Emergency department case-finding for high-risk older adults: the Brief Risk Identification for Geriatric Health Tool (BRIGHT).
OBJECTIVE
The objective was to test the ability of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify older emergency department (ED) patients with functional and physical impairment.


METHODS
This was a cross-sectional study in which 139 persons > or = 75 years, who presented to an urban New Zealand ED over a 12-week period, completed the 11-item BRIGHT case-finding tool. Then, within 10 days of their index ED visit, 114 persons completed a comprehensive geriatric assessment. A "yes" response to at least 3 of the 11 BRIGHT items was considered "positive." Primary outcome measures were instrumental activities of daily living (IADL), cognitive performance scale (CPS), and activities of daily living (ADL).


RESULTS
The BRIGHT-identified IADL deficit (64% prevalence) with a sensitivity of 0.76, specificity of 0.79, and receiver operating characteristic (ROC) of 0.83 (95% confidence interval [CI] = 0.74 to 0.91, p < 0.01); cognitive deficit (35% prevalence) sensitivity of 0.78, specificity of 0.54, and ROC of 0.66 (95% CI = 0.55 to 0.76, p = 0.006); and ADL deficit (29% prevalence) sensitivity of 0.83, specificity of 0.53, and ROC of 0.64 (95% CI = 0.53 to 0.75, p = 0.020). Positive likelihood ratios (LR+) for the three outcomes of interest were 3.6, 1.7, and 1.8, respectively. Negative likelihood ratios (LR-) were 0.3, 0.4, and 0.3.


CONCLUSIONS
The 11-item BRIGHT successfully identifies older adults in the ED with decreased function and may be useful in differentiating elder patients in need of comprehensive assessment.
Boyd
Michal
M
Division of Home and Older Adult Services, Waitemata District Health Board, North Shore City. Michal.Boyd@waitematadhb.govt.nz
Koziol-McLain
Jane
J
Yates
Kim
K
Kerse
Ngaire
N
McLean
Chris
C
Pilcher
Carole
C
Robb
Gillian
G
D000203:Activities of Daily Living; D000368:Aged; D019540:Area Under Curve; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D012680:Sensitivity and Specificity