For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. We considered 2 cut-off points for the BI (≥90 points for screening frailty and <60 points for diagnosing severe dependence). To analyze the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). Modifications of the French-TRST that may improve the diagnostic performance of ED physicians are discussed. Emergency-TRSTs rated four French-TRST items less well than Geriatrician-TRSTs.ConclusionsĪs a substitute for SEGA in the ED, the French-TRST performed quite well overall but the ED physicians detected frail patients less well than the geriatricians. 93% p=0.04) and tended to have lower negative predictive value (66% vs. Geriatrician-TRST was used to identify TRST items that associated with ED physician misclassification of frail patients.ResultsEmergency-TRST was significantly less sensitive than Geriatrician-TRST (88% vs. Diagnostic accuracy variables were calculated. The ability of ED physicians using this French-TRST to accurately detect frail patients who require comprehensive geriatric assessment was assessed.DesignProspective cross-sectional study on diagnostic accuracy relative to the gold standard, namely, geriatrician-administered SEGA.SettingTertiary-care hospital, France.Subjects and measurementsThe participants were 498 ≥75-year-old patients who visited the ED in 2018–2019 and were administered French-TRSTs by first ED physicians and then geriatricians, followed by SEGA, all within 24 hours. A national committee recently generated a new version of the fast and simple 5-item Triage Risk Screening Tool (TRST) in which a subjective item (‘nurse concern’) was replaced by an item assessing basic activities of daily living. Screening by ED physicians would greatly facilitate detection of frail older patients but our previous attempt to introduce routine ED-physician screening with Short Emergency Geriatric Assessment (SEGA), a 13-item frailty tool that French geriatricians use to identify frail patients, failed due to its length and complexity. A simplified PROFUNCTION index was derived containing seven items (≥85 years, neurological condition, osteoarticular disease, III–IV functional class of dyspnea, ≥4 polypathology categories, basal BIįrailty in older people associates with poor outcomes. TRST/VIP fitted well but their discrimination power was poor (area under the curve=0.49 and 0.46, respectively). The activities for daily living that declined most frequently were toilet use, grooming, dressing and bathing. Basal/12-month BI was 85/70, respectively. Results: Nine hundred and fifty-eight patients from the 1632 included survived during follow-up. Development of the new score was performed by dividing into a derivation cohort (constructing the index by logistic regression), and a validation cohort (in which calibration/discrimination of the index were tested).
Accuracy of TRST/VIP was assessed by calibration/discrimination tests. Functional decline was defined as loss of ≥20 points on Barthel’s index (BI). Methods: Prospective 12-month follow-up study of PPs from 36 hospitals. Our objective was to assess accuracy of the Triage Risk Screening Tool (TRST), the Variable Indicative of Placement risk (VIP) and to develop a specific functional prognostic index adjusted to this population in a multicenter cohort of hospital-based PP. Background: Little is known about the fitness of the available tools in predicting functional decline of polypathological patients (PPs).