The following is a summary of “Validation of a seven-question tool (PRISMA-7) in predicting prognosis of older adults in the emergency department: A prospective study,” published in the November 2023 issue of Emergency Medicine by Wang, et al.

Older patients arriving at the emergency department (ED) often present with complex medical challenges, and current ED triage models frequently underestimate the severity of illness in this population. Recognizing the significance of identifying frailty in older patients during urgent care, researchers sought to evaluate the predictive accuracy of the seven-question tool from the Program on Research for Integrating Services of the Maintenance of Autonomy (PRISMA-7) in the ED for 28-day mortality among older adults.

A prospective, multicenter observational study was conducted at West China Hospital of Sichuan University, Shangjinnanfu of West China Hospital, and People’s Hospital of Henan Province. ED patients aged ≥65 years from the three tertiary care centers over 8 weeks. The primary outcome, 28-day all-cause mortality, was assessed using a Cox proportional hazards regression model. Secondary endpoints, such as intensive care unit (ICU) transfer, were investigated using multivariable logistic regression. A comparison with trained study assistants was performed.

The study included 1,043 consecutive patients aged ≥65 years. The area under the receiver operating characteristic (ROC) curve (AUC) for 28-day mortality was 0.80 (95% CI: 0.76–0.84) for PRISMA-7, outperforming Emergency Severity Index (ESI) and quick Sepsis Related Organ Failure Assessment (qSOFA) with AUCs of 0.73 (95% CI: 0.68–0.77) and 0.78 (95% CI: 0.73–0.83), respectively. No significant difference in the AUC was observed between PRISMA-7 and qSOFA (P = 0.374). For ICU admission, the AUC was 0.78 (95% CI: 0.75–0.80) for PRISMA-7, 0.62 (95% CI: 0.59–0.66) for ESI, and 0.68 (95% CI: 0.64–0.72) for qSOFA. Statistically significant differences in AUC for ICU admission were found between PRISMA-7 and both ESI (P<0.001) and qSOFA (P<0.001), as well as between qSOFA and ESI (P = 0.005).

PRISMA-7 proved to be a reliable and valid instrument for identifying frailty in the ED, enhancing the prediction of ICU admission, although there was no significant difference in predicting all-cause mortality compared to other triage tools.

Source: sciencedirect.com/science/article/abs/pii/S0735675723004485