Malnutrition: A highly predictive risk factor of short-term mortality in elderly presenting to the emergency department

Gentile, Stéphanie; Lacroix, O.; Durand, Anne; Crétel, E.; Alazia, M.; Sambuc, Roland; Bonin‐Guillaume, Sylvie

doi:10.1007/s12603-012-0398-0

Cited by 69 publications

(47 citation statements)

References 32 publications

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“…10,37,64,69,73 Assessing prognostic accuracy for these instruments at different thresholds did not improve on the summary estimates of accuracy from our meta-analysis. In addition, one trial reported sufficient detail to compute interval likelihood ratios (iLR).…”

Section: Screening Instrumentsmentioning

confidence: 59%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

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Objectives: A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.Methods: A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical testtreatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.Results: A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR-= 0.27) and nursing home placement (LR-= 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR-range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Conclusions: Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the r...

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Section: Screening Instrumentsmentioning

confidence: 59%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

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“…Increased morbidity, such as infections and poor recovery, compounds the problem of dysphagia in elderly patients with debilitating organic disease. Malnutrition in diseases such as stroke has additionally been shown to have a direct impact on survival (5).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: A systematic review

Jaafar

Mahadeva

Morgan

et al. 2015

The Journal of nutrition, health and aging

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“…For the MNA‐LF, the ability to predict mortality was described in numerous studies in different settings . Only a few studies have examined the ability of the revised MNA‐SF to predict mortality, with inconsistent results . The ability of either MNA form to predict functional decline is less well studied; investigations using the three categorical classification are lacking.…”

mentioning

confidence: 99%

Prognostic Differences of the Mini Nutritional Assessment Short Form and Long Form in Relation to 1‐Year Functional Decline and Mortality in Community‐Dwelling Older Adults Receiving Home Care

Kiesswetter

Pohlhausen

Uhlig

et al. 2014

J American Geriatrics Society

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Malnutrition: A highly predictive risk factor of short-term mortality in elderly presenting to the emergency department

Abstract: Malnutrition is the strongest independent risk factor predicting short-term mortality in elderly patients visiting the ED, and it was easily detected by MNA-SF and supported from the ED visit.

Cited by 69 publications

References 32 publications

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: A systematic review

Prognostic Differences of the Mini Nutritional Assessment Short Form and Long Form in Relation to 1‐Year Functional Decline and Mortality in Community‐Dwelling Older Adults Receiving Home Care

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