PRISMA-7 and Risk for Short-Term Adverse Events in Older Patients Visiting the Emergency Department: Results of a Large
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PRISMA-7 AND RISK FOR SHORT-TERM ADVERSE EVENTS IN OLDER PATIENTS VISITING THE EMERGENCY DEPARTMENT: RESULTS OF A LARGE OBSERVATIONAL AND PROSPECTIVE COHORT STUDY O. BEAUCHET1,2,3,4, K. GALERY1,3, C. VILCOCQ1,3, É. MAUBERT1,3, M. AFILALO5, C.P. LAUNAY1,3 1. Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; 2. Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 3. Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada; 4. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; 5. Emergency Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Corresponding author: Olivier Beauchet, MD, PhD; Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montréal, QC H3T 1E2, Canada; E-mail: olivier.beauchet@ mcgill.ca; Phone: (+1) 514-340-8222, # 24741; Fax: (+1) 514-340-7547
Abstract: Background: The “Program of Research on the Integration of Services for the Maintenance of Autonomy” (PRISMA-7) is the reference tool for the assessment of older patients visiting the emergency departments (EDs) in the province of Quebec (Canada). This study aimed to examine 1) whether the PRISMA-7 high-risk level for disabilities was associated with the length of stay in ED and in hospital, and hospital admission; and 2) performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR]) of the PRISMA-7 high-risk level for the length of stay in ED and hospital, and hospital admission in older ED users. Methods: A total of 12,983 older ED users of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited in this observational and prospective cohort study. All enrolled participants had a PRISMA-7 assessment upon their arrival at ED. The length of stay in ED and hospital, and hospital admission were used as outcomes. Results: A PRISMA-7 high-risk level was associated with an increased length of stay in ED and hospital (β ≥2.1 with P≤0.001 and Hazard ratio (HR)= ≥1.2 with P≤0.001) as well as in hospital (HR=1.27 with P≤0.001) in patients on a stretcher. All performance criteria were low (i.e., 12 days) for patients on stretcher. For patients not on a stretcher the highest tertile of length of stay in ED was >7 hours)
2017 and July 2018 were recruited in this observational and prospective cohort study. The inclusion criteria were age ≥ 75, unplanned ED visit, PRISMA-7 completed and agree to participate in the study. The exclusion criterion was concomitant participation in an experimental study. During the 10-month period of recruitment, 14,288 patients aged ≥ 75 visited the ED of the Jewish General Hospital. A total of 12,983 (90.9 %)
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