Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments

Salvi, F.; Morichi, Valeria; Grilli, Annalisa; Spazzafumo, Liana; Giorgi, Raffaella; Polonara, Stefano; Tommaso, G. De; Dessı̀-Fulgheri, Paolo

doi:10.1007/bf03324901

Cited by 59 publications

(65 citation statements)

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“…(18) The RockwoodMitnitski frailty index is relatively simple to calculate and provides a high degree of precision. Due to the broad nature of Test-retest reliability -0.78 (33) Predictive validity has been assessed independently (34,35) Adverse Outcomes Sensitivity:72% Specificity:58%…”

Section: Discussionmentioning

confidence: 99%

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

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BackgroundOlder adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature.MethodsPubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting.ResultsIn the broad clinical literature, three types of measures can be identified: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature.ConclusionsThere is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

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Section: Discussionmentioning

confidence: 99%

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

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“…Major trauma and cardiorespiratory instability were no exclusion criteria. In accordance with an Italian validation study, we did not exclude patients from long-term care facilities in order to identify patients at risk for negative health events regardless of their current living status [7]. …”

Section: Methodsmentioning

confidence: 99%

“…Dramé et al [6] showed an institutionalization rate, defined as admission to a nursing home or long-term care facility, of 18% 6 months after an ED visit. Mortality 6 months after an ED visit is described in 20-24% of patients [4,7]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…Sementara itu, Bari, dkk. 24 di Italia mendapatkan mortalitas 6 bulan sebesar 16%. Tingginya angka mortalitas di penelitian ini bila dibandingkan dengan di negara-negara Eropa tersebut dapat disebabkan karena sebagian besar pasien pada penelitian ini datang dengan kondisi akut yang berat.…”

Section: Insiden Mortalitas 30 Hari Pasien Usia Lanjut Yang Datang Keunclassified

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

Rizka¹,

Harimurti²,

Pitoyo³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Rapid Emergency Medicine Score (REMS) merupakan suatu instrumen yang banyak digunakan untuk melakukan stratifikasi risiko pasien non-bedah di Instalasi Gawat Darurat (IGD). Namun, pasien usia lanjut yang datang ke IGD seringkali datang dengan manifestasi klinis yang atipikal, sehingga performa REMS untuk populasi khusus ini perlu diuji. Penelitian ini dilakukan untuk menilai performa REMS pada populasi pasien usia lanjut yang datang ke IGD.Metode. Dilakukan penelitian kohort prospektif berbasis penelitian prognostik pada pasien usia >60 tahun yang datang ke IGD RS dr. Cipto Mangunkusumo (RSCM), Jakarta selama September hingga Oktober 2016. Subjek diikuti selama 30 hari sejak kedatangan ke IGD. Selanjutnya dilakukan perhitungan kalibrasi (uji Hosmer Lemeshow) dan diskriminasi (perhitungan Area under ROC Curve) REMS dalam memprediksi mortalitas 30 hari pasien usia lanjut.Hasil. Terdapat 321 pasien usia lanjut masuk IGD selama periode penelitian dan 306 di antaranya memenuhi kriteria pemilihan. Dari seluruh subjek, 163 (53,2% pasien adalah laki-laki. Insiden kematian 30 hari sebanyak 22,8% (IK95% 22,3-23,3). Rerata usia 68,3 (SB 6,7) tahun. Sebanyak 83 (27%) pasien dikategorikan triage merah. Terdapat 154 (50%) pasien dengan REMS 0-7, 140 (46%) dengan REMS 8-17 dan 12(4%) with REMS lebih dari 17. Plot kalibrasi menunjukkan r=0,23 dengan hasil uji Hosmer Lemeshow buruk (p=0,00). AUC REMS untuk memprediksi mortalitas 30 hari pasien usia lanjut adalah 0,45 (95% CI 0,23-0,66).Simpulan. REMS menunjukkan performa yang buruk dalam memprediksi mortalitas 30 hari pasien usia lanjut di IGD.

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Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments

Abstract: ISAR can be used as a screening test to identify Italian elderly ED patients who have an increased 6-month risk of death, LTC placement, functional decline, ED revisit, or hospitalization.

Cited by 59 publications

References 25 publications

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

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

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

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