Prediction of Emergency Department Re-Visits in Older Patients by the Identification of Senior at Risk (ISAR) Screening

Abstract

Abstract:The "Identification of Seniors at Risk" (ISAR) screening is a tool to identify seniors at risk of adverse outcomes. We investigated whether seniors with a positive ISAR screening have an increased risk of Emergency Department (ED) re-visits and health-service costs. In a pilot project, we enrolled 96 ED patients (≥70 years) who received an ISAR screening in the ED. We compared the rate of ED re-visits and in-hospital costs between ISAR positive (≥2 pts) and ISAR negative (<2 pts) patients. In some patients, a geriatrician performed a single Geriatric Consultation (GC) during the ED stay to assess older patients' needs.32% of the study population had an unplanned ED re-visit (31 of 96). Fifty patients were ISAR positive (52%) and showed an increased risk of ED re-visits compared with ISAR negative patients (dds ratio (OR) 6.8, 95% confidence interval (CI) 2.2-21.0, p = 0.001). The positive ISAR screening tool fairly predicted ED re-visits in seniors (area under the curve (AUC) 0.711). A single GC during the ED stay did not reduce the risk of unplanned ED re-visits in ISAR positive patients (p = 0.80) ISAR positive patients with GC did not have higher in-hospital costs than ISAR negative patients without GC. Based on these findings, we aim to establish a comprehensive outpatient geriatric assessment program to identify relevant risk factors for ED re-visits and to recommend preventive strategies in ISAR positive ED seniors.

Emergency department: risk stratification in the elderly

“…Conflicting results are available for the predictive capacity of ISAR 17,18,22 . In our study the ISAR positivity at the ED admission was 72.4%, which appears in line with the literature, although a variability is observed from 52.1 to 81.5% [17][18][19][20][21][22] . This tool at Mann Whitney test was able to predict the risk of mortality, hospital admission and ED readmission ED in line with ISAR validation (excluding institutionalization not considered for the low number of subjects institutionalized -10 of 421).…”

Development and Validation of a Nomogram for Predicting Risk of Emergency Department Revisits in Chinese Older Patients

“…The risk prediction models for ED revisits in older adults were also reported in prior studies, although many of them evaluated ED-return risk within a shorter period after discharge and did not specifically calculate the probability. For example, ISAR (consisting of six assessment items: presence of home help, increased dependency, recent hospitalization, impaired vision, impaired memory, and polypharmacy) 8 , 19 , 25 , 26 and TRST (including six items: cognitive impairment, living alone or no caregiver, difficulties with walking or transfer, recent ED admission or hospitalization, polypharmacy, and professional recommendation) 8 , 15 , 16 were the two most studied tools to detect high-risk patients for unplanned ED revisits, both of which produced similar discriminative ability as in our nomogram. These two tools, however, were disadvantaged because they can only dichotomize patients into high/low risks but cannot calculate an estimated percentage chance of revisit.…”

Comparison of G8 and ISAR Screening Results in Geriatric Urology

“…A score higher than 2 of a maximum of 6 points is considered positive for geriatric risk factors or frailty. Initially, it was introduced and most intensively evaluated as a tool for emergency units [ 20 ]. However, it has recently become, in our region, a general tool for all hospitalized patients [ 12 , 16 ].…”