Validation of the Triage Risk Stratification Tool to Identify Older Persons at Risk for Hospital Admission and Returning to the Emergency Department

Lee, Jacques; Schwindt, Graeme; Langevin, Mara; Moghabghab, Rola; Alibhai, Shabbir M.H.; Kiss, Alex; Naglie, Gary

doi:10.1111/j.1532-5415.2008.01959.x

Cited by 42 publications

(32 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies reported composite outcomes of various combinations of undesired outcomes as "any adverse outcome." 66,67,70,76,77,79 The ISAR studies assessed the instrument's prognostic accuracy for ED return visits at 30 to 180 days, functional decline at 30 to 90 days, and hospital readmission at 30 to 180 days. In addition, multiple studies reported composite outcomes of "any adverse outcome" at 30 to 180 days, although the components of the combined endpoint varied from study to study.…”

Section: Screening Instrumentsmentioning

confidence: 99%

“…One study reported the prognostic accuracy of TRST for functional decline with the outcome 78 Additionally, five studies assessed a composite outcome of "any adverse outcome" at 30 days using various combinations of endpoints. 10,67,70,77,79 Two studies evaluated "any adverse outcome" at 90 days 65,66 and another two at 120 days. 77,79 Several studies reported prognostic accuracy estimates at various thresholds ranging from one to three "yes" responses on the TRST.…”

Section: Screening Instrumentsmentioning

confidence: 99%

“…10,67,70,77,79 Two studies evaluated "any adverse outcome" at 90 days 65,66 and another two at 120 days. 77,79 Several studies reported prognostic accuracy estimates at various thresholds ranging from one to three "yes" responses on the TRST. 10,64,69,70,79 For this meta-analysis, the original threshold of ≥2 was used across studies.…”

Section: Screening Instrumentsmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

View full text Add to dashboard Cite

Objectives: A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.Methods: A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical testtreatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.Results: A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR-= 0.27) and nursing home placement (LR-= 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR-range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Conclusions: Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the r...

show abstract

Section: Screening Instrumentsmentioning

confidence: 99%

Section: Screening Instrumentsmentioning

confidence: 99%

Section: Screening Instrumentsmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

View full text Add to dashboard Cite

show abstract

“…Inter-rater reliability -kappa 0.94-1.0 (24) / 0.9 (28) Validated by Moons et al (35) Lee et al (36) Ruciman et al (25) VEQ (Vulnerable Elderly Questionnaire)…”

Section: Two Urban Academic Ed N=647mentioning

confidence: 99%

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

View full text Add to dashboard Cite

BackgroundOlder adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature.MethodsPubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting.ResultsIn the broad clinical literature, three types of measures can be identified: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature.ConclusionsThere is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

show abstract

“…Receiver Operating Curve (ROC) of the final PERIL prediction rule, paramedic clinical judgment, and the ISAR tool were also reported and areas under the curve (AUC) were compared. 34 …”

Section: Cjem Jcmumentioning

confidence: 99%

Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

Lee

Verbeek

Schull

et al. 2016

CJEM

Self Cite

View full text Add to dashboard Cite

Objectives: We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics' observations. Methods: We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed interobserver reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression. Results: We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) "Problems in the home contributing to adverse outcomes?" (OR 1.43); 2) "Called 911 in the last 30 days?" (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p = 0.02) and adherence was better for PERIL than for ISAR. Conclusions: The four-item PERIL rule has good interobserver reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk. RÉSUMÉObjectifs: Les auteurs ont mené un programme de recherche afin de dériver une règle de prévision clinique et d'en vérifier la fiabilité, règle qui permettrait de reconnaître les personnes âgées fortement prédisposées à la perte d'autonomie à l'aide des observations des ambulanciers paramédicaux. Méthode: Les auteurs ont d'abord élaboré une liste de vérification, la Paramedics assessing Elders at Risk of Independence Loss (PERIL), qui comprenait 43 questions à répondre par oui ou par non, dont les éléments de l'outil Identifying Seniors at Risk (ISAR). Par la suite, 1185 ambulanciers paramédicaux provenant de trois services en Ontario ont été formés pour utiliser la liste de vérification, après quoi a été évaluée la fidélité interobservateurs dans un échantillon de commodité. Le principal critère d'évaluation, soit le retour au service des urgences, l'hospitalisation ou la mort en l'espace d'un mois, a été évalué à l'aide de bases de données provinciales. Enfin, les auteurs ont procédé à la dérivation d'une règle de prévision clinique à l'aide de modèles de régression logistique à plusieurs variables.

show abstract

Validation of the Triage Risk Stratification Tool to Identify Older Persons at Risk for Hospital Admission and Returning to the Emergency Department

Cited by 42 publications

References 32 publications

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule

Contact Info

Product

Resources

About