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

Abstract

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.

Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma

“…Scores were categorised as <10 seconds, 10-19 seconds, 20-29 seconds and ≥30 seconds as originally described by Podsialo [6]. (2) The Older Americans Resources and Service Scale was used to measure functional status, with a decrease of 2/28 points on the Scale defined as functional decline [15][16][17].…”

Comparison of functional outcomes in elderly who have sustained a minor trauma with or without head injury: a prospective multicenter cohort study

“…Some authors have proposed a drop of three points instead of two as a cut-off on the OARS scale. 27 However, our sensitivity analyses using different cut-offs on the OARS scale did not show any difference in the results.…”

Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study

“…The overall magnitude of change observed in our IADL and BADL measures during the 30 months appears to approximate a clinically meaningful difference in functional status [ 18 , 38 , 39 ]. In their recent study of depressive symptoms among older adults with stable coronary heart disease, Sin and colleagues [ 18 ] argued for the clinical relevance of a 1-point decrease in comparable IADL and BADL measures on the basis that a change of this magnitude would capture those needing assistance with an additional activity (or shifting to complete dependence from partial assistance for an activity).…”