{"id":26147,"date":"2024-08-04T04:46:00","date_gmt":"2024-08-03T20:46:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26147"},"modified":"2024-08-04T21:15:18","modified_gmt":"2024-08-04T13:15:18","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e8%80%81%e5%b9%b4%e4%ba%ba%e4%b8%b4%e7%bb%88%e7%ad%9b%e6%9f%a5%e5%b7%a5%e5%85%b7%e9%a2%84%e6%b5%8b6%e4%b8%aa%e6%9c%88%e7%97%85%e6%ad%bb","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26147","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u8001\u5e74\u4eba\u4e34\u7ec8\u7b5b\u67e5\u5de5\u5177\u9884\u6d4b6\u4e2a\u6708\u75c5\u6b7b\u7387"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Geriatrics<\/p>\n\n\n\n

May 31, 2024<\/p>\n\n\n\n

Geriatric End-of-Life Screening Tool Prediction of 6-Month Mortality in Older Patients<\/h1>\n\n\n\n

Adrian D. Haimovich, Ryan C. Burke, Larry A. Nathanson, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2024;7(5):e2414213. doi:10.1001\/jamanetworkopen.2024.14213<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Can the Geriatric End-of-Life Screening Tool (GEST) accurately identify older adults in the emergency department with high 6-month mortality risk?<\/p>\n\n\n\n

Findings<\/strong>  In this prognostic study of 82\u202f371 ED encounters within a tertiary care emergency department, GEST performed robustly on external validation, identifying 11.6% of the population as having a 30% or greater mortality risk. Compared with serious illness diagnoses, GEST provided a greater net benefit as a screening tool using decision curve analysis.<\/p>\n\n\n\n

Meaning<\/strong>  The findings of this prognostic external validation study highlight the opportunity to use pragmatic, prognostic electronic health record algorithms to identify older adults in the emergency department for end-of-life care interventions.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Emergency department (ED) visits by older adults with life-limiting illnesses are a critical opportunity to establish patient care end-of-life preferences, but little is known about the optimal screening criteria for resource-constrained EDs.<\/p>\n\n\n\n

Objectives<\/strong>  To externally validate the Geriatric End-of-Life Screening Tool (GEST) in an independent population and compare it with commonly used serious illness diagnostic criteria.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This prognostic study assessed a cohort of patients aged 65 years and older who were treated in a tertiary care ED in Boston, Massachusetts, from 2017 to 2021. Patients arriving in cardiac arrest or who died within 1 day of ED arrival were excluded. Data analysis was performed from August 1, 2023, to March 27, 2024.<\/p>\n\n\n\n

Exposure<\/strong>  GEST, a logistic regression algorithm that uses commonly available electronic health record (EHR) datapoints and was developed and validated across 9 EDs, was compared with serious illness diagnoses as documented in the EHR. Serious illnesses included stroke\/transient ischemic attack, liver disease, cancer, lung disease, and age greater than 80 years, among others.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was 6-month mortality following an ED encounter. Statistical analyses included area under the receiver operating characteristic curve, calibration analyses, Kaplan-Meier survival curves, and decision curves.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0This external validation included 82\u202f371 ED encounters by 40\u202f505 unique individuals (mean [SD] age, 76.8 [8.4] years; 54.3% women, 13.8% 6-month mortality rate). GEST had an external validation area under the receiver operating characteristic curve of 0.79 (95% CI, 0.78-0.79) that was stable across years and demographic subgroups. Of included encounters, 53.4% had a serious illness, with a sensitivity of 77.4% (95% CI, 76.6%-78.2%) and specificity of 50.5% (95% CI, 50.1%-50.8%). Varying GEST cutoffs from 5% to 30% increased specificity (5%: 49.1% [95% CI, 48.7%-49.5%]; 30%: 92.2% [95% CI, 92.0%-92.4%]) at the cost of sensitivity (5%: 89.3% [95% CI, 88.8-89.9]; 30%: 36.2% [95% CI, 35.3-37.1]). In a decision curve analysis, GEST outperformed serious illness criteria across all tested thresholds. When comparing patients referred to intervention by GEST with serious illness criteria, GEST reclassified 45.1% of patients with serious illness as having low risk of mortality with an observed mortality rate 8.1% and 2.6% of patients without serious illness as having high mortality risk with an observed mortality rate of 34.3% for a total reclassification rate of 25.3%.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  The findings of this study suggest that both serious illness criteria and GEST identified older ED patients at risk for 6-month mortality, but GEST offered more useful screening characteristics. Future trials of serious illness interventions for high mortality risk in older adults may consider transitioning from diagnosis code criteria to GEST, an automatable EHR-based algorithm.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Geriatrics May 31,&nb […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26147"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26147"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26147\/revisions"}],"predecessor-version":[{"id":26524,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26147\/revisions\/26524"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26147"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26147"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}