• J Am Geriatr Soc · Jul 2020

    Observational Study

    Old and New Geriatric Screening Tools in a Belgian Emergency Department: A Diagnostic Accuracy Study.

    • Pieter Heeren, Els Devriendt, Wellens Nathalie I H NIH Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium. , Mieke Deschodt, Johan Flamaing, Marc Sabbe, and Koen Milisen.
    • Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
    • J Am Geriatr Soc. 2020 Jul 1; 68 (7): 1454-1461.

    ObjectivesTo compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department Screener for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged ≥70 years) community-dwelling adults admitted to the ED.DesignSingle-center, prospective, observation study.SettingED with embedded observation unit in University Hospitals Leuven (Belgium).ParticipantsA total of 794 patients (median age = 80 years; 55% female) were included.MeasurementsStudy nurses collected data using semistructured interviews and patient record review during ED admission. Outcome data were collected with patient record review.ResultsHospitalization (following index ED stay) and unplanned ED readmission at 30 and 90 days occurred in 67% (527/787) of patients and in 12.2% (93/761) and 22.1% (168/761) of patients, respectively. For all outcomes at cutoff 2, the three screening tools had moderate to high sensitivity (range = 0.71-0.90) combined with (very) low specificity (range = 0.14-0.32) and low accuracy (range = 0.21-0.67). At all cutoffs, likelihood ratios and interval likelihood ratios had no or small impact (range = 0.46-3.95; zero was not included) on the posttest probability of the outcomes. For all outcomes, area under the receiver operating characteristics curve varied in the range of 0.49 to 0.62.ConclusionDiagnostic characteristics of all screening tools were comparable. None of the tools accurately predicted the outcomes as a stand-alone index. Future studies should explore the clinical effectiveness and implementation aspects of ED-specific minimum geriatric assessment and intervention strategies. J Am Geriatr Soc 68:1454-1461, 2020.© 2020 The American Geriatrics Society.

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