Geriatric emergency Department, National Institute of Health and Research on Aging (INRCA), Ancona, Italy.
J Nutr Health Aging. 2012 Apr;16(4):313-8. doi: 10.1007/s12603-011-0155-9.
Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Comprehensive geriatric assessment (CGA) has been proposed to screen for frailty in the ED, but it is difficult to carry out. We tested whether a CGA-based approach using the Identification of Seniors At Risk (ISAR) screening tool was associated with the brief deficit accumulation index (DAI) of frailty.
Prospective observational study.
Two urban EDs in Italy.
A cohort of 200 elderly (≥65 years) ED patients.
Identifiers, triage, clinical and social data along with the administration of ISAR. CGA was performed using: Charlson Index, Short Portable Mental Status Questionnaire and Katz's ADL. Follow-up data at 30 and 180 days included: mortality, ED revisit, hospital admission, and functional decline. Frailty was defined according to a brief DAI. Logistic regression evaluated the consistency of the frailty definition; ROC curves evaluated ISAR ability in identifying frailty.
Frailty was present in 117 (58.5%) subjects and predicted ED revisit and frequent ED return, hospitalization and 6-month mortality. ISAR had an AUC of 0.92 (95%CI 0.88-0.96, p<0.0001) in identifying frail elders in the ED and using a cut-off of 2 showed 94% sensitivity and 63% specificity.
ISAR is a useful screening tool for frailty and identifies elderly patients at risk of adverse outcomes after an ED visit. ISAR can also be used to select high-risk patients more likely to benefit from a geriatric approach or intervention, independently of admission or discharge.
在急诊科就诊后，虚弱的老年患者发生不良结局的风险增加。全面老年评估（CGA）已被提出用于急诊科筛查虚弱，但难以实施。我们测试了使用 Identification of Seniors At Risk（ISAR）筛查工具的基于 CGA 的方法是否与虚弱的简短缺陷积累指数（DAI）相关。
前瞻性观察性研究。
意大利的两家城市急诊科。
一组 200 名老年（≥65 岁）急诊科患者。
标识符、分诊、临床和社会数据以及 ISAR 的管理。使用 Charlson 指数、简短便携精神状态问卷和 Katz 的 ADL 进行 CGA。30 天和 180 天的随访数据包括：死亡率、急诊科复诊、住院和功能下降。根据简短的 DAI 定义了虚弱。逻辑回归评估了虚弱定义的一致性；ROC 曲线评估了 ISAR 在识别虚弱方面的能力。
117 名（58.5%）患者存在虚弱，且预测了急诊科复诊和频繁急诊科复诊、住院和 6 个月死亡率。ISAR 在 ED 中识别虚弱老年人的 AUC 为 0.92（95%CI 0.88-0.96，p<0.0001），使用 2 作为截断值显示出 94%的敏感性和 63%的特异性。
ISAR 是一种用于筛查虚弱的有用工具，可识别急诊科就诊后发生不良结局风险较高的老年患者。ISAR 还可用于选择更有可能从老年方法或干预中受益的高危患者，而与入院或出院无关。
