Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.
Swiss Med Wkly. 2012 Jan 3;142:w13327. doi: 10.57187/smw.2012.13327. eCollection 2012.
The Identification of Senior At Risk (ISAR) and the Triage Risk Stratification Tool (TRST) are the two most studied screening tools to detect high-risk patients for unplanned readmission after an emergency department (ED)-visit. Since their performance was unclear among ED-patients over 75 years, we evaluated their capacities to predict readmission at 1, 3, 6 and 12 months as well as their usefulness in avoiding unnecessary further comprehensive geriatric assessment (CGA) in negative screened patients.
Historical cohort study with systematic routine data collection of functional status, comorbid conditions and readmission rate of patients released home after an ED-visit between 2007 and 2009 at the Geneva University Hospitals.
345 patients were included (mean age 84y; 63% female). Readmission rates were 25%, 38%, 49%, and 60% at 1, 3, 6, and 12 months, respectively. Positive ISAR (≥2/6) and TRST (≥2/5) predicted modestly unplanned readmission at each time point (AUC range: 0.607-0.664). Prediction of readmission with ISAR or TRST was not modified after adjustment for variables significantly associated with readmission (being male, having poor functional or comorbid scores). In case of negative ISAR or TRST, their high negative predictive values (NPV) would safely allow avoiding 64 useless CGA (ISAR <2: 7/64 readmissions at 1 month).
Both ISAR and TRST tools predicted modestly unplanned readmission after an ED-visit among patients over 75 years. Nevertheless, due to their low specificity and high NPV these screening tools are useful to select elderly ED-patients who can safely return home without any further CGA.
Senior At Risk（ISAR）和 Triage Risk Stratification Tool（TRST）是两种研究最多的筛查工具，用于检测急诊科（ED）就诊后计划外再入院的高危患者。由于它们在 75 岁以上的 ED 患者中的表现尚不清楚，我们评估了它们在 1、3、6 和 12 个月预测再入院的能力，以及在阴性筛查患者中避免不必要的进一步全面老年评估（CGA）的有用性。
这是一项历史队列研究，对 2007 年至 2009 年期间从日内瓦大学医院出院的 ED 就诊患者的功能状态、合并症和再入院率进行了系统的常规数据收集。
共纳入 345 例患者（平均年龄 84 岁；63%为女性）。1、3、6 和 12 个月的再入院率分别为 25%、38%、49%和 60%。阳性 ISAR（≥2/6）和 TRST（≥2/5）在每个时间点都适度预测了计划外再入院（AUC 范围：0.607-0.664）。在调整与再入院显著相关的变量后，ISAR 或 TRST 预测再入院的能力没有改变（男性、功能或合并症评分差）。如果 ISAR 或 TRST 为阴性，其高阴性预测值（NPV）可安全避免 64 例不必要的 CGA（ISAR<2：1 个月时 64 例中有 7 例再入院）。
ISAR 和 TRST 工具都适度预测了 75 岁以上患者 ED 就诊后的计划外再入院。然而，由于其特异性低和 NPV 高，这些筛查工具可用于选择可以安全回家而无需进一步 CGA 的老年 ED 患者。
