scholarly journals Inter-Rater Reliability of the Retrospectively Assigned Clinical Frailty Scale Score in a Geriatric Outreach Population

2018 ◽  
Vol 21 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jasmine Davies ◽  
Jennifer Whitlock ◽  
Iris Gutmanis ◽  
Sheri-Lynn Kane
Keyword(s):  
Scale Score ◽  
Daily Living ◽  
Chart Review ◽  
Tertiary Care ◽  
Clinical Syndrome ◽  
Clinical Frailty Scale ◽  
Rater Reliability ◽  
Outreach Service ◽  
Increased Risk ◽  
Nurse Clinician

BackgroundFrailty, a common clinical syndrome in older adults associated with increased risk of poor health outcomes, has been retrospectively calculated in previous publications; however, the reliability of retrospectively assigned frailty scores has not been established. The aim of this study was to see if frailty scores, based on chart review data, agreed with clinician-determined scores based on a comprehensive geriatric assessment.MethodsPer standard practice, all patients seen by one nurse clinician (JW) from the Southwestern Ontario Regional Geriatric Program, a tertiary care-based outreach service, between August 15, 2013 and December 31, 2015 received a comprehensive geriatric assessment which included the assignment of an interview-based Clinical Frailty Scale score (CFS-I). Subsequently, a medical student researcher (JD), blinded to the CFS-I, assigned each consenting patient a frailty score based on chart review data (CFS-C). The inter-rater reliability of the CFS-I and CFS-C was then determined.ResultsOf the 41 consented patients, 39 had both a CFS-I and CFSC score. The median CFS score was 6, indicating patients were moderately frail and required assistance for some basic activities of daily living. Cohen’s kappa coefficient was 0.64, indicating substantial agreement.ConclusionCFS scores can be reliably assigned retrospectively, thereby strengthening the utility of this measure.

scholarly journals Retrospective frailty determination in critical illness from a review of the intensive care unit clinical record

2019 ◽  
Vol 47 (4) ◽  
pp. 343-348 ◽  
Author(s):  
Jai N Darvall ◽  
Tristan Boonstra ◽  
Jen Norman ◽  
Donal Murphy ◽  
Michael Bailey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Scale Score ◽  
Clinical Record ◽  
Next Of Kin ◽  
Clinical Frailty Scale ◽  
Rater Reliability ◽  
Charlson Comorbidity Score ◽  
Future Work

Frailty is one of the major challenges for intensive care, affecting one-third of intensive care unit patients and being associated with a range of poor health outcomes. Determination of frailty in critical illness using the Clinical Frailty Scale has recently been adopted by the Australian and New Zealand Intensive Care Society, but it is not known whether this is able to be measured from the clinical record without interviewing patients or their relatives. The aims of this retrospective cohort study were to test whether a Clinical Frailty Scale score could be assigned in an intensive care unit population from the clinical record, and to assess the inter-rater reliability of frailty measured in this manner. A total of 144 patients were enrolled. Of these, 137 (95%) were able to have a Clinical Frailty Scale score assigned, and 22 (15%) were scored as frail (Clinical Frailty Scale ≥5). Cohen’s kappa coefficient for inter-rater reliability between assessors was 0.67, confirming substantial agreement. Consistent with other critically ill cohorts, frailty was associated on multivariate analysis with age, Charlson comorbidity score, dependence with activities of daily living, and limitation of medical treatment, indicating validity of this approach to frailty measurement. Our results imply that frailty measurement is possible and feasible from the intensive care unit clinical record, which is of importance as routine measurement and reporting of frailty in intensive care units in our region increases. Future work should seek to validate an assigned Clinical Frailty Scale score with that obtained directly from patients or their next of kin.

scholarly journals The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241554 ◽  
Author(s):  
Jenelle L. Pederson ◽  
Raj S. Padwal ◽  
Lindsey M. Warkentin ◽  
Jayna M. Holroyd-Leduc ◽  
Adrian Wagg ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Tertiary Care ◽  
Functional Decline ◽  
Surgical Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Clinical Frailty Scale ◽  
Increased Risk ◽  
The Impact ◽  
Emergency Abdominal Surgery

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs. 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs. 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153

Abstract 3456: Incidence of Vasospasm and Outcomes in Angiography-negative Perimesencephalic Subarachnoid Hemorrhage with and without Ventricular Extension

