Does the identification of seniors at risk (ISAR) score effectively select geriatric patients on emergency admission?


The number of older patients admitted to emergency departments (ED) increases continuously. The Identification of Seniors at Risk (ISAR) score is currently recommended to screen patients in German ED, but its appropriateness is being criticized. ISAR scores and clinical characteristics from 98 emergency admissions (EA), 80 from acute geriatrics (AG) and 89 from a geriatric rehabilitation (GR) unit were compared retrospectively. No significant differences were found between groups, being the ISAR score positive in 87.7% of EA, 94.9% of AG and 94.4% of GR cases. None of positively identified geriatric patients in the EA was transferred to the geriatric ward of competence. EA patients showed significantly higher number of functional impairments (p = 0.001) and higher BI score (p < 0.0001) compared to AG and GR groups. A higher ISAR score threshold and additional functional information might be needed to better select patients in need of prompt treatment by a geriatric team.

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  1. 1.

    Conroy S, Nickel C, Mooijaart SP (2018) Urgent care. In: Roller-Wirnsberger RE, Singler K, Polidori MC (eds) Learning geriatric medicine, Springer, New York

    Google Scholar 

  2. 2.

    McCusker J, Bellavance F, Cardin S et al. (1998) Screening for geriatric problems in the emergency department: reliability and validity. Identification of seniors at risk (ISAR) Steering Committee. Acad Emerg Med 5:883–893

    CAS  Article  Google Scholar 

  3. 3.

    McCusker J, Bellavance F, Cardin S et al. (1999) Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 47:1229–1237

    CAS  Article  Google Scholar 

  4. 4.

    Thiem U, Greuel HW, Reingräber A et al. (2012) Consensus for the identification of geriatric patients in the emergency care setting in Germany. Z Gerontol Geriat 45:310–314

    CAS  Article  Google Scholar 

  5. 5.

    Carpenter CR, Shelton E, Fowler S et al. (2015) Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med 22:1–21

    Article  Google Scholar 

  6. 6.

    Singler K, Heppner HJ, Skutetzky A et al. (2014) Predictive validity of the identification of seniors at risk screening tool in a German emergency department setting. Gerontology 60:413–419

    Article  Google Scholar 

  7. 7.

    Hwang U, Carpenter C (2016) Assessing geriatric vulnerability for post emergency department adverse outcomes: challenges abound while progress is slow. EMJ 33:2–3

    Article  Google Scholar 

  8. 8.

    Yao J-L, Fang J, Lou Q-Q et al. (2015) A systematic review of the identification of seniors at risk (ISAR) tool for the prediction of adverse outcome in elderly patients seen in the emergency department. Int J Clin Exp Med 8:4778–4786

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    CAS  Google Scholar 

  10. 10.

    Di Bari M, Salvi F, Roberts AT et al. (2011) Prognostic stratification of elderly patients in the emergency department: a comparison between the “Identification of Seniors at risk” and the “Silver Code”. J Gerontol A Biol Sci Med Sci 67:544–550

    PubMed  Google Scholar 

  11. 11.

    Edmans J, Bradshaw L, Gladman JRF et al. (2013) The identification of seniors at risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units. Age Ageing 42:747–753

    Article  Google Scholar 

  12. 12.

    Galvin R, Gilleit Y, Wallace E et al. (2017) Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the identification of seniors at risk (ISAR) screening tool. Age Ageing 46:179–186

    PubMed  Google Scholar 

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This study was presented at the 2018 German Gerontology and Geriatrics Conference.

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Correspondence to W. Weinrebe.

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The study was approved by the Ethics Committee of the University of Cologne as well as by the Ethics Committee of the Clinic Wartenberg.

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Heppner HJ and Polidori MC are equal supervisors.

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Weinrebe, W., Schiefer, Y., Weckmüller, K. et al. Does the identification of seniors at risk (ISAR) score effectively select geriatric patients on emergency admission?. Aging Clin Exp Res 31, 1839–1842 (2019).

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  • Emergency admission
  • Geriatric patients
  • ISAR
  • Selection for acute geriatric treatment