scholarly journals LO054: The emergency department usage and utility of ISAR and CAM assessment tools in identifying hip fracture patients at risk for developing delirium

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S48-S49
Author(s):  
C. Thompson ◽  
A. Sandre ◽  
S.L. McLeod ◽  
B. Borgundvaag
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Hip Fracture ◽  
Functional Decline ◽  
Assessment Method ◽  
Assessment Tools ◽  
Screening Tools ◽  
Future Research ◽  
Early Management ◽  
Patients At Risk

Introduction: Delirium is an acute state of mental confusion that is a frequent complication in older adults with a hip fracture, and is often unrecognized by clinicians in the emergency department (ED). It is associated with prolonged hospitalization, functional decline, hospital readmission, and death. The Identification of Seniors At Risk (ISAR) and Confusion Assessment Method (CAM) are two standardized tools designed to facilitate prompt screening and detection of functional decline and delirium respectively amongst adults 65 and older. The objective of this study was to determine the ED usage and utility of ISAR and CAM assessment tools in identifying hip fracture patients at risk for developing delirium. Methods: This was a retrospective chart review of patients aged 65 and older, presenting to an academic ED (annual census 60,000) with a discharge diagnosis of hip fracture from January 1st 2014 to July 31st 2015. At this institution, both the ISAR and CAM are included in the standard ED nursing documentation and are intended to be completed for all patients over 65 years of age. Results: Of the 243 hip fracture cases included in this study, the ISAR and CAM scores were completed for 131 (53.9%) and 69 (28.4%) patients, respectively. There were 43 (17.7%) cases of recorded in-hospital acute delirium. Of the delirium cases, 20 (46.5%) had an ISAR assessment. Patients with an ISAR score of ≥3 were more likely to experience delirium compared to those with lower ISAR scores (28.3% vs 8.3%; Δ 20.0%, 95% CI: 6.6%, 34.9%). Of the 43 patients with delirium, 11 (25.6%) had a CAM score recorded. Patients with a positive CAM score (meeting 3 of 4 criteria in the diagnostic algorithm) were more likely to experience delirium compared to those with negative CAM scores (66.7% vs 11.1%; Δ 55.6%, 95% CI: 17.5%, 79.9%). Conclusion: Vigilant efforts are needed to ensure these screening tools are applied for all patients over the age of 65 presenting to the ED to improve the recognition and early management of delirium. Future research should focus on initiatives to improve delirium screening compliance by ED personnel.

scholarly journals P131: Emergency department falls risk management screening tool comparison

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S121-S122
Author(s):  
R. Tomlinson ◽  
T. Yokota ◽  
P. Jaggi ◽  
C. Kilburn ◽  
D. Bakken ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Risk Management ◽  
Fall Risk ◽  
Screening Tool ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Procedural Sedation ◽  
Patients At Risk

Introduction: Emergency Department (ED) fall risk screening has been newly implemented in Alberta based on Accreditation Canada requirements. Two existing inpatient tools failed to include certain ED risk conditions. One tool graded unconsciousness as no risk for falling, and neither considered intoxication or sedation. This led to the development of a new fall risk management screening tool, the FRM (Tool1). This study compared Tool1 with inpatient utilized Schmid Fall Risk Assessment Tool (Tool2) and the validated Hendrich II Fall Risk Model (Tool3). Methods: Patients (≥17 years old) in a tertiary care adult ED with any of the following; history of falling in the last 12 months, elderly/frail, incontinence, impaired gait, mobility assist device, confusion/disorientation, procedural sedation, intoxication/sedated, or unconscious were included. Forms were randomized to score patients using different paired screening tools: Tool1 paired with either Tool2 or Tool3. Percent agreement (PA) between the tools based on identification of a patient at either risk/no risk for falling; higher PA indicating more tool homogeneity. Results: A total of 928 screening forms were completed within our 8-week study period; 452 and 443 comparing Tool1 to Tool2 and Tool1 to Tool3, respectively. Thirty-two forms included only Tool1 scores, excluding them from comparative analysis. The average patient age (n=895) was 64.8±21.4 years. Tool1 identified 66.4% of patients at risk, whereas Tool2 and Tool3 identified only 19.2% and 31.4%, respectively. Tool1 and 2 had a PA of 50.2%, whereas Tool1 and Tool3 had a PA of 65.9%. Conclusion: The FRM tool had higher agreement with the validated assessment tool, identifying patients at risk for falling but better identified patients presenting with intoxication, need for procedural sedation and unconsciousness. The other tools generally miss these common ED conditions, putting these patients at risk. Validation and reliability assessments of the FRM tool are warranted.

scholarly journals Screening instruments to predict adverse outcomes for undifferentiated older adults attending the emergency department: Protocol for a prospective cohort study

2021 ◽  
Vol 4 ◽  
pp. 2
Author(s):  
Aoife Leahy ◽  
Gillian Corey ◽  
Aoife O'Neill ◽  
Owen Higginbotham ◽  
Collette Devlin ◽  
...  
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Adverse Outcomes ◽  
Screening Tools ◽  
Index Visit

