Recent admissions are a risk indicator for returning emergency room (ER) visits and readmissions: screening using Identification of Seniors at Risk (ISAR).

Background

Emergency rooms (ER) are frequently the gateway for older adults seeking acute medical care. The Identification of Seniors at Risk (ISAR) tool is a brief screening instrument intended to identify older people at risk for adverse health outcomes. However, its predictive value for short-term hospital returns remains unclear. We aimed to determine the predictive value of the ISAR questionnaire for ultra-short-term adverse outcomes, namely 3-day ER revisits and 3-day readmissions, in older adults in Taiwan.

Methods

This prospective study included patients aged ≥65 years who visited the ER of a community hospital in Taiwan in 2021 and 2022. ISAR screening was performed by trained nurses. The outcome variables were 3-day ER revisits and 3-day readmissions. The main predictor variables included total ISAR score (≧2vs.≦1) and individual ISAR items. Covariates included age, gender, triage level, arrival method, pain score, observation time and disease category.

Results

Of 9697 eligible patients, 3039 (31.3%) underwent ISAR screening. ISAR-screened patients had a higher rate of both 3-day ER revisits and readmission (6.2% vs. 4.7%, p < 0.001; 1.7% vs. 0.9%, p = 0.001). Of the individual ISAR questions, the item "recent hospitalization within 6 months" was significantly associated with both 3-day ER revisits and readmission (OR = 1.852 and OR = 2.290), respectively. The accuracy was 88.1% and 91.6%, respectively.

Conclusion

The single item "recent hospitalization within 6 months" can be an independent risk indicator. Emergency triage should prioritize this specific question for short-term risk stratification.