Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs
BackgroundThe growing number of older and oldest-old patients often present in the emergency room (ER) with undiagnosed geriatric syndromes posing them at high risk for complications in acute care.ObjectiveTo develop and validate an ER screening tool (ICEBERG) to capture 9 geriatric domains of risk...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-09-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1240082/full |
| _version_ | 1797672140209651712 |
|---|---|
| author | Heike A. Bischoff-Ferrari Heike A. Bischoff-Ferrari Heike A. Bischoff-Ferrari Michael Gagesch Michael Gagesch Dai-Hua Tsai Clara Richter Patricia Lanz Patrick Sidler Uenal Can Dagmar I. Keller Markus Minder Bettina von Rickenbach Ali Yildirim-Aman Katharina Geiling Katharina Geiling Gregor Freystaetter Gregor Freystaetter |
| author_facet | Heike A. Bischoff-Ferrari Heike A. Bischoff-Ferrari Heike A. Bischoff-Ferrari Michael Gagesch Michael Gagesch Dai-Hua Tsai Clara Richter Patricia Lanz Patrick Sidler Uenal Can Dagmar I. Keller Markus Minder Bettina von Rickenbach Ali Yildirim-Aman Katharina Geiling Katharina Geiling Gregor Freystaetter Gregor Freystaetter |
| author_sort | Heike A. Bischoff-Ferrari |
| collection | DOAJ |
| description | BackgroundThe growing number of older and oldest-old patients often present in the emergency room (ER) with undiagnosed geriatric syndromes posing them at high risk for complications in acute care.ObjectiveTo develop and validate an ER screening tool (ICEBERG) to capture 9 geriatric domains of risk in older patients.Design, setting, and participantsFor construct validity we performed a chart-based study in 129 ER patients age 70 years and older admitted to acute geriatric care (pilot 1). For criterion validity we performed a prospective study in 288 ER patients age 70 years and older admitted to acute care (pilot 2).ExposureIn both validation steps, the exposure was ICEBERG test performance below and above the median score (10, range 0–30).Outcome measures and analysisIn pilot 1, we compared the exposure with results of nine tests of the Comprehensive Geriatric Assessment (CGA). In pilot 2, we compared the exposure assessed in the ER to following length of hospital stay (LOS), one-on-one nursing care needs, in-hospital mortality, 30-day re-admission rate, and discharge to a nursing home.Main resultsMean age was 82.9 years (SD 6.7; n = 129) in pilot 1, and 81.5 years (SD 7.0; n = 288) in pilot 2. In pilot 1, scoring ≥10 was associated with significantly worse performance in 8 of 9 of the individual CGA tests. In pilot 2, scoring ≥10 resulted in longer average LOS (median 7 days, IQR 4, 11 vs. 6 days, IQR 3, 8) and higher nursing care needs (median 1,838 min, IQR 901, 4,267 vs. median 1,393 min, IQR 743, 2,390). Scoring ≥10 also increased the odds of one-on-one nursing care 2.9-fold (OR 2.86, 95%CI 1.17–6.98), and the odds of discharge to a nursing home 3.7-fold (OR 3.70, 95%CI 1.74–7.85). Further, scoring ≥10 was associated with higher in-hospital mortality and re-hospitalization rates, however not reaching statistical significance. Average time to complete the ICEBERG tool was 4.3 min (SD 1.3).ConclusionOur validation studies support construct validity of the ICEBERG tool with the CGA, and criterion validity with several clinical indicators in acute care. |
| first_indexed | 2024-03-11T21:25:49Z |
| format | Article |
| id | doaj.art-5112da5cbd28422181ea6760cb37d9be |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-11T21:25:49Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-5112da5cbd28422181ea6760cb37d9be2023-09-28T04:27:10ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-09-011010.3389/fmed.2023.12400821240082Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needsHeike A. Bischoff-Ferrari0Heike A. Bischoff-Ferrari1Heike A. Bischoff-Ferrari2Michael Gagesch3Michael Gagesch4Dai-Hua Tsai5Clara Richter6Patricia Lanz7Patrick Sidler8Uenal Can9Dagmar I. Keller10Markus Minder11Bettina von Rickenbach12Ali Yildirim-Aman13Katharina Geiling14Katharina Geiling15Gregor Freystaetter16Gregor Freystaetter17Center on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, SwitzerlandUniversity Clinic for Aging Medicine, City Hospital Zurich, Zurich, SwitzerlandDepartment of Aging Medicine, University Hospital Zurich, Zurich, SwitzerlandCenter on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, SwitzerlandDepartment of Aging Medicine, University Hospital Zurich, Zurich, SwitzerlandCenter on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, SwitzerlandCenter on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, SwitzerlandUniversity Clinic for Aging Medicine, City Hospital Zurich, Zurich, SwitzerlandInstitute for Emergency Medicine, City Hospital Zurich, Zurich, SwitzerlandInstitute for Emergency Medicine, City Hospital Zurich, Zurich, SwitzerlandInstitute for Emergency Medicine, University Hospital Zurich, Zurich, SwitzerlandCenter for Aging Medicine and Palliative Care, Hospital Affoltern, Affoltern, SwitzerlandCenter for Aging Medicine and Palliative Care, Hospital Affoltern, Affoltern, SwitzerlandInterdisciplinary Emergency Center, Hospital Affoltern, Affoltern, SwitzerlandCenter