title: A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department.
abstract: OBJECTIVE
  To evaluate the predictive ability of a simple six-item triage risk screening tool (TRST) to identify elder emergency department (ED) patients at risk for ED revisits, hospitalization, or nursing home (NH) placement within 30 and 120 days following ED discharge.
  
  
  METHODS
  Prospective cohort study of 650 community-dwelling elders (age 65 years or older) presenting to two urban academic EDs. Subjects were prospectively evaluated with a simple six-item ED nursing TRST. Participants were interviewed 30 and 120 days post-ED index visit and the utilization of EDs, hospitals, or NHs was recorded. Main outcome measurement was the ability of the TRST to predict the composite endpoint of subsequent ED use, hospital admission, or NH admission at 30 and 120 days. Individual outcomes of ED use, hospitalization, and NH admissions were also examined.
  
  
  RESULTS
  Increasing cumulative TRST scores were associated with significant trends for ED use, hospital admission, and composite outcome at both 30 and 120 days (p < 0.0001 for all, except 30-day ED use, p = 0.002). A simple, unweighted five-item TRST ("lives alone" item removed after logistic regression modeling) with a cut-off score of 2 was the most parsimonious model for predicting composite outcome (AUC = 0.64) and hospitalization at 30 days (AUC = 0.72). Patients defined as high-risk by the TRST (score > or = 2) were significantly more likely to require subsequent ED use (RR = 1.7; 95% CI = 1.2 to 2.3), hospital admission (RR = 3.3; 95% CI = 2.2 to 5.1), or the composite outcome (RR = 1.9; 95% CI 1.7 to 2.9) at both 30 days and 120 days than the low-risk cohort.
  
  
  CONCLUSIONS
  Older ED patients with two or more risk factors on a simple triage screening tool were found to be at significantly increased risk for subsequent ED use, hospitalization, and nursing home admission.
authors.affiliation: Case Western Reserve University Department of Emergency Medicine at MetroHealth Medical Center, Cleveland, OH 44109, USA. smeldon@metrohealth.org
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Meldon
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Mion
authors.forename: Robert M
authors.initials: RM
authors.lastname: Palmer
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Drew
authors.forename: Jason T
authors.initials: JT
authors.lastname: Connor
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Lewicki
authors.forename: David M
authors.initials: DM
authors.lastname: Bass
authors.forename: Charles L
authors.initials: CL
authors.lastname: Emerman
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009735:Nursing Homes / Q000706:statistics & numerical data; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment; D014218:Triage / Q000379:methods*