Screening for older inpatients at risk for long length of stay : which clinical tool to use?

Background: Screening for inpatients at risk for long length of stay (LOS) is the first step of an effective hospital care plan for older inpatients. This study aims, in older adults admitted to a geriatric acute care ward, to examine and compare the 6-item brief geriatric assessment (BGA) and the “...

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Main Authors: Beauchet, Olivier, Fung, Shek, Launay, Cyrille P., Cooper-Brown, Liam Anders, Afilalo, Jonathan, Herbert, Paul, Afilalo, Marc, Chabot, Julia
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2019
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Online Access:https://hdl.handle.net/10356/87836
http://hdl.handle.net/10220/49292
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spelling sg-ntu-dr.10356-878362020-11-01T05:31:20Z Screening for older inpatients at risk for long length of stay : which clinical tool to use? Beauchet, Olivier Fung, Shek Launay, Cyrille P. Cooper-Brown, Liam Anders Afilalo, Jonathan Herbert, Paul Afilalo, Marc Chabot, Julia Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Older Inpatients Epidemiology Background: Screening for inpatients at risk for long length of stay (LOS) is the first step of an effective hospital care plan for older inpatients. This study aims, in older adults admitted to a geriatric acute care ward, to examine and compare the 6-item brief geriatric assessment (BGA) and the “Programme de Recherche sur l’Intégration des Services pour le Maintien de l’Autonomie” (PRISMA-7) risk levels with long LOS, and to establish their performance criteria (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios) for LOS. Methods: Based on an observational, retrospective, cohort design, 166 inpatients aged ≥75 admitted to a geriatric acute care ward of a McGill University-affiliated hospital (Montreal, Quebec, Canada) were recruited. The risk levels of the 6-item BGA (low, moderate and high) and the PRISMA-7 (low versus high) were calculated from a baseline assessment. The LOS was subsequently calculated in number of days. Results: Only the 6-item BGA high risk level was associated with a long LOS (Odds ratio = 1.1 with P = 0.028 and Hazard ratio = 2.1 with P = 0.004). Kaplan-Meier distributions showed that there was no significant difference in the delay of hospital discharge between the low and high-risk level reported by the PRISMA-7 (P = 0.381), whereas the 6-item BGA three risk levels differed significantly (P = 0.008), with individuals at high risk levels being discharged later when compared to those with low (P = 0.001) and moderate (P = 0.019) risk levels. Both tools’ performance criteria were poor (i.e., < 0.70), except for PRISMA-7’s sensitivity which was 100%. Conclusion: The 6-item BGA risk levels were associated with LOS, low risk-level being associated with short LOS and high-risk level with long LOS, but no association was reported with the PRISMA-7 risk levels. Both tools had poor performance criteria for long LOS, suggesting that they cannot be used as prognostic tools with current scientific knowledge. Published version 2019-07-11T06:56:18Z 2019-12-06T16:50:29Z 2019-07-11T06:56:18Z 2019-12-06T16:50:29Z 2019 Journal Article Beauchet, O., Fung, S., Launay, C. P., Cooper-Brown, L. A., Afilalo, J., Herbert, P., . . . Chabot, J. (2019). Screening for older inpatients at risk for long length of stay : which clinical tool to use? BMC Geriatrics, 19(1), 156-. doi:10.1186/s12877-019-1165-4 https://hdl.handle.net/10356/87836 http://hdl.handle.net/10220/49292 10.1186/s12877-019-1165-4 en BMC Geriatrics © 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 8 p. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
Older Inpatients
Epidemiology
spellingShingle Science::Medicine
Older Inpatients
Epidemiology
Beauchet, Olivier
Fung, Shek
Launay, Cyrille P.
Cooper-Brown, Liam Anders
Afilalo, Jonathan
Herbert, Paul
Afilalo, Marc
Chabot, Julia
Screening for older inpatients at risk for long length of stay : which clinical tool to use?
description Background: Screening for inpatients at risk for long length of stay (LOS) is the first step of an effective hospital care plan for older inpatients. This study aims, in older adults admitted to a geriatric acute care ward, to examine and compare the 6-item brief geriatric assessment (BGA) and the “Programme de Recherche sur l’Intégration des Services pour le Maintien de l’Autonomie” (PRISMA-7) risk levels with long LOS, and to establish their performance criteria (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios) for LOS. Methods: Based on an observational, retrospective, cohort design, 166 inpatients aged ≥75 admitted to a geriatric acute care ward of a McGill University-affiliated hospital (Montreal, Quebec, Canada) were recruited. The risk levels of the 6-item BGA (low, moderate and high) and the PRISMA-7 (low versus high) were calculated from a baseline assessment. The LOS was subsequently calculated in number of days. Results: Only the 6-item BGA high risk level was associated with a long LOS (Odds ratio = 1.1 with P = 0.028 and Hazard ratio = 2.1 with P = 0.004). Kaplan-Meier distributions showed that there was no significant difference in the delay of hospital discharge between the low and high-risk level reported by the PRISMA-7 (P = 0.381), whereas the 6-item BGA three risk levels differed significantly (P = 0.008), with individuals at high risk levels being discharged later when compared to those with low (P = 0.001) and moderate (P = 0.019) risk levels. Both tools’ performance criteria were poor (i.e., < 0.70), except for PRISMA-7’s sensitivity which was 100%. Conclusion: The 6-item BGA risk levels were associated with LOS, low risk-level being associated with short LOS and high-risk level with long LOS, but no association was reported with the PRISMA-7 risk levels. Both tools had poor performance criteria for long LOS, suggesting that they cannot be used as prognostic tools with current scientific knowledge.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Beauchet, Olivier
Fung, Shek
Launay, Cyrille P.
Cooper-Brown, Liam Anders
Afilalo, Jonathan
Herbert, Paul
Afilalo, Marc
Chabot, Julia
format Article
author Beauchet, Olivier
Fung, Shek
Launay, Cyrille P.
Cooper-Brown, Liam Anders
Afilalo, Jonathan
Herbert, Paul
Afilalo, Marc
Chabot, Julia
author_sort Beauchet, Olivier
title Screening for older inpatients at risk for long length of stay : which clinical tool to use?
title_short Screening for older inpatients at risk for long length of stay : which clinical tool to use?
title_full Screening for older inpatients at risk for long length of stay : which clinical tool to use?
title_fullStr Screening for older inpatients at risk for long length of stay : which clinical tool to use?
title_full_unstemmed Screening for older inpatients at risk for long length of stay : which clinical tool to use?
title_sort screening for older inpatients at risk for long length of stay : which clinical tool to use?
publishDate 2019
url https://hdl.handle.net/10356/87836
http://hdl.handle.net/10220/49292
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