Pieter Heeren1,2,3, Els Devriendt1,2, Nathalie I H Wellens1,4, Mieke Deschodt5,6, Johan Flamaing2,5, Marc Sabbe7,8, Koen Milisen1,2. 1. Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium. 2. Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. 3. Research Foundation Flanders, Brussels, Belgium. 4. Department of Public Health and Social Affairs (DSAS), Direction Générale de la Santé Canton Vaud, Etat de Vaud, Lausanne, Switzerland. 5. Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium. 6. Department of Public Health, Nursing Science, University of Basel, Basel, Switzerland. 7. Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium. 8. Department of Public Health and Primary Care, Emergency Medicine, KU Leuven, Leuven, Belgium.
Abstract
OBJECTIVES: To compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department Screener for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged ≥70 years) community-dwelling adults admitted to the ED. DESIGN: Single-center, prospective, observation study. SETTING: ED with embedded observation unit in University Hospitals Leuven (Belgium). PARTICIPANTS: A total of 794 patients (median age = 80 years; 55% female) were included. MEASUREMENTS: Study nurses collected data using semistructured interviews and patient record review during ED admission. Outcome data were collected with patient record review. RESULTS: Hospitalization (following index ED stay) and unplanned ED readmission at 30 and 90 days occurred in 67% (527/787) of patients and in 12.2% (93/761) and 22.1% (168/761) of patients, respectively. For all outcomes at cutoff 2, the three screening tools had moderate to high sensitivity (range = 0.71-0.90) combined with (very) low specificity (range = 0.14-0.32) and low accuracy (range = 0.21-0.67). At all cutoffs, likelihood ratios and interval likelihood ratios had no or small impact (range = 0.46-3.95; zero was not included) on the posttest probability of the outcomes. For all outcomes, area under the receiver operating characteristics curve varied in the range of 0.49 to 0.62. CONCLUSION: Diagnostic characteristics of all screening tools were comparable. None of the tools accurately predicted the outcomes as a stand-alone index. Future studies should explore the clinical effectiveness and implementation aspects of ED-specific minimum geriatric assessment and intervention strategies. J Am Geriatr Soc 68:1454-1461, 2020.
OBJECTIVES: To compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department Screener for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged ≥70 years) community-dwelling adults admitted to the ED. DESIGN: Single-center, prospective, observation study. SETTING: ED with embedded observation unit in University Hospitals Leuven (Belgium). PARTICIPANTS: A total of 794 patients (median age = 80 years; 55% female) were included. MEASUREMENTS: Study nurses collected data using semistructured interviews and patient record review during ED admission. Outcome data were collected with patient record review. RESULTS: Hospitalization (following index ED stay) and unplanned ED readmission at 30 and 90 days occurred in 67% (527/787) of patients and in 12.2% (93/761) and 22.1% (168/761) of patients, respectively. For all outcomes at cutoff 2, the three screening tools had moderate to high sensitivity (range = 0.71-0.90) combined with (very) low specificity (range = 0.14-0.32) and low accuracy (range = 0.21-0.67). At all cutoffs, likelihood ratios and interval likelihood ratios had no or small impact (range = 0.46-3.95; zero was not included) on the posttest probability of the outcomes. For all outcomes, area under the receiver operating characteristics curve varied in the range of 0.49 to 0.62. CONCLUSION: Diagnostic characteristics of all screening tools were comparable. None of the tools accurately predicted the outcomes as a stand-alone index. Future studies should explore the clinical effectiveness and implementation aspects of ED-specific minimum geriatric assessment and intervention strategies. J Am Geriatr Soc 68:1454-1461, 2020.
Authors: Márlon Juliano Romero Aliberti; Kenneth E Covinsky; Flavia Barreto Garcez; Alexander K Smith; Pedro Kallas Curiati; Sei J Lee; Murilo Bacchini Dias; Victor José Dornelas Melo; Otávio Fortes do Rego-Júnior; Valéria de Paula Richinho; Wilson Jacob-Filho; Thiago J Avelino-Silva Journal: Age Ageing Date: 2021-01-08 Impact factor: 10.668