以臨床衰弱量表、檢傷分類與共病指數評估醫院急診高齡病人預後之研究

Abstract

背景：人口老化是全球近年來極為關注的議題。隨著老年人口逐年上升，急診65歲以上就診民眾更高達四成，其健康狀態不再僅受疾病本身影響，還涉及活動功能、心智、環境、經濟和社會因素。因此，醫療照護必須調整，從傳統疾病轉向功能評估。如果急診65歲以上高齡者的評估結果能有效預測預後，將有助於衛生教育和醫療決策。目的：本研究透過臨床衰弱等級量表(Clinical Frailty Scale，CFS)、臺灣五級檢傷分類系統(Taiwan Triage and Acuity Scale, TTAS)、查爾森多重共病指數(Charlson Comorbidity Index, CCI)等量表探討其評估結果及與預後的關係。並根據研究結果，提出具體建議。方法：本研究採病歷回溯法，收集某醫學中心自2019年1月1日到2023年12月31日，於急診接受臨床衰弱量表(CFS)評估的高齡者，依據其病歷資料之特性、評估結果及預後進行分析。結果：本研究共分析9594位個案病例。結果顯示，老人評估量表對再入院及死亡皆具預測力，在控制干擾變項後，三個量表皆為死亡的獨立預測因子。而臨床衰弱量表(CFS)和共病指數(CCI)為短期再入院的獨立預測因子。追蹤再入院與死亡之預測力，以臨床衰弱量表(CFS)最優，其次為檢傷分類(TTAS)為共病指數(CCI)。結論：臨床衰弱量表(CFS)、檢傷分類(TTAS)及共病指數(CCI)皆為急診高齡者預後之預測工具。其中臨床衰弱量表(CFS)作為急診老人預後評估的首選工具，建議未來推廣於急診老人評估中，配合檢傷分類(TTAS)及共病指數(CCI)，作為醫療建議及處置之參考依據。Background: Population aging has become a globally significant issue in recent years. With the elderly population gradually increasing, the percentage of patients over 65 years old visiting emergency departments has reached 40%. Their health status is influenced not only by diseases but also by functional activities, mental state, environmental, economic, and social factors. Therefore, medical care must shift from traditional disease-oriented assessments to functional evaluations. If the assessment results for elderly patients over 65 years old in emergency departments can effectively predict prognosis, it will benefit health education and medical decision-making.Objectives: This study aims to explore the assessment results and their relationship with prognosis using various scales, including the Clinical Frailty Scale (CFS), Taiwan Triage and Acuity Scale (TTAS), and Charlson Comorbidity Index (CCI). Based on the research findings, specific recommendations will be proposed.Methods: The study employed a retrospective analysis method, collecting data from a medical center between January 1, 2019, and December 31, 2023. Elderly patients assessed with the Clinical Frailty Scale (CFS) in the emergency department were analyzed based on the characteristics of their medical records, assessment results, and prognosis.Results: The study analyzed a total of 9,594 cases. The results showed that elderly assessment scales have predictive power for readmission and mortality. After controlling for confounding variables, all three scales were independent predictors of mortality. Both the Clinical Frailty Scale (CFS) and the Charlson Comorbidity Index (CCI) were independent predictors of short-term readmission. The Clinical Frailty Scale (CFS) had the best predictive power for readmission and mortality, followed by the Taiwan Triage and Acuity Scale (TTAS), and then the Charlson Comorbidity Index (CCI).Conclusion: The Clinical Frailty Scale (CFS), Taiwan Triage and Acuity Scale (TTAS), and Charlson Comorbidity Index (CCI) are all predictive tools for the prognosis of elderly patients in emergency departments. The Clinical Frailty Scale (CFS) is recommended as the primary tool for prognosis assessment in elderly patients in emergency settings. It is suggested to integrate TTAS and CCI as reference tools for medical advice and management.