Introduction
Characteristics of the ED setting and risk stratification with identification of seniors at risk (ISAR)
Methods
Study design and participants
Measures and outcomes
Statistical methods
Results
Characteristic | Total (N = 260) | SPMSQ normal (<3) (N = 200) | SPMSQ impaired (≥3) (N = 60) | p-value |
---|---|---|---|---|
Age (years) | 79.31 (5.97) | 78.40 (5.65) | 82.31 (6.07) | <0.001 |
Sex | ||||
Male | 163 (63%) | 130 (65%) | 33 (55%) | 0.16 |
Female | 97 (37%) | 70 (35%) | 27 (45%) | |
BMI | 26.84 (4.74) | 27.06 (4.49) | 26.08 (5.47) | 0.21 |
CACI | 5 (4–7) | 5 (4–7) | 6 (5–7.5) | 0.12 |
Education | ||||
None | 37 (14%) | 21 (11%) | 16 (27%) | <0.001 |
Apprenticeship | 156 (60%) | 118 (59%) | 38 (63%) | |
University degree | 48 (19%) | 45 (23%) | 3 (5%) | |
PhD or similar | 19 (7%) | 16 (8%) | 3 (5%) |
Time after initial contact | n | Patients with adverse outcome (n, %) | Univariate | Multivariate/adjusteda | ||
---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | |||
1 month | 250 | 64 (26%) | 1.13 | 0.94–1.36 | 1.09 | 0.90–1.32 |
3 months | 249 | 117 (47%) | 1.34** | 1.12–1.60 | 1.31** | 1.09–1.57 |
6 months | 245 | 145 (59%) | 1.47*** | 1.20–1.80 | 1.45*** | 1.18–1.79 |
12 months | 245 | 165 (67%) | 1.54*** | 1.22–1.93 | 1.53*** | 1.20–1.94 |
Discussion
- SPMSQ seems to be a useful predictor of adverse outcomes in older German ED patients; however, not for brief (e.g. 1 month) but only for longer observation periods (e.g. 1 year). This relationship remained stable when controlling for a range of confounders.
- The suggested ≥3 errors cut-off appeared to be the most useful when predicting adverse outcomes at different points in time.
- While the specificity is high sensitivity is low. Overall, these characteristics can be regarded as insufficient for use as a screening tool.
- Although a tendency was observed for a decreased 1‑year survival probability of patients with a SPMSQ score of ≥3 errors when compared to those with <3 errors, results were not statistically significant.
Limitations
Conclusion
Practical conclusion
-
The SPMSQ proved to be feasible for use in the ED setting in this sample and was a predictor of adverse outcomes.
-
The SPMSQ does not have the capacity to replace risk stratification with common geriatric screening tools like the ISAR.
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Further research into risk stratification with different cognitive screening tools and combinations with other risk stratification devices may produce results with higher sensitivity.