Publication

Clinical impression for identification of vulnerable older patients in the Emergency Department

Calf, A. H., Lubbers, S., van den Berg, A., van den Berg, E., Jansen, C. J., van Munster, B. C., de Rooij, S. E. & ter Maaten, J. C., Sep-2019, (Accepted/In press) In : European journal of emergency medicine. 27, 2, p. 137-141 5 p.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Calf, A. H., Lubbers, S., van den Berg, A., van den Berg, E., Jansen, C. J., van Munster, B. C., ... ter Maaten, J. C. (Accepted/In press). Clinical impression for identification of vulnerable older patients in the Emergency Department. European journal of emergency medicine, 27(2), 137-141. https://doi.org/10.1097/MEJ.0000000000000632

Author

Calf, Agneta H. ; Lubbers, Sonja ; van den Berg, Annemarie ; van den Berg, Else ; Jansen, Carolien J. ; van Munster, Barbara C. ; de Rooij, Sophia E. ; ter Maaten, Jan C. / Clinical impression for identification of vulnerable older patients in the Emergency Department. In: European journal of emergency medicine. 2019 ; Vol. 27, No. 2. pp. 137-141.

Harvard

Calf, AH, Lubbers, S, van den Berg, A, van den Berg, E, Jansen, CJ, van Munster, BC, de Rooij, SE & ter Maaten, JC 2019, 'Clinical impression for identification of vulnerable older patients in the Emergency Department', European journal of emergency medicine, vol. 27, no. 2, pp. 137-141. https://doi.org/10.1097/MEJ.0000000000000632

Standard

Clinical impression for identification of vulnerable older patients in the Emergency Department. / Calf, Agneta H.; Lubbers, Sonja; van den Berg, Annemarie; van den Berg, Else; Jansen, Carolien J.; van Munster, Barbara C.; de Rooij, Sophia E.; ter Maaten, Jan C.

In: European journal of emergency medicine, Vol. 27, No. 2, 09.2019, p. 137-141.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Calf AH, Lubbers S, van den Berg A, van den Berg E, Jansen CJ, van Munster BC et al. Clinical impression for identification of vulnerable older patients in the Emergency Department. European journal of emergency medicine. 2019 Sep;27(2):137-141. https://doi.org/10.1097/MEJ.0000000000000632


BibTeX

@article{5d233422052747b2a880824b89eb1f0d,
title = "Clinical impression for identification of vulnerable older patients in the Emergency Department",
abstract = "Objectives To investigate whether the clinical impression of vulnerability (CIV) and the Dutch Safety Management Program (VMS), a screening instrument on four geriatric domains (ADL, falls, malnutrition, delirium), are useful predictors of 1-year mortality in older patients in the Emergency Department (ED). Methods This was a prospective observational study in the ED of a tertiary care teaching hospital. Patients aged 65 years and older visiting the ED, and their attending physicians and nurses were included. CIV appraised by physician and nurse and the VMS-screening were recorded. Results We included 196 patients of whom 64.8{\%}, 61.7{\%}, and 52.6{\%} were considered vulnerable based on the CIV of physicians, nurses, and VMS-screening respectively. Agreement between CIV of physicians and nurses, and VMS-screening were both fair (overall agreement 63.3{\%} for both, and respectively kappa 0.32 and kappa 0.31). CIV of physicians, nurses, and VMS-screening had a sensitivity of respectively 94{\%}, 86{\%}, and 73{\%} for predicting 1-year mortality. A positive CIV was associated mostly with factors which can be observed directly during first patient contact after arrival to the ED, such as age, nutritional status and functional impairment. Conclusion The CIV is a simple dichotomous question which can be used as a first step in the identification of vulnerable older ED patients, whereas the more time-consuming VMS-46 screening is more specific for detection of vulnerability. The CIV is therefore useful in a busy ED environment where time and resources are limited.",
keywords = "aged, clinical impression, emergency department, frailty, screening, vulnerability, COMPREHENSIVE GERIATRIC ASSESSMENT, ADVERSE OUTCOMES, FRAILTY, ADULTS",
author = "Calf, {Agneta H.} and Sonja Lubbers and {van den Berg}, Annemarie and {van den Berg}, Else and Jansen, {Carolien J.} and {van Munster}, {Barbara C.} and {de Rooij}, {Sophia E.} and {ter Maaten}, {Jan C.}",
year = "2019",
month = "9",
doi = "10.1097/MEJ.0000000000000632",
language = "English",
volume = "27",
pages = "137--141",
journal = "European journal of emergency medicine",
issn = "0969-9546",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "2",

}

RIS

TY - JOUR

T1 - Clinical impression for identification of vulnerable older patients in the Emergency Department

AU - Calf, Agneta H.

