Emergency department: risk stratification in the elderly

Background & aims. The older adults have very frequent access to the Emergency Department (ED). The aim of this study is to explore the ability of some geriatric screening tools validated for the ED to predict outcomes (mortality, hospitalization, ED readmission and institutional-ization) at 6 months. Methods. Older adults consecutively admitted to Cagliari University’s ED between May and December of 2017 were enrolled. In ED older patients were screened with three tools: Identification of Seniors at Risk tool (ISAR); Triage Risk Screening Tool (TRST); International Resident Assessment Instrument Emergency Department Screener (InterRAI ED Screener). At 6 months patients were contacted by phone to verify: mortality, ED readmission, hospital admission, and institutionalization. Results. Of the 421 patients (median age 77, Interquartile Range 71-83; 55.8% women) enrolled, 72.4% were positive at the ISAR, 50.1% at the TRST; moreover 44.9% of enrolled subjects needed a urgent geriatric evaluation at the InterRAI ED Screener. The dead subjects had ISAR, TRST and InterRAI ED Screener with greater severity compared to the alive ones. The ISAR and the TRST were also more severe in subjects who had ED readmission, while those hospitalized, in addition to the ISAR, had the more severe Inter-RAI ED Screener. However, applying stepwise logistic regression, of the three tools used, only the ISAR was a predictor for hospitalization (OR = 1.23; CI = 1.03-1.48; P = 0.02; AUC = 0.63). Conclusions. The association of ISAR and InterRAI ED Screener may be useful in ED to intercept both critical issues typical of the elderly, and the need and priority of the geriatric evaluation.