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

摘要

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 (beta >= 2.1 with P = 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., <0.78). Patients with a PRISMA-7 high-risk level were discharged significantly later from ED and hospital compared to those with low-risk level (P=0.001). Interpretation A PRISMA-7 high-risk level was associated with a long length of stay in ED and hospital, and hospital admission in patients on a stretcher but had poor performance criteria for these adverse events, suggesting that it cannot be used as a prognostic tool in older ED users.