A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance

Schoenenberger, Andreas; Bieri, Christoph; Özgüler, Sait Onur; Moser, André; Haberkern Schläpfer, Monika; Zimmermann, Heinz; Stuck, Andreas; Exadaktylos, Aristomenis (2014). A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance. American journal of emergency medicine, 32(6), pp. 623-628. W.B. Saunders 10.1016/j.ajem.2014.03.024

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic > Geriatric Clinic Inselspital
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Geriatrie/Altersmedizin

UniBE Contributor:

Schoenenberger, Andreas; Özgüler, Sait Onur; Moser, André; Haberkern Schläpfer, Monika; Zimmermann, Heinz; Stuck, Andreas and Exadaktylos, Aristomenis

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services
300 Social sciences, sociology & anthropology > 330 Economics

ISSN:

0735-6757

Publisher:

W.B. Saunders

Language:

English

Submitter:

Romana Saredi

Date Deposited:

01 Apr 2015 15:58

Last Modified:

09 Nov 2015 09:50

Publisher DOI:

10.1016/j.ajem.2014.03.024

PubMed ID:

24746885

BORIS DOI:

10.7892/boris.67025

URI:

https://boris.unibe.ch/id/eprint/67025

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