices for advanced heart failure patients, communication barriers, inadequate training in end-of-life care, limitations in emergency department design, heavy workloads, the influence of cultural and religious factors, and the importance of psychological and emotional support for patients and families. The findings highlight the need for structured training, cultural sensitivity, and improved environments to address these challenges.

Conclusions

This study emphasizes the complexities of providing care for patients nearing the end of life in emergency settings. Addressing gaps in communication, training, and cultural competence is critical. Tailored strategies for Saudi Arabia’s unique context are essential to enhance care for advanced heart failure patients.

背景：为晚期心力衰竭患者提供护理面临着重大挑战，特别是在紧急情况下，主要重点是挽救生命的干预措施。在这一关键背景下，探索急诊科工作人员的看法对于确定障碍和改善护理服务至关重要。方法：在沙特阿拉伯的两家医院进行定性研究。与30名急救人员完成了半结构化访谈。一项专题分析被用来确定为接近生命终点的病人提供护理的挑战。结果：确定了七个主题：晚期心力衰竭患者的现行做法，沟通障碍，临终关怀培训不足，急诊科设计的局限性，繁重的工作量，文化和宗教因素的影响，以及对患者和家属的心理和情感支持的重要性。研究结果强调，需要有组织的培训、文化敏感性和改善环境来应对这些挑战。结论：本研究强调了在紧急情况下为接近生命末期的患者提供护理的复杂性。解决沟通、培训和文化能力方面的差距至关重要。针对沙特阿拉伯独特国情的量身定制战略对于加强对晚期心力衰竭患者的护理至关重要。

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引用次数: 0

How confident are Queensland paramedics with seizure recognition, differentiation, and management? A pilot study 昆士兰护理人员对癫痫的识别、鉴别和管理有多自信？一项初步研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-01-29 DOI: 10.1016/j.auec.2025.01.002

Jordan J. Hill , Brooke L. Hill , Brett Williams

Background

Paramedics in Australia present as the opportune medical personnel to initiate medical intervention of seizure presentations and perform a fundamental role in the prevention of seizure associated morbidity and mortality. Despite being well equipped to manage seizures, no literature exists regarding their confidence to recognise, differentiate, or manage seizures.

Methods

An online cross-sectional survey was undertaken by 168 paramedics practicing clinically for the Queensland Ambulance Service in Australia. The survey assessed paramedic perceived self-confidence surrounding seizure presentations. Non-parametric Kruskal-Wallis H-Test and post hoc pairwise comparisons were conducted to assess between group differences in relation to practicing qualifications, and years of service.

Results

Paramedics were confident in generalised convulsive seizure recognition and management, however, displayed less confidence surrounding non-convulsive, focal, and psychogenic seizure classifications. Critical care paramedics reported higher confidence than advanced care and graduate paramedics across various seizure presentation elements (p < 0.05). Paramedics with greater than 10 years of service reported higher confidence than those with fewer years of service, particularly less than two years.

Conclusion

Future education and professional development opportunities for paramedics require a greater focus on the development of self-confidence, with mechanisms implemented to increase paramedics’ exposure to the broad spectrum of seizure presentations.

背景：护理人员在澳大利亚目前作为适当的医务人员，以启动医疗干预癫痫的介绍，并执行在预防癫痫相关的发病率和死亡率的基本作用。尽管有很好的装备来管理癫痫发作，没有文献存在关于他们的信心来识别，区分，或管理癫痫发作。方法：对澳大利亚昆士兰救护车服务的168名临床护理人员进行了在线横断面调查。该调查评估了护理人员在癫痫发作时的自信心。进行非参数Kruskal-Wallis h检验和事后两两比较，以评估与执业资格和服务年限相关的组间差异。结果：护理人员对全面性惊厥发作的识别和管理有信心，然而，对非惊厥、局灶性和心因性发作分类的信心较低。在各种癫痫发作表现要素中，重症护理护理人员比高级护理护理人员和研究生护理人员报告的自信心更高(p 结论：护理人员未来的教育和专业发展机会需要更加关注自信心的发展，并实施机制来增加护理人员接触广泛的癫痫发作表现。

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引用次数: 0

Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study 急诊科分诊前等待期的消费者体验：一项混合方法研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-01-22 DOI: 10.1016/j.auec.2025.01.001

Rebecca Sedgman , Noah Pallot , Annette Peart , Sebastian Wrobel , Joseph Miller , Liam Hackett , Katrina Maybury , Emogene Aldridge , Patrick J. Owen , Paul Buntine

Background

Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments.

Methods

This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically.

Results

Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3–90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %).

