title: Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments.
abstract: OBJECTIVE
  To compare the abilities of four different screening tools to predict return visits of older persons after they have been discharged from the emergency department (ED).
  
  
  METHODS
  We assessed 83 short-term (discharged within 24 h) patients (aged 65 years and above) who visited the ED of the University Hospitals Leuven, Belgium, from 15 October 2005 to 24 December 2005. The Identification of Seniors at Risk (ISAR), the Triage Risk Screening Tool (TRST), the eight-item questionnaire of Runciman, and the seven-item questionnaire of Rowland were administered at admission to screen the patients for risk factors of future ED readmission. By telephone follow-up 14, 30, and 90 days after discharge from the ED, we asked the patients (or their families) whether readmission had occurred since their initial discharge from the ED.
  
  
  RESULTS
  Readmission rates were 10%, 15.8%, and 32.5% after 14, 30, and 90 days, respectively. When using three or more positive answers as the cutoff scores, the Rowland questionnaire proved to be the most accurate predictive tool with a sensitivity of 88%, specificity of 72%, and negative predictive value of 98% at 14 days after discharge. Thirty days after discharge, the sensitivity was 73%, specificity was 75%, and negative predictive value was 92%.
  
  
  CONCLUSIONS
  Repeat visits in older persons admitted to an ED seemed to be most accurately predicted by using the Rowland questionnaire, with an acceptable number of false positives. This instrument can be easily integrated into the standard nursing assessment.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer, Belgium. Philip.Moons@med.kuleuven.be
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.forename: Koen
authors.initials: K
authors.lastname: De Ridder
authors.forename: Katrien
authors.initials: K
authors.lastname: Geyskens
authors.forename: Marc
authors.initials: M
authors.lastname: Sabbe
authors.forename: Tom
authors.initials: T
authors.lastname: Braes
authors.forename: Johan
authors.initials: J
authors.lastname: Flamaing
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D019538:Health Care Surveys; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage