title: Does the get up and go test improve predictive accuracy of the Triage Risk Screening Tool or Rowland questionnaire in older patients admitted to the emergency department?
abstract: OBJECTIVE
  To assess the diagnostic characteristics of the get up and go test (GUGT) as a stand-alone test and in combination with the Flemish Triage Risk Screening Tool (fTRST) and Rowland questionnaire. One aim was to determine whether the diagnostic accuracy of these instruments could be improved for predicting unplanned emergency department (ED) readmission following ED discharge.
  
  
  METHODS
  We carried out a prospective cohort study at the ED of the University Hospitals Leuven, Belgium. All patients aged at least 75 years (n=380) completed fTRST, Rowland, and GUGT testing at the index ED admission. Diagnostic characteristics for unplanned ED readmission were determined for hospitalized and discharged patients 1 and 3 months after the index ED visit.
  
  
  RESULTS
  In both hospitalized and discharged patients, fTRST and Rowland (cut-off ≥2) had good to excellent sensitivity and negative predictive value (NPV) but low to moderate specificity and accuracy; GUGT had low sensitivity and good to excellent NPV and specificity. The combined fTRST/GUGT or Rowland/GUGT had moderate to excellent NPV (56.3-94.3%). The combined fTRST (cut-off ≥2)/GUGT had low sensitivity and moderate to excellent specificity. Sensitivity of the combined Rowland (cut-off ≥4)/GUGT was good at the 1-month follow-up and moderate at the 3-month follow-up for hospitalized patients; it was low for discharged patients. Specificity was low for hospitalized patients and good for discharged patients.
  
  
  CONCLUSIONS
  Neither the objective measure of mobility (GUGT) nor the combined fTRST/GUGT or Rowland/GUGT improved the results. Our analysis shows that the predictive accuracy of the stand-alone, self-reported screening instruments fTRST and Rowland (cut-off=2) is still good. This study also confirmed their previously known limitations.
authors.affiliation: Departments of Public Health and Primary Care, Academic Centre for Nursing and Midwifery.|Departments of Geriatric Medicine.
authors.forename: Els
authors.initials: E
authors.lastname: Devriendt
authors.affiliation: Departments of Public Health and Primary Care, Academic Centre for Nursing and Midwifery.|Departments of Geriatric Medicine.|Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.
authors.forename: Mieke
authors.initials: M
authors.lastname: Deschodt
authors.affiliation: Departments of Public Health and Primary Care, Academic Centre for Nursing and Midwifery.
authors.forename: Maarten
authors.initials: M
authors.lastname: Delaere
authors.affiliation: Clinical and Experimental Medicine.|Departments of Geriatric Medicine.
authors.forename: Johan
authors.initials: J
authors.lastname: Flamaing
authors.affiliation: Public Health and Primary Care, Emergency Medicine, KU Leuven - University of Leuven.|Emergency Medicine, KU Leuven - University of Leuven, University Hospitals Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Sabbe
authors.affiliation: Departments of Public Health and Primary Care, Academic Centre for Nursing and Midwifery.|Departments of Geriatric Medicine.
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000368:Aged; D001530:Belgium; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D013997:Time Factors; D014218:Triage