Screening is Not Equal to Screening - A Systematic Comparisonof 6 Screenings in the Admission Process in 288 Geriatric Patients

Abstract

The number of elderly patients in the emergency department is
increasing annually [1-6]. At the same time, the probability for
these elderly patients to be treated as inpatients is increasing [7]. Professional societies call for regulated triage [8]. According to German jurisprudence, acute inpatient care includes early rehabilitation services that are necessary in the individual case and begin at the earliest possible time [9]. For this purpose, the patient must be identified as a geriatric patient. According to the German Society of Geriatrics DGG, the geriatric patient shows geriatric multimorbidity and is of advanced age (> 75 years) or is older than 80 years and shows increased vulnerability due to age-related functional limitations and deterioration of selfhelp status [10]. The S1 guideline mentions level-1- assessments (standard screenings) as a tool for identifying geriatric patients [11]. In 2012, the position paper of the German Geriatrics Society (DGG), the German Geriatrics Association (BVG), and the German Gerontology and Geriatrics Society (DGGG) recommends
the ISAR instrument for use as a level-1-assessment based on the evaluation, the quality of the available evidence, and the practicability [12]. This recommendation is controversial [13]. Other level-1- assessments are available, such as the historically oldest level-1- assessment LACHS from 1990 [14]. The Arbeitsgemeinschaft der Geriatrie in Bayern (AFGIB) created the AFGIB Screening in 2011 and the Baden-Württemberg Hospital
Association BWKG created the Geriatrics Check in 2017 [15- 17]. Most comprehensively, the ISAR score and the TRST have been studied Internationally, the Fast Trial Risk Screening Tool (TRST) is in use [18-21]. Evaluation studies are available for the Geriatric Check, the GERAMOVER, and the APOP Screening [22-24]. Scientific studies on the LACHS have been obtained from 2001 [25]. The AFGIB screening has not been evaluated
to date. GERAMOVER and APOP screening are available as online emergency screenings [26,27]. The present study compared standard screenings and validated online emergency screenings in terms of outcome, recommendations and control potential in the admission situation.