Performance of Identification of Seniors at Risk tool to predict unplanned revisits to the emergency department in 6 months was low in predictive accuracy: A single-center study

Abstract

Background: Elderly people are at risk for mortality, functional decline, reattendance, and hospitalization after an emergency department visit. Objective: The aim of this study was to evaluate the performance of Identification of Seniors at Risk tool to predict unplanned readmissions after an emergency department visit. Methods: Records of patients aged ⩾65 years, who completed Identification of Seniors at Risk tool as they were being discharged from the emergency department, were analyzed. Patients were called back at 30th, 60th, 90th, 120th, and 180th days after emergency department discharge to assess their readmission to emergency department. Descriptive statistics and receiver operating characteristic curve analysis were performed. Results: This was a single-center study conducted with elderly patients with chronic diseases in a tertiary-level hospital within a period of 10 months with the follow-up calls. During the first month, 1792 patients were admitted to emergency department and 333 patients were aged ⩾65 years. Patients who completed Identification of Seniors at Risk tool as they were discharged from the emergency department were 170 out of 333. In 6 months, 71 patients out of 170, 36 men (50.7%) and 35 women (49.3%), were able to complete the follow-up. For predictive unplanned admissions, specificity and sensitivity at 1, 3, and 6 months were 40%, 40%, 38% and 69%, 78%, 67%, respectively, which demonstrates that sensitivity of Identification of Seniors at Risk tool was higher than its specificity. Although representing poor performance, Identification of Seniors at Risk tool was better at 3 months in predicting health risks for the elderly who have visited emergency department. Conclusion: Predictive ability of Identification of Seniors at Risk tool at the usual cutoff ⩾2 points to identify elderly at risk for revisiting emergency department for adverse health outcomes is limited. Multicentered studies, with standardized procedures and well-defined patient profile, are needed to improve the predictive ability of Identification of Seniors at Risk tool to screen elderly who require additional support after hospitalization.