PMID- 26063056
OWN - NLM
STAT- MEDLINE
DCOM- 20180126
LR  - 20180126
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 17
IP  - 6
DP  - 2015 Nov
TI  - National Survey of Emergency Physicians to Define Functional Decline in Elderly 
      Patients with Minor Trauma.
PG  - 639-47
LID - 10.1017/cem.2015.37 [doi]
AB  - BACKGROUND: There are a number of screening tools to predict return to the 
      emergency department (ED) in elderly trauma patients, but none exist to 
      specifically screen for functional decline after a minor injury. The objective of 
      this study was to identify outcome measures for a possible future clinical 
      decision rule to be used in the ED to identify previously independent patients at 
      high risk of functional decline at six months post minor injury. METHODS: After a 
      rigorous development process, a survey instrument was administered to a random 
      sample of 178 emergency physicians using the Dillman's Tailored Design Method. 
      RESULTS: Of 156 eligible surveys, we received 81 completed surveys (response rate 
      51.9%). Considering all 14 activities of daily living (ADL) items, 90% of 
      physicians deemed a minimal clinically important difference (MCID) in function to 
      be at least three points on the 28-point Older Americans Resources and Services 
      (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to 
      detect patients at risk of functional decline at six months post injury would 
      meet or exceed the sensitivity deemed to be required by 90% of physicians. The 
      majority of emergency physicians do not assess elderly injured patients for the 
      majority of the tasks. CONCLUSIONS: A drop of three points on the 28-point OARS 
      ADL Scale would be deemed clinically important by the vast majority of emergency 
      physicians. Further, a sensitivity of 93% for a clinical decision tool would 
      satisfy the MCID requirements of the vast majority of emergency physicians. There 
      appears to be a gap between physician knowledge and actual practice. We intend to 
      use these findings in the development of a clinical decision rule to identify 
      high-risk elderly trauma patients.
FAU - Abdulaziz, Kasim
AU  - Abdulaziz K
AD  - *Department of Epidemiology and Community Medicine,University of 
      Ottawa,Ottawa,ON.
FAU - Brehaut, Jamie
AU  - Brehaut J
AD  - *Department of Epidemiology and Community Medicine,University of 
      Ottawa,Ottawa,ON.
FAU - Taljaard, Monica
AU  - Taljaard M
AD  - *Department of Epidemiology and Community Medicine,University of 
      Ottawa,Ottawa,ON.
FAU - Emond, Marcel
AU  - Emond M
AD  - double daggerDepartment of Family and Emergency Medicine,Universite Laval,Laval,QC.
FAU - Sirois, Marie-Josee
AU  - Sirois MJ
AD  -  section signUnite de recherche en traumatologie-urgence-soins intensifs du Centre de 
      recherche FRQ-S du CHA de Quebec,Laval,QC.
FAU - Lee, Jacques S
AU  - Lee JS
AD  - ǁClinical Epidemiology Unit,Department of Emergency Medicine,University of 
      Toronto,Sunnybrook Health Sciences Center,Toronto,ON.
FAU - Wilding, Laura
AU  - Wilding L
AD  - **Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
FAU - Perry, Jeffrey J
AU  - Perry JJ
AD  - *Department of Epidemiology and Community Medicine,University of 
      Ottawa,Ottawa,ON.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20150611
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
SB  - IM
MH  - *Activities of Daily Living
MH  - Adult
MH  - Aged
MH  - Canada/epidemiology
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Geriatric Assessment/*methods
MH  - Humans
MH  - Incidence
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - Physicians/*statistics & numerical data
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - *Surveys and Questionnaires
MH  - Wounds and Injuries/diagnosis/*epidemiology
OTO - NOTNLM
OT  - Activities of Daily Living (ADL)
OT  - Elderly
OT  - Emergency Department
OT  - Functional Decline
OT  - Geriatric Assessment
OT  - Minor Injuries
OT  - Older Americans Resources and Services (OARS)
EDAT- 2015/06/13 06:00
MHDA- 2015/06/13 06:01
CRDT- 2015/06/12 06:00
PHST- 2015/06/12 06:00 [entrez]
PHST- 2015/06/13 06:00 [pubmed]
PHST- 2015/06/13 06:01 [medline]
AID - S1481803515000378 [pii]
AID - 10.1017/cem.2015.37 [doi]
PST - ppublish
SO  - CJEM. 2015 Nov;17(6):639-47. doi: 10.1017/cem.2015.37. Epub 2015 Jun 11.