Conclusion

Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.

背景：急诊科分诊前的等待期受到了有限的关注。我们的目的是探讨在急诊室就诊的消费者在分诊前的经验和观点。方法：这项混合方法的横断面研究包括92名参与者（患者、护理人员和监护人），他们在墨尔本大都会（维多利亚，澳大利亚）的三所公立医院急诊科之一就诊。定量自我报告的结果是等待时间（分钟）和以前急诊室就诊的次数。定性结果（通过内容分析探索）是消费者的体验和急诊部门的观点，特别是分诊前的等待期。结果：参与者报告的中位数（IQR）等待时间为45（100）分钟，65% % （n = 60）经历了3-90 分钟的预分流等待时间。最常见的知觉pre-triage等待期是一个期望等(n = 16、17 %),然而46 % (n = 42)报道的困难在此期间,如其他病人减少队列(6.5 n = 6日 %)。与分诊前等待期相关的阳性结果很少，改善这一时期的建议往往侧重于促进排队系统（n = 18,20 %）。结论：消费者期望并理解分诊，但在分诊前等待期报告了各种困难和很少的积极因素，并建议改进现行系统，需要调查改善排队的干预措施。

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引用次数: 0

Emergency care experiences of patients known to palliative care services and their family: A qualitative interview study 姑息治疗患者及其家属的急诊护理经验：一项质性访谈研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-30 DOI: 10.1016/j.auec.2024.12.003

Reuben Sutton , Natalie Elizabeth Anderson , Merryn Gott

Background

With aging and comorbid populations and healthcare services under pressure, emergency department presentations related to palliative care needs are increasing. Little is known about patient and family experiences of care in this context. This study explores the emergency department care experiences of palliative patients and their family members.

Methods

Semi-structured interviews with patients known to palliative care services who had presented to an urban emergency department within the study recruitment period. Six patients and five family members were interviewed. Reflexive thematic analysis methodology was underpinned by social constructivism.

Findings

Participants often described misalignment between emergency care priorities and their own, which was sometimes associated with challenges, including dehumanisation. However, participants also shared stories of supported self-advocacy, associated with positive care experiences.

Conclusion

This research identifies challenges patients and their family experience when accessing emergency department care. Symptom management, time, environment, and advocacy were impactful aspects of patient and family experience. There is a need to develop and support palliative care skills and knowledge within EDs, and adapt the environment to provide a safe space for sensitive communication and person-centred care.

背景：随着老龄化和合并症人群以及医疗保健服务面临压力，与姑息治疗需求相关的急诊科报告正在增加。在这种情况下，对病人和家庭的护理经验知之甚少。本研究探讨姑息病人及其家属在急诊科的护理经验。方法：对在研究招募期间到城市急诊科就诊的已知姑息治疗服务患者进行半结构化访谈。对6名患者和5名家属进行了访谈。反身性主题分析方法以社会建构主义为基础。研究结果：参与者经常描述紧急护理优先事项与他们自己的优先事项之间的不一致，这有时与挑战相关，包括非人性化。然而，参与者也分享了支持自我倡导的故事，这些故事与积极的护理经历有关。结论：本研究确定了患者及其家庭在接受急诊科护理时面临的挑战。症状管理、时间、环境和宣传是影响患者和家庭经验的方面。有必要发展和支持急诊科的姑息治疗技能和知识，并调整环境，为敏感的沟通和以人为本的护理提供安全的空间。

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引用次数: 0

RESCUE - Rapid, Effective, Safe Communication in Emergency Departments: A cross-sectional e-survey 救援——急诊科快速、有效、安全的通信：一项横断面电子调查。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-27 DOI: 10.1016/j.auec.2024.12.002

Amy Freeman-Sanderson , Nicola Clayton , Margaret Fry , Rebecca Sullivan , Bronwyn Hemsley

Background

Effective staff-to-staff and patient-provider communication in the Emergency Department (ED) is essential for safe, quality care. Routine wearing of Personal-Protective-Equipment (PPE) has introduced new challenges to communication. We aimed to understand the perspectives of ED staff about communicating while wearing PPE, and to identify factors contributing to communication success, breakdown, and repair.

Methods

Study design was a descriptive cross-sectional online survey with convenience sampling. Categorical data were analysed using descriptive statistics and qualitative data analysed using content thematic analysis.

