Validation of the geriatrie-check for identification of geriatric patients in emergency departments

Background The geriatric check was developed for identification of geriatric patients in emergency departments (ED) as part of the concept for geriatric care in Baden-Wurttemberg. Aim Determination of convergent and predictive validity of the geriatric check with respect to identification and outcome prediction of geriatric patients in the ED. Material and methods A prospective cohort study between November 2015 and April 2016 including 146 patients older than 70 years in the internal medicine ED of Ulm University Hospital. Separate assessment by physicians and nursing staff of the following: identification of seniors at risk (ISAR), geriatric check, additional cognitive and functional assessments and for outcome: change in care index, Barthel index, living arrangements. Results The ISAR classified 117 patients as geriatric patients and the geriatric check 107. The correlation was 78.1%. With ISAR as the gold standard the geriatric check showed a sensitivity of 82.0% and a specificity of 62.1%. The positive and negative predictive values were 89.7% and 46.1%, respectively. The identification by simple estimation was better for nurses than for doctors (sensitivity 70.5% vs. 58%, specificity 88.9% vs. 83.3%). The predictive validity 5 months after admission with respect to the abovementioned outcome parameters was best for nurses and doctors (especially regarding specificity). Both tests were very sensitive but not very specific. Discussion The geriatric check is comparable to the ISAR. The convergent validity showed little difference. Both the ISAR and geriatric check were slightly more sensitive than doctors and nurses. Regarding predictive validity, doctors and nurses were superior to both scores. An algorithm starting with ISAR or geriatric check and followed by an estimation by doctors or nurses could be most suitable for optimal resource allocation.