ArticleEuropean geriatric medicine2018
Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.
Article in European geriatric medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 63 citations in OpenAlex.
- Identifying older adults with frailty approaching end-of-life: A systematic review.Palliative medicine · 2021Pooled it
- A cost-consequence analysis of a nudge intervention to improve hospital care of older people at the end of life: results from a stepped-wedge cluster randomised trial.Age and ageing · 2025Trial
- A simplified clinical frailty scale predicts mortality in emergency department patients with acute dyspnea.GeroScience · 2026Article
- Observational
- The Experience of Frail Older Patients in the Boarding Area in the Emergency Department: A Qualitative Systematic Review.Journal of clinical medicine · 2025Review
- What can we learn from 68 000 clinical frailty scale scores? Evaluating the utility of frailty assessment in emergency departments.Age and ageing · 2025Article
- Implications of assisted dying for nursing practice.Nursing ethics · 2025Article
- Prevalence of Value-Based Care for Older People with Dementia Likely to Be Nearing End of Life: A Hospital Retrospective Cohort.Healthcare (Basel, Switzerland) · 2024Article
- Article
- Association between Boarding of Frail Individuals in the Emergency Department and Mortality: A Systematic Review.Journal of clinical medicine · 2024Review
- Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale.BMC palliative care · 2024Article
- Development of an emergency department end of life care audit tool: A scoping review.International journal of nursing studies advances · 2023Article
- Development and preliminary usability testing of an electronic conversation guide incorporating patient values and prognostic information in preparation for older people's decision-making near the end of life.Internet interventions · 2023Article
- Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach.Journal of clinical medicine · 2023Review
- Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review.Internal and emergency medicine · 2022Article
- Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department.BMC emergency medicine · 2022Article
- Discordance and concordance on perception of quality care at end of life between older patients, caregivers and clinicians: a scoping review.European geriatric medicine · 2022Article
- Concerns and potential improvements in end-of-life care from the perspectives of older patients and informal caregivers: a scoping review.BMC geriatrics · 2021Article
- Challenges and facilitators in delivering optimal care at the End of Life for older patients: a scoping review on the clinicians' perspective.Aging clinical and experimental research · 2021Article
- External Prospective Validation of the Modified CriSTAL Score for 30- and 90-day Mortality in Geriatric Urgent Surgical Patients.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021Article
Corrections and comments
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Authors and funding
26 authors at 16 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
abstractTo determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients.
methodsProspective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy.
results2493 patients, with median age 78-80 years (DK-Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7-8.6 vs. 5.8 95% CI 5.6-5.9) and Danish mean 7.1 (95% CI 6.6-7.5 vs. 5.5 95% CI 5.4-5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL's accuracy was only modest for in-hospital death prediction in either setting.
conclusionsThe modified CriSTAL tool (with CFS instead of Fried's frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician's confidence in initiating earlier end-of-life discussions.
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