Results

Across nursing, medical and allied health, 78 staff responded with mean age= 38.8 years and mean ED clinical experience= 8.8 years). Respondents reported PPE impacted communication with patients/family members (81 %) and staff (61 %), with almost three-quarters of patient interactions rated as “somewhat difficult” or “extremely difficult”. Content themes were: (i) impacts of mask-wearing on communication, (ii) impacts of mask-wearing on patient care quality and safety, and (iii) strategies for repairing communication breakdown. Health impacts of communicating in PPE (50 %) included voice fatigue, skin irritation, and throat dryness.

Conclusion

ED staff perceived that wearing PPE impacted communication and compromised safe and efficient quality care delivery. Staff reported using increased voice volume, repetition, gestures, increased proximity, and emphasised facial movements to enhance their communication.

背景：在急诊科（ED），有效的员工与员工和患者与提供者之间的沟通对于安全、优质的护理至关重要。个人防护装备（PPE）的日常穿戴给沟通带来了新的挑战。我们的目的是了解急诊科工作人员对戴着PPE进行沟通的看法，并确定影响沟通成功、失败和修复的因素。方法：采用描述性横断面在线调查，方便抽样。分类数据采用描述性统计分析，定性数据采用内容专题分析分析。结果：在护理、医疗和相关健康领域，78名员工的平均年龄= 38.8岁，平均ED临床经验= 8.8岁。受访者表示，PPE影响了与患者/家属（81% %）和工作人员（61% %）的沟通，几乎四分之三的患者互动被评为“有些困难”或“极其困难”。内容主题为：(i)戴口罩对沟通的影响，（ii）戴口罩对患者护理质量和安全的影响，以及（iii）修复沟通故障的策略。穿着个人防护用品交流对健康的影响（50% %）包括声音疲劳、皮肤刺激和喉咙干燥。结论：急诊科工作人员认为佩戴个人防护装备影响了沟通，影响了安全高效的优质医疗服务。员工们报告说，他们通过提高音量、重复、做手势、拉近距离，并强调面部动作来加强沟通。

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引用次数: 0

Maintenance of normothermia in the out-of-hospital setting: A pilot comparative crossover study of a foil blanket versus self-warming blanket 院外环境中正常体温的维持：铝箔毯与自温毯的试点比较交叉研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-18 DOI: 10.1016/j.auec.2024.12.001

Kathleen M. O’Leary , Rebecca Henderson , Joanne N. Caldwell Odgers , Benjamin N. Meadley

Introduction

Hypothermia can increase mortality in certain patients. Paramedics apply cotton and foil "space" blankets for warming, yet their effectiveness remains uncertain. This pilot study aimed to evaluate combining cotton blankets with a self-warming blanket versus a combination of cotton blankets and a foil blanket in an out-of-hospital simulation.

Methods

Eight participants were allocated to warming with either two cotton blankets and one foil blanket, or two cotton blankets and one self-warming blanket, with the alternate method applied in a subsequent session. Participants were cooled using an ice-vest and fan until shivering onset, after which the warming method was applied. Simulation involved transitioning through three environments: baseline (22 °C), cooling/warming (16 °C), and “ambulance” (27 °C). Core temperature was monitored via oesophageal probe, skin temperature via thermistors (recorded every minute), and tympanic temperature and thermal sensation and comfort were recorded five minutely.

Results

There were minor differences in thermal sensation. For the primary outcome there was no significant difference between blanket methods (core: foil 36.98 ± 0.08 °C vs. self-warming 36.95 ± 0.10 °C, P > 0.05).

Conclusion

The combination of cotton and self-warming blankets did not exhibit superiority compared to cotton and foil blankets in out-of-hospital simulation. Future research should explore alternative warming methodologies to optimise normothermia maintenance.

引言：低温可增加某些患者的死亡率。医护人员使用棉和箔“太空”毯取暖，但其效果仍不确定。本初步研究旨在评估在院外模拟中棉毯与自温毯的组合与棉毯与箔毯的组合。方法：8名参与者被分配到使用两个棉毯和一个铝箔毯或两个棉毯和一个自温毯进行加热，并在随后的会议中使用替代方法。参与者使用冰背心和风扇降温，直到开始发抖，之后使用升温方法。模拟涉及三种环境的转换：基线（22°C）、冷却/升温（16°C）和“救护车”（27°C）。通过食管探头监测核心温度，通过热敏电阻监测皮肤温度（每分钟记录一次），每5分钟记录鼓室温度和热感觉及舒适度。结果：两组患者热感觉差异较小。对于主要结局，毯子方法之间无显著差异（核心：箔36.98±0.08°C vs自温36.95±0.10°C, P > 0.05）。结论：在院外模拟中，棉与自温毯组合并不比棉与箔毯组合具有优势。未来的研究应该探索其他的变暖方法来优化恒温维持。

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引用次数: 0

First Nations women’s experiences of out-of-hospital childbirth: Insights for enhancing paramedic practice – A scoping review 第一民族妇女院外分娩的经验：加强护理实践的见解-范围审查。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-09 DOI: 10.1016/j.auec.2024.11.002

Arwen Wilkinson , Haley Findlay , Jayne Lawrence , Linda Deravin

Background

Birthing on Country principles in Australia have seen a revitalisation in midwifery care over the last decade with it being seen as a metaphor for the best start to life for First Nations peoples. This scoping review aimed to explore the extent of evidence of Australian First Nations women's experiences of out-of-hospital childbirth and the alignment with Birthing on Country principles to inform paramedic practice.

