Original Articles

Aging Clinical and Experimental Research

, Volume 21, Issue 1, pp 69-75

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

  • Fabio SalviAffiliated withDepartment of Internal Medicine, University Politecnica delle Marche Email author 
  • , Valeria MorichiAffiliated withDepartment of Internal Medicine, University Politecnica delle Marche
  • , Annalisa GrilliAffiliated withDepartment of Internal Medicine, University Politecnica delle Marche
  • , Liana SpazzafumoAffiliated withStatistic and Biometry Center, Department of Gerontological Research, National Institute for Research and Care on Aging (INRCA)
  • , Raffaella GiorgiAffiliated withU.O. Accettazione Medica, INRCA
  • , Stefano PolonaraAffiliated withDepartment of Emergency Medicine, Azienda “Ospedali Riuniti”
  • , Giuseppe De TommasoAffiliated withU.O. Accettazione Medica, INRCA
  • , Paolo Dessì-FulgheriAffiliated withDepartment of Internal Medicine, University Politecnica delle Marche

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Abstract

Background and aims: Elderly patients presenting to Emergency Departments (ED) have complex health problems and often undergo adverse outcomes after an ED visit. In Canadian ED, the Identification of Seniors At Risk (ISAR) is useful in screening for these aspects. This study evaluated the predictive validity of ISAR for elderly patients presenting to Italian ED. Methods: Prospective observational study of a cohort of 200 elderly patients presenting to two urban ED in Ancona (Italy). Identifiers and triage, clinical and social data were collected, and the ISAR was administered. The following single outcomes were considered: early (30-day) and late (6-month) ED revisit, frequent ED return, hospital admission, and functional decline. Composite outcomes were: [1] death, long-term care (LTC) placement, functional decline; [2] the same as [1] plus any ED revisit or hospitalization. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: ISAR was positive for 141 (70.5%) subjects, who had high comorbidity, disability and cognitive impairment. ISAR-positive atients hadan OR of 4.77(95% CI, 2.19–10.42) to undergo composite outcome [1] and of 3.46 (95% CI, 1.68–7.15) to experience composite outcome [2]. ISAR also predicted ED revisit and frequent use, hospitalization and functional decline at 6 months. ISAR was also an independent predictor of 6-month mortality (Hazard Ratio 6.9, 95%, CI 1.65–29, p=0.008). Conclusions: 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.

Keywords

Aged emergency department geriatric assessment outcome predictive validity screening