title: National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma.
abstract: BACKGROUND
  There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury.
  
  
  METHODS
  After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method.
  
  
  RESULTS
  Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks.
  
  
  CONCLUSIONS
  A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.
authors.affiliation: *Department of Epidemiology and Community Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Kasim
authors.initials: K
authors.lastname: Abdulaziz
authors.affiliation: *Department of Epidemiology and Community Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Jamie
authors.initials: J
authors.lastname: Brehaut
authors.affiliation: *Department of Epidemiology and Community Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: ‡Department of Family and Emergency Medicine,Université Laval,Laval,QC.
authors.forename: Marcel
authors.initials: M
authors.lastname: Émond
authors.affiliation: §Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec,Laval,QC.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Sirois
authors.affiliation: ǁClinical Epidemiology Unit,Department of Emergency Medicine,University of Toronto,Sunnybrook Health Sciences Center,Toronto,ON.
authors.forename: Jacques S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: **Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Laura
authors.initials: L
authors.lastname: Wilding
authors.affiliation: *Department of Epidemiology and Community Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology*
keywords: Activities of Daily Living (ADL); Elderly; Emergency Department; Functional Decline; Geriatric Assessment; Minor Injuries; Older Americans Resources and Services (OARS)