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Centre for Policy on Ageing | |
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Adverse outcomes in older adults attending emergency departments
— a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool | | Author(s) | Rose Galvin, Yannon Gilleit, Emma Wallace |
| Journal title | Age and Ageing, vol 46, no 2, March 2017 |
| Publisher | Oxford University Press, March 2017 |
| Pages | pp 179-186 |
| Source | https://academic.oup.com/ageing |
| Keywords | Admission [hospitals] ; Accident & emergency depts ; At risk ; Screening ; Instruments ; Evaluation. |
| Annotation | Older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. The objective of this study was to perform a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool, to determine its predictive value in identifying adults aged 65 years or above at risk of functional decline, unplanned emergency department (ED) readmission, emergency hospitalisation or death within 180 days after index ED visit/hospitalisation. A systematic literature search of various relevant databases was conducted in order to identify validation and impact analysis studies of the ISAR tool. A pre-specified ISAR score of 2 or more (maximum score 6 points) was used to identify patients at high risk of adverse outcomes. A bivariate random effects model generated pooled estimates of sensitivity and specificity. Statistical heterogeneity was explored and methodological quality was assessed using validated criteria. 32 validation studies were included. At 2 or less, the pooled sensitivity of the ISAR for predicting ED return, emergency hospitalisation and mortality at 6 months was found to be 0.80 respectively, with a pooled specificity of 0.31 and 0.35. Similar values were demonstrated at 30 and 90 days. Three heterogeneous impact analysis studies examined the clinical implementation of the ISAR and reported mixed findings across patient and process outcomes. The authors conclude that the ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged. (JL). |
| Accession Number | CPA-170324212 A |
| Classmark | LD:QKH: LD6: CA3: 3V: YW4: 4C |
Data © Centre for Policy on Ageing |
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| ...from the Ageinfo database published by Centre for Policy on Ageing. |
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