The revised identification of seniors at risk screening tool predicts readmission in older hospitalized patients: A cohort study
Date
2022
Authors
McCusker, Jane
Warburton, Rebecca N.
Lambert, Sylvie D.
Belzile, Eric
de Raad, Manon
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Geriatrics
Abstract
Background: The Identification of Seniors at Risk (ISAR) screening tool is a widely-used risk stratification tool for
older adults in the emergency department (ED). Few studies have investigated the use of ISAR to predict outcomes of
hospitalized patients. To improve usability a revised version of ISAR (ISAR-R), was developed in a quality improvement
project. The ISAR-R is also widely used, although never formally validated. To address these two gaps in knowledge,
we aimed to assess the ability of the ISAR-R to predict readmission in a cohort of older adults who were hospitalized
(admitted from the ED) and discharged home.
Methods: This was a secondary analysis of data collected in a pre-post evaluation of a patient discharge education
tool. Participants were patients aged 65 and older, admitted to hospital via the ED of two general community
hospitals, and discharged home from the medical and geriatric units of these hospitals. Patients (or family caregivers
for patients with mental or physical impairment) were recruited during their admission. The ISAR-R was administered
as part of a short in-hospital interview. Providers were blinded to ISAR-R scores. Among patients discharged home,
90-day readmissions were extracted from hospital administrative data. The primary metrics of interest were sensitivity
and negative predictive value. The Area Under the Curve (AUC) was also computed as an overall measure of
performance.
Results: Of 711 attempted recruitments, 496 accepted, and ISAR-R was completed for 485. Of these 386 patients
were discharged home with a complete ISAR-R, the 90-day readmission rate was 24.9%; the AUC was 0.63 (95% CI
0.57,0.69). Sensitivity and negative predictive value at the recommended cut-point of 2 + were 81% and 87%, respectively.
Specificity was low (40%).
Conclusions: The ISAR-R tool is a potentially useful risk stratification tool to predict patients at increased risk of
readmission. Its high values of sensitivity and negative predictive value at a cut-point of 2 + make it suitable for rapid
screening of patients to identify those suitable for assessment by a clinical geriatric team, who can identify those with
geriatric problems requiring further treatment, education, and follow-up to reduce the risk of readmission.
Description
Keywords
Older adults, Hospital, Readmission, Risk stratification, Discharge planning
Citation
McCusker, J., Warburton, R. N., Lambert, S. D., Belzile, E., & de Raad, M. (2022). “The Revised Identification of Seniors At Risk screening tool predicts readmission in older hospitalized patients: A cohort study.” BMC Geriatrics, 22(888). https://doi.org/10.1186/s12877-022-03458-w