Assessing risk of functional decline in emergency departments MS Bakken, MD PhD student X EAMA Advanced Postgraduate Course in Geriatrics Martigny, Switzerland, January 2013. Outline. Definitions Background Why? How? Current knowledge & trends Conclusions Questions. Functional decline.
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Assessing risk of functional decline in emergency departmentsMS Bakken, MD PhD studentX EAMA Advanced Postgraduate Course in GeriatricsMartigny, Switzerland, January 2013
(other adverse outcomes)
-studies in hospitalized patients abundant
Improved care. Two – step procedure?
Biological parameters (IL-6, CRP, TNF)
Physical parameters (muscle strength, walking stick, gait speed, TUG, one leg balance)
Identification of Seniors at Risk
Triage Risk Screening Tool
Both: 6 items, completed by patient/ caregiver/clinician
Graf 2012, de Saint-Hubert 2010
Takes both specificity and sensitivity into account
Interpretation: 0.90-1.00 excellent
*ROC -Receiver Operating Characteristic
Excluded: Tools developed and validated for patients discharged ≥ 48 hours after attendance at ED: BRASS, Inouye, SHERPA; tool to assess complex care needs in hospital: COMPRI; tools for hospitalized patients: HARP, ISAR-HP.
Umbrella review of tools to assess risk of poor outcome in older people attending acute medical units. Edmans 2012 Medical Crises in Older People. Discussion paper series
Poor-fair predictive value in more recent studies
Potentially suitable selecting high risk patients
Can be used to safelyselectpatients for discharge (?)
*Silver Code, not included in reviews. Edmans 2012.
Few studies focus on ED patients at risk of functional decline
Tools, settings & outcomes vary
No gold standard
Other (physical/biological) parameters?
Two-step procedure: screening + CGA?