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Bryan J Bonder ◽  
Edwin A Vargas ◽  
Richard Jung ◽  
Jitendra Sharma ◽  
Kristine A Blackham
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Chart Review ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Modified Rankin Scale ◽  
Perimesencephalic Subarachnoid Hemorrhage ◽  
Fisher Grade ◽  
Increased Risk ◽  
Discharge Summaries

Background: Angiography negative perimesencephalic subarachnoid hemorrhage (SAH) is considered a relatively benign entity compared to aneurysmal SAH. However, some patients with angiography negative perimesencephalic subarachnoid hemorrhage with extension of hemorrhage beyond the perimesencephalic area are at increased risk for vasospasm. Here we present a series of 21 patients with angiography negative perimesencephalic pattern of SAH both with and without ventricular extension and describe their incidence of vasospasm and clinical outcomes. Methods: Retrospective chart review was performed among patients who underwent invasive angiography from 8/2007-6/2010. Inclusion criteria were presenting clinical symptoms typical of SAH, computed tomography (CT) evidence of perimesencephalic SAH with or without ventricular extension, no recent trauma or stroke, and cerebral angiography negative for aneurysm or arteriovenous malformation. 21 patients, 8 men and 13 women, with a mean age of 55.1 years met these criteria. The presenting CTs were examined and a modified Fisher Grade assigned. The patients’ clinical course was reviewed for incidence and treatment of vasospasm. The patients’ discharge summaries were evaluated and each patient given a modified Rankin Scale score. Results: The modified Fisher Scale score derived from the presenting CT was 1 for 29% (n=6), 2 for 5% (n=1), 3 for 19% (n=4), and 4 for 47% (n=10) of the patients. Amongst the 52% (n=11) of patients with intraventricular hemorrhage as defined by a modified Fisher Scale score of 2 or 4, 24% (n=5) developed angiographical evidence of vasospasm. 10% (n=2) of the patients required intra-arterial verapamil. 90% (n=9) of patients without intraventricular extension had good outcomes at discharge as defined by modified Rankin Scale score less than or equal to 2, while only 36% (n=4) of patients with angiography negative SAH with intraventricular extension had good outcomes. Conclusions: Although angiography negative perimesencephalic SAH is considered to have less associated morbidity and mortality than aneurysmal perimesencephalic SAH, patients with extension of hemorrhage into the ventricles are at increased risk for vasospasm and poor functional outcomes.

scholarly journals Benzodiazepine Use and Morbidity-Mortality Outcomes in a Geriatric Palliative Care Unit: A Retrospective Review

2021 ◽  
pp. 1-9
Author(s):  
Helen Senderovich ◽  
Sandra Gardner ◽  
Anna Berall ◽  
Michael Ganion ◽  
Dennis Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Scale Score ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Hospice And Palliative Care ◽  
Performance Scale ◽  
Overall Mortality

<b><i>Introduction:</i></b> Patients often experience delirium at the end of life. Benzodiazepine use may be associated with an increased risk of developing delirium. Alternate medications used in conjunction with benzodiazepines may serve as an independent precipitant of delirium. The aim is to understand the role of benzodiazepines in precipitating delirium and advanced mortality in palliative care population at the end of life. <b><i>Methods:</i></b> A retrospective medical chart review was conducted at a hospice and palliative care inpatient unit between the periods of June 2017–December 2017 and October 2017–November 2018. It included patients in hospice and palliative care inpatient units who received a benzodiazepine and those who did not. Patient characteristics, as well as Palliative Performance Scale score, diagnosis, and occurrence of admission, terminal, and/or recurrent delirium, were collected and analyzed. <b><i>Results:</i></b> Use of a benzodiazepine was not significantly associated with overall mortality nor cause-specific death without terminal delirium rate. However, it was significantly associated with higher cause-specific death with terminal delirium rate and a higher recurrent delirium rate. <b><i>Discussion:</i></b> This retrospective chart review suggests an association between benzodiazepine use and specific states of delirium and cause-specific death. However, it does not provide strong evidence on the use of this drug, especially at the end of life, as it pertains to the overall mortality rate. Suggested is a contextual approach to the use of benzodiazepines and the need to consider Palliative Performance Scale score and goals of care in the administration of this drug at varying periods during patient length of stay.

