Screening for Older Emergency Department Inpatients at Risk of Prolonged Hospital Stay: The Brief Geriatric Assessment Tool

Abstract

BackgroundThe aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS.MethodsBased on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry.ResultsArea under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6.ConclusionCombinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.

Predicting prolonged length of hospital stay in older emergency department users: Use of a novel analysis method, the Artificial Neural Network

“…The study procedure of recruitment has been previously described in detail [5]. The inclusion criteria for the present analysis were: hospitalization in acute care wards after an ED visit, age of 80 years and over, and willingness to participate in research.…”

“…Prolonged LHS has been associated with greater prevalence of in-hospital morbidity and mortality and increased health expenditures, explaining why previous studies attempted to develop screening tools to identify older inpatients at risk of prolonged LHS [5][6][7]. Interest in these screening tools is rising because they could be useful to target resources and interventions for vulnerable older ED users [7][8][9][10].…”

“…Recently, a simple screening tool called "6-item brief geriatric assessment" (BGA) has been developed and proved to be easily usable in clinical routine by non-geriatricians [5,6,10]. Whereas items and their combinations were associated with a greater risk of prolonged LHS, their prognostic value remained limited [5].…”

“…Whereas items and their combinations were associated with a greater risk of prolonged LHS, their prognostic value remained limited [5]. Such inconclusive result could be, partly, related to the linear statistical models used to predict prolonged LHS.…”

“…Such inconclusive result could be, partly, related to the linear statistical models used to predict prolonged LHS. Indeed, prolonged LHS results from a complex interplay between multiple health and socio-environmental factors [1][2][3][4][5][6][7][8][9]. Thus, LHS may be considered as a "chaotic" event (i.e., an inherent unpredictable event in a complex system).…”