Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/19565
Title: The association of clinical frailty with outcomes of patients reviewed by rapid response teams: an international prospective observational cohort study.
Authors: So, Ralph K L;Bannard-Smith, Jonathan;Subbe, Chris P;Jones, Daryl A;van Rosmalen, Joost;Lighthall, Geoffrey K
Affiliation: Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr. H3580, Stanford, CA, 94305, USA
Department of Intensive Care, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, the Netherlands
Department of Critical Care, Manchester Royal Infirmary, Central Manchester University NHS Hospitals, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, UK
Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 22-Sep-2018
EDate: 2018-09-22
Citation: Critical care (London, England) 2018; 22(1): 227
Abstract: Frailty is a state of vulnerability to poor resolution of homeostasis after a stressor event and is strongly associated with adverse outcomes. Therefore, the assessment of frailty may be an essential part of evaluation in any healthcare encounter that might result in an escalation of care. The purpose of the study was to assess the frequency and association of frailty with clinical outcomes in patients subject to rapid response team (RRT) review. In this multi-national prospective observational cohort study, centres with existing RRTs collected data over a 7-day period, with follow up of all patients at 24 h following their RRT call and at hospital discharge or 30 days following the event trigger (whichever came sooner). Investigators also collected data on the triggers and interventions provided and a bedside assessment on the level of patients' frailty using a clinical frailty scale. Amongst 1133 patients, 40% were screened as frail, which was associated with older age (p < 0.001), admission under a medical speciality (p < 0.001), increased severity of illness at the time of the RRT review (p = 0.0047), and substantially higher frequency of limitations of care (p < 0.001). Importantly, 72% of patients screened as frail were either dead or dependent on hospital care by 30 days (p < 0.001). In the multivariable analysis, the significant risk factors for the composite endpoint "poor recovery" (died or were hospital-dependent by 30 days) were age (odds ratio (OR), 1.04; 95% confidence interval (CI), 1.03-1.05; p < 0.001), frailty level (p < 0.001), existing limitation of care (OR, 2.0; 95% CI, 1.3-3.0; p < 0.001), and the quick sequential organ failure assessment (qSOFA) score (p < 0.001). Higher frailty scores were associated with increased mortality and dependence on health care at 30 days. Our results indicate that frailty has an influence on the clinical trajectory of deteriorating patients and that such assessment should be included in discussion of goals and expectations of care. Netherlands Trial Registry, NTR5535 . Registered on 23 December 2015.
URI: http://ahro.austin.org.au/austinjspui/handle/1/19565
DOI: 10.1186/s13054-018-2136-4
ORCID: 0000-0003-4604-268X
PubMed URL: 30241490
Type: Journal Article
Subjects: Acute illness
Advanced directives
Frailty
Medical emergency team
Outreach team
Rapid response team
Appears in Collections:Journal articles

Files in This Item:
There are no files associated with this item.


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.