title: Six screening instruments for frailty in older patients qualified for emergency abdominal surgery.
abstract: BACKGROUND
  The literature on geriatric assessment in emergency admitted patients is scarce, particularly there are no studies regarding the efficacy of frailty screening tests among patients qualified for emergency abdominal surgery. Therefore, the aim of this study was to compare the diagnostic accuracy of six screening instruments in this group of patients.
  
  
  METHODS
  The diagnostic accuracy of the Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric-8 (G8), Groningen Frailty Index (GFI), Rockwood, Balducci score was evaluated in a prospective group of 184 consecutive patients ≥65 years of age. Outcome measure was sensitivity, specificity, positive and negative predictive values of these tests in prediciting 30-day postoperative outcome.
  
  
  RESULTS
  Patients mean age was 76.9±5.8 (65-100) years. The prevalence of frailty, as diagnosed by screening methods, was: 50-79.9% (Balducci/Rockwood-G8). Multivariate analyses have identified all screening tests apart from Rockwood and TRST as independent factors that predict postoperative outcome. The sensitivity and negative predictive value in case of postoperative mortality were 60-91% (Rockwood-VES-13) and 30-93% (GFI-VES13). In case of postoperative morbidity they were 52-85% (Rockwood-VES-13 and G8) and 44-70% (Rockwood-VES-13), respectively.
  
  
  CONCLUSIONS
  Considering these results, it is possible to perform safely and efficiently screening test for frailty in older patients qualified for emergency abdominal surgery. The VES-13 was the best screening instrument; it had the highest sensitivity and negative predictive value both for the postoperative mortality and morbidity. This instrument may offer physicians additional information that can be used in the postoperative optimisation of the treatment of these high-risk group of patients.
authors.affiliation: 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: jkenig@cm-uj.krakow.pl.
authors.forename: Jakub
authors.initials: J
authors.lastname: Kenig
authors.affiliation: 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: betiz@interia.eu.
authors.forename: Beata
authors.initials: B
authors.lastname: Zychiewicz
authors.affiliation: 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: urszula.olszewska@szeptem.pl.
authors.forename: Urszula
authors.initials: U
authors.lastname: Olszewska
authors.affiliation: 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: marbar@mp.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Barczynski
authors.affiliation: 3rd Department of General Surgery, Jagiellonian Univeristy Medical College, Pradnicka str. 35-37, 31-202 Krakow, Poland. Electronic address: chirurgia@narutowicz.krakow.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Nowak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Emergency surgery in the elderly; Frailty; Screening