The Predictive Value of the “Identification of Seniors at Risk” Score on Mortality, Length of Stay, Mobility and the Destination of Discharge of Geriatric Hip Fracture Patients

Abstract

Purpose The German Society for Geriatrics recommends the “ISAR” questionnaire as a screening tool for patients ≥70 for geriatric screening in emergency rooms. Although the ISAR-score is collected routinely in the “AltersTraumaRegister DGU ® ” (ATR-DGU), to date less is known about the predictive value of the “ISAR”-score in geriatric trauma patients. Patients and Methods Currently, 84 clinics participate in the ATR-DGU. This evaluation is limited to the subgroup of proximal femur fractures from 2016–2018. Patients ≥70 years, who underwent surgery for a hip fracture are included in the ATR-DGU. In this evaluation, the influence of the “ISAR”-score on mortality, length of stay, mobility and the destination of discharge was examined. Results Overall 10,098 patients were included in the present study. The median age was 85 years (interquartile range (IQ) 80–89 years). According to the ISAR-score 80.6% (n=8142) of the patients were classified as geriatric patients (cut off “ISAR”-score ≥2 points). These group of patients had a length of stay of 16 days (IQ10.1–22.1) compared to the non-geriatric patient cohort showing a length of stay of 15 days (IQ10.1–20.1). Patients showing an ISAR-score ≥2 had an increased risk of being discharged to a nursing home (OR 8.25), not being able to walk (OR 12.52) and higher risk of mortality (OR 3.45). Conclusion The “ISAR”-score shows predictive power for the length of stay, mobility, hospital mortality and discharge after hospital in the collective of geriatric trauma patients. It therefore seems suitable as a screening tool for geriatric trauma patients in the emergency department and should be considered in this context.

Identification of Seniors at Risk Score to Determine Geriatric Evaluations on Trauma Patients With Hip Fractures

“…Dingley et al (2022) reported that as the ISAR score increases, so does the need for discharge to an SNF. Similarly, Knauf et al concluded that a positive ISAR score (≥2) in hip fracture patients predicted an increased risk of being discharged to an SNF (Knauf et al, 2022). Discharging patients to an SNF or a subacute rehabilitation (SAR) facility is the typical plan of care for a patient admitted for a hip fracture at the study site, contrary to Gronewold et al (2017), who reported rare discharges to SNF and/or SAR facilities in patients who were admitted to the orthopedics and trauma surgery.…”

“…This variability includes screening performed by differing providers (nursing staff, residents, and advanced practice providers) and the frequency in which patients were assessed using the screening tool (within 24–72 hr of admission, twice a week, and daily). Inzitari et al (2015) utilized a cutoff score of 3 as a positive ISAR score, whereas others considered 2 as warranting a geriatric evaluation (Asomaning & Loftus, 2014; Dingley et al, 2022; Edmans et al, 2013; Gronewold et al, 2017; Knauf et al, 2022). To the existing body of literature, this study adds outcomes stratified by each ISAR score for patients with hip fractures and the outcomes associated with geriatric evaluations using the score with a cutoff of 2 as a trigger for the evaluation.…”

“…For patients older than 60 years sustaining a hip fracture, the most common ISAR score was 3 (22.5%), whereas Głuszewska et al (2017) similarly reported an ISAR score of 3 as the most frequent score (33.3%) in adults older than 59 years with a history of falling. Knauf et al (2022) reported a median ISAR of 3; however, they used the age of 70 years and older. Those with an ISAR score of 5 contributed the most advanced age, consistent with a German study (Weinrebe et al, 2019).…”

Hyponatremia and Identification of Seniors at Risk (ISAR) Score in Geriatric Patients: An Analytical Cross-Sectional Study

“…ISAR score cut-off of 2 indicates a low-risk group with safe discharge of geriatric patients. ISAR maximum score of 6 indicates a very high-risk group that needs further assessment and follow-up of the hospitalized patient [ 7 ]. The length of stay of hospitalized geriatric patients, from admission to discharge, was also documented.…”

“…It's ideal for correcting the underlying pathology; thereby, sodium and total body water composition is maintained [ 6 ]. Hyponatremic high-risk patients are identified using the Identification of Seniors at Risk (ISAR) tool, which includes six straightforward dichotomous questions [ 7 ]. The research aims to determine the incidence of hyponatremia and the relative risk of ISAR score in elderly individuals.…”