Cyrille P Launay1,2, Joshua Lubov3, Kevin Galery3,4, Christine Vilcocq3,4, Éric Maubert3,4, Marc Afilalo5, Olivier Beauchet3,6,7. 1. Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada. cyrille.launay@mcgill.ca. 2. Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada. cyrille.launay@mcgill.ca. 3. Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada. 4. Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada. 5. Emergency Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 6. Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 7. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Indonesia.
Abstract
BACKGROUND: The "Program of Research on the Integration of Services for the Maintenance of Autonomy" (PRISMA-7) and "Emergency room evaluation and recommendations" (ER2) are both clinical tools used in Québec Emergency Departments (EDs) for screening of older ED users at higher risk of poor outcomes, such as prolonged length of stay (LOS) in EDs and in hospital. The study aimed to: 1) examine whether the PRISMA-7 and ER2 risk levels were associated with length of stays in ED and hospital, as well as hospital admission; and 2) compare the criteria performance (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under receiver operating characteristic curve) of the PRISMA-7 and ER2 high-risk levels for these three ED adverse events in Québec older patients visiting ED on a stretcher. METHODS: A total of 1905 older patients who visited the ED of the Jewish General Hospital (Montreal, Québec, Canada) on stretchers were recruited in this prospective observational cohort. Upon their ED arrival, PRISMA-7 and ER2 were performed. The outcomes were LOS in ED and in hospital, and hospital admission. RESULTS: The PRISMA-7 and ER2 risk levels were associated with length of stay in ED and hospital as well as with hospital admission. Prolonged stays and higher hospitalization rates were associated with high-risk levels, whereas those in low-risk level groups had significantly shorter LOS and a lower rate of hospital admission (P < 0.006). While performance measures were poor for both assessment tools, ER2 had a greater prognostic testing accuracy compared with PRISMA-7. CONCLUSION: PRISMA-7 and ER2 were both associated with incidental short-term ED adverse events but their overall prognostic testing accuracy was low, suggesting that they cannot be used as prognostic tools for this purpose.
BACKGROUND: The "Program of Research on the Integration of Services for the Maintenance of Autonomy" (PRISMA-7) and "Emergency room evaluation and recommendations" (ER2) are both clinical tools used in Québec Emergency Departments (EDs) for screening of older ED users at higher risk of poor outcomes, such as prolonged length of stay (LOS) in EDs and in hospital. The study aimed to: 1) examine whether the PRISMA-7 and ER2 risk levels were associated with length of stays in ED and hospital, as well as hospital admission; and 2) compare the criteria performance (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under receiver operating characteristic curve) of the PRISMA-7 and ER2 high-risk levels for these three ED adverse events in Québec older patients visiting ED on a stretcher. METHODS: A total of 1905 older patients who visited the ED of the Jewish General Hospital (Montreal, Québec, Canada) on stretchers were recruited in this prospective observational cohort. Upon their ED arrival, PRISMA-7 and ER2 were performed. The outcomes were LOS in ED and in hospital, and hospital admission. RESULTS: The PRISMA-7 and ER2 risk levels were associated with length of stay in ED and hospital as well as with hospital admission. Prolonged stays and higher hospitalization rates were associated with high-risk levels, whereas those in low-risk level groups had significantly shorter LOS and a lower rate of hospital admission (P < 0.006). While performance measures were poor for both assessment tools, ER2 had a greater prognostic testing accuracy compared with PRISMA-7. CONCLUSION: PRISMA-7 and ER2 were both associated with incidental short-term ED adverse events but their overall prognostic testing accuracy was low, suggesting that they cannot be used as prognostic tools for this purpose.
Authors: Christopher R Carpenter; Kennon Heard; Scott Wilber; Adit A Ginde; Kirk Stiffler; Lowell W Gerson; Neal S Wenger; Douglas K Miller Journal: Acad Emerg Med Date: 2011-06 Impact factor: 3.451
Authors: Jaime M Hughes; Caroline E Freiermuth; Megan Shepherd-Banigan; Luna Ragsdale; Stephanie A Eucker; Karen Goldstein; S Nicole Hastings; Rachel L Rodriguez; Jessica Fulton; Katherine Ramos; Amir Alishahi Tabriz; Adelaide M Gordon; Jennifer M Gierisch; Andrzej Kosinski; John W Williams Journal: J Am Geriatr Soc Date: 2019-03-15 Impact factor: 5.562
Authors: Jane McCusker; Nandini Dendukuri; Pierre Tousignant; Josée Verdon; Louise Poulin de Courval; Eric Belzile Journal: Acad Emerg Med Date: 2003-03 Impact factor: 3.451
Authors: Philip Moons; Koen De Ridder; Katrien Geyskens; Marc Sabbe; Tom Braes; Johan Flamaing; Koen Milisen Journal: Eur J Emerg Med Date: 2007-12 Impact factor: 2.799