Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool

McCusker, Jane; Bellavance, François; Cardin, Sylvie; Trepanier, Sylvain; Verdon, Josée; Ardman, Orly

doi:10.1111/j.1532-5415.1999.tb05204.x

Cited by 535 publications

(504 citation statements)

References 48 publications

(74 reference statements)

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“…This study adds to the evidence supporting the feasibility of community paramedicine, a model of care whereby paramedics apply their training and skills in "nontraditional," preventative, community-based roles. [19][20][21][22][23][24] Gerson et al first studied screening by paramedics for clues of unmet needs in the home environment of older adults. 18 In 121/124 cases where paramedics identified older adults as having unmet needs, this was confirmed during a home-visit by a "gold-standard" geriatric assessor from a community agency.…”

Section: Discussionmentioning

confidence: 99%

“…We also included all questions from the Identifying Seniors at Risk (ISAR), and trained paramedics in how to use the ISAR questions. 24 We then developed a curriculum to educate paramedics about the study rationale, objectives, and use of the PERIL data form. 25 We used existing one-hour EMS continuing educational sessions to train 1,185 paramedics, including advanced and basic care providers.…”

Section: Methodsmentioning

confidence: 99%

“…24,27,28 It included any repeat visit to the ED, hospitalization, or death within 30 days of the initial EMS encounter. We excluded adverse outcomes that were related to the initial EMS call, i.e., occurred on the same day as the initial EMS call with no ED discharge occurring prior to the adverse event.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

Lee

Verbeek

Schull

et al. 2016

CJEM

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Objectives: We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics' observations. Methods: We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed interobserver reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression. Results: We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) "Problems in the home contributing to adverse outcomes?" (OR 1.43); 2) "Called 911 in the last 30 days?" (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p = 0.02) and adherence was better for PERIL than for ISAR. Conclusions: The four-item PERIL rule has good interobserver reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk. RÉSUMÉObjectifs: Les auteurs ont mené un programme de recherche afin de dériver une règle de prévision clinique et d'en vérifier la fiabilité, règle qui permettrait de reconnaître les personnes âgées fortement prédisposées à la perte d'autonomie à l'aide des observations des ambulanciers paramédicaux. Méthode: Les auteurs ont d'abord élaboré une liste de vérification, la Paramedics assessing Elders at Risk of Independence Loss (PERIL), qui comprenait 43 questions à répondre par oui ou par non, dont les éléments de l'outil Identifying Seniors at Risk (ISAR). Par la suite, 1185 ambulanciers paramédicaux provenant de trois services en Ontario ont été formés pour utiliser la liste de vérification, après quoi a été évaluée la fidélité interobservateurs dans un échantillon de commodité. Le principal critère d'évaluation, soit le retour au service des urgences, l'hospitalisation ou la mort en l'espace d'un mois, a été évalué à l'aide de bases de données provinciales. Enfin, les auteurs ont procédé à la dérivation d'une règle de prévision clinique à l'aide de modèles de régression logistique à plusieurs variables.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

Lee

Verbeek

Schull

et al. 2016

CJEM

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“…[41][42][43] It is also close to the mean response rate of 54% reported by a systematic review of physician postal surveys. 32,35 Our rigorous methodological approach, including key informant interviews, cognitive interviews, pilottesting, short and concise questionnaires with incentives to half of the physicians, and a special contact, optimized our response rate and yielded very few missing data.…”

Section: Respondentsmentioning

confidence: 99%

“…30,34 The OARS ADL scale has been validated for ED patients and has been successfully used in ED studies for both in-person and over the telephone interviews. 32,35 There are a number of screening tools for return to the ED, but none exist to specifically screen for functional decline after a minor injury. Our goals were to determine what emergency physicians deem to be a minimal clinically important difference on the 28-point OARS ADL Scale, and what the required sensitivity would be for a clinical decision tool to identify elderly patients at high risk of functional decline six months after sustaining a minor trauma.…”

Section: Introductionmentioning

confidence: 99%

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

Abdulaziz

Brehaut

Taljaard

et al. 2015

CJEM

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Background: There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury. Methods: After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method. Results: Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks. Conclusions: A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.

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Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries

et al. 2021

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Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool

Abstract: The ISAR is a short self-report questionnaire that can quickly identify older patients in the ED at increased risk of several adverse health outcomes and those with current disability.

Cited by 535 publications

References 48 publications

Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries

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