A Brief Risk Stratification Tool to Predict Functional Decline in Older Adults Discharged from Emergency Departments

摘要: OBJECTIVES: To determine the effectiveness of six-item Triage Risk Screening Tool (TRST) to assess baseline functional status and predict subsequent decline in older community-dwelling adults discharged home from emergency department (ED). DESIGN: Secondary data analysis a randomized, controlled trial. SETTING: EDs two urban academic hospitals. PARTICIPANTS: Six hundred fifty aged 65 presenting ED home. Patients were categorized priori as “high risk” if they had cognitive impairment or more risk factors on TRST. MEASUREMENTS: Functional status: summed activity daily living (ADL) instrumental (IADL) scores at baseline, 30 days, 120 days. Self-perceived physical health: standardized health component Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). decline: loss one ADLs IADLs Decline self-perceived follow-up SF-36 four points lower than baseline. RESULTS: TRST correlated with ADL impairments, IADL all endpoints (P<.001). A score was moderately predictive (30-day area under receiver operating characteristic curve (AUC)=0.64; 95% confidence interval (CI)=0.56–0.72; 120-day AUC=0.66; CI=0.58–0.74) but not perceived health. CONCLUSION: The identifies patients is after an initial visit. provides valid proxy measure for assessing may be useful identifying high-risk who would benefit referrals further evaluation surveillance upon discharge.