Risk stratification of older patients in the emergency department: Comparison between the identification of seniors at risk and triage risk screening tool

Background and Objectives: The increasing number of elderly patients accessing emergency departments (ED) requires use of validated, rapid assessment instruments. The aim of this study was to compare the Identification of Seniors at Risk (ISAR) and Triage Risk Screening Tool (TRST), based on direct patient evaluation. Research Design and Subjects: This study was a prospective observational study with 6 months follow-up. Subjects were 2,057 residents in the Marche Region, aged 65 or more years, accessing the first-level ED of a geriatric hospital in Ancona, Italy, over a 6-month period. Methods: ISAR and TRST were administered at triage by nurse. Outcomes were in need of hospital admission and mortality at the index ED access, early (within 30 days) and late ED revisit, hospitalization, and death in 6 months. Results: ISAR (cutoff of≥2) was positive in 68% of patients, whereas 64% were TRST-positive. The two scores were significantly correlated and had similar areas under the receiver operating characteristic (ROC) curves in predicting hospital admission (ISAR, 0.68; TRST, 0.66) and mortality (ISAR, 0.74; TRST, 0.68), as well as early ED revisit (ISAR, 0.63; TRST, 0.61). In the 6-month follow-up of patients discharged alive, the tools predicted comparably ED return visit (ISAR, 0.60; TRST, 0.59), hospital admission (ISAR, 0.63; TRST, 0.60), and mortality (ISAR, 0.74; TRST, 0.73). A similar performance was observed in the subgroup of participants discharged directly from the ED. Conclusions: Risk stratification of elderly ED patients with ISAR or TRST is substantially comparable for selecting elderly ED patients who could benefit from geriatric interventions. ISAR had slightly higher sensitivity and lower specificity than TRST.