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Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments

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Abstract

Background and aims: Elderly patients presenting to Emergency Departments (ED) have complex health problems and often undergo adverse outcomes after an ED visit. In Canadian ED, the Identification of Seniors At Risk (ISAR) is useful in screening for these aspects. This study evaluated the predictive validity of ISAR for elderly patients presenting to Italian ED. Methods: Prospective observational study of a cohort of 200 elderly patients presenting to two urban ED in Ancona (Italy). Identifiers and triage, clinical and social data were collected, and the ISAR was administered. The following single outcomes were considered: early (30-day) and late (6-month) ED revisit, frequent ED return, hospital admission, and functional decline. Composite outcomes were: [1] death, long-term care (LTC) placement, functional decline; [2] the same as [1] plus any ED revisit or hospitalization. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: ISAR was positive for 141 (70.5%) subjects, who had high comorbidity, disability and cognitive impairment. ISAR-positive atients hadan OR of 4.77(95% CI, 2.19–10.42) to undergo composite outcome [1] and of 3.46 (95% CI, 1.68–7.15) to experience composite outcome [2]. ISAR also predicted ED revisit and frequent use, hospitalization and functional decline at 6 months. ISAR was also an independent predictor of 6-month mortality (Hazard Ratio 6.9, 95%, CI 1.65–29, p=0.008). Conclusions: ISAR can be used as a screening test to identify Italian elderly ED patients who have an increased 6-month risk of death, LTC placement, functional decline, ED revisit, or hospitalization.

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Authors and Affiliations

  1. Department of Internal Medicine, University Politecnica delle Marche, Ancona, Italy

    Fabio Salvi MD, Valeria Morichi, Annalisa Grilli & Paolo Dessì-Fulgheri

  2. Statistic and Biometry Center, Department of Gerontological Research, National Institute for Research and Care on Aging (INRCA), Ancona, Italy

    Liana Spazzafumo

  3. U.O. Accettazione Medica, INRCA, Ancona, Italy

    Raffaella Giorgi & Giuseppe De Tommaso

  4. Department of Emergency Medicine, Azienda “Ospedali Riuniti”, Ancona, Italy

    Stefano Polonara

Authors
  1. Fabio Salvi MD
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  2. Valeria Morichi
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  3. Annalisa Grilli
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  4. Liana Spazzafumo
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  5. Raffaella Giorgi
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  7. Giuseppe De Tommaso
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  8. Paolo Dessì-Fulgheri
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Correspondence to Fabio Salvi MD.

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Salvi, F., Morichi, V., Grilli, A. et al. Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments. Aging Clin Exp Res 21, 69–75 (2009). https://doi.org/10.1007/BF03324901

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