Improvement of the Identification of Seniors at Risk scale for predicting adverse health outcomes of elderly patients in the emergency department

• Published in: International emergency nursing Vol. 68; p. 101274
• Main Authors: Hsu, Chin-Wang, Lee, Ching-Wei, Hsu, Shih-Chang, Huang, Wen-Cheng, Hsu, Yuan-Pin, Chi, Mei-Ju
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2023
• Subjects: Aged; Charlson comorbidity index; Elderly patients; Emergency department; Emergency Service, Hospital; Geriatric Assessment; Humans; Identification of seniors at risk; Mortality; Outcome Assessment, Health Care; Prospective Studies; Readmission; Risk Assessment; Readmission; Emergency department; Identification of seniors at risk; Elderly patients; Mortality; Charlson comorbidity index
• ISSN: 1755-599X; 1532-9267; 1878-013X
• DOI: 10.1016/j.ienj.2023.101274

•Elderly patients prone to adverse outcomes after emergency need to be identified.•Sensitive identification tool of high-risk patients after emergency is needed.•ISAR incorporates the Charlson index may increase the discriminative performance. To explore the validity of the Chinese version of the Identification of Seniors at Risk (ISAR) screening tool in emergency rooms (ERs) to identify elderly patients prone to adverse outcomes after being discharged from the ER. A prospective single-center observational study design was adopted and included 497 elderly (aged ≥65 years) ER patients of a medical center in northern Taiwan. Before discharge from the ER, baseline sociodemographic and clinic data were collected by researchers and the ISAR was administered. Adverse health outcomes (ER revisits, readmissions, and mortality) at 30 days were evaluated by medical records and follow-up telephone interviews. ISAR screening showed that 334 (67.2%) elderly patients in the ER were at high risk after discharge. Higher-risk patients were older, had had a fall within the previous 6 months, and had complex comorbidities. The ISAR had good sensitivity (0.77∼1.00) for screening adverse health outcomes in these elderly patients. The discrimination of the ISAR for adverse health outcomes was 0.60∼0.77, and it increased to 0.64∼0.80 when the age-adjusted Charlson comorbidity index (ACCI) was simultaneously considered. The ISAR exhibited good sensitivity for screening adverse outcomes for elderly patients at risk. The ACCI is recommended to simultaneously be considered to improve the prognostic performance of the ISAR.