Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Int Emerg Nurs. 2023 May;68:101274. doi: 10.1016/j.ienj.2023.101274. Epub 2023 Mar 15.
To explore the validity of the Chinese version of the Identification of Seniors at Risk (ISAR) screening tool in emergency rooms (ERs) to identify elderly patients prone to adverse outcomes after being discharged from the ER.
A prospective single-center observational study design was adopted and included 497 elderly (aged ≥65 years) ER patients of a medical center in northern Taiwan. Before discharge from the ER, baseline sociodemographic and clinic data were collected by researchers and the ISAR was administered. Adverse health outcomes (ER revisits, readmissions, and mortality) at 30 days were evaluated by medical records and follow-up telephone interviews.
ISAR screening showed that 334 (67.2%) elderly patients in the ER were at high risk after discharge. Higher-risk patients were older, had had a fall within the previous 6 months, and had complex comorbidities. The ISAR had good sensitivity (0.77∼1.00) for screening adverse health outcomes in these elderly patients. The discrimination of the ISAR for adverse health outcomes was 0.60∼0.77, and it increased to 0.64∼0.80 when the age-adjusted Charlson comorbidity index (ACCI) was simultaneously considered.
The ISAR exhibited good sensitivity for screening adverse outcomes for elderly patients at risk. The ACCI is recommended to simultaneously be considered to improve the prognostic performance of the ISAR.
探讨识别老年人风险（ISAR）筛查工具中文版在急诊室（ER）中识别易发生 ER 出院后不良结局的老年患者的有效性。
采用前瞻性单中心观察性研究设计，纳入台湾北部一家医学中心的 497 名老年（≥65 岁）ER 患者。在从 ER 出院前，由研究人员收集基线社会人口统计学和临床数据，并进行 ISAR 评估。通过病历和随访电话访谈评估 30 天内的不良健康结局（ER 复诊、再入院和死亡）。
ISAR 筛查显示，ER 中有 334 名（67.2%）老年患者出院后风险较高。高风险患者年龄较大，在过去 6 个月内有过跌倒，并且合并有复杂的共病。ISAR 对这些老年患者不良健康结局的筛查具有良好的敏感性（0.771.00）。ISAR 对不良健康结局的区分度为 0.600.77，当同时考虑年龄调整 Charlson 合并症指数（ACCI）时，区分度增加至 0.64~0.80。
ISAR 对高危老年患者不良结局的筛查具有良好的敏感性。建议同时考虑 ACCI 以提高 ISAR 的预后性能。