Methods

Four databases were searched including MEDLINE, CINAHL, EBSCOhost Health and Scopus utilising the Joanna Briggs Institute (JBI) methodology for Scoping Reviews. Inclusion and exclusion criteria were identified. All articles were reviewed in a two stage process.

Results

Fifty two papers were yielded with 6 meeting the inclusion criteria. Using reflective thematic analysis four key themes were generated; Birthing on Country and identity, inequitable access to healthcare, trusting relationships and medicalisation of birth.

Conclusions

There is a large gap in the literature surrounding delivery of care by paramedics to First Nations women birthing out-of-hospital in Australia. This review proposes supports and actions required to implement Birthing on Country principles into paramedicine. Further, standard maternity care has been found to be insufficient for First Nations women due to a lack of culturally safe care.

背景：在过去的十年里，澳大利亚的乡村原则分娩已经看到了助产护理的复兴，它被视为第一民族生活的最佳开端的隐喻。本综述旨在探讨澳大利亚第一民族妇女院外分娩经验的证据程度，并与国家分娩原则保持一致，以告知护理人员实践。方法：采用乔安娜布里格斯研究所（JBI）的范围评价方法，检索MEDLINE、CINAHL、EBSCOhost Health和Scopus 4个数据库。确定纳入和排除标准。所有文章的审查分两个阶段进行。结果：共纳入论文52篇，符合纳入标准6篇。通过反思性主题分析，产生了四个关键主题；国家和身份的分娩，获得医疗保健的不公平机会，信任关系和分娩医疗化。结论：在文献中有一个很大的差距，围绕护理人员提供护理第一民族妇女在澳大利亚院外分娩。本审查提出了在辅助医学中实施国家分娩原则所需的支持和行动。此外，由于缺乏文化上安全的护理，标准的产妇护理已被发现对第一民族妇女是不够的。

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引用次数: 0

The experiences of trans (binary and non-binary) people accessing emergency department care in Australia: A grounded theory study 跨性别（二元和非二元）人在澳大利亚急诊科就诊的经历：一项有根据的理论研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-04 DOI: 10.1016/j.auec.2024.11.001

Jake A. Muller, Elizabeth M. Forster, Katina Corones-Watkins, Belinda Chaplin

Background

This study aimed to explore the experiences of trans (binary and non-binary) people accessing emergency department care in Australia.

Method

This qualitative descriptive study utilised a grounded theory approach. Seven people who identified as trans were recruited through social media and trans support groups. Individuals participated in an in-depth narrative interview. Interview transcriptions were analysed using a constant comparative approach.

Results

Following thematic analysis, four key themes were identified: 1. identity; 2. clinical care; 3. communication; and 4. perceptions of health professional education, beliefs and experience in caring for trans people.

Conclusion

This study is the first in Australia to explore the experiences of trans people utilising emergency department services. The findings of this study are similar to international data whereby the delivery of gender affirming care in emergency departments is inconsistent, health professionals are perceived as poorly educated and gender identity is inadequately recognised.

背景：本研究旨在探讨澳大利亚跨性别（双性恋和非双性恋）人士获得急诊护理的经历。方法：本定性描述性研究采用扎根理论方法。七名变性人是通过社交媒体和变性人支持团体招募的。个人参与了一个深入的叙述性访谈。访谈记录采用持续比较方法进行分析。结果：通过主题分析，确定了四个关键主题：1。的身份;2. 临床护理;3. 沟通;和4。对卫生专业教育的认知、对变性人护理的信仰和经验。结论：本研究是澳洲首个探讨跨性别人士使用急诊科服务经验的研究。这项研究的结果与国际数据相似，即急诊科提供的性别肯定护理不一致，卫生专业人员被认为受教育程度低，性别认同没有得到充分承认。

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引用次数: 0

Gender bias in text-to-image generative artificial intelligence depiction of Australian paramedics and first responders 澳大利亚护理人员和急救人员的文本到图像生成人工智能描述中的性别偏见。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-02 DOI: 10.1016/j.auec.2024.11.003

Geoffrey Currie , Johnathan Hewis , Phillip Ebbs

Introduction

In Australia, almost 50 % of paramedics are female yet they remain under-represented in stereotypical depictions of the profession. The potentially transformative value of generative artificial intelligence (AI) may be limited by stereotypical errors, misrepresentations and bias. Increasing use of text-to-image generative AI, like DALL-E 3, could reinforce gender and ethnicity biases and, therefore, is important to objectively evaluate.

