Performance of Identification of the Seniors At Risk (ISAR) tool and Triage Risk-Screening Tool (TRST) for frail elderly emergency room patients.

ABSTRACT

OBJECTIVE: This objective of this study was to measure the performance of the identification of the seniors at risk (ISAR) tool and triage risk-screening tool (TRST) for frailty screening in elderly emergency room (ER) patients. METHODS: A cross-sectional study involving subjects aged 60 years or older was conducted at Cipto Mangunkusumo General Hospital ER from September-November 2018. Frailty was defined by the Forty Item Frailty Index (FI-40). The ISAR and TRST performance were measured as sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (LR+ and LR-) and the area under the curve (AUC). RESULTS: A total of 471 subjects were examined, of which 300 (63.7%) were in the 60-69-year-old subgroup with a median age of 66 years and an age range of 60-95 years. There were 262 (55.6%) male subjects and 445 (94.5%) were non-trauma patients. According to the FI-40, 386 (82%) were classified as frail. ISAR and TRST showed a sensitivity of 87.6% vs 93.8%, a specificity of 58.8% vs 43.5%, a PPV of 90.6% vs 88.3%, an NPV of 51% vs 60.7%, a LR+ of 2.13 vs 1.66 and a LR- of 0.21 vs 0.14, respectively. Both had similar AUCs of 0.8 (95% CI ISAR [0.76, 0.86] and TRST [0.75, 0.86], p = 0.91). CONCLUSIONS: ISAR and TRST showed outstanding frailty-screening results among elderly ER patients.