AU - Lubbers, Sonja

AU - van den Berg, Annemarie

AU - van den Berg, Else

AU - Jansen, Carolien J.

AU - van Munster, Barbara C.

AU - de Rooij, Sophia E.

AU - ter Maaten, Jan C.

PY - 2019/9

Y1 - 2019/9

N2 - Objectives To investigate whether the clinical impression of vulnerability (CIV) and the Dutch Safety Management Program (VMS), a screening instrument on four geriatric domains (ADL, falls, malnutrition, delirium), are useful predictors of 1-year mortality in older patients in the Emergency Department (ED). Methods This was a prospective observational study in the ED of a tertiary care teaching hospital. Patients aged 65 years and older visiting the ED, and their attending physicians and nurses were included. CIV appraised by physician and nurse and the VMS-screening were recorded. Results We included 196 patients of whom 64.8%, 61.7%, and 52.6% were considered vulnerable based on the CIV of physicians, nurses, and VMS-screening respectively. Agreement between CIV of physicians and nurses, and VMS-screening were both fair (overall agreement 63.3% for both, and respectively kappa 0.32 and kappa 0.31). CIV of physicians, nurses, and VMS-screening had a sensitivity of respectively 94%, 86%, and 73% for predicting 1-year mortality. A positive CIV was associated mostly with factors which can be observed directly during first patient contact after arrival to the ED, such as age, nutritional status and functional impairment. Conclusion The CIV is a simple dichotomous question which can be used as a first step in the identification of vulnerable older ED patients, whereas the more time-consuming VMS-46 screening is more specific for detection of vulnerability. The CIV is therefore useful in a busy ED environment where time and resources are limited.

AB - Objectives To investigate whether the clinical impression of vulnerability (CIV) and the Dutch Safety Management Program (VMS), a screening instrument on four geriatric domains (ADL, falls, malnutrition, delirium), are useful predictors of 1-year mortality in older patients in the Emergency Department (ED). Methods This was a prospective observational study in the ED of a tertiary care teaching hospital. Patients aged 65 years and older visiting the ED, and their attending physicians and nurses were included. CIV appraised by physician and nurse and the VMS-screening were recorded. Results We included 196 patients of whom 64.8%, 61.7%, and 52.6% were considered vulnerable based on the CIV of physicians, nurses, and VMS-screening respectively. Agreement between CIV of physicians and nurses, and VMS-screening were both fair (overall agreement 63.3% for both, and respectively kappa 0.32 and kappa 0.31). CIV of physicians, nurses, and VMS-screening had a sensitivity of respectively 94%, 86%, and 73% for predicting 1-year mortality. A positive CIV was associated mostly with factors which can be observed directly during first patient contact after arrival to the ED, such as age, nutritional status and functional impairment. Conclusion The CIV is a simple dichotomous question which can be used as a first step in the identification of vulnerable older ED patients, whereas the more time-consuming VMS-46 screening is more specific for detection of vulnerability. The CIV is therefore useful in a busy ED environment where time and resources are limited.

KW - aged

KW - clinical impression

KW - emergency department

KW - frailty

KW - screening

KW - vulnerability

KW - COMPREHENSIVE GERIATRIC ASSESSMENT

KW - ADVERSE OUTCOMES

KW - FRAILTY

KW - ADULTS

U2 - 10.1097/MEJ.0000000000000632

DO - 10.1097/MEJ.0000000000000632

M3 - Article

VL - 27

SP - 137

EP - 141

JO - European journal of emergency medicine

JF - European journal of emergency medicine

SN - 0969-9546

IS - 2

ER -

ID: 96370415