title: A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance.
abstract: OBJECTIVE
  Geriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems.
  
  
  METHODS
  The EGS tool consisted of short validated instruments used to screen 4 domains (cognition, falls, mobility, and activities of daily living). Emergency geriatric screening was introduced for ED patients 75 years or older throughout a 4-month period. We analyzed the prevalence of abnormal EGS and whether EGS increased the number of EGS-related diagnoses in the ED during the screening, as compared with a preceding control period.
  
  
  RESULTS
  Emergency geriatric screening was performed on 338 (42.5%) of 795 patients presenting during screening. Emergency geriatric screening was unfeasible in 175 patients (22.0%) because of life-threatening conditions and was not performed in 282 (35.5%) for logistical reasons. Emergency geriatric screening took less than 5 minutes to perform in most (85.8%) cases. Among screened patients, 285 (84.3%) had at least 1 abnormal EGS finding. In 270 of these patients, at least 1 abnormal EGS finding did not result in a diagnosis in the ED and was reported for further workup to subsequent care. During screening, 142 patients (42.0%) had at least 1 diagnosis listed within the 4 EGS domains, significantly more than the 29.3% in the control period (odds ratio 1.75; 95% confidence interval, 1.34-2.29; P<.001). Emergency geriatric screening predicted nursing home admission after the in-hospital stay (odds ratio for ≥3 vs <3 abnormal domains 12.13; 95% confidence interval, 2.79-52.72; P=.001).
  
  
  CONCLUSIONS
  The novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. Electronic address: Andreas.Schoenenberger@insel.ch.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bieri
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Onur
authors.initials: O
authors.lastname: Özgüler
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Moser
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Monika
authors.initials: M
authors.lastname: Haberkern
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Aristomenis
authors.initials: A
authors.lastname: Exadaktylos
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D011446:Prospective Studies; D015203:Reproducibility of Results