screening

Screening instruments for identification of vulnerable older adults at the emergency department: a critical appraisal

Original Articles, Volume 17, Issue 3, Pages 117 – 172 (2018)

Abstract

Background: Early detection of vulnerable older adults at the emergency department (ED) and implementation of targeted interventions to prevent functional decline may lead to better patient outcomes.

Objective: To assess the level of agreement between four frequently used screening instruments: ISAR-HP, VMS, InterRAI ED Screener and APOP.

Methods: Observational prospective cohort study in patients ≥ 70 years attending Dutch ED.

Results: The prevalence of vulnerability ranged from 19% (APOP) to 45% (ISAR-HP). Overall there was a moderate agreement between the screening instruments (Fleiss Kappa of 0.42 (p<0.001)). Conclusion: Depending on the screening instrument used, either only a small percentage or almost as many as half of the presenting patients will be eligible for targeted interventions, leading to large dissimilarities in working processes, resources and costs.

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Out-patient detection of deep vein thrombosis using a combination of risk scoring and strain-gauge-plethysmography: a follow-up study

Original Articles, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

Patients are frequently referred to hospital for exclusion of deep vein thrombosis (DVT); however, the diagnosis is only confirmed in 12% of those undergoing investigation. An effective strategy is required, which minimises the number of negative investigations, while safely excluding or confirming the diagnosis. This study investigates the combination of clinical risk scoring and strain-gauge plethysmography in the initial assessment of patients with suspected DVT. A survey was conducted of 1300 patients referred with suspected DVT over the course of a year. The results of this investigation were comparable to previous clinical trials and supports the use of strain-gauge plethysmography combined with clinical risk score in a busy acute medical unit.

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