Prognostic value of screening instrument based on the Dutch national VMS guidelines for older patients in the emergency department

Snijders, Birgitta M G; Emmelot-Vonk, Mariëlle H.; Souwer, Esteban T.D.; Kaasjager, H. A. H.; Bos, Frederiek van den

doi:10.1007/s41999-020-00385-0

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…However, a recent study showed good correlation between categories of CFS (fit (CFS 1–3), pre-frail (CFS 4–5) and frail (CFS 6–9)) when collected retrospectively versus prospectively [ 22 ]. Furthermore, the CFS was predominantly determined based on the prospectively collected VMS data from the Dutch National Safety Management System, which has previously been validated to predict mortality in older emergency department patients [ 23 ]. In addition, our sensitivity analyses found similar results for the Katz ADL as for the CFS, suggesting validity of the use of the CFS.…”

Section: Discussionmentioning

confidence: 99%

Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

et al. 2021

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Background During the first wave of the COVID-19 pandemic older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multi-centre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (IQR 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 vs. 7 days), lower oxygen demand and lower levels of CRP. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared to patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95%CI 1.3–3.0) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95%CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.

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Section: Discussionmentioning

confidence: 99%

Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

et al. 2021

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“…Previous studies on the predictive properties of the DSMS vulnerability score have reported contradictory findings regarding early readmission and mortality in older hospital patients. 20,21,36) No association was found between DSMS vulnerability and mortality, complications, or readmission in geriatric, cardiac, or gynecological patients. 19,[37][38][39] However, in patients with hip fractures, the DSMS vulnerability score was positively associated with mortality and a complicated rehabilitation trajectory.…”

Section: Dsms Vulnerability Screeningmentioning

confidence: 99%

“…The DSMS tool consists of short screening instruments in four geriatric domains: delirium, functional impairment, malnutrition, and fall risk. [19][20][21][22] Early identification of vulnerable older patients at hospital admission aims to diminish the risk of functional decline during the hospital stay through targeted in-hospital geriatric interventions. Subsequently, early and repeated assessments of rehabilitation needs, exploration of individual motivation, and establishment of an individual prognosis for recovery may identify candidates for geriatric rehabilitation early during their hospital stay and enhance personalized PAC decision-making.…”

Section: Introductionmentioning

confidence: 99%

Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay

de Groot,

Wattel,

van Balen

et al. 2023

Ann Geriatr Med Res

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Background: We assessed the vulnerability of patients aged ≥70 years during hospital admission based on the Short Dutch Safety Management Screening (DSMS). Screening of four geriatric domains aims to prevent adverse outcomes and may support targeted discharge planning for post-acute care. We explored whether the DSMS criteria for acutely admitted patients were associated with rehabilitation-oriented care needs.Methods: This retrospective cohort study included community-dwelling patients aged ≥70 years acutely admitted to a tertiary hospital. We recorded patient demographics, morbidity, functional status, malnutrition, fall risk, and delirium and used descriptive analysis to calculate the risks by comparing the discharge destination groups. Results: Among 491 hospital discharges, 349 patients (71.1%) returned home, 60 (12.2%) were referred for geriatric rehabilitation, and 82 (16.7%) to other inpatient post-acute care. Non-home referrals increased with age from 21% (70–80 years) to 61% (>90 years). A surgical diagnosis (odds ratio [OR]=4.92; 95% confidence interval [CI], 2.03–11.95), functional decline represented by Katz-activities of daily living positive screening (OR=3.79; 95% CI, 1.76–8.14), and positive fall risk (OR=2.87; 95% CI, 1.31–6.30) were associated with non-home discharge. The Charlson Comorbidity Index did not differ significantly between the groups.Conclusion: Admission diagnosis and vulnerability screening outcomes were associated with discharge to rehabilitation-oriented care in patients >70 years of age. The usual care data from DSMS vulnerability screening can raise awareness of discharge complexity and provide opportunities to support timely and personalized transitional care.

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“…Previous research in various populations showed that the VMS screening tool 'frail elderly', is a useful instrument for hospitalized patients to detect frail older patients at risk for adverse outcomes [16][17][18][19][20][21][22]. Also, the VMS screening tool was found to be comparable with the Groningen Frailty Index (GFI); paired analysis showed that there was no difference between the two diagnostic tools (P = 0.237) [19].…”

Section: Introductionmentioning

confidence: 99%

Risk assessment for postoperative outcomes in a mixed hospitalized gynecological population by the Dutch safety management system (Veiligheidsmanagementsysteem, VMS) screening tool ‘frail elderly’

Zanden

Paarlberg

Zaag-Loonen

et al. 2021

Arch Gynecol Obstet

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Purpose Frailty is associated with a higher risk for negative postoperative outcomes. This study aimed to determine the association between the screening tool of the Dutch safety management system, Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ and postoperative complications in a gynecological population. Methods This cohort study included women aged 70 years or older, who were scheduled for any kind of gynecological surgery. VMS screening data (including risk for delirium, falling, malnutrition, and functional impairment) were extracted from the electronic patient records. VMS score could range between 0 and 4 patients with a VMS score of one or more were considered frail. Data on possible confounding factors and complications within 30 days after surgery, classified with the Clavien–Dindo classification, were collected. Regression analysis was performed. Results 157 women were included with a median age of 74 years (inter quartile range 71–79). Most patients underwent prolapse surgery (52%) or hysterectomy (31%). Forty-one patients (26%) experienced any postoperative complication. Sixty-two patients (39%) were considered frail preoperatively by the VMS screening tool. Frailty measured with the VMS screening tool was not independently associated with postoperative complications in multivariable analysis (Odds ratio 1.18; 95% CI 0.49–2.82). However, a recent fall in the last 6 months (n = 208) was associated with postoperative complications (Odds ratio 3.90; 95% CI 1.57–9.66). Conclusion An independent association between frailty, determined by the VMS screening tool ‘Frail elderly’, and postoperative complications in gynecological surgery patients could not be confirmed. A recent fall in the last 6 months seems associated with postoperative complications.

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Prognostic value of screening instrument based on the Dutch national VMS guidelines for older patients in the emergency department

Cited by 7 publications

References 19 publications

Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay

Risk assessment for postoperative outcomes in a mixed hospitalized gynecological population by the Dutch safety management system (Veiligheidsmanagementsysteem, VMS) screening tool ‘frail elderly’

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