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Article: Feasibility of predictive model by clinical and laboratory parameters for risk stratification of geriatric abdominal pain

TitleFeasibility of predictive model by clinical and laboratory parameters for risk stratification of geriatric abdominal pain
Authors
Issue Date2018
PublisherSage Publishing on behalf of the Hong Kong College of Emergency Medicine and The Hong Kong Society for Emergency Medicine and Surgery. The Journal's web site is located at http://www.hkjem.com
Citation
Hong Kong Journal of Emergency Medicine, 2018, Epub of 2018 How to Cite?
AbstractBackground:Assessment of geriatric patients presented with abdominal pain had been challenge for emergency physicians with the ageing population. A rapid, reproducible risk stratification model for the assessment of the need for admission for geriatric abdominal pain would be required to identify low-risk patients to be managed as out-patient basis.Objective:Assess the feasibility of risk stratification model to predict the need of hospital admission based on readily available bedside parameters in emergency departments.Methods:This is a multicenter retrospective cohort study in four emergency departments. Patients aged at least 65 who presented with chief complaint of abdominal pain within the previous 7?days of attendance as the chief complaint were included. Chart review was performed for the included patients. The primary outcome was defined as a composite of mortality, abdominal surgery or endoscopic treatment, and other inpatient treatments for abdominal diseases within 14?days, surrogating the need of hospital admission. Logistic regression was modeled to identify independent predictors. The diagnostic accuracy of the risk model was evaluated with the receiver operating characteristic curve and compared with the clinical gestalt of decision for hospital admission by the attending physician.Results:In total, 553 patients were included. Symptoms of upper gastrointestinal bleeding, non-ambulatory presenting status, pain duration, focal abdominal tenderness, hyperglycemia, leukocytosis, and elevated creatinine were independent predictors of the outcome. The area under the receiver operating characteristic curve of the predicted probabilities of the logistic model was 0.741. In keeping for a low-risk criterion to achieve more than 90% sensitivity, the predictive model would only achieve 18.2% specificity which was inferior to clinical gestalt for hospital admission (sensitivity 99.3%, specificity 44.3%).Conclusion:Risk stratification model by clinical assessment and laboratory markers alone were inadequate and inferior to clinical gestalt for identification of the group of patients requiring inpatient treatment.
Persistent Identifierhttp://hdl.handle.net/10722/263343
ISSN
2017 Impact Factor: 0.202
2015 SCImago Journal Rankings: 0.173

 

DC FieldValueLanguage
dc.contributor.authorLui, C-
dc.contributor.authorChing, W-
dc.contributor.authorTsui, K-
dc.contributor.authorChu, H-
dc.contributor.authorTsui, AT-
dc.contributor.authorAu, T-
dc.contributor.authorWong, TW-
dc.contributor.authorFan, KL-
dc.contributor.authorLeung, LP-
dc.date.accessioned2018-10-22T07:37:23Z-
dc.date.available2018-10-22T07:37:23Z-
dc.date.issued2018-
dc.identifier.citationHong Kong Journal of Emergency Medicine, 2018, Epub of 2018-
dc.identifier.issn1024-9079-
dc.identifier.urihttp://hdl.handle.net/10722/263343-
dc.description.abstractBackground:Assessment of geriatric patients presented with abdominal pain had been challenge for emergency physicians with the ageing population. A rapid, reproducible risk stratification model for the assessment of the need for admission for geriatric abdominal pain would be required to identify low-risk patients to be managed as out-patient basis.Objective:Assess the feasibility of risk stratification model to predict the need of hospital admission based on readily available bedside parameters in emergency departments.Methods:This is a multicenter retrospective cohort study in four emergency departments. Patients aged at least 65 who presented with chief complaint of abdominal pain within the previous 7?days of attendance as the chief complaint were included. Chart review was performed for the included patients. The primary outcome was defined as a composite of mortality, abdominal surgery or endoscopic treatment, and other inpatient treatments for abdominal diseases within 14?days, surrogating the need of hospital admission. Logistic regression was modeled to identify independent predictors. The diagnostic accuracy of the risk model was evaluated with the receiver operating characteristic curve and compared with the clinical gestalt of decision for hospital admission by the attending physician.Results:In total, 553 patients were included. Symptoms of upper gastrointestinal bleeding, non-ambulatory presenting status, pain duration, focal abdominal tenderness, hyperglycemia, leukocytosis, and elevated creatinine were independent predictors of the outcome. The area under the receiver operating characteristic curve of the predicted probabilities of the logistic model was 0.741. In keeping for a low-risk criterion to achieve more than 90% sensitivity, the predictive model would only achieve 18.2% specificity which was inferior to clinical gestalt for hospital admission (sensitivity 99.3%, specificity 44.3%).Conclusion:Risk stratification model by clinical assessment and laboratory markers alone were inadequate and inferior to clinical gestalt for identification of the group of patients requiring inpatient treatment.-
dc.languageeng-
dc.publisherSage Publishing on behalf of the Hong Kong College of Emergency Medicine and The Hong Kong Society for Emergency Medicine and Surgery. The Journal's web site is located at http://www.hkjem.com-
dc.relation.ispartofHong Kong Journal of Emergency Medicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleFeasibility of predictive model by clinical and laboratory parameters for risk stratification of geriatric abdominal pain-
dc.typeArticle-
dc.identifier.emailWong, TW: drtwwong@hku.hk-
dc.identifier.emailFan, KL: kkllfan@hku.hk-
dc.identifier.emailLeung, LP: leunglp@hku.hk-
dc.identifier.authorityFan, KL=rp02019-
dc.identifier.authorityLeung, LP=rp02032-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1177/1024907918802070-
dc.identifier.hkuros294548-
dc.identifier.volumeEpub of 2018-
dc.identifier.spage1024907918802070-
dc.identifier.epage1024907918802070-
dc.publisher.placeHong Kong-

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