Dr Foster global frailty score: an international retrospective observational study developing and validating a risk prediction model for hospitalised older persons from administrative data sets

Soong, John; Kaubryte, Jurgita; Liew, Danny; Peden, Carol J.; Bottle, Alex; Bell, Derek; Cooper, Carolyn; Hopper, Adrian

doi:10.1136/bmjopen-2018-026759

Cited by 29 publications

(39 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Level of consciousness used a modified five-point ordinal scale: alert, new confusion, response to voice, responsive to pain, unresponsive (‘ACVPU’). Co-morbidity was assessed using the Elixhauser co-morbidity index and frailty was assessed using the Dr Foster Global Frailty Score [ 25 , 26 ]. Time of critical care admission was defined as the time of the first recorded heart rate observation, to avoid errors associated with administrative processes.…”

Section: Methodsmentioning

confidence: 99%

The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19

Prower¹,

Grant²,

Bisquera³

et al. 2021

EClinicalMedicine

View full text Add to dashboard Cite

Background: Patients admitted to hospital with Covid-19 are at risk of deterioration. The National Early Warning Score (NEWS2) is widely recommended, however it's validity in Covid-19 is not established and indices more specific for respiratory failure may be more appropriate. We aim to describe the physiological antecedents to deterioration, test the predictive validity of NEWS2 and compare this to the ROX index ([SpO 2 /FiO 2 ]/respiratory rate). Method: A single centre retrospective cohort study of adult patients who were admitted to a medical ward, between 1/3/20 and 30/5/20, with positive results for SARS-CoV-2 RNA. Physiological observations and the NEWS2 were extracted and analysed. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours. A generalized linear model was used to assess the association of physiological values, NEWS2 and ROX with the outcome. Findings: The primary outcome occurred in 186 patients (26%). In the preceding 24 hours, deterioration was most marked in respiratory parameters, specifically in escalating oxygen requirement; tachypnoea was a late sign, whilst cardiovascular observations remained stable. The area under the receiver operating curve was 0.815 (95% CI 0.804À0.826) for NEWS2 and 0.848 (95% CI 0.837À0.858) for ROX. Applying the optimal level of ROX, the majority of patients triggered four hours earlier than with NEWS2 of 5. Interpretation: NEWS2 may under-perform in Covid-19 due to intrinsic limitations of the design and the unique pathophysiology of the disease. A simple index utilising respiratory parameters can outperform NEWS2 in predicting the occurrence of adverse events.

show abstract

Section: Methodsmentioning

confidence: 99%

The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19

Prower¹,

Grant²,

Bisquera³

et al. 2021

EClinicalMedicine

View full text Add to dashboard Cite

show abstract

“…Likewise, old age was identified by Byrne [13] and by Wolinsky et al [14] as the most important factor associated with mortality; our findings are consistent with those previously reported. Similarly, Soong et al [15] reported that increased the frailty is among the most prominent features observed among the elderly, and that reduction of the physiological reserve was frequently a factor associated with the aging process; the role of the Foster global vulnerability score as important for developing risk prediction models for hospitalized elderly [15]. We agree that the most important multifactorial term with a substantial impact on hospital mortality is fragility; we believe that the basis of fragility is the decrease in physiological reserves associated with aging.…”

Section: Discussionmentioning

confidence: 86%

Risk indices that predict in-hospital mortality of elderly patients

Dülger

Albuz²

2020

Turk J Med Sci

View full text Add to dashboard Cite

Materials and methods 2.1. Patients This retrospective study was approved on January 16, 2020 by the Ankara City Hospital Ethics Committee of the Ministry of Health Provincial Health Directorate (approval number of E1-20-263). Patients were identified via a retrospective examination of the registry entries of 29 Mayıs State Hospital from July 2015 through January Background/aim: Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status. Material and methods: We retrospectively analyzed outcomes from patients with clinical follow-up between July 2015 and January 2020 at 29 Mayıs State Hospital, Ankara, Turkey. Patient records with missing or ambiguous data were excluded. Age, sex, length of hospital stay, comorbidities, consultation requests and diagnoses that include infectious diseases were evaluated for their role in predicting in-hospital mortality using binary logistic regression analysis. Primary outcomes focused on factors that had an impact on overall in-hospital mortality in the elderly population. Results: Our study included 11,430 patients; of this group, 39.9% were elderly, which we defined as 65 years of age or older. Risk factors for in-hospital mortality in this cohort included consultation requests (AOR = 1.95, CI (1.53-2.49), P < 0.001) and length of hospital stay of ≥4 days (AOR = 2.49, CI (1.90-3.26), P < 0.001). Conclusion: Elderly patients are at significantly higher risk for in-hospital mortality than are younger patients. Among the factors that may be used to predict the risk of in-hospital mortality in the elderly patient cohort, the most important factor is the length of hospital stay.

show abstract

“…Sickness severity was estimated using the sequential organ failure assessment (SOFA) [ 27 ] on day one of the critical care admission. Co-morbidity was assessed using the Charlson–Deyo co-morbidity index [ 28 ] and frailty was assessed using the Dr Foster Global Frailty Score [ 29 ]. Out-of-hours was defined as 00:00 Saturday to 00:00 Monday, and 20:00–07.59 on weekdays.…”

Section: Methodsmentioning

confidence: 99%

Increased time from physiological derangement to critical care admission associates with mortality

et al. 2021

View full text Add to dashboard Cite

Background Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using ‘decision to admit’ to critical care, or arrival in the emergency department as ‘time zero’, rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission [‘Score to Door’ (STD) time] impacts on patient outcomes. Methods A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. Results Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0–1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0–1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. Conclusion In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the ‘Score to Door’ concept as a clinical indicator within rapid response systems.

show abstract

Dr Foster global frailty score: an international retrospective observational study developing and validating a risk prediction model for hospitalised older persons from administrative data sets

Cited by 29 publications

References 41 publications

The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19

The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19

Risk indices that predict in-hospital mortality of elderly patients

Increased time from physiological derangement to critical care admission associates with mortality

Contact Info

Product

Resources

About