João Paulo de Almeida Tavares1, Pedro Sá-Couto2, Marie Boltz3, Elizabeth Capezuti4. 1. Coimbra Hospital and Universitary Center, Rua António José de Almeida, lote 12, 6° Esquerdo, 3000-046 Coimbra, Portugal. Electronic address: enf.joaotavares@hotmail.com. 2. Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal. Electronic address: p.sa.couto@ua.pt. 3. Penn State College of Nursing, Nursing Sciences Bldg, University Park, PA 16802, United States. Electronic address: mpb40@psu.edu. 4. Hunter-Bellevue School of Nursing Hunter College of CUNY, Brookdale Campus West, Room 500A 425 E, 25th Street Mailbox #925 NY, NY 10010, United States. Electronic address: ec773@hunter.cuny.edu.
Abstract
INTRODUCTION: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED. METHODS: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated. RESULTS: ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff≥2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR=2.43, 95% CI 1.35-4.35, p<0.01) and late returns to the ED (AO=1.70, 95% CI 1.04-2.79, p<0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180days. DISCUSSION: The ISAR predicted returns to EDs at 30 and 180days for OAs at risk, but was unable to predict early or late hospital readmission.
INTRODUCTION: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED. METHODS: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated. RESULTS: ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff≥2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR=2.43, 95% CI 1.35-4.35, p<0.01) and late returns to the ED (AO=1.70, 95% CI 1.04-2.79, p<0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180days. DISCUSSION: The ISAR predicted returns to EDs at 30 and 180days for OAs at risk, but was unable to predict early or late hospital readmission.