Predictive value of nonspecific symptoms for acute illness in nursing home residents
Predictive value of nonspecific symptoms for acute illness in nursing home residents
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DOI：
10.1046/j.1532-5415.2003.51360.x
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发表时间：
2003-08-01
影响因子：
6.3
通讯作者：
Lachs, MS
中科院分区：
文献类型：
--
作者：
Boockvar, KS;Lachs, MS
目的：检查非特异性症状对疗养院居民急性疾病的预测价值。设计：前瞻性观察性研究。地点：位于城市环境的学术疗养院。参与者：202 名新入院的居民。测量：通过审查疗养院工作人员在病历中记录的观察结果，确定了 11 种非特异性症状。研究人员根据护士报告和病历审查先前制定的标准独立识别急性疾病。随访分为 10 天的间隔，并确定这些间隔内非特异性症状与急性疾病之间的一致性。根据标准公式计算预测值。结果：非特异性症状和急性疾病的发生率分别为 10 天间隔的 21.7% 和 12.5%。嗜睡、虚弱和食欲下降的阳性预测值 (PPV) 最高，其中每一项都能正确预测急性疾病的存在，其报告症状的两倍之一。烦躁和迷失方向有三分之一的人会患上急性疾病，而跌倒则有四分之一的人会患上急性疾病。总体而言，出现任何非特异性症状的 PPV 为 0.24，不存在非特异性症状的阴性预测值为 0.91。 结论：低活性非特异性症状比其他非特异性症状更有可能是急性疾病初期的征兆。需要研究来确定对具有这些非特异性症状的居民进行干预是否可以实现急性疾病的早期发现和治疗。
OBJECTIVES: To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents.DESIGN: Prospective, observational study.SETTING: Academic nursing home located in an urban setting.PARTICIPANTS: Two hundred two newly admitted residents.MEASUREMENTS: Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record. Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review. Follow-up was divided into 10-day intervals, and concordance between nonspecific symptoms and acute illness within these intervals was determined. Predictive values were calculated according to standard formulae.RESULTS: Nonspecific symptoms and acute illnesses occurred in 21.7% and 12.5% of 10-day intervals, respectively. Positive predictive values (PPVs) were highest for lethargy, weakness, and decreased appetite, each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported. Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Overall, the PPV of the occurrence of any nonspecific symptom was 0.24, and the negative predictive value of the absence of nonspecific symptoms was 0.91.CONCLUSION: Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness. Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness.