title: Prognostic stratification of elderly patients in the emergency department: a comparison between the "Identification of Seniors at Risk" and the "Silver Code".
abstract: BACKGROUND
  The increasing number of elderly patients accessing emergency departments (EDs) requires use of validated assessment tools. We compared the Identification of Seniors at Risk (ISAR), using direct patient evaluation, with the Silver Code (SC), based on administrative data.
  
  
  METHODS
  Subjects aged 75+ years accessing a geriatric ED over an 8-month period were enrolled. Outcomes were need for hospital admission and mortality at the index ED access, ED return visit, hospitalization, and death at 6 months.
  
  
  RESULTS
  Of 1,632 participants (mean age 84 ± 5.5 years), 75% were ISAR positive, and the sample was homogeneously distributed across the four SC risk categories (cutoffs of 0-3, 4-6, 7-10, and 11+). The two scores were mildly correlated (r = .350, p < .001) and had a similar area under the receiver-operating characteristic curve in predicting hospital admission (ISAR: 0.65, SC: 0.63) and mortality (ISAR: 0.72, SC: 0.70). ISAR-positive subjects were at greater risk of hospitalization and death (odds ratio 2.68 and 5.23, respectively, p < .001); the risk increased across SC classes (p < .001). In the 6-month follow-up of discharged patients, the tools predicted similarly ED return visit, hospital admission, and mortality. The SC predicted these outcomes even in participants not hospitalized at the index ED access.
  
  
  CONCLUSIONS
  Prognostic stratification of elderly ED patients with the SC is comparable with that obtained with direct patient evaluation. The SC, previously validated in hospitalized patients, predicts ED readmissions and future hospitalizations even in patients discharged directly from the ED.
authors.affiliation: Department of Critical Care Medicine, Unit of Gerontology and Geriatric Medicine, University of Florence, Florence, Italy. mauro.dibari@unifi.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.forename: Fabio
authors.initials: F
authors.lastname: Salvi
authors.forename: Anna T
authors.initials: AT
authors.lastname: Roberts
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Barbara
authors.initials: B
authors.lastname: Lorenzetti
authors.forename: Valeria
authors.initials: V
authors.lastname: Morichi
authors.forename: Lorena
authors.initials: L
authors.lastname: Rossi
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D014218:Triage / Q000379:methods