title: Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments.
abstract: OBJECTIVE
  To compare the prognostic value of four screening instruments used to detect the risk for poor outcomes [in terms of likelihood of recurrent emergency department (ED) visits, hospitalizations, or mortality] for older patients discharged home from an ED in the Netherlands.
  
  
  METHODS
  This is a prospective cohort study, which included all consecutive patients of at least 65 years discharged from the ED of a university teaching hospital in the Netherlands, between 1 December 2005, and 1 November 2006. Four screening instruments were tested: the identification of seniors at risk, the triage risk screening tool, and the Runciman and Rowland questionnaires. The cutoff of the Runciman questionnaire was adapted and the age cutoff was adapted for the other instruments. Recurrent ED visits, subsequent hospitalization, and mortality within 30 and 120 days after the index visit were collected from administrative data.
  
  
  RESULTS
  In total, 381 patients were included, with a mean age of 79.1 years. Within 120 days, 14.7% of the patients returned to ED, 17.2% were hospitalized, and 2.9% died. The area under the curve was low for all instruments (between 0.43 and 0.60), indicating poor discriminatory power.
  
  
  CONCLUSIONS
  Older ED patients discharged home are at higher risk of poor outcomes. None of the instruments were able to clearly discriminate between patients with and without poor outcomes. Differences in organization of the health care systems might influence the prognostic abilities of screening instruments.
authors.affiliation: Department of Internal Medicine, Geriatric section, University of Amsterdam, The Netherlands. b.m.vanes@amc.uva.nl
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Buurman
authors.forename: Wendy
authors.initials: W
authors.lastname: van den Berg
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
authors.forename: Rob J
authors.initials: RJ
authors.lastname: de Haan
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires / Q000592:standards; D014218:Triage / Q000379:methods*