• Am J Emerg Med · Jun 2014

    A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance.

    • Andreas W Schoenenberger, Christoph Bieri, Onur Özgüler, André Moser, Monika Haberkern, Heinz Zimmermann, Andreas E Stuck, and Aristomenis Exadaktylos.
    • Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. Electronic address: Andreas.Schoenenberger@insel.ch.
    • Am J Emerg Med. 2014 Jun 1;32(6):623-8.

    PurposesGeriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems.Basic ProceduresThe EGS tool consisted of short validated instruments used to screen 4 domains (cognition, falls, mobility, and activities of daily living). Emergency geriatric screening was introduced for ED patients 75 years or older throughout a 4-month period. We analyzed the prevalence of abnormal EGS and whether EGS increased the number of EGS-related diagnoses in the ED during the screening, as compared with a preceding control period.Main FindingsEmergency geriatric screening was performed on 338 (42.5%) of 795 patients presenting during screening. Emergency geriatric screening was unfeasible in 175 patients (22.0%) because of life-threatening conditions and was not performed in 282 (35.5%) for logistical reasons. Emergency geriatric screening took less than 5 minutes to perform in most (85.8%) cases. Among screened patients, 285 (84.3%) had at least 1 abnormal EGS finding. In 270 of these patients, at least 1 abnormal EGS finding did not result in a diagnosis in the ED and was reported for further workup to subsequent care. During screening, 142 patients (42.0%) had at least 1 diagnosis listed within the 4 EGS domains, significantly more than the 29.3% in the control period (odds ratio 1.75; 95% confidence interval, 1.34-2.29; P<.001). Emergency geriatric screening predicted nursing home admission after the in-hospital stay (odds ratio for ≥3 vs <3 abnormal domains 12.13; 95% confidence interval, 2.79-52.72; P=.001).Principal ConclusionsThe novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.Copyright © 2014 Elsevier Inc. All rights reserved.

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