Predictive Validity of the Identification of Seniors at Risk Screening Tool in a German Emergency Department Setting

Abstract

Background: The identification of patients at high risk for adverse outcomes [death, unplanned readmission to emergency department (ED)/hospital, functional decline] plays an important role in emergency medicine. The Identification of Seniors at Risk (ISAR) instrument is one of the most commonly used and best-validated screening tools. As to the authors' knowledge so far there are no data on any screening tool for the identification of older patients at risk for a negative outcome in Germany. Objectives: To evaluate the validity of the ISAR screening tool in a German ED. Design: This was a prospective single-center observational cohort study in an ED of an urban university-affiliated hospital. Participants were 520 patients aged ≥75 years consecutively admitted to the ED. Measurements: The German version of the ISAR screening tool was administered directly after triage of the patients. Follow-up telephone interviews to assess outcome variables were conducted 28 and 180 days after the index visit in the ED. The primary end point was death from any cause or hospitalization or recurrent ED visit or change of residency into a long-term care facility on day 28 after the index ED visit. Results: The mean age ± SD was 82.8 ± 5.0 years. According to ISAR, 425 patients (81.7%) scored ≥2 points, and 315 patients (60.5%) scored ≥3 points. The combined primary end point was observed in 250 of 520 patients (48.1%) on day 28 and in 260 patients (50.0%) on day 180. Using a continuous ISAR score the area under the curve on day 28 was 0.621 (95% confidence interval, CI 0.573-0.669) and 0.661 (95% CI 0.615-0.708) on day 180, respectively. Conclusion: The German version of the ISAR screening tool acceptably identified elderly patients in the ED with an increased risk of a negative outcome. Using the cutoff ≥3 points instead of ≥2 points yielded better overall results.

Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors

“…We assumed an incidence poor 30-day outcome of at least 25%. Based on prior research, the ISAR tool should be able to detect this outcome with an AUC of 0.65 24. Under these assumptions, using with 80% power and a significance level of α=5%, the study should be adequately powered to detect an ROC AUC of 0.65 with a 95% CI of ±5%.…”

Practical approach on frail older patients attended for acute heart failure

“…Some authors have suggested a higher cut-off point, or that consideration as a continuous variable, may facilitate more efficient use of care resources [31]. They suggest a cut-off of 3 as better in terms of discriminative capacity for adverse outcomes [36]. …”

Geriatric Screening Tools to Select Older Adults Susceptible for Direct Transfer From the Emergency Department to Subacute Intermediate-Care Hospitalization

“…To improve the clinical meaningfulness and eventual practical use of the results, we used continuous score as well as cutoffs to identify patients at risk, based on previous works for SilverCode (>11 points) 12 and Walter indicator (>6 points). 11 Top versus other 2 tertiles (>3 points), a cutoff already used in the literature, 13 was used for the ISAR. Data were collected by expert physicians or nurses working in the unit, which were selected, trained, and stable during the study period.…”