Higher Admission Frailty Scores Predict Increased Mortality, Morbidity, and Healthcare Utilization in the Elderly Burn Population

2021 ◽  
Author(s):  
Kathleen A Iles ◽  
Emilie Duchesneau ◽  
Paula D Strassle ◽  
Lori Chrisco ◽  
T Clark Howell ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Physiological State ◽  
Tertiary Care ◽  
Care Facility ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
Risk Of Death ◽  
Increased Risk

Abstract The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype and predictor of mortality in the geriatric population. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and inpatient outcomes. This was a retrospective analysis of burn patients ≥ 65 years from 2015-2019. Patients were assigned to frailty subgroups based on comprehensive medical, social work, and therapy assessments. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality. Our study included 644 patients (low frailty: 262, moderate frailty: 345, and high frailty: 37). Frailty was associated with higher median TBSA and age at admission. The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA, and inhalation injury, high frailty was associated with increased 30-day mortality, compared to low (HR 5.73; 95% CI 1.86, 17.62). Moderate frailty also appeared to increase 30-day mortality, although estimates were imprecise (HR 2.19; 95% CI 0.87-5.50). High frailty was associated with increased morbidity and healthcare utilization, including need for intensive care stay (68% vs 37% and 21%, p&lt;0.001) and rehab or care facility at discharge (41% vs 25% and 6%, p&lt;0.001), compared to moderate and low frailty subgroups. Our findings emphasize the need to consider pre-injury physiological state and the increased risk of death and morbidity in the elderly burn population.

scholarly journals Changing Pattern of Clinical Illness in Children with Group A Streptococcal Bacteremia

1993 ◽  
Vol 4 (6) ◽  
pp. 341-346 ◽  
Author(s):  
Kim J Burrows ◽  
Scott A Halperin ◽  
Margaret Swift ◽  
Robert Bortolussi
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Clinical Syndrome ◽  
Deep Tissue ◽  
The Past ◽  
Recent Group ◽  
Group A ◽  
Clinical Illness ◽  
Seriously Ill

Objective: To test the hypothesis that bacteremia caused by group A streptococci (gas) has become more common and the presentation of the infection more severe in the Izaak Walton Killam Hospital for Children during the past decade.Design: Retrospective analysis by laboratory log and chart review.Setting: A pediatric teaching hospital providing primary and tertiary care.Results: There was no difference in the frequency of detection ofgasbacteremia between the two periods studied (1980 to 1988 and 1988 to 1991). However, severegasinfection with deep tissue invasion was more common in the last three-year period (77% versus 11%, P=0.01). Severity, as measured by length of hospital stay, was also greater in the recent group (17.9 days versus 3.3 days, P=0.03). A recent group of four children was identified with a unique clinical syndrome of rash, severe myalgias, hyperesthesia, and refusal to bear weight.Conclusion: The number of cases of severegasdisease has increased in the past several years, andgasinfection should be included in the differential diagnosis of seriously ill children,gasinfection must be managed aggressively with vigilance for additional deep tissue involvement, even while on appropriate antimicrobial therapy.

Nasal Mucormycosis: Our experience with 24 cases

2020 ◽  
Vol 74 (4) ◽  
pp. 37-40
Author(s):  
Satvinder Singh Bakshi ◽  
Soumyajit Das ◽  
Seepana Ramesh ◽  
Suriyanarayanan Gopalakrishnan
Keyword(s):  
Liposomal Amphotericin ◽  
Chart Review ◽  
Hematologic Malignancy ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
First Line ◽  
The Past ◽  
Increased Risk ◽  
Shed Light

<b>Background:</b> Mucormycosis is a rare fungal infection affecting people with impaired immunity. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with mucormycosis hospitalized at a tertiary care center in Pondicherry. <br><b>Methods:</b> We conducted a retrospective chart review between January 2008 and January 2018. All patients with proven or probable mucormycosis were included. <br><b>Results:</b> A total of 24 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. <br><b>Conclusion:</b> The incidence of mucormycosis has significantly increased over the past 10 years at our institution, most likely due to increased risk factors.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

scholarly journals Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
T. Muhammad ◽  
Shobhit Srivastava ◽  
T. V. Sekher
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Psychological Health ◽  
Daily Living ◽  
Basic Needs ◽  
Well Being ◽  
Asset Ownership ◽  
Increased Risk

Abstract Background Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. Methods Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. Results About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21–1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72–0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. Conclusion The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

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