Background: The number of older adults with complex medical comorbidities and functional impairment is increasing throughout the world. Frail older adults frequently attend the Emergency Department (ED) and are at increased risk of adverse outcomes following presentation. A number of screening tools exist that aim to screen older adults for frailty and identify those at risk of functional decline, unscheduled readmission, institutionalisation and mortality. We propose to determine the predictive accuracy of four commonly used screening tools, namely the Identification of Seniors at Risk Screening (ISAR), Clinical Frailty Scale (CFS), Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA 7) and InterRAI ED, to determine adverse events at 30 days and six months among older adults who present to the ED. Methods and analysis: This is a prospective cohort study where patients over the age of 65 will have four screening tools (ISAR, CFS, PRISMA 7, interRAI ED) performed by face-to-face interview with a research nurse during their index visit to one Irish ED. Older adults will be included if they are willing and able to provide written informed consent, have a Manchester Triage Category 2-5 and are resident in the hospital catchment area. Demographic information will be collected at the index visit. A telephone follow up will occur at 30 days and six months, completed by a research nurse who is blinded to the initial assessment. Outcome data will include mortality rates, ED re-attendance, hospital readmission, functional decline and institutionalisation. We will analyse the risk of adverse outcomes using multivariable logistic regression and we will report adjusted risk ratios (RR) with 95% CI. Dissemination: Study findings will be disseminated through publication in peer-reviewed journals and presentations at relevant academic and clinical conferences. National and International gerontology conferences will be targeted.

Perioperative Neurocognitive Screening Tools for At-Risk Surgical Patients

2021 ◽  
pp. 10.1212/CPJ.0000000000001132
Author(s):  
Lilia Kaustov ◽  
Andrew Fleet ◽  
Connor T.A. Brenna ◽  
Beverley A. Orser ◽  
Stephen Choi
Keyword(s):  
At Risk ◽  
Perioperative Period ◽  
Assessment Tools ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Clinical Implementation ◽  
Socioeconomic Impacts ◽  
Advantages And Disadvantages ◽  
Clinical Scenarios ◽  
Patients At Risk

AbstractPurpose of Review:Perioperative neurocognitive disorders are common following surgery and have serious socioeconomic impacts. Despite this, these disorders remain under recognized and underdiagnosed. To facilitate detection and direct patients towards appropriate preventative interventions, assessment of cognition during the perioperative period is of critical importance. However, there are considerable barriers to the widespread clinical implementation of cognitive assessments, including a lack of consensus regarding the optimal tool for use in specific clinical scenarios.Recent Findings:We provide an overview of the most widely used and validated cognitive assessment tools, including those that permit telemedicine-enabled patient encounters.Summary:No single tool is optimal for all contexts. This narrative review can help clinicians to identify the appropriate cognitive screening tool for their needs by describing the advantages and disadvantages of several available tools, thereby enabling the identification of patients at risk of cognitive decline and facilitating optimization of patient-focused perioperative care.

scholarly journals Lung injury prediction score for the emergency department: first step towards prevention in patients at risk

2012 ◽  
Vol 5 (1) ◽  
Author(s):  
Marie-Carmelle Elie-Turenne ◽  
◽  
Peter C Hou ◽  
Aya Mitani ◽  
Jonathan M Barry ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Lung Injury ◽  
Prediction Score ◽  
Injury Prediction ◽  
Patients At Risk

Piloting a Statewide Emergency Department Take‐Home Naloxone Program: Improving the Quality of Care for Patients at Risk of Opioid Overdose

2021 ◽  
Author(s):  
Aaron Dora‐Laskey ◽  
Joan Kellenberg ◽  
Chin Hwa Dahlem ◽  
Elizabeth English ◽  
Monica Gonzalez Walker ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Quality Of Care ◽  
Opioid Overdose ◽  
Patients At Risk

A Systematic Review and Meta-Analysis of Personality Disorder Prevalence and Patient Outcomes in Emergency Departments

2020 ◽  
Vol 34 (3) ◽  
pp. 324-347
Author(s):  
Alexander Collins ◽  
Kirsten Barnicot ◽  
Piyal Sen
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Emergency Departments ◽  
Meta Analysis ◽  
Assessment Method ◽  
Screening Tools ◽  
Future Research ◽  
Prevalence Rates ◽  
Self Harm ◽  
Improve Patient Management

The objectives of this study were to perform a systematic review and meta-analysis of studies reporting prevalence of personality disorders (PDs) in emergency departments (EDs) and evaluate the effect of comorbid PDs on clinical outcomes. A systematic search of five databases along with manual searching and expert consultation was performed. A quality appraisal was conducted. A total of 29 articles were included. Prevalence of PDs in ED attendees varied depending on presenting complaint, Q(4) = 577.5, p < .01, with meta-analytic prevalence rates of suicide and self-harm at 35% and 22%, respectively. The assessment method had a significant effect on prevalence rates, Q(3) = 17.36, p < .01. Comorbid PD was a risk factor for repeating presenting complaint, subsequent ED return, and hospitalization. Better identification of PDs using screening tools in EDs could improve patient management and clinical outcomes. Future research should focus on PD prevalence in unselected ED populations using validated diagnostic interviews.

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