Acil Servise Başvuran Yaşlı Bireylerde Edmonton Kırılganlık Ölçeği, ISAR ve PRISMA-7’nin Kısa Dönem Mortaliteyi Öngörme Değeri

Öz

Kırılganlık, acil servise (AS) başvuran yaşlı bireylerde klinik sonuçların belirleyicilerinden biri olarak giderek daha fazla önem kazanmaktadır. Ancak yaygın olarak kullanılan kırılganlık tarama araçlarının karşılaştırmalı prognostik performansına ilişkin kanıtlar sınırlıdır. Bu çalışmanın amacı, acil servis ortamında kısa dönem mortaliteyi öngörmede Edmonton Kırılganlık Ölçeği (EFS), Yaşlılarda Risk Tanımlama Aracı (Identification of Seniors at Risk, ISAR) ve PRISMA-7’nin prediktif doğruluğunu değerlendirmek ve karşılaştırmaktır. Bu prospektif gözlemsel çalışmaya, Ocak–Temmuz 2022 tarihleri arasında üçüncü basamak bir acil servise başvuran ≥65 yaşındaki hastalar dâhil edilmiştir. Kırılganlık, başvuru sırasında EFS, ISAR ve PRISMA-7 kullanılarak değerlendirilmiştir. Birincil sonlanım noktası 30 günlük tüm nedenlere bağlı mortalite olarak belirlenmiştir. Gruplar arası karşılaştırmalar Mann–Whitney U ve ki-kare testleri ile yapılmıştır. Prognostik doğruluk, alıcı işletim karakteristiği (ROC) eğrileri kullanılarak değerlendirilmiş, optimal kesme noktaları Youden İndeksi ile belirlenmiştir. Toplam 103 hastanın (ortalama yaş 73,9±7,2 yıl) 16’sı (%15,5) 30 gün içinde hayatını kaybetmiştir. Hayatta kalmayan hastalarda tüm ölçeklerde kırılganlık skorları daha yüksek bulunmuştur (EFS 11’e karşı 7; ISAR 4’e karşı 3; PRISMA-7 5’e karşı 3; tümü için p≤0,001). EFS, ISAR ve PRISMA-7 için eğri altında kalan alan (AUC) değerleri sırasıyla 0,811, 0,765 ve 0,754 olarak saptanmıştır. >7 kesme noktasında EFS %100 duyarlılık gösterirken, ISAR ve PRISMA-7 daha dengeli bir duyarlılık–özgüllük profili sunmuştur. EFS, ISAR veya PRISMA-7 ile yapılan kırılganlık taraması, acil serviste değerlendirilen yaşlı hastalarda değerli prognostik bilgiler sağlamaktadır. EFS en yüksek duyarlılığı sunarken, ISAR ve PRISMA-7 daha dengeli performanslarıyla klinik uygulamada tamamlayıcı kullanımını desteklemektedir.

Anahtar Kelimeler

• kırılganlık
• Edmonton Kırılganlık Ölçeği
• ISAR
• PRISMA-7
• acil servis
• mortalite

Predictive Value of Edmonton Frailty Scale, ISAR, and PRISMA-7 for Short-Term Mortality in Older Adults Presenting to the Emergency Department

Öz

Frailty has emerged as a critical determinant of outcomes among older adults presenting to the emergency department (ED). However, limited evidence exists regarding the comparative prognostic performance of commonly used frailty screening tools. This study aimed to evaluate and compare the predictive accuracy of the Edmonton Frailty Scale (EFS), Identification of Seniors at Risk (ISAR), and PRISMA-7 for short-term mortality in the ED setting. This prospective observational study included patients aged ≥65 years admitted to a tertiary ED between January and July 2022. Frailty was assessed at admission using EFS, ISAR, and PRISMA-7. The primary outcome was 30-day all-cause mortality. Group comparisons were performed with Mann–Whitney U and chi-square tests. Prognostic accuracy was evaluated using receiver operating characteristic (ROC) curves, and optimal cut-offs were defined with the Youden Index. Among 103 patients (mean age 73.9±7.2 years), 16 (15.5%) died within 30 days. Non-survivors had higher frailty scores on all tools (EFS 11 vs. 7; ISAR 4 vs. 3; PRISMA-7 5 vs. 3; all p≤0.001). AUC values were 0.811 for EFS, 0.765 for ISAR, and 0.754 for PRISMA-7. At a cut-off of >7, EFS showed 100% sensitivity, while ISAR and PRISMA-7 provided a more balanced sensitivity–specificity profile. Frailty screening with EFS, ISAR, or PRISMA-7 yields valuable prognostic information in older ED patients. EFS offers maximal sensitivity, whereas ISAR and PRISMA-7 achieve greater balance, supporting complementary use in practice.

Anahtar Kelimeler

• frailty
• Edmonton Frailty Scale
• ISAR
• PRISMA-7
• emergency department
• mortality

Kaynakça

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