Method

In March 2024, DALL-E 3 was utilised via GPT-4 to generate a series of individual and group images of Australian paramedics, ambulance officers, police officers and firefighters. In total, 82 images were produced including 60 individual-character images, and 22 multiple-character group images. All 326 depicted characters were independently analysed by three reviewers for apparent gender, age, skin tone and ethnicity.

Results

Among first responders, 90.8 % (N = 296) were depicted as male, 90.5 % (N = 295) as Caucasian, 95.7 % (N = 312) as a light skin tone, and 94.8 % (N = 309) as under 55 years of age. For paramedics and police the gender distribution was a statistically significant variation from that of actual Australian workforce data (all p < 0.001). Among the images of individual paramedics and ambulance officers (N = 32), DALL-E 3 depicted 100 % as male, 100 % as Caucasian and 100 % with light skin tone.

Conclusion

Gender and ethnicity bias is a significant limitation for text-to-image generative AI using DALL-E 3 among Australian first responders. Generated images have a disproportionately high misrepresentation of males, Caucasians and light skin tones that are not representative of the diversity of paramedics in Australia today.

导读：在澳大利亚，近50%的护理人员是女性，但她们在职业的刻板印象中仍然代表性不足。生成式人工智能（AI）的潜在变革价值可能会受到刻板错误、虚假陈述和偏见的限制。越来越多地使用文本到图像的生成人工智能，如dall - e3，可能会加强性别和种族偏见，因此，客观评估是很重要的。方法：于2024年3月，利用DALL-E 3通过GPT-4生成一系列澳大利亚护理人员、救护人员、警察和消防员的个人和群体图像。共生成图像82张，其中单字图像60张，多字组图像22张。所有326个描绘的角色都由三名评论者独立分析，包括表面性别、年龄、肤色和种族。结果：在第一反应者中，90.8% （N = 296）为男性，90.5% （N = 295）为白种人，95.7% （N = 312）为浅肤色，94.8% （N = 309）为55岁以下。对于护理人员和警察，性别分布在统计上与澳大利亚实际劳动力数据有显著差异(所有p结论：性别和种族偏见是澳大利亚急救人员使用dall - e3进行文本到图像生成人工智能的重大限制。生成的图像对男性、白种人和浅肤色的歪曲程度过高，不能代表当今澳大利亚护理人员的多样性。

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引用次数: 0

The Clinical Frailty Scale offers little utility as part of a prediction model for community-dwelling older fallers at risk of re-presenting to the emergency department. 临床虚弱量表作为预测模型的一部分，对社区居住的老年老年人再次出现在急诊科的风险没有多大用处。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2024-12-02 DOI: 10.1016/j.auec.2024.11.004

Loren Barton , Mark Nelson , Kirsten Strudwick , Corey Scholes

Background

There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls’ re-presentation in community-dwelling older people.

Methods

A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.

Results

The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.

Conclusions

The CFS cannot be used to prognosticate an individual’s risk of ED re-presentation within 6 months of an index extrinsic fall.

背景：目前还没有关于临床虚弱量表（CFS）对急诊科（ED）人群跌倒风险的预测能力的已发表文献。本研究旨在建立一个预后模型，以确定CFS对社区居住老年人ED跌倒再次出现的预测能力。方法：一项回顾性观察队列研究于2019年7月至2022年7月完成，研究对象是75岁及以上的社区居民，他们因外源性跌倒而就诊，并记录了CFS评分。主要结局是与跌倒相关的再次出现ED；次要结局是死亡率。采用随时间变化的灵活参数生存模型，预测6个月内再次跌倒的概率。评估校准并生成决策支持曲线。结果：模型具有合理的大尺度标定（斜率= 0.999），CFS与跌倒再现概率拟合良好。CFS模型在识别有跌倒相关ED在指数表现后6个月内再次表现风险的老年人方面显示出可忽略的判别能力（C-statistic = 0.534）。结论：CFS不能用于预测个体在指数外源性下降后6个月内再次出现ED的风险。

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引用次数: 0