Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool

Galvin, Rose, Gilleit, Yannick, Wallace, Emma, Cousins, Gráinne, Bolmer, Manon, Rainer, Timothy ORCID: https://orcid.org/0000-0003-3355-3237, Smith, Susan M. and Fahey, Tom 2017. Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool. Age and Ageing 46 (2) , pp. 179-186. 10.1093/ageing/afw233

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Abstract

Background older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. Objective 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 ≥65 years at risk of functional decline, unplanned emergency department (ED) readmission, emergency hospitalisation or death within 180 days after index ED visit/hospitalisation. Methods a systematic literature search was conducted in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library to identify validation and impact analysis studies of the ISAR tool. A pre-specified ISAR score of ≥2 (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. Results thirty-two validation studies (n = 12,939) are included. At ≥2, the pooled sensitivity of the ISAR for predicting ED return, emergency hospitalisation and mortality at 6 months is 0.80 (95% confidence interval (CI) 0.70–0.87), 0.82 (95% CI 0.74–0.88) and 0.87 (95% CI 0.75–0.94), respectively, with a pooled specificity of 0.31 (95% CI 0.24–0.38), 0.32 (95% CI 0.24–0.41) and 0.35 (95% CI 0.26–0.44). Similar values are 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. Conclusion the ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Oxford University Press (OUP): Policy A - Oxford Open Option D
ISSN:	0002-0729
Date of First Compliant Deposit:	17 December 2018
Date of Acceptance:	1 September 2016
Last Modified:	25 Nov 2024 05:45
URI:	https://orca.cardiff.ac.uk/id/eprint/105798

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