A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance - 28/05/14
, Christoph Bieri a, Onur Özgüler, MD b, André Moser, PhD a, c, Monika Haberkern, MD b, Heinz Zimmermann, MD b, Andreas E. Stuck, MD a, Aristomenis Exadaktylos, MD, FCEM bAbstract |
Purposes |
Geriatric 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 procedures |
The 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 findings |
Emergency 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 conclusions |
The novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.
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| ☆ | Funding sources: This study was supported by the Geriatric Research Fund (Spital Netz Bern, University Hospital Bern, Bern, Switzerland). |
Vol 32 - N° 6
P. 623-628 - juin 2014 Retour au numéro
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