on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, SwitzerlandDepartment of Aging Medicine, University Hospital Zurich, Zurich, SwitzerlandCenter on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, SwitzerlandDepartment of Aging Medicine, University Hospital Zurich, Zurich, SwitzerlandBackgroundThe growing number of older and oldest-old patients often present in the emergency room (ER) with undiagnosed geriatric syndromes posing them at high risk for complications in acute care.ObjectiveTo develop and validate an ER screening tool (ICEBERG) to capture 9 geriatric domains of risk in older patients.Design, setting, and participantsFor construct validity we performed a chart-based study in 129 ER patients age 70 years and older admitted to acute geriatric care (pilot 1). For criterion validity we performed a prospective study in 288 ER patients age 70 years and older admitted to acute care (pilot 2).ExposureIn both validation steps, the exposure was ICEBERG test performance below and above the median score (10, range 0–30).Outcome measures and analysisIn pilot 1, we compared the exposure with results of nine tests of the Comprehensive Geriatric Assessment (CGA). In pilot 2, we compared the exposure assessed in the ER to following length of hospital stay (LOS), one-on-one nursing care needs, in-hospital mortality, 30-day re-admission rate, and discharge to a nursing home.Main resultsMean age was 82.9 years (SD 6.7; n = 129) in pilot 1, and 81.5 years (SD 7.0; n = 288) in pilot 2. In pilot 1, scoring ≥10 was associated with significantly worse performance in 8 of 9 of the individual CGA tests. In pilot 2, scoring ≥10 resulted in longer average LOS (median 7 days, IQR 4, 11 vs. 6 days, IQR 3, 8) and higher nursing care needs (median 1,838 min, IQR 901, 4,267 vs. median 1,393 min, IQR 743, 2,390). Scoring ≥10 also increased the odds of one-on-one nursing care 2.9-fold (OR 2.86, 95%CI 1.17–6.98), and the odds of discharge to a nursing home 3.7-fold (OR 3.70, 95%CI 1.74–7.85). Further, scoring ≥10 was associated with higher in-hospital mortality and re-hospitalization rates, however not reaching statistical significance. Average time to complete the ICEBERG tool was 4.3 min (SD 1.3).ConclusionOur validation studies support construct validity of the ICEBERG tool with the CGA, and criterion validity with several clinical indicators in acute care.https://www.frontiersin.org/articles/10.3389/fmed.2023.1240082/fullgeriatricsolder patientsemergency roomscreening toolvalidationICEBERG |
| spellingShingle | Heike A. Bischoff-Ferrari Heike A. Bischoff-Ferrari Heike A. Bischoff-Ferrari Michael Gagesch Michael Gagesch Dai-Hua Tsai Clara Richter Patricia Lanz Patrick Sidler Uenal Can Dagmar I. Keller Markus Minder Bettina von Rickenbach Ali Yildirim-Aman Katharina Geiling Katharina Geiling Gregor Freystaetter Gregor Freystaetter Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs Frontiers in Medicine geriatrics older patients emergency room screening tool validation ICEBERG |
| title | Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs |
| title_full | Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs |
| title_fullStr | Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs |
| title_full_unstemmed | Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs |
| title_short | Validation of the ICEBERG emergency room screening tool for early identification of older patients with geriatric consultation needs |
| title_sort | validation of the iceberg emergency room screening tool for early identification of older patients with geriatric consultation needs |
| topic | geriatrics older patients emergency room screening tool validation ICEBERG |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1240082/full |
| work_keys_str_mv | AT heikeabischoffferrari validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT heikeabischoffferrari validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT heikeabischoffferrari validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT michaelgagesch validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT michaelgagesch validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT daihuatsai validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT clararichter validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT patricialanz validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT patricksidler validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT uenalcan validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT dagmarikeller validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT markusminder validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT bettinavonrickenbach validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT aliyildirimaman validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT katharinageiling validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT katharinageiling validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT gregorfreystaetter validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds AT gregorfreystaetter validationoftheicebergemergencyroomscreeningtoolforearlyidentificationofolderpatientswithgeriatricconsultationneeds |