title: Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool.
abstract: BACKGROUND
  The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS.
  
  
  METHODS
  Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry.
  
  
  RESULTS
  Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6.
  
  
  CONCLUSIONS
  Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
authors.forename: Cyrille P
authors.initials: CP
authors.lastname: Launay
authors.affiliation: Department of Geriatrics, EA 1156-12, Nantes University Hospital, Nantes, France.
authors.forename: Laure
authors.initials: L
authors.lastname: de Decker
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
authors.forename: Anastasiia
authors.initials: A
authors.lastname: Kabeshova
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Robarts Research Institute, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada.
authors.forename: Cédric
authors.initials: C
authors.lastname: Annweiler
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Biomathics, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Beauchet
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors