title: Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial.
abstract: BACKGROUND
  To determine if risk stratification followed by rapid geriatric screening in an emergency department (ED) reduced functional decline, ED reattendance and hospitalisation.
  
  
  METHODS
  This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months.
  
  
  RESULTS
  There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p < 0.01). 82.9% of the intervention group had unmet needs; 62.1% accepted our interventions. Common positive findings were fall risk (65.0%), vision (61.4%), and footwear (58.2%). 28.2% were referred to a geriatric clinic and 11.8% were admitted. 425 (85.0%) controls and 234 (83.6%) in the intervention group completed their follow-up. After adjusting for TRST and baseline IADL, the intervention group had significant preservation in function (Basic ADL -0.99 vs -0.24, p < 0.01; IADL -2.57 vs +0.45, p < 0.01) at 12 months. The reduction in ED reattendance (OR0.75, CI 0.55-1.03, p = 0.07) and hospitalization (OR0.77, CI0.57-1.04, p = 0.09) were not significant, however the real difference would have been wider as 21.2% of the control group received geriatric screening at the request of the ED doctor. A major limitation was that a large proportion of patients who were randomized to the intervention group either refused (18.8%) or left the ED before being approached (32.0%). These two groups were not followed up, and hence were excluded in our analysis.
  
  
  CONCLUSIONS
  Risk stratification and focused geriatric screening in ED resulted in significant preservation of patients' function at 12 months.
  
  
  BACKGROUND
  National Healthcare Group (NHG) Domain Specific Review Board (DSRB) C/09/023. Registered 5th March 2009.
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. chik_loon_foo@ttsh.com.sg.
authors.forename: Chik Loon
authors.initials: CL
authors.lastname: Foo
authors.forename: Vivan Wing Yin
authors.initials: VW
authors.lastname: Siu
authors.forename: Hou
authors.initials: H
authors.lastname: Ang
authors.forename: Madeline Wei Ling
authors.initials: MW
authors.lastname: Phuah
authors.forename: Chee Kheong
authors.initials: CK
authors.lastname: Ooi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D012308:Risk Management / Q000379:methods* / Q000592:standards; D013997:Time Factors