Identification of Seniors at Risk (ISAR) in the emergency room

Older adults (OA) often experience adverse events after an emergency department (ED) visit. Identified OA at risk for adverse outcomes at initial index visit of emergency department care is recommended | International Emergency Nursing

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Image source: Andrea Squatrito – Flickr // CC BY-NC-ND 2.0

Introduction: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED.

Methods: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated.

Results: ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff ≥ 2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR=2.43, 95% CI 1.35-4.35, p<0.01) and late returns to the ED (AO=1.70, 95% CI 1.04-2.79, p<0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180 days.

Discussion: The ISAR predicted returns to EDs at 30 and 180 days for OAs at risk, but was unable to predict early or late hospital readmission.

Full reference: de Almeida Tavares, J.P. et al. (2017) Identification of Seniors at Risk (ISAR) in the emergency room: a prospective study. International Emergency Nursing. Published online